Culturally Grounded Scapegoating in Response to Illness and the COVID-19 Pandemic

Abstract

For years, violence against doctors and healthcare workers has been a growing social issue in China. In a recent series of studies, we provided evidence for a motivated scapegoating account of this violence. Specifically, individuals who feel that the course of their (or their family member's) illness is a threat to their sense of control are more likely to express motivation to aggress against healthcare providers. Drawing on existential theory, we propose that blaming and aggressing against a single individual represents a culturally afforded scapegoating mechanism in China. However, in an era of healthcare crisis (i.e., the global COVID-19 pandemic), it is essential to understand cultural variation in scapegoating in the context of healthcare. We therefore undertook two cross-cultural studies examining how people in the United States and China use different scapegoating responses to re-assert a sense of control during medical uncertainty. One study was conducted prior to the pandemic and allowed us to make an initial validating and exploratory investigation of the constructs of interest. The second study, conducted during the pandemic, was confirmatory and investigated mediation path models. Across the two studies, consistent evidence emerged that, both in response to COVID-related and non-COVID-related illness scenarios, Chinese (relative to U.S.) individuals are more likely to respond by aggressing against an individual doctor, while U.S. (relative to Chinese) individuals are more likely to respond by scapegoating the medical industry/system. Further, Study 2 suggests these culture effects are mediated by differential patterns of primary and secondary control-seeking.

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

“…Further research is urgently needed to better understand the context and severity of these experiences, which may or may not differ significantly across geographies. Potential factors that may impact these experiences regionally include the presence of a culture of blame within the society ( 119 ) and differences in how HCWs are portrayed by the media ( 120 ). When comparing different cultural responses to illness during the COVID-19 pandemic, one study found that individuals from China were more likely to behave aggressively toward doctors compared to individuals from the United States, who were more likely to direct their blame toward the health system ( 119 ).…”

“…Potential factors that may impact these experiences regionally include the presence of a culture of blame within the society ( 119 ) and differences in how HCWs are portrayed by the media ( 120 ). When comparing different cultural responses to illness during the COVID-19 pandemic, one study found that individuals from China were more likely to behave aggressively toward doctors compared to individuals from the United States, who were more likely to direct their blame toward the health system ( 119 ). Finally, the media may play a role in perpetuating violence against HCWs, as noted by reports of misleading journalism in India ( 120 ).…”

Taking control of violence against doctors

“…Nevertheless, convergent operationalizations would be informative. For instance, Yang, Tai-Seale et al (2021), Yang, Wang et al (2021), andYang, Young et al (2021) examined archival data, namely public online comments in reaction to real-world incidents of violence against doctors. In other empirical research, the correlation between aggressive behavioural intentions and aggressive behaviour was significant (r = .168, p = .013; Santos et al, 2019).…”

How to minimize adverse effects of physical workplace violence on health sector workers: A preliminary study

“…Possible reasons were generated to account for this difference, including healthcare systems, numbers of health sector workers per 1,000 population, and government health expenditure in the health sector ( Bandara, 2006 ). Yang and her colleagues’ study showed that differences in culturally afforded scapegoating can also influence patients’ violence against health sector workers ( Yang et al, 2021 ).…”