Our hands are vital for performing tasks throughout our daily lives and must be taken care of and cleaned regularly. They can easily spread germs, bacteria, or viruses such as Covid-19 (Coronavirus). Coronavirus has spread rapidly throughout the entire world in the past few months and health officials are very adamant that hand hygiene can help prevent further escalation of the virus. The reason is simple; viruses can spread from our hands to other objects that we touch, to which other people can touch those same objects and possibly contract the virus by putting their hands on their face. According to the World Health Organization, proper hand sanitation that uses alcohol-based rub or hot water and soap can kill Coronavirus and other viruses [1].

For some people, such as healthcare professionals, there are actually major consequences for neglecting hand hygiene. For example, the dirty hands of these professionals have a negative impact of 40% in the transport and spread of resistant microorganisms among patients. Hospital infections are actually among one of the main catalysts for increased disability and death rates in hospitals, along with additional healthcare costs [2]. In the United States, 1.7 million patients develop health-related infections every year, and 100,000 of them die. This increases the length of hospital stay by 20 times and the cost of treatment by 5 times [3].

It was not until the 19^th century that we began to understand that infectious diseases can be prevented by washing our hands. In the middle of the same century, the pioneer of antiseptic processes, known as the “savior of mothers,” Hungarian physician Ignaz Semmelweis, showed that microorganisms could be transmitted to patients via the hands of medical staff. This discovery began a new era of hygiene and healthcare. It is now well known that microbes reproduce rapidly, and that it is possible to prevent the spread of disease by keeping the hands and body, which is possible by following personal hygiene rules.

Hand hygiene is maintained in different ways in modern medicine. In daily life, washing hands with soap and water to remove dirt is called “social hand washing.” Common examples include washing after a meal and when visiting the toilet. For this purpose, it is sufficient to rub the hands and fingers for 15 seconds with a non-antimicrobial feature soap, rinse, dry with a disposable towel, and turn off the tap with a towel. Cloth towels used by many people in public places are not considered suitable for hygiene.

The more serious and professional form of hand washing is “hygienic hand washing,” where antimicrobial soaps are used in the washing process before and after contact with patients and bodily fluids. Other hand hygiene methods during surgical operations cover applications where alcohol-based 3-5 ml hand-disinfectant is rubbed until dry along with hand disinfection and surgical hand antisepsis, which includes washing the hands, including the forearms, with chemical solutions such as soaps, isopropanol, chlorhexidine specifically produced for this purpose for 2-3 minutes, and later wearing sterile gloves until the end of any procedures.

The World Health Organization published a guide on proper hand hygienics and explained when, how often, and how healthcare providers should wash their hands [4]. Despite the development of various programs and policies, especially hand hygiene, and increasing material expenditures in the fight against infections observed in health services, the control of infections remains well below the desired level.

Today, research also looks at the effects of hand washing on individual psychology. An experiment carried out by two psychologists from the University of Michigan, Spike W.S. Lee and Norbert Schwarz, shows that hand-washing reduces this classic post-decisional dissonance effect:

In individual sessions, 40 undergraduates browsed 30 CD covers as part of an alleged consumer survey as if they were in a music store. They selected 10 CDs they would like to own and ranked them by preference. Later, the experimenter offered them a choice between their 5th and 6th ranked CDs as a token of appreciation from the sponsor. Following the choice, participants completed an ostensibly unrelated product survey that asked for evaluations of a liquid soap; half merely examined the bottle before answering, whereas others tested the soap by washing their hands. After a filler task, participants ranked the 10 CDs again, allegedly because the sponsor wanted to know what people think about the CDs after leaving the store.

For those who merely examined the soap, the preference for the chosen over the rejected alternative increased from before choice to after choice by an average of 1.9 ranks, replicating the standard dissonance effect. In contrast, for those who washed their hands, preferences were unaffected by their decision. Thus, handwashing significantly reduced the need to justify one’s choice by increasing the perceived difference between alternatives. “Washing one’s hands after making a choice eliminates post-decisional dissonance effects, suggesting that hand-washing psychologically removes traces of the past, including concerns about past decisions” [5].

In another study conducted in 2008, Schnall, et. Al. “hypothesized that physical cleanliness reduces the severity of moral judgments. In support of this idea, they found that individuals make less severe judgments when they are primed with the concept of cleanliness and when they wash their hands after experiencing disgust” [6]. This effect of hand washing, which relieves conscience, is called the “Macbeth Effect.”

Washing hands is one of those simple but compulsory practices we tend to take for granted and lose interest in as we progress in science and education. Simple practices like using each of our hands for different purposes and frequent hand-washing will surely contribute to the fight against healthcare infections and infectious diseases that threaten public health.

There are several traditions of Prophet Muhammad, peace be upon him, in which washing hands is strongly emphasized.

“The blessings of food lie in washing hands before and after eating.”

“Wash your hands after you wake up; you do not know where your hands have moved while you were sleeping.”

The Prophet advised using each hand for different tasks. It is narrated that his wife Aisha said: “The right hand of the Messenger of God (peace be upon him) was for his purification and food, and his left hand was for using the restroom and anything that was dirty.”

Notes

1. “Advice for Public.” World Health Organization, World Health Organization, www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public.
2. Pittet D, Allegranzi B, Storr J, Donaldson L. Clean care is safer care: the global patient safety challenge 2005-2006. Int J Infect Dis. 2006; 10(6): 419–24.
3. Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D. The first global patient safety challenge “Clean care is safer care”: from launch to current progress and achievements. J Hosp Infect. 2007; 65(Suppl. 2): 115–23.
4. WHO Guidelines on Hand Hygiene in Health Care, www.who.int/gpsc/5may/tools/9789241597906/en/
5. Lee SW, Schwarz N. Washing away postdecisional dissonance. Science. 2010 May 7;328(5979):709. doi: 10.1126/science.1186799.
6. Schnall S, Benton J, Harvey S. With a clean conscience: cleanliness reduces the severity of moral judgments. Psychol Sci. 2008 Dec;19(12):1219-22. doi: 10.1111/j.1467-9280.2008.02227.x. Also see https://psycnet.apa.org/fulltext/2014-20922-011.html in which Johnson, D. J. et. al. suggest that “researchers investigating the connections between cleanliness and morality should therefore use large sample sizes to have the necessary power to detect subtle effects.”

The example given above-not stealing customers’ money versus not being a rich person-is just one possible case among others which human beings feel tension because of conflicting cognitions. Most people have personal beliefs, principles, and values shaping their lives fundamentally. Psychologists use the concept of cognition to imply all of these factors that guide our choices. Cognitions regulate our lives at any moment regardless of our consciousness of them. For instance, some people could venture everything to have more money because they have a cognition whispering “money, money, money,” or others can sacrifice everything for the sake of beliefs because of their cognition, “I believe therefore I am.” Even though human beings feel good when these cognitions drive us to success, good decisions, and a satisfying life, they turn out to be a source of frustration when a certain cognition conflicts with another one. In such cases, what we usually do is to find a way to resolve the conflict because we do not like to live with this tension. How then can we cope with this conflict?

The most common attitude under such circumstances is “self-justification.” If we turn to our example, Peter chose one of the two alternatives: continue to steal his customers’ money in order to become a rich person. Now he must find a good reason to justify himself and reduce his inner conflict:

“Not stealing is not the only way of being an honest person. You cannot be a bad guy just because of one unique behavior in your life, given that other people are also committing such sins, even worse sometimes.”

“My customers are the richest people in the State; it is not greed if I want them to share some of their money. Actually, they do not deserve it at all.”

“I did that to ensure the future happiness of my family; I know that making your family happy is more important than being honest.”

There can be many other reasons or justifications for such a behavior. The truth is that, Peter is trying to convince himself about his behavior. Although people’s attempts to convince themselves are not necessarily rational, they try to rationalize their behaviors by changing their cognitions or adding new ones.

All of the above are in the simple processes of Leon Festinger’s (1957) theory of cognitive dissonance. He contends that when an individual has two or more cognitions (beliefs, opinions, ideas etc.) which are inconsistent with each other, then tension emerges and people attempt to reduce this tension. How can the tension be reduced? The answer is through changing one or both cognitions or by adding new cognitions to alleviate discrepancies between cognitions. Our behaviors in such situations will determine the way we behave the next time we encounter a similar situation. Our ultimate behavior will depend on the strength of one’s cognitions (Aronson, 2004). If being a rich person is more important than not being greedy, a person is more likely to choose to steal money.

It is critical that the choice does not have to be right or rational. Let’s remember Peter’s excuses for stealing. He tended to believe that stealing was not as bad as he thought before because he found some justifications. Now he seems to feel better, but what about the next step? Most probably, he will continue to steal. As one can easily see, dissonance reduction is mostly an irrational behavior. Apparently, these irrational behaviors help people to defend their “self” or “ego.” Through the help of these irrational beliefs, people continue to define themselves as if they are good, smart, decent, or generous people. The underlying motive is the need for self-justification.

Cognitive dissonance from the perspective of religion

There are many musts and must-nots in a believer’s mind. One common practice of dissonance reduction appears at a point where one must choose between committing a sin or making a righteous decision. While preaching or reading holy books nurtures spiritual “cognitions” in a religious mind, obeying concupiscence and chasing essentially worldly goals will weaken this. After every sin that a believer committed, the battle of the cognitions starts between “I am a religious guy” and “I committed a sin, therefore I am not a decent person.” Since these cognitions cannot live peacefully together in a religious mind, one of the conflicting cognitions will grow out of this battle.

This process meshes with a religious idea that “Within each sin is a path leading to unbelief” (Nursi, The Second Gleam). If a person insists on performing a sinful act, he starts to disdain his sin. After a while, as he keeps behaving in the same manner, he becomes addicted to the sin and tends to see it as a normal act. Instead of acknowledging that the sins are witnessed by the angels and seen by God, an unrighteous man may like the idea that they may not exist at all, which is again comforting. With that idea, the cognition of “I am a religious person” is surpassed by a new cognition, “Maybe the religion that I accepted has some flaws” or “is questionable” which were added to relieve the pain arising from the cognition “I am not a good person.” From this point of view, people’s preferences about their beliefs are not independent of their behaviors which foster or challenge their religious cognitions.

One’s tendency to justify himself is usual but may not be what ought-to-be from the moral point of view. As people justify themselves, they will ignore whatever is wrong with their behaviors or cognitions, which will make them insensitive. Going beyond psychology’s objective description of human beings as rationalizing or justifying beings, religious sources suggest rejecting self-justification in most of cases. The Qur’an quotes the Prophet Joseph: “Yet I do not claim my self free of error, for assuredly the human carnal soul always commands evil, except that my Lord has mercy. Surely my Lord is All-Forgiving, All-Compassionate” (Yusuf 12:53). This means, self-awareness about the conflicting cognitions is critical for human beings. When the person has inconsistent cognitions, choosing the option that does not solely serve to justify himself will prevent the person from going toward unbelief. Christianity also pointed to the importance of facing up to our sins: “I acknowledged my sin to You, and in my iniquity I have not hidden. I said, ‘I will confess my transgressions to the Lord,’ and You forgave the iniquity of my sin” (Psalms 32:5).

Between the good and bad

Human cognitions determine their choices and actions, which in turn nurture, shape or weaken our cognitions. Repeating a sin a second time is easier than the first time, and we feel less dissonance because cognitions creating dissonance are replaced by those that bring inner comfort. People who exhibit extremely deviant and sociopathic behaviors should be reconsidered from this point of view. Extremely deviant behaviors should be considered a series of earlier choices which gradually led to the ultimate misconduct rather than the consequence of a unique decision made at a specific time.

Another possible implication of the theory of cognitive dissonance is the difficulty with judging absolute good or bad. Given the fact that cognitions may become weaker or stronger, personal views on the appropriateness of behaviors are subject to change. Human cognitions are potential mechanisms that lead one to behave in a certain way. Therefore, deviant behaviors might have a long history fed by the cognitions which turn out to be one’s rationale for inappropriate behaviors. As a result, cognitive dissonance uncovers the gray area between the continuum of good and bad through which human beings swing all the time.

Conclusion

Cognitive dissonance theory provides convincing explanations about how human beings make their decisions and behave in a moral or immoral manner. Also, it brings a resourceful perspective to illuminate spiritual experiences. It successfully explains how people swing on the path from good to bad and vice versa instead of considering them as dwelling on two discrete entities. Awareness of the above-mentioned processes is critical to increase self-awareness.

One last comment should be made about the role of conscience in cognitive dissonance. Although cognitive dissonance theory successfully explains many cognitive processes, a mental faculty that is responsible for recognizing the discrepancy in our cognitions and regulating the balance between them is conscience. However, psychology’s account of conscience is rather limited and inconclusive. Psychology offers evidence of the way human beings behave in dissonant situations. Religious resources, however, provide prescriptive guidelines to remain on the right track. As in the case of this unique theory, understanding the theories of psychology as well as making sense of them in the light of religious texts provides individuals with a heightened self-awareness.

References

• Aronson, E. 2004. The Social Animal, 9th edition, Worth Publishers: New York, NY
• Festinger, L. 1957. A Theory of Cognitive Dissonance. Evanston, IL: Row, Peterson.