Blame Transfer & ' Scapegoating'

When Rahul Saxena (name changed) died recently of liver cirrhosis due to excessive drinking for 20 years, the family blamed the doctors and the hospital for his death. His parents did not blame themselves or their son for drinking away his health. A fleeting mention of his wife for not doing enough to stop him earlier or his friends who gave him company every evening for booze, paled away in the face of the hospital and the doctors who they considered responsible for the tragic outcome. That Rahul was brought to hospital in a critical state having vomited 2 litres of blood did not mitigate their fury. The 10 minutes of delay in the doctor’s attending to Rahul and the one hour time lag for procuring blood for transfusion, they were convinced, caused Rahul’s death and all their problems!

In blame transfer or scapegoating, feelings of guilt, blame and suffering are transferred away from a person or group so as to fulfill an unconscious drive to resolve or avoid such bad feelings. This is done by the displacement of responsibility and blame to another who serves as a target for blame both for the scapegoater and his supporters.

In this case, Rahul’s family, by shifting the entire onus of his death on to the doctor and hospital, unconsciously shifted their own sense of blame and helplessness on to others. Also, in the process, by identifying one external scapegoat, the family members found a way of remaining united emotionally.Scapegoating therefore can be seen as the perpetrator's defense mechanism against unacceptable emotions such as shame and guilt.

Blame transfer or scapegoating is something we do almost everyday without quite realizing. When a smoker develops lung cancer after years of heavy smoking, it is the tobacco lobby at fault. If the cancer, when detected is at an advanced stage, the fault is of the 1^st doctor who ignored that nagging cough and did not ask for a bronchoscopy. If he finally succumbs to his disease, then the cancer specialist and hospital are guilty for not being able to achieve a cure. Everyone is guilty, except the smoker himself or his family, the people who really allowed all this to happen.

Studies have shown that scapegoating increases as the importance of religion or faith declines in our lives. It is no longer God’s will or destiny. Happiness has become our right and if we are prevented from achieving it, someone must be responsible. And as often happens in matters of health and life, doctors are the favoured scapegoats. It is a lot easier at parties to blame someone rather than ourselves if something has gone awfully wrong in our lives or our families.

Doctors need to understand this unique need of desperately distressed patients and their relatives to want to paradoxically blame them instead of thanking them for their efforts. It is not logic but compassion that these blamers seek. And doctors need to be generous to them.

 As published in HT City (Hindustan Times) dated 30 January, 2011.