Perspectives in Biology and Medicine

BENIGN MAGICAL THINKING RICHARD B. BLACHER" A charming, if apocryphal, story concerns Niels Bohr, the eminent physicist , who was asked by a friend who had noticed a horseshoe hanging on his wall, "Do you really believe in the superstition about horseshoes?" "Absolutely not," replied Bohr. "Then why do you hang one in your home?" "Because," responded Bohr, "it has been clearly demonstrated that horseshoes bring good luck, even when one doesn't believe in them" [I]. This is a wonderful example of what I call "benign magical thinking," a style which resonates with most of us, since it is such a commonplace in our everyday lives. I call it "benign" to distinguish it from the malignant thinking of the psychotic, while recognizing that the results of such thinking can sometimes be far from benign. The struggle between benign magic and a strict, scientific approach has marked the practice of medicine for the past few hundred years. A recent three-day meeting at the New York Academy of Science was entitled "The Flight from Science and Reason" [2]. Scientists joined to defend scientific method against those who insist that "truth" in science depends on one's point of view rather than on scientific methodology. They decried pseudoscientific trends such as astrology, faith healing, and paranormal charlatanism. It was pointed out that the media are filled with such anti- and un-scientific concepts, which, after all, are much more intriguing to the average reader and viewer than are the results of statistical analyses of controlled laboratory studies. So-called "near-death" experiences and "abductions by aliens from outer space" are given more news coverage than most real scientific work. The history of medicine is replete with errors and misinterpretations, and there is a major difference between our current view of the scientific method and that of physicians of a few hundred years ago. Much ofmedical *Departments of Psychiatry, Tufts University School of Medicine, and Boston University School of Medicine. Correspondence: 50 Plainfield Street, Waban, MA 02168. The author would like to thank Marjorie McDonald, M.D., and Marjory Blacher for reviewing and editing the manuscript.© 1996 by The University of Chicago. All rights reserved. 0031-5982/96/3904-0976$01 .00 190 Richard B. Blacher ¦ Magical Thinking practice was then based on deference to authority, with Galen having a powerful influence for many years. Only four specific medications were used by physicians until this century: opium for pain, from the time of the ancient Greeks; cinchona bark for malaria, discovered in the New World in the 1500s; citrus fruit for scurvy, from the 17th century; and digitalis, used first by Withering in the early 1700s. A glance at a Materia Medica from a few hundred years ago is shocking, with drugs ranging from useless to disgusting (it is doubtful that powdered bat droppings as a medicine ever helped anybody) . Bleeding and cupping have long been replaced by more carefully evaluated therapeutic endeavors. Despite this past record of ineffective and even dangerous treatments, physicians have been highly regarded and respected members of society for millennia, probably in good measure because of their reassuring and hope-giving presence in the sickroom . Medicine has shown a continuing increase in stringency in applying scientific method to its work, but even in the recent past we have ignored variables that we were not able to control. For instance, it has been only in the past few decades that double-blindedness has been an accepted requirement for clinical trials. Yet it is important for us to be aware that contemporary errors in medicine are made despite our attempts to be careful, and not by ignoring reasonable criteria for scientific method. This has marked us off from cult healers of all sorts whose "theories" are based on rather arbitrary, non-scientific ideas. Physicians have become more strict in their demands for scientific evaluations of new therapies, yet they nevertheless are aware that in their day-today practice they utilize techniques in the art of medicine that have not necessarily been subjected to controlled studies. These techniques, often placebo, seem to help patients even though we do not know why they are effective. However, the rationale for their use is...