Suicide

From Fashion to Suicide: Why We Imitate Each Other

Suggestibility underlies psychosomatics, placebos, social contagion, and culture

Posted Mar 11, 2021 | Reviewed by Matt Huston

Juan Carlos Munoz | AdobeStock
Source: Juan Carlos Munoz | AdobeStock
  • Social influence can help explain a vast array of human behaviors, from everyday forms of learning and relating, to long-term increases in mental illness and violence.
  • Basic forms of imitation begin in infancy, and involuntary mimicry is evident in phenomena like contagious yawning.
  • Imitation and suggestibility are features of being human, but may have many harmful side effects.

In 1774, Johann Wolfgang von Goethe published Die Leiden des jungen Werthers (The Sorrows of Young Werther). In the novel, the main character Werther shoots himself with a pistol after he is rejected by the woman he loves. Shortly after the book’s publication, there were reports of young men dressing in yellow pants and blue jackets like Werther and shooting themselves in acts of hopelessness. This resulted in the book being banned in several places.

The phenomenon of copycat suicides, which has been verified numerous times by research in recent decades, has become known as the Werther effect. It is a form of social contagion, and is thought to be mediated by social learning, whereby a vulnerable person identifies with someone depicted in the media and may be inclined to emulate their suicidal behavior. The effect seems to be greatest in youth, a group that is highly susceptible to social learning. The effect appears to be especially great when the publicized suicide is that of a celebrity, and when that person is romanticized or glorified. As a result, many countries have in recent years implemented media guidelines on suicide reporting.1

What Is Social Contagion?

Social contagion2 is a more general phenomenon extending far beyond suicide. It is the spread of ideas, attitudes, or behavior patterns in a group through imitation and conformity (among other factors).3 It is a complex and incompletely understood phenomenon, with various conscious (volitional) and unconscious (involuntary) processes contributing to it. The American Psychological Association’s definition of social contagion4 lists a few of those processes:

  • Imitation—copying the behavior of another person or group, intentionally or unintentionally.5 In some situations there can also be an element of mimicry, in which people, without conscious awareness or intent, automatically copy other people’s physical movements.6
  • Conformity and the pressure to conform: conformity is the adjustment of one’s opinions, judgments, or actions so that they become more consistent with the group.
  • Universality, which refers to the tendency to assume that one’s attitudes or behaviors are common to everyone in the group and are permissible ‘because everybody’s doing it,’ as in the case of rule-breaking by a crowd or mob. This has a disinhibiting effect, as well as a reciprocally reinforcing effect, setting up a circular reaction. Anonymity, impulsivity, and feelings of invincibility also play important roles in mob situations.7

Some other factors mediating social contagion might include:

  • The need for approval and affiliation.
  • Sharing the other’s goals, or inferring/understanding their intentions and motivations.
  • Being ‘inspired’ and impressed by the other, and in some cases trying to gain recognition and even notoriety by surpassing the ‘accomplishment’ of the other, as in the case of antisocial/psychopathic acts such as mass shootings.
  • Emotional contagion—the rapid spread of an emotion from one or a few individuals to others, as in a political rally or a sports stadium packed with fans, or even just a room full of friends.
  • Group-think, as may occur for example in political organizations, or in corporations—in which cohesiveness or the desire for cohesiveness within a group produces a tendency among its members to agree at all costs, which leads the group to minimize conflict and reach a consensus decision without critical evaluation. Members of a group can often feel peer pressure to ‘go along with the crowd’ for fear of rocking the boat, or out of concern for their teammates’ perceptions of them.8
  • Presence of a highly influential/domineering/authoritative role model.
  • Social facilitation9
  • The human propensity to be strongly swayed by compelling narratives.
  • Suggestibility—social contagion is accelerated by a high degree of suggestibility.10 Suggestibility is a highly potent, underestimated force, with manifestations extending far beyond social contagion.

What Is Suggestibility?

Suggestibility is the quality of being inclined to accept and act on the suggestions of others,11 or being easily influenced by other people's opinions.12 It also usually implies a state of uncritical compliance with an influence.13 Another important factor playing into suggestibility is expectation. The brain is a prediction machine, and expectations have a powerful influence on how we perceive and experience things. Other people’s experiences, not just our own, can shape our expectations. Suggestibility may operate with and without awareness, i.e. consciously and unconsciously.14, 15

Suggestibility and expectation are central to placebo effects. Sometimes placebo response rates for certain kinds of treatments might even increase in a society over time, as a result of rising societal expectations for the effectiveness of particular treatments.16 Some conditions have higher placebo response rates than others.  A sizeable portion of antidepressants' effect sizes is attributable to the placebo effect (with the medications being modestly superior overall, on average).17

Social Contagion and Suggestibility in Mental Disorders

The manifestations of social contagion and suggestibility are wide-ranging. Here are a few examples in the mental health field in which a problem has probably been at least amplified by social contagion effects and/or suggestibility:

  • Suicides, as already noted.18
  • Non-suicidal self-harm especially self-cutting, the prevalence of which has increased greatly in the last couple of decades. When I trained as a psychiatrist in the early 1990s, self-cutting was considered practically diagnostic of borderline personality disorder, whereas today it is merely a common way that anxious or depressed teens distract or soothe themselves when upset.
  • Mass shootings, such as school shootings—these have increased greatly since 1999, especially in the U.S., in what has clearly been shown to be a copycat effect ("the Columbine effect").
  • The apparent anxiety epidemic and mental health crisis in youth today.
  • Psychosomatic symptoms.
  • Functional Neurological Disorders, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Fibromyalgia, some cases of Chronic Lyme Disease, and some cases of post-concussion syndrome. Note: all of these syndromes may indeed have a physiological/neurobiological basis, some of which may be mediated by stress—it’s complicated. While there may be a significant element of suggestibility involved in some of these disorders, and their prevalence may have been at least partially amplified by social contagion effects, they cannot be dismissed as simply "all in your head."19
  • Mass psychogenic illness (what used to be called mass hysteria)—there have been a great many famous examples in history.20
  • Anorexia Nervosa is probably another example of a now well-entrenched disorder with its origins partly in social contagion and suggestibility, with cultural factors fueling the epidemic. Common personality factors predispose certain individuals to develop anorexia, such as perfectionism and a high need for control (traits with a heritable basis). Cases of anorexia continue to be driven upwards by social contagion in vulnerable groups, sometimes quite consciously and intentionally, as in social media sites that foster competition in weight loss between teenage girls, in a race to the bottom.
  • There have actually been quite a number of examples of disorders/diagnoses within psychiatry that have increased over the years, some of them legitimate disorders where increased recognition accounts for the increase in diagnoses, others more dubious—such as the 1980s/90s rise of so-called multiple personality disorder.21 Similarly, in those same decades, the supposed uncovering of repressed memories—from which valuable lessons were eventually learned about how easily false memories could unwittingly be induced by the insistent suggestion of well-intended but misguided, fervently believing therapists.22

Social Contagion Is a Broad Societal Phenomenon

Social contagion effects are at play far beyond mental health, in such disparate examples as the very divergent behaviors of communities during a pandemic (e.g. widespread mask wearing versus widespread flouting of public health measures), the proliferation of political conspiracist groups, the behavior of stock markets and financial manias/crashes, moral panics, witch hunts, religious manias and cults.23 And of course the entire phenomenon of fashion, fads, and crazes (not to mention marketing, which intentionally exploits social contagion and suggestibility effects).

Social contagion is in many ways a side effect of the central place of social learning in human development, group coherence, and culture. Humans are intensely social primates. Observation and imitation of others is one of the most important ways in which we learn ("monkey see, monkey do," or "aping"). We do this from a very young age. Some of it is unconscious and hard-wired, such as the social smile—a fixed developmental milestone that has infants automatically smiling back when smiled at, beginning at around two months of age. Or, the way we yawn when we see others yawn (the physiological and evolutionary reasons for which remain something of a mystery). The process of toddlers acquiring language is another early developmental example.

Indeed, the transmission of culture itself operates in large part by imitative processes of social learning, contagion, and suggestibility. The inclination to conform to those around us and adopt their behaviors, consciously or unconsciously, is often irresistible—such as the way immigrant kids will usually adopt the accent that is prominent in their new home.

Culture has many definitions. One useful way of defining it is: all of the information that individuals acquire from others by a variety of social learning processes, including teaching and imitation.24

There are many ways of understanding how culture spreads. One way is memetic theory, which is almost synonymous with social contagion.25 The term meme, coined by the evolutionary biologist Richard Dawkins, is intentionally similar to geneMemes are units of cultural transmission that spread through processes similar to natural selection, in ways analogous to genes, or like viruses infecting minds. Memes spread especially profusely in humans in part because we are such a prodigiously imitative species and because we have the cognitive capacity, especially linguistic ability, to imitate very complex memes.

A Feature, Not a Bug

Our propensity to imitate each other in dysfunctional ways is thus a side effect of the centrality that imitation and suggestibility play in social learning and culture. There is much more research needed on this still incompletely understood phenomenon. We would do well to heighten our awareness of its profound, far-reaching influence on our behavior, personal health, and societal functioning.26

"Men, it has been well said, think in herds; it will be seen that they go mad in herds, while they only recover their senses slowly, and one by one."

—Charles MacKay, Extraordinary Popular Delusions and the Madness of Crowds, 1841

References

1. Sinyor M, Schaffer A, Heisel MJ, et al. Media Guidelines for Reporting on Suicide: 2017 Update of the Canadian Psychiatric Association Policy Paper. The Canadian Journal of Psychiatry. 2018;63(3):182-196. doi: 10.1177/0706743717753147

2. also called group contagion or behavioral contagion.

3. Colman, A. (2008). social contagion. In A Dictionary of Psychology: Oxford University Press.

[CLICK 'MORE' TO VIEW FOOTNOTES 4-26]

4. American Psychological Association Dictionary of Psychology

5. As noted, suicide contagion, as a particular form of social contagion, tends to involve identification with and emulation of the person whose suicide was publicized and romanticized—the more so when that person was a celebrity. Emulation means something similar to imitation, but to emulate carries the additional implication of striving to match or surpass the other’s success at achieving their goal. Emulation carries the connotation of wishing to distinguish oneself and achieve importance by modeling oneself on someone who is worthy of esteem.  For researchers in observational learning theory (social learning theory), there is a slightly more technical definitional difference between emulation and imitation: emulation means achieving the outcome or goal of the observed behavior, and it requires comprehension of that goal, whereas imitation involves more exact copying of the specific actions of the behavior.

6. The intriguing role of mirror neurons as a neurobiological mechanism of imitative behavior (and in the capacity to understand the behavior being imitated) is now old news [Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci. 2004;27:169-192. doi: 10.1146/annurev.neuro.27.070203.144230]. Many theories have been proposed concerning the possible role of mirror neurons in a wide array of human behaviors and capabilities, such as empathy. Some of the more far-reaching claims have yet to be fully substantiated.

7. Crowds, mobs and other chaotic social groups can also be modelled as complex adaptive systems (applying complexity theory— the whole is greater than the sum of its parts). Social contagion effects are collective behaviors that can be understood as emergent phenomena resulting from the complex dynamics of the group’s interactions. People in groups behave in ways that would not be expected or predicted from any of those individuals on their own, and might even be unthinkable to those individuals, in the absence of the interactional effects. Mobs may act without any clear goals, as for example in ecstatic celebratory riots following a sports victory.   Another relevant theory in understanding the collective behavior of crowds, mobs, mass movements, cults, etc. is emergent norm theory, which posits that the uniformity in action often observed in such groups is caused by members’ conformity to unique social norms that develop spontaneously in those groups.

10. Benjamin J. Sadock et al., eds., Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 10th ed. (Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2017), p. 4571.

13. (Or uncritical acceptance of an idea, belief, or attitude). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, p. 4615.

14. The term suggestibility is often used to refer to the ‘power of suggestion:’ the process by which a physical or mental state is influenced by a thought or idea (https://www.merriam-webster.com/dictionary/suggestion) or a propensity to be abnormally compliant with suggestions, commands, directions, instructions, or orders from another person, as in hypnosis [Colman, A. (2008). suggestibility. In A Dictionary of Psychology: Oxford University Press]. But the popular belief that hypnosis is an altered state of consciousness in which the hypnotized subject is under the ‘control’ of the hypnotist is a myth. Hypnosis is merely a state of heightened suggestibility, in a state of induced relaxation and trust. In the theatrics of stage hypnosis, a good deal of voluntary role-playing and peer pressure are usually involved as well.

15. Closely related to suggestibility (and hypnotic susceptibility) is the phenomenon of dissociation, which ranges from normal, common sensations experienced by everyone at times—a feeling of emotional detachment from one’s surroundings (more common when tired / hungry / intoxicated / sensory-deprived / stressed / anxious / panicky / traumatized), to more intense, distressing or strange experiences in which the person feels a sense of being completely disconnected from reality, or as though they are observing themselves and their surroundings from outside their body. There are a few psychiatric disorders in which severe or frequent dissociation is a defining characteristic. Dissociative phenomena also underlie many mystical and trance-like states, and are incorporated into many religious / spiritual practices and beliefs.

16. Placebo effects can be defined as positive responses to the therapeutic context surrounding administration of an active or inactive treatment. [Burke MJ, Faria V, Cappon D, Pascual-Leone A, Kaptchuk TJ, Santarnecchi E. Leveraging the Shared Neurobiology of Placebo Effects and Functional Neurological Disorder: A Call for Research. J Neuropsychiatry Clin Neurosci. 2020;32(1):101-104. doi: 10.1176/appi.neuropsych.19030077].  In other words, placebo effects are influenced by how a person responds to the physical and social environment around a treatment. https://www.theglobeandmail.com/life/health-and-fitness/article-placebos-could-save-lives-and-health-care-dollars-so-why-cant/.  Another factor in placebo effects is the conditioned behavioral response, which helps explain why placebos still have effects even when the person is told they are being given a placebo.

17. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. doi: 10.1016/S0140-6736(17)32802-7

18. Niederkrotenthaler T, Braun M, Pirkis J, et al. Association between suicide reporting in the media and suicide: systematic review and meta-analysis. BMJ. 2020;368:m575. Published 2020 Mar 18. doi: 10.1136/bmj.m575;  

19. It's in your head, yes, but only in the same sense that your brain and everything that can go wrong with it is in your head. The neurobiology of these disorders, which are often partly stressed-based (with expectation and conditioning also often playing a role), is turning out to be more interesting and complicated than was previously appreciated: Burke MJ. "It's All in Your Head"—Medicine's Silent Epidemic. JAMA Neurol. 2019; 76(12):1417-1418. doi: 10.1001/jamaneurol.2019.3043;  Burke MJ, et al. Leveraging the Shared Neurobiology of Placebo Effects and Functional Neurological Disorder [cited above];  Stone J. The bare essentials: Functional symptoms in neurology. Pract Neurol. 2009;9(3):179-189. doi: 10.1136/jnnp.2009.177204.  See also Functional Neurological Disorder (FND) : a patient's guide.

20. One interesting case in recent years is Havana Syndrome, the alleged microwave attack on U.S. (and Canadian) diplomats in Cuba and China. It is still being debated and could yet turn out to not be psychogenic, but it certainly has many of the hallmarks of such, as argued by Psychology Today blogger sociologist Robert Bartholomew, among others. If Havana Syndrome does turn out to be psychogenic, it will be a useful reminder that anyone, no matter how mentally resilient, is susceptible to such symptoms. Much was made of the fact that the affected diplomats are highly resilient people and therefore supposedly could not have been suffering from psychogenic symptoms. This assumption reflects a misunderstanding of how suggestibility and social contagion work.  See also https://www.skeptic.com/reading_room/havana-syndrome-skepticism-it-was-probably-psychogenic-by-robert-bartholomew/; and https://www.buzzfeednews.com/article/danvergano/microwave-attacks-havana-syndrome-diplomats

21. Multiple personality disorder is now referred to as Dissociative Identity Disorder, a term that better captures the nature of the problem.

22. Many have suggested that the current explosive increase in gender dysphoria is a social contagion phenomenon, with teens misattributing other sources of distress, such as adolescent problems of identity confusion and of not fitting in, to gender, fueled by the issue’s high profile in the media and by prominent celebrity cases. The counter-argument has been made that perhaps gender dysphoria (or gender fluidity) was always highly prevalent but underestimated and suppressed by stigma in the past, and that individuals now feel more permitted to come out, in much the same way as homosexuality a generation or two earlier. A third speculative possibility is that even if the true prevalence of gender fluidity was uncommon in the past, the current phenomenon of large numbers of youth identifying as gender-fluid could conceivably cause a more enduring cultural change, such that a higher prevalence of gender fluidity could become the new societal reality—a fact on the ground, if you will. Only time will tell if the high prevalence turns out to be a transient or more enduring cultural phenomenon. But given the risks associated with irreversible hormone and surgical treatments, and the fact that at least some of these kids change their minds as they get older after having undergone gender affirming treatments as teens, it is certainly important to be researching this field more deeply and trying to understand all the complex individual and societal factors at play.

23. William J. Bernstein, The Delusions of Crowds: Why People Go Mad in Groups (New York: Atlantic Monthly Press, 2021).

24. Richerson PJ, Boyd R, Henrich J. Colloquium paper: gene-culture coevolution in the age of genomics. Proc Natl Acad Sci U S A. 2010;107 Suppl 2(Suppl 2):8985-8992. doi: 10.1073/pnas.0914631107

25. Marsden P. Memetics and social contagion: two sides of the same coin. J Memet Evol Model Inf Transm. 1998;2(2):171–85. http://cfpm.org/jom-emit/1998/vol2/marsden_p.html

26. A final note, regarding the image chosen for this blog post: Interestingly, even the howling style of howler monkeys shows signs of cultural transmission, i.e. social learning:  Briseño-Jaramillo M, Estrada A, Lemasson A. Behavioural innovation and cultural transmission of communication signal in black howler monkeys. Sci Rep. 2015;5:13400. Published 2015 Aug 25. doi: 10.1038/srep13400.  Monkey see, monkey do.