Rituals in the Wounded Business of Health Care

Tim Leberecht, in his recent article, The Romance of Healthcare, cuts through the fabric of rationality that covers the body of medicine like gauze over an open wound. The bandage is a necessary one, to prevent infection from the outside. If medicine were to become a culture for every idea for healthy living that goes viral, after all, it would quickly perish. However, those who manage the care of the medical profession would do well to look beneath these wrappings from time to time, to judge its condition under an honest light.

The procedures and materials of medicine must be rigorously evaluated according to the rules of logic, tested quantitatively, and applied with cool precision. We all want technical excellence from our doctors when we are ill.

Yet, technical excellence is not all that we want from our doctors. It is not all that we need.

The Limits Of Innovation

When we suffer from physical ailments, we need compassionate guides to give meaning to our suffering. We need health care professionals to do more than just diagnose our conditions. We need to help us undergo the deep psychological transformation necessary to live with our conditions.

No pill can deliver this service. There will never be a robotically-guided scalpel precise enough to slice through to this deeper problem in medicine. A healthy human can’t be made through surgery or pharmaceuticals alone. The most skillful heart surgeon will never be able to provide much help to patients who don’t know how to change their habits of diet and exercise. Charlie Sheen’s high-priced HIV specialists won’t be able to keep him healthy for long if he neglects to take the medications they prescribe.

Medical procedures can give us the opportunity for recover. Pharmaceuticals can support our healing. However, the most stubborn challenges that medicine now faces are emotional, not technological. To address these challenges, medicine needs to develop behavioral technologies, rather than relying only on digital ones. Because the emotional challenges in the practice of medicine originate in our ancient biological heritage, the place to find these is not in a technical future, but in the cultural past.

The cultural technology of ritual has been in existence for as long as there have been human beings. Rites of passage have moved people to accept the unavoidable changes of life, not by persuading them to change, but by immersing them in powerful experiences, saturated with symbolic codes of profound meaning, that awaken psychological modes of transformation that have nothing to do with logic. These rituals have not just enabled people to endure great ordeals, but have used the power of suffering to heighten the significance of the transformative experience, and seal the commitment required to live out the new roles into which ritual participants are initiated.

Leberecht explains, “The patient experience is always a journey of transformation guided by symbolic acts of meaning, in other words, by rituals. Since the beginning of humanity, rituals have allowed us to shift between our multiple identities, to leave society and reenter it, and to, literally and metaphorically, heal. One has to understand the underlying rituals, the deeper meaning of the patient experience, in order to design for it and make it more human-centric. This lens of deeper meaning, of rituals creating and restoring ‘sacred spaces’ at those very moments when we feel the most vulnerable and the most authentic, is a romantic proposition.”

Finding Ritual in Medicine

There are elements of ritual that remain in the rationalized system of medicine that has become standard in our society, but these remnant fragments of the old rites of passage are improvised inconsistently, rather than being designed and applied in a purposeful manner. Instead, doctors are nurses are taught to deal with their patients as if they were students in medical school. The usual approach these days is to educate patients about their conditions and their treatments, presuming that once patients have the right information about the likely medical consequences of failure to comply with doctors’ orders, they’ll do the rational thing, and faithfully maintain the regimen they have been taught to follow.

In practice, as every health care professional knows, large numbers of patients actually fail to comply with their prescribed regimens, even when it’s clear that their lives are on the line. It seems that patients are determined to be anything but rational.

Even though they know that patient noncompliance rates are high, most health care professionals keep on applying the standard approach, trying to lecture, argue, and cajole their patients into taking their medications. When patients fail to obey, and their health deteriorates as a result, doctors shrug their shoulders, and say that they did everything that they could.

What else could they do, after all?

Well, for one thing, health care systems could accept that education isn’t an effective method for getting people to accept the need to change. Doctors could work with the insight that most patients aren’t going to be rational, especially when their illnesses are frightening and painful. As Leberecht explains, “even if rational arguments are sound, emotions override them at any time.”

When fear and pain arouse emotions in patients that override their rationality, the rational thing for health care professionals to do is stop trying to work against those emotions, and learn instead how to harness emotions to provoke the transformations patients desperately need.

Becoming The Kind Of People Who Will Take Their Medicine

Ritual is the ancient cultural tool designed to harness emotion to enable lasting transformation. When we are in crisis, the ritual process breaks us away from our old ways of living, blends symbolic stimulus with tests of worthiness that strengthen our resolve to change, and then provide guidance in the new rules that we must obey when initiation is complete.

At the conclusion of an effective rite of passage, initiates are ready to behave differently than they did before the ritual began — not because they have received information, but because the ritual has changed who they are. Through the symbolic journey of the ritual, they have shifted into a new identity, and the changes in their behavior arise authentically from that new identity, rather than through a constant struggle to enact abstract knowledge through the willpower of the rational mind.

Because the ritual process works with people as they actually are, rather than how they theoretically ought to be, its application in the field of medicine can deliver remarkable therapeutic benefits, and result in financial rewards as well, as medical institutions avoid the considerable costs associated with patient noncompliance. However, to harness the power of ritual requires a different approach than is usually seen in the quest for efficiency through the application of scientific management principles by medical administrators.

Ritual will get patients where they need to go, but it won’t travel in a straight line. A health care organization that seeks to harness ritual needs to allow the space and time for the ritual process to follow its curving path. It’s a process that requires human attention, listening, compassion, and care, and it can’t be rushed.

As Leberecht advises, “A truly human-centered approach to healthcare delivery must transcend mere process excellence and embrace a spiritual workplace and patient culture characterized by significance. It must allow for moments of intimacy and delight, and not only be valued by rigorous operational metrics but qualitative metrics that measure the holistic patient experience, how he or she felt.”

Paying attention to how patients feel is the nice thing to do, of course, but in the practice of medicine, attending to patient emotions shouldn’t just be an act of abstract kindness. Rather, medical professionals who are trained to guide patients through the rites of medicine need to assess patient emotion as a different kind of diagnosis: One to determine where patients are in the ritual process.

We need the technical prowess enabled by the scientific approach to medicine to get patients’ bodies through times of acute medical crisis. To integrate these episodes of intense interaction with health care systems into a life that remains on a healthy track, however, requires a model of health that is cultural as well as biological. Properly applied, the ritual process can enable health care systems to develop experiences that lead patients to intrinsically identify with the new modes of behavior that are most likely to reduce the need for future medical intervention. In this way, a ritualized practice of medicine will lead to increased well being for patients, physicians, and administrators alike.