Monday, June 29, 2009

Magical Thinking

Zusne and Jones (1989: 13) define magical thinking as the belief that that one's thought, words, or actions can achieve specific physical effects in a manner not governed by the principles of ordinary transmission of energy or information.

When I went to medical school, we were taught that magical thinking was either a harmless superstition like crossing one's fingers to bring them luck, or a dangerous psychotic delusion, like stepping off a ledge and expecting that you are going to fly.

Since school, I have observed (and frankly participated in) varying degrees of magical thinking. Some lines of thought are fun and some are scary but all have at their core the fervent hope that things will be different than what they are for real.

Since my "evolution" as a physician I have been able to observe that the most ardent practitioners of magical thinking are those of us in the medical profession. It is common practice, for instance, when performing minor procedures at the bedside to disinfect an area of the skin three times prior to performing the procedure. There is no evidence to prove this, but it is commonly done... so much so that the little packets of iodine swabs used for skin disinfection have three little pre-saturated swabs.

Much of this has come down to us from the middle ages mixed with the very real concerns for public health and the provable infection control practices of modern medicine... but still curious.

Unfortunately there are two common threads of magical thinking out there that are perpetuated by the health care community.

The first one is that medicine and medicines can cure anything from cuts and bruises to severe depression. Like any good magical thought, it has it's basis the provable facts of cure from many diseases, however medicine cannot cure many of the ills associated with life itself, such as aging, self abuse such as smoking and obesity. These require the more tedious and "obnoxious" change in lifestyle.

The second (and infinitely more cruel) form of magical thinking is perpetuated by the fears and hopes of medical practitioners themselves. When a person is found to have a terminal illness of any kind (cancer, heart disease, lung disease, etc...) rarely is this information related to the patient. The severity and need for frank and honest discussion of the very real prognosis is held back in the "magical thought" of not wanting to take away hope. Often the thoughts of the practitioner and the thoughts of the family and patient become so intertwined that they begin to exist in each other's fantasy of cure, instead of the reality of treatment and hope for a good life for as long as it lasts.

I am a deeply religious man and I believe strongly in prayer and the power of hope. I have seen in my life what I perceive as being true miracles. However I have seen these miracles happen in the face of a patient that realizes that these are indeed miracles, that these cures and recoveries are the products of a higher power and not the result of crossing our fingers and rubbing our rabbit's foot for luck.

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