SECOND OPINION: AS YOU relax and enjoy a leisurely read in the post-Christmas lull, you might reflect on the enduring strength of this ancient festival.
Even in a pluralist and more commercial era, and in the face of decreasing attendance at religious ceremonies, there is no other time of the year which affects us all so profoundly in such a collective way.
The festive season has a marked impact on the healthcare system. From St Stephen’s Day onwards, there is hectic activity in emergency admissions, but elective admissions go into hibernation. Contrary to urban myth, older people are not dumped in hospitals by uncaring families – in fact, families seem to go the extra mile over Christmas – but much human suffering from alcohol, loneliness, domestic violence, self-harm and alienation is also seen at this time in emergency departments, more usually in younger age groups.
That the origin of these major changes in the activity of the health system arises from what is still for many an important focus of their faith affords us an opportunity to reflect on the interplay between faith, tradition and healthcare in a pluralist society.
Indeed, when a teaching hospital in Dublin removed the Christmas crib from its atrium a few years ago, the response to the resulting public outcry suggested a timorous confusion about the difference between pluralism and secularism that is not uncommon in medicine.
As artists are ever to the fore in illuminating societal dilemmas, South Park(a programme of stupefying poverty of taste) provides an amusing if scabrous insight into what we can lose by failing to recognise socially evolved traditions which are deeply embedded in our society.
The makers of South Park,both declared agnostics, picked up on how rigid political correctness can blind us to the bigger picture. In this episode, the Jewish Kyle is forbidden by his mother to take the part of Joseph in the nativity play: she also asks for all religious elements to be removed from the school.
Mayor McDaniels then decides to take anything “offensive” from Christmas celebrations, including Santa Claus, mistletoe, wreaths and candy canes. The Christmas pageant becomes a bizarre minimalist production with music by Philip Glass.
All the while, Kyle has developed his own Christmas ritual with all-singing, all-dancing Mr Hankey, the Christmas Poo, who, in a demented allegory to A Christmas Carol, appears in person and spreads havoc (and mess) across South Park.
All is eventually resolved, with the townspeople singing Christmas carols and watching Mr Hankey flying off with Santa Claus: in a touching gesture to the season of goodwill, it also is the first episode where Kenny avoids death.
An awareness of religious beliefs, practice and sensitivities (including humanism) should form a part of the fabric of healthcare, regardless of the personal belief systems of practitioners, and increasingly so given patterns of migration and diversity. At a pragmatic level, this is needed for a range of issues from blood transfusion through diet to burial customs.
Good medicine also promotes an understanding of what motivates and consoles many of our patients. In ethics, we are mindful too of the role of the great religions as sources of virtuous thinking, as the “methodological atheist” and philosopher Habermas discerned.
But most elusive to an outwardly scientific medical system is an understanding of the role of ritual and traditions, particularly in modern urban society, and the danger of throwing babies out with the bathwater. The philosopher Gadamer spoke of our shaping by “historically effected consciousness”.
In a similar vein, Bruno Bettelheim's exploration of the role of fairy tales in The Uses of Enchantment– whereby children can use these dark and often grim tales to understand their fears and the multiple contradictions of life when growing up – also emphasises that an appreciation of these deep undercurrents is important.
So, while not for the faint-hearted or easily offended, there is much food for thought (and a rollercoaster of entertainment) in this episode of South Park. It provides an impetus to ensure that we work out how to articulate, celebrate and make due space for the tradition in our lives, as well as those of our patients and their families, in the practice of good medicine without losing sight of the negotiation and compromise needed in a truly pluralist society.
Some elements of this column have previously appeared as a BMJ blog
Prof Des O’Neill is a consultant in geriatric and stroke medicine