Superstition and Ritual
Some years ago, our beloved Steelers were on the wrong end of a close game midway through the third quarter and had just done something that defied explanation. Fed up with the way the team was playing, my sons, both teenagers at the time, looked at each other and said, in one voice, “Xbox?” Without another word, they got up from the couch, went to the basement, and fired up the latest edition of Madden.
This was their gametime superstition for when things went south during Steeler games. There had been one game where the Black and Gold were playing so poorly that they lost interest, but after thirty or forty minutes of manipulating simulated NFL players and teams on the other screen in the basement, they came back upstairs to find the real team winning the game in the final seconds. From then on it became their safety valve, a way of shifting the energy of the football universe in the Steelers’ favor.
As the beer commercial from that year proclaimed, “It’s only weird if it doesn’t work.”
Sports fans are not the only ones with superstitious behaviors like this. Joe Kita, in a recent article for Medscape online[i], digs into why medical professionals seem so prone to superstitious behaviors and rituals. He describes negative superstitions that I myself adhere to, um, religiously, like never saying the words “quiet” or “slow” in an ER or while on call (it’s the equivalent of saying “Macbeth” in a theater – you are asking for trouble) or not playing the songs “Stairway to Heaven” or “Another One Bites the Dust” in a hospital elevator (although that second song does have the perfect rhythm and tempo to pace yourself while performing CPR).
He details personal devotions that can take up to 2 hours to perform, like colorectal surgeon Carmen Fong’s multi-step ritual that encompasses her alarm clock, her breakfast, the patient’s blood clot prevention measures, and a final word to them before the anesthesia takes effect. And Kita highlights rigid fashion choices and magical thinking; plastic surgeon Anureet Bajaj shares her tales of a friendship bracelet, her ‘80s music playlist, and her Wonder Woman clogs, all designed to steer her surgeries toward a successful outcome.
It’s a brilliant article, with one major issue – the conflation of superstition with ritual. Growing up, I attended a Reform temple that used that era’s standard Reform siddur (prayerbook, for my non-Jewish friends and colleagues reading this). During the Aleinu prayer, there was one line in the translation that has stayed with me for forty years, describing a future time when “superstition will no longer enslave the mind, nor idolatry blind the eye.”[ii] We were praying, doing a ritual, quite literally for God’s sake, but superstition – that had no place. Half a decade or so later, in college, my decidedly secular professor Adolf Grunbaum, of blessed memory (he is rolling over in his grave as I say this, except he didn’t believe in the afterlife), made the same conflation as Joe Kita when he chuckled at Boris Yeltsin saying he wasn’t religious, “But I am superstitious (wink).”[iii] Then as now, I thought of the prayer.
Superstition, as Kita readily admits in his article, is meant to assert control over things that are out of our control – something all of us, but especially medical professionals, would like to believe don’t exist but are the rule rather than the exception. “The more unknowns and trepidation,” he explains, “the greater the tendency toward . . . ‘magical thinking.’” Not saying a word, not playing a song, or only wearing a certain bracelet or pair of shoes can’t possibly affect the outcome of a surgery or the census in your ER, but, “it can’t hurt, right?”
Kita’s contention, though, is that it can hurt, because it can contribute to rigidity, compulsiveness, avoidance of responsibility, and ultimately the circular reasoning of self-fulfilling prophecy. It’s terrible for the provider’s mental health, and it’s not great for the patient either. Kita repeats an urban legend of a doctor who forgot to complete his pre-operative ceremony and left the OR mid-surgery to correct the omission. Notice I didn’t use the word ritual in that last sentence, even though Kita does. So what would make that behavior a ritual?
Ritual, beginning with our most common ritual, prayer, isn’t about controlling the universe around us. It’s about taking responsibility for controlling ourselves by examining our behavior and doing concrete actions to recognize that some things are sacred. One of Kita’s examples that I would recognize as a ritual is the prayer that USC transplant surgeon Juliet Emamaullee says before beginning her work. She calls a moment of silence to acknowledge the donor, and then says a prayer to herself that she “do a good job with this generous gift of life.”
See the difference? Emamaullee is centering herself in the knowledge that someone else had to die or make a conscious decision to give up an organ they were actively using to allow her to do her work – that she was, in a sense, playing God. She is recognizing the need to treat this gift with the utmost respect and gratitude, not to allow herself to become cocky or cavalier in her work. She has no control over the universe; as the prayer I said this very morning reminds me, “There are many thoughts in a person’s heart, but God’s counsel will endure.”[iv] We don’t get to manipulate God – only to set ourselves straight on what we are responsible for.
The secular medical world has ritual, too, and it serves the same purpose. Maybe wearing white coats won’t make us more competent. Maybe white coats have a negative impact on our interactions with our patients when we wear them in clinic (including scaring small children, raising people’s blood pressure, and serving as a giant vector for germs). But white-coat ceremonies raise up the values the profession is supposed to serve, mark our students’ entry into a community of healers, and serve as an aspirational moment for those of us in mid-career to recommit to doing things the way we always wanted to.
Prayer, and more concrete rituals, aims to remind us of what’s important and put us on the path to doing it. When I build a sukkah, I’m reminding myself how tenuous our homes are in this world, and how many people have no home at all. When I have a seder and hold up a sad-looking piece of matzah, I’m calling my attention to people who are still enslaved, hungry, or symbolically broken. And deep prayer, like what Jews do in our season of repentance, is supposed to shake us awake from behavior we feel secure and comfortable in, but which is affecting the universe around us – for the worse. It’s even supposed to rattle the foundations of our religious beliefs – the ones that we want to allow us to serenely believe ourselves to be superior to people that don’t share them, but which should actually be causing us all to tremble before the Creator who gave us awesome responsibilities like figuring out why someone’s body is rebelling against them, bringing a new life into the fresh air, or moving a beating heart from a dying person to a living one. There are no Wonder Woman clogs for that.
If something in what I’ve said causes you to tremble over something you’ve been saying, thinking, or doing outside the world of medicine, whether related to big world events, your own professional life, or an intimate relationship, well, that was kind of the point. Tap into your rituals to show you the way for you to move forward, instead of using them to game the Fates.
Now if you’ll excuse me, there’s a Pirate game about to start. I need to go play some MLB 2K on the Xbox.
[i] Kita, Joe. “Why Do So Many Doctors Embrace Superstitions and Rituals?” Medscape Medical News, March 29, 2024. https://www.medscape.com/viewarticle/why-do-so-many-doctors-embrace-superstitions-and-rituals-2024a100060b?ecd=WNL_mdpls_240402_mscpedit_imed_etid6415861&uac=126525SZ&spon=18&impID=6415861
[ii] Gates of Prayer, circa 1986. I apologize for not having a page number or publication information. Consider writing this footnote part of a ritual to change my behavior to be more conscientious about attribution.
[iii] I have no idea where Dr. Grunbaum was quoting from, but I remember his face vividly as he told the story. That will have to do.
[iv] Proverbs 19:21. https://www.sefaria.org/Proverbs.19.21?lang=bi&with=all&lang2=en
