When It's Gonna Rain......

There is a much-quoted Chinese saying.  It says: 「天要下雨，娘要嫁人。」.  It carries the meaning that when something is going to happen, it will happen anyway.  You can do nothing about it.  Just like when it is going to rain, or when your mother is going to get you a step-father.  (Some people interpret the second half of the quote as when a young lady is going to get married instead of when a mother is going to get married.  They think that it would make more sense as it was not really common or natural for mothers to get married again in the old days.  Well, you can say that the quote implies no matter something is natural or strange, if it is going to happen, one can still do nothing about it.  Anyway, the passive and helpless meaning remains the same.)

Recently I hear this quote very often.  I hate this quote.  I hate this quote to the extent that I get agitated when I hear it.  Having gone through so much (or rather, so little) about psychology, mindfulness and Buddhist teachings, I try to analyze.  When I look into my emotion, I feel quite strange about it.  I am now practicing to be kind rather than to be right.  I learn this from Pat Peoples of The Silver Linings Playbook, hoping to have Jennifer Lawrence as the end result.  Moreover, although I am not to the extent of having negativistic personality disorder, I am most likely to be a Five in the Enneagram system of personality typing.  Learned helplessness is the central theme.  It should be me who is talking about “天要下雨，娘要嫁人; you can do nothing about it” and then get others agitated.  I should have jumped out and echoed with those who spelled out my motto.  How come the oppposite happens?  No, it is not self-denial.  I am confused.

The answer dawned on me one rainy day when I was at a meeting.  While the quote was mentioned again (and again), I received the Amber rainstorm warning signal from my smart phone.  I thought I was sudden enlightened.  The reason for my rage was that there existed a difference between an individual and an association.  I could not tolerate a type Five association.  If learned helplessness was to dominate, why would we waste time in meetings?  How was the association to answer to its members?  Why should the association exist?  When it is going to rain, the Hong Kong Observatory realizes that there are risks associated with heavy rain.  It has developed the rainstorm warning signal system to predict and to alert the citizens of the rainstorms.  The system is widely promulgated and there are user-friendly applications for quick and wide information dissemination.  Citizens even do not need to go to work when the Black signal is hoisted.  So, there are many things an association can do when it is going to rain.

But wait! Before we go into those harm-reduction actions, are we talking about raining?  Except some national actions to manipulate the weather with missiles, there is not much an association can do to stop raining.  However, there might be something that can be done when mother is going to marry someone (else).  I do read in novels that it is not uncommon for mothers to consult their sons and daughters before they plan to formalize their relations.  As for young ladies getting married, in the old TV series The Bund (Shanghai Tien), Hui Man Keung chose to interrupt the wedding ceremony of Fung Ching Ching.

It might be futile to stop something natural from happening.  However, policy of an authority, such as the Hospital Authority, is never something natural.  For example, I do not believe that we can do nothing to stop the Hospital Authority from launching a new programme, or we can do nothing to change an existing policy of the Hospital Authority.  If we identify that something dangerous is going to happen, we need to stand firm and fight against it.  We might not succeed, but our stance should be clear and firm.  We might fail, but we should have issued the warning signal and have contingency planning.

「天要下雨，娘要嫁人。」is not the worst quote.  There is often another saying to go with it.  It is: “If you can’t beat them, join them.”  When big principles are involved, these two quotes are not options.  An association cannot and should not defeat itself by classifying light-heartedly everything to be natural and unbeatable.  Members cannot afford to be sold by the association whom decides to join the fathomed unbeatable counterpart and counts money for it.

Recalling that I am now practicing to be kind rather than to be right, I should not be furious about others’ behaviors whatever the intention behind, be it self-interest or for the good of the majority.  However, please be diligent and innovative enough to bluff me with theories and analysis of pros and cons.  Don’t tell me that an association can do nothing when it’s gonna rain.

(Source: HKMA News April 2013)

March 2003

Ten years ago, in March 2003, the Hong Kong Special Administrative Region (HKSAR) suffered from the attack of a new deadly virus.  Around 1750 people contracted the disease.  Sadly, among them, about 300 patients died.  A significant proportion of the patients and the diseased were healthcare workers.  After a few months, the virus was identified to be a corona virus; and the disease named as Severe Acute Respiratory Syndrome, SARS, or the SAR Syndrome.

Now is March 2013, while we pay our respects and salute to the sufferers, we might want to review the tragedy.  Luckily SARS was unheard after 2003, though there are now sporadic cases of a new corona virus.  But can we handle another outbreak of severe infectious disease?

There have been quite a number of reviews in the media.  I have gone through some of them, and I have chatted with some colleagues.  On an individual level, since the causative agent is a virus, we do not have a magic bullet for it.  Ribavirin is out.  Steroid is for the immune response.  It is doubtful if the aged anti-SARS serum is effective.  We do have better supportive treatment now, such as better ventilators and Extra-corporeal Lung Support (ECLS).  On infection control level, we now have the quick screening test for SARS, allowing prompt identification of probable subjects.  We have better protective equipment, which is regularly used by healthcare professions.  We have better ward facilities such as negative pressure wards.  We have the precedent of quarantining a hotel during the swine flu period in 2009.  We have better action plans and we have trained people for strategy execution.

However, are we prepared psychologically for an outbreak?  For those who experienced SARS ten years ago, do you still remember how you felt at that time?  For those younger doctors, have you ever thought of the life as a doctor in the period of a disaster?  I try to recall my feelings ten years ago.  Although I was by no means in close contact with SARS patients, as a family doctor I was still a frontline worker.  Every patient with fever was a potent sufferer of SARS.  I had to wear protective gears.  I could not play with babies and kids and I could not hold them in my arms.  I did not eat at my clinic, and I dined alone in open areas during lunch.  I avoided lifts as far as possible.  I went straight for a bath when I reached home.  I heard story from patients about how their friends and relatives got infected.  I knew that some of my colleagues were affected.  I read in newspaper that the number of casualties increased every day.

I then realize that I would have to prepare to face “losses” if there were another outbreak.  In the worst case, I might lose my life.  More likely, I might lose my freedom, which includes the freedom to travel, the freedom of not being isolated, the freedom to meet and chat and dine with friends without worry.  Surely, I would lose the trust of breathing in without the filter of a mask, maybe at the same time losing the trust on my patients.  Others would suffer similar losses, to a greater or lesser extent.  Apart from physical and psychological aspects, the economy of Hong Kong, maybe the whole world, would be affected.

Reviewing the tragedy ten years ago, and contemplating what would happen if I were to face it again, a saying keeps ringing in my mind.  It says that the most delicious food is just dumplings; and that the most comfortable thing (to do) is just lying down.  最好吃不過是餃子；最舒服不過是躺下。 In some northern provinces of China, dumplings are the staple food, just like our rice or the Caucasians’ bread.  After experiencing major events, be they good or bad, one would likely come up with the conclusion that uneventful lives are most valued and longed for.  Just like a commercial advertisement of an airline years ago, after travelling around the world and tasting cuisines from different countries, what the traveler misses most is a bowl of rice.

It might be enlightening while you compare your troubles now and your anticipated losses if there were SARS again.  You might be troubled by the continuous rise in real estate prices, a fall of stock market, your rival getting promoted, failure to gain the love of the one you admired, and so on, and so forth.  But looking back at the list of losses you do not want to encounter, they are mostly mundane things that we have forgotten, or failed to notice.  They are: freedom, trust, or even the down-to-earth things as breathing and being able to live.

In March 2013, here I again pay tribute to the diseased and the sufferers from SARS.  I pray for Hong Kong that no tragedies will happen in the future.  I treasure the bowl of rice I am going to have for dinner, after which I would lie down, and sleep through the night.

(Source: HKMA News March 2013) 

What is the big picture?

I have difficulty interpreting the Healthcare section of the Policy Address 2013 delivered by the Chief Executive of Hong Kong.  I cannot get the big picture.

The Policy Address is for the general public.  While most of them are laymen to healthcare policies, all of them are users of healthcare services.  The aim of the Policy Address is to tell the users what they will expect from the new government.  There is in fact no right or wrong healthcare policy.  There is even no absolute good or bad healthcare policy.  There is by no means a government can create and implement a perfect healthcare policy.  Afterall we all know that such policy does not exist.  There are always some stakeholders getting more than others, some getting less than what they expected, and some being neglected or even discriminated upon.  The government is entitled to identify problems and to set its own priorities.  But at least the government needs to tell us what its vision is, why it thinks so, and how it is going to achieve it.  I do not see these in the Policy Address.

The Policy Address states only one guiding principle.  The provision of quality and affordable healthcare services has been a proud achievement.  However, there exists a problem, which is the rise in medical costs due to different reasons.  The government needs to “tackle the root of the problem”.  So apparently it seems clear that the government identifies a problem and is going to tackle it in this year or in the coming five years.  However, it does not elaborate what the root of the problem is.  Obviously the problem is the rise in costs.  But what is the root of the problem?

Without identifying the root of the problem, we can still try to tackle a problem of rise in cost.  Theoretically, it is simple.  You can either cut the cost, or you can put in more money.  Of course you can do both, but there is always an inclination to either way.

Reading the Policy Address, injecting more money is in solid terms: “The Government allocated additional funding of about $2.5 billion to the HA last year, raising its annual recurrent subvention to $40.4 billion.  We will continue to set aside resources to strengthen our public healthcare system and enhance its service quality.”

  

Before we search for items to cut costs, I suggest looking into items that go the other way, that is, items that further raise the cost.  By cost I mean cost borne by the government but not cost paid directly from an individual citizen for medical expenses.  These policies, once implemented, will be unlikely to be “uninstalled” and will contribute to the rise in cost to the government.  The number of beds under HA hospitals will be raised.  New hospitals and clinics will be built.  Existing hospitals will be expanded.  The Drug Formulary will be expanded.  The waiting lists of specialist out-patient clinics will be optimized.  Waiting time for semi-urgent and non-urgent cases will be shortened by, again, injecting more resources.  The role of Chinese medicine and Chinese medicine practitioners in the public healthcare system will be expanded.  Chinese medicine in-patient services will be introduced.  (One point to note is that it is quite uncommon for Policy Address to specifically aim at “enhancing the status of Chinese medicine practitioners”.)  

While injecting money is relatively simple (theoretically, not practically), cutting cost is the talented part.  Let’s have a look at what the government has offered.  It is hinted that the private healthcare sector is a solution.  However, there is no commitment.  Public private partnership is mentioned.  Despite the cannot-be-considered-favorable comments from the Audit Commission on the few previous public private partnership pilot projects, the HA is just going to “study the feasibility of further service outsourcing”.  The section on private healthcare sector is then dominated by the eye-catching title of “Regulation of Private Hospitals”.  This is in-line with the all-too-often-heard comment that people prefer HA to the private healthcare sector mainly because of the relative lack of regulation.  The huge price differential of having a laparoscopic cholecystectomy with $50,000 in private versus $300 in HA is never a major factor except to the users.  Traditionally, regulation is never considered a kind of facilitation.  The Health Protection Scheme can be a mean to encourage patients going for the private sector and cut the cost of the government.  However, it is still in the going-to-be-consultation stage.  Whether it is helpful or not depends on the scale and details of the scheme.

The balance between the public and private sectors is the only strategy in cutting the cost.  Other proven and useful methods are not considered.  Preventive medicine and primary care have been practiced with success in many developed countries in cutting the cost of healthcare and in promoting the health of their citizens.  Preventive medicine and primary care were once the high-lighted healthcare policies in Hong Kong.  They have remained in the talking level, but then disappear completely in this Policy Address.

I scratch my head and think about what the root of the problem is.  I am thinking about drawing the conclusion that the government is going to tackle the problem of rise in cost by just injecting more money into the HA.  Then it comes the epilogue of the Policy Address.  I hear from the news that apart from what have been mentioned, there will be other policies.  They will be in the mode of 成熟一項推一項.  I do not know how to translate it, as I am not sure what it means.  Is it referring to the maturity of a policy from consultation and discussion?  Or is it referring to the right timing?  Or in fact the beauty is the ambiguity in meaning and the freedom from scrutiny?

So, the conclusion is that no conclusion is needed.  Let’s forget about the Policy Address in the meantime.

 

(Source: HKMA News February 2013)

Looking Back

(Source: HKMA News January 2013)

The personality paradox

I got lost this month.

My small-sized brain could not understand why prominent people and public figures kept talking nonsense.  Frank lies were thrown in our faces.  Public declarations that were affronts to common sense were made.  I would not consider them stupid.  Experience told me that it was usually those calling others stupid who were themselves stupid.  These prominent people and public figures were well known to be reliable and smart.  They were supported by people I respected.  Even for the nonsense, the people I respected kept their faith in those prominent people and public figures.

There must be reasons behind their behaviors.  Such reasons must be beyond my ability to comprehend.  I had thought about Buddhism.  Could it be collective karma?  This explanation did have some calming effects when you found lies thrown in your face.  But it did not offer much help in explaining individual behavior.  It was the same for my favorite Mappo Theory.  Well, if you are reading this Editorial, that means the world has not ended by December 21.

I turned to psychology to seek for hypotheses and theories to explain human behaviors.  I came across personality theories.  Personality could be defined as “psychological quantities that contribute to an individual’s enduring and distinctive patterns of feeling, thinking and behaving.”[1]  There had been constant searches and researches trying to classify, to understand, to predict and to change human behaviors.  In the recent hundred years, personality theories went in a circular fashion.  It went through biological theories, psychoanalytic theories, type theories, trait theories, social learning theories, the Big Five theories, and then returned to biological theories.  Yet, there was not a single unified and simple personality theory that could fulfill all these functions.  Among them, I found the Personal Construct Theory by George Kelly enlightening when applied to the above scenario.

George A Kelly (1905-1967) was a clinical psychologist engaged in the treatment of patients.  He found his standard Freudian psychoanalytic training inadequate when managing his patients.  He then developed a new theory in personality: the Personal Construct Theory.  Kelly started to explain his theory by assuming that people were like scientists in the sense that they would postulate theories, test them, and use them in their daily lives: “We started out with two notions: (1) that, viewed in the perspective of the centuries, man might be seen as an incipient scientist, and (2) that each individual man formulates in his own way constructs through which he views the world of events.  As a scientist, man seeks to predict, and thus control, the course of events.  It follows, then, that the constructs which he formulates are intended to aid him in his predictive efforts”.[2]  Here, the term “construct” was introduced and it stayed the key word for the theory.  He then stated out his Fundamental Postulate: “A person's processes are psychologically channelized by the ways in which he anticipates events.”[3]

I try to summarize the theory, in over simplified terms, into the following components:

1. Although both the external environment and thinking are in real existent, people perceive the external environment differently.  They construct the external environment in their minds according to their own experience and interpretations.
2. People behave in a way best to anticipate the future according to existing constructs, and to avoid conflicts with and contrast to their own constructs.
3. Stress and discomfort would develop if the outcome or anticipation of outcome does not conform to the person’s construct.
4. The process of construct formation and the constructs themselves are dynamic and modifiable.

So it was “construct” that mattered. While it took two to dance, it took three to form a construct.  When someone was saying that something was white, he was actually taking another two things as references.  One was similar to the object which he referred to as “white”, and another one as different from the two.  We could never know what exactly he meant without knowing what the two references were.  Nonsense that was an affront to our common sense might not be an affront to the liar’s common sense.  He was taking reference to something or someone else.  He did so in order to predict and to control the event in his own manner.

Of course he might have pathology in his construct formation.  Ironically, the treatment for defective construct system was Fixed-role therapy designed by Kelly.  In this therapy, the therapist worked out a new role with new sets of constructs for the patient to follow.  The patient would try to think and to behave as if he were the new person as prescribed.

Thus, the personality paradox I mentioned in the heading was several-folded.  First, I could not be sure whether I was the one having defective construct system.  Those prominent people and public figures with their supporters-whom-I-respected might have perfect constructs that guided them towards their brilliant future.  Second, they might be having pathological construct systems and thus they might benefit from treatment.  Third, they might be already undergoing treatment with the Fixed-role Therapy, but God knows who the therapist was.  Sadly, this paradox could not be elucidated as even post-mortem could not give an answer to psychological myths. 

---

[1] P. 8, Personality Theory and Research 11^th Edition, Lawrence A Pervin 

[2] P. 12, The Psychology of Personal Constructs Volume One (1955), George A Kelly, Universal Digital Library 

[3] P. 46, The Psychology of Personal Constructs Volume One (1955), George A Kelly, Universal Digital Library

(Source: HKMA News December 2012)

The criminal charge of indecent assault and the disciplinary charge of misconduct in a professional respect

On November 4, 2012, a young doctor was found guilty of misconduct in a profession respect after a disciplinary inquiry held by the Medical Council.  The Inquiry Panel ordered that his name be removed from the General Register indefinitely.  The Inquiry Panel further ordered that the removal should take effect immediately upon its publication in the Gazette.  The Inquiry Panel also stated that the young doctor could not be a fit and proper person to practice as a doctor and that he could not be restored to the General Register at all.  The media referred the sentencing as the heaviest penalty ever imposed by the Medical Council.  Comparisons were also made to previous cases in which the defendant doctors were found guilty in criminal courts.  In contrast, this young doctor was found not guilty for the criminal charge of indecent assault, which aroused from a similar set of events leading to his removal from the General Register.  I shall analyze all these from a legal perspective.

In April 2010, the young doctor faced a criminal charge of indecent assault after he allegedly performed per vaginal examination on and took photographs from a female patient who consulted him for herpes zoster involving the lower body.  There were two major factors for his acquittal.  First, for the charge of indecent assault, there needed to be two components: actus reus (the act) and mens rea (the intention).  The act of touching the patient’s private part could constitute the act of indecent assault.  However, the prosecution also needed to prove that the defendant did it with an intention.  For example, if you waved at a taxi but accidental touched the breast of a lady walking from behind, it would unlikely be indecent assault.  In a medical setting, consent from the patient would be a legitimate reason for the act.  So the judge had to decide on whether there was consent, or implied consent, and the scope of the consent.

Second, for a criminal charge, the standard of proof was that the charge should be proved beyond reasonable doubt.  The jury or the judge had to be one hundred percent sure that the defendant had the intention to act indecently.  In this case, the judge, after taking all material facts and statements from witnesses into consideration, satisfied himself that there was a chance, maybe a very slim one, that the defendant doctor lacked the intent to act in a criminal way.  His acts, though stupid or inappropriate, might be accounted for by his relative lack of clinical experience.

For disciplinary inquiries by the Medical Council, things were different.  One should note that if this young doctor had been found guilty of his criminal charge, he would have been charged under section 21 (1)(a) of the Medical Registration Ordinance (MRO): that he had been convicted in Hong Kong or elsewhere of any offence punishable with imprisonment.  For this charge, he would have been judged by the inquiry panel mainly on the gravity of his offence.  And it would not have been a decision on professional misconduct.

In this actual case, an acquittal would not in itself lead to a disciplinary inquiry.  The inquiry was held because the case was referred by the Preliminary Investigation Committee (PIC) after investigating into a complaint or complaints received.  Section 21 (1)(b) of the MRO was invoked.  Basically, the young doctor was charged for conducting improper and unnecessary physical examinations; and improperly taking photographs and videos of several patients during consultations without consent.  The decision was whether he was guilty of misconduct in a professional respect.  The test for professional misconduct was set by the judge in the case of Koo Kwok Ho v the Medical Council of Hong Kong to be "whether the doctor's conduct has fallen short of the standard expected amongst doctors".  Note that there was no involvement of intention in the test.  Even when there was good intention, not to say malice ones, the doctor could be found guilty if his acts or behavior fell short of peer standards.

The standard of proof in disciplinary proceedings had been a focus of controversy.  Recently, it seemed to have been settled by a Court of Final Appeal case [Solicitor (24/07) and the Law Society of Hong Kong (2008) 11HKCFAR 117].  In para 116, it was stated that “the standard of proof for disciplinary proceedings in Hong Kong is a preponderance of probability under the Re H approach.  The more serious the act or omission alleged, the more inherently improbable must it be regarded.  And the more inherently improbable it is regarded, the more compelling will be the evidence needed to prove it on a preponderance of probability.  If that is properly appreciated and applied in a fair-minded manner, it will provide an appropriate approach to proof in disciplinary proceedings.  Such an approach will be duly conducive to serving the public interest by maintaining standards within the professions and the services while, at the same time, protecting their members from unjust condemnation.”  So, the standard of proof was not the criminal standard of beyond reasonable doubt, but the civil standard of a balance of probability with a somewhat circular logic built in.

After deciding that the defendant doctor had more probable than not fallen short of expected standards, the defendant doctor was found guilty of professional misconduct.  The Inquiry Panel ordered the removal of the name of the defendant doctor from the General Register in accordance with section 21 (1)(i) of the MRO.  This was in contrast to section 21 (1)(ii) where a time period was fixed for the removal.  Seemingly, removal without a fixed period was a heavier punishment as it appeared in the sequence in the Ordinance.  However, technically, the defendant doctor could apply for inclusion of his name in the General Register again as soon as the removal of his name was published in the Gazette.  So for a clearer message, both to the defendant doctor and to the general public, the Inquiry Panel also opined that there was practically no chance for his re-registration.

Another point to note was that the Inquiry Panel also ordered the removal to take effect immediately upon its publication in the Gazette in accordance with section 21 (1)(iva).  This meant that the Inquiry Panel satisfied that it was necessary to do so for the protection of the public.  This also added to the gravity of the sentencing as in normal circumstance, the removal order would not take effect if there was an appeal lodged.  

(Source: HKMA News November 2012)

Cogito Ergo Sum and Brain Washing

“Cogito Ergo Sum” can be translated as “I think, therefore I am.”  Many people take the words in their plain meaning literally and interpret the statement as encouraging people to think, and to think more so as to make their lives meaningful.  However, some regard “Cogito ergo sum” as the important conclusion of Descartes’ deep meditation to prove his own existence because of the fact and the action that he engaged in thinking.  His focus was on the “I”.  He satisfied himself that there was a thinker existing behind the act of thinking.  This seemingly obvious thinker/thinking paradox has haunted many philosophers.  Also through deep meditation, an opposite conclusion was reached by the Buddha.  He realized that there was no real existence of the person.  There was no thinker behind the act of thinking.  Rather, the thinker was an illusion made up to explain the act of thinking.

There are many philosophers and scientists who also doubt the obvious, particularly in the fields of the brain, the mind and thinking.  In late 1880s, psychologist William James came up with a new theory to explain the relation between our emotion and our behavior.  He proposed that our behavior was something instinctive, and our emotion only came after the behavior so as to rationalize it, or to explain for it as a habit of experience.  So, by his theory, our common sense was reversed.  People did not run from a bear because they were afraid of it.  Rather, they became afraid of bear because of the act that they ran from it.  Similarly, people did not smile because they were happy, but they felt happy because they were smiling.

Then in late 1960s, a young psychologist James Laird encountered William James theory and designed an ingenious experiment trying to verify it.  He succeeded in showing that people making happy facial expressions really felt happier; while those making angry facial expressions really felt angry.  Amazed by the results, other psychologists carried out various studies, in equally ingenious but different designs, and confirmed his findings.    

Also in the 1960s, another psychologist, Stanley Schachter, extended William James’ theory into bodily sensations.  At that time, it was known that different emotions were associated with different bodily sensations, such as change in heart rate, skin temperature and sweating.  However, there were obviously not enough parameters to account for the vast categories of emotions.  By a set of not-so-ethical experiments involving injecting adrenalin into participants, he was able to show that people tried to make sense of their increased heart rates by looking around them.  Thus people were much happier with increased heart rates from the adrenalin shots in a happy setting, and also angrier in an angry setting, than the controls with the saline shots.  So it was the bear that made you sweat, and then you looked around, saw the bear, and then began to feel afraid.

How about one step further?  Would the way we behave affect the way we think?  Can keep singing the national anthem make you more patriotic?  The book “The Wave” described how a 25-year-old history teacher and baseball coach created (too easily) a microcosm of Nazi Germany in his school.  In reality, in 1967, Ron Jones somehow unethically gradually modified his students’ behaviors to study the rise of Nazi Germany.  He lectured about the beauty of discipline, asked the students to sit in attention postures, and asked the class to repeatedly recite the phase “Strength through Community”.  He also created a class salute, gave memberships cards to students for the newly formed organization called the “Third Wave”, and encouraged students to report on anyone who openly expressed skepticism about the project.  The Third Wave grew by itself in days’ time and soon got out of control.  Ron had to call off the project in an assembly, and to explain to the students that how easily people’s behavior and belief could be manipulated.

You must have come across Zimbardo’s prison experiment about participants playing the roles of prisoners and guards.  Soon enough, participants fitted into their assigned roles.  The guards began to abuse the prisoners, while the prisoners tended to take such abuses reluctantly.  This was another strong illustration on how one’s behavior, in this case taking a certain role, would change one’s mindset.  You might not know that this experiment is required by law to be described in all books about the history of social psychology.  You might also not know that Zimbardo had himself adopted the role of the prison superintendent in his experiment.  He was astonished to find that his thinking had also been altered to the extent that he was unwilling to stop the experiment early when things got out of control.

When talking about brain washing, people tend to figure directly something to do with the brain.  However, in psychology, there is no crazy operation, flashing lights, white noise or injection of novel chemical to achieve this task.  Thinking is manipulated by modification of behavior in well proven experiments. 

(Source: HKMA News October 2012)