The Effectiveness of Medical Rituals: An Analogical Argument
Nathaniel J. Brown, MD, PhD, Assistant Professor & Staff Physician, University of Colorado SOM / Rocky Mountain Regional VAMC
Seeing medicine as innately liturgical clarifies much of the otherwise cacophonous landscape that comprises modern biomedicine. Religious traditions steeped in liturgy can shed light on why this mode of thinking has so much explanatory power, even in an ostensibly non-religious context such as a modern day hospital. This paper will explore how Christian liturgy, specifically, can contribute to the discussion. In Christianity, liturgy serves at least three “higher level” functions: bringing people together into a community, teaching, and bringing one into communion with the Divine. Each category above can be broken down into important sub-categories, and all three categories have striking parallels in modern medicine. In this talk, I will discuss the last of these three, namely how liturgies enact change.
If Christian communion changes the communicant, medical liturgy seeks to change its participants in two ways. Kimbell Kornu talks about liturgy as formative and effective. The formative aspect is teaching. The effective aspect is more analogous to Christian communion in that it seeks to change and make that change official, or binding.
Liturgy can be about power, and its effective exercise to achieve certain ends. The ways in which power is seen to be legitimated often involve liturgical rituals. Georgio Agamben’s key insight was that if the governed see the rituals as legitimate, they accept the rules enacted. Similarly, if there is ambiguity or violation of ritual, crisis can ensue. Agamben developed a theory of political liturgy as, essentially, performative justification. Agamben talks about “the state of exception” as being liturgically enacted by government in the face of extraordinary circumstances. There’s a resemblance in medicine, too. Think of the “emergent exception” to informed consent, wherein two attending physicians attest that the patient cannot consent, there is not time to track down an alternate person to provide consent, and a “reasonable person” would consent to the proposed procedure. This is a liturgically enacted state of exception.
Agamben's “liturgy of effectiveness” is where the rubber meets the road for lots of what we do in medicine. The performative and ritual aspects are center stage and the goal is to change meaning and have that change be accepted by those whose involvement in the ritual elements are as observant participants, much like those attending Divine Liturgy. It is in this form that Kornu provides a critique of the concept of brain death, not just as a performative, liturgical justification for organ harvesting, but as a strong critique of the perversion of liturgy in medicine. He goes so far as to call it ersatz liturgy. In the framework I am exploring, the practices Kornu describes as ersatz liturgies would instead be examples of divergent liturgical practices. They could represent radically different perspectives on what medicine is and what its teloi are.
Medicine’s liturgies of effectiveness are biopolitical, often—as in the case of brain death—in high relief, but they exist in less charged situations as well, such as FMLA paperwork, exact time of birth, etc. There are emerging debates where the biopolitical power of medicine is not fully tested, such as taking positions on mandatory vaccination laws. Most tellingly, liturgies of effectiveness exist because of the secular priesthood of medicine, which itself exists, at least in large part, because of our collective desire to somehow enshrine science in the role of arbiter of ultimate meaning, a task destined to leave all unsatisfied.
If Christian communion changes the communicant, medical liturgy seeks to change its participants in two ways. Kimbell Kornu talks about liturgy as formative and effective. The formative aspect is teaching. The effective aspect is more analogous to Christian communion in that it seeks to change and make that change official, or binding.
Liturgy can be about power, and its effective exercise to achieve certain ends. The ways in which power is seen to be legitimated often involve liturgical rituals. Georgio Agamben’s key insight was that if the governed see the rituals as legitimate, they accept the rules enacted. Similarly, if there is ambiguity or violation of ritual, crisis can ensue. Agamben developed a theory of political liturgy as, essentially, performative justification. Agamben talks about “the state of exception” as being liturgically enacted by government in the face of extraordinary circumstances. There’s a resemblance in medicine, too. Think of the “emergent exception” to informed consent, wherein two attending physicians attest that the patient cannot consent, there is not time to track down an alternate person to provide consent, and a “reasonable person” would consent to the proposed procedure. This is a liturgically enacted state of exception.
Agamben's “liturgy of effectiveness” is where the rubber meets the road for lots of what we do in medicine. The performative and ritual aspects are center stage and the goal is to change meaning and have that change be accepted by those whose involvement in the ritual elements are as observant participants, much like those attending Divine Liturgy. It is in this form that Kornu provides a critique of the concept of brain death, not just as a performative, liturgical justification for organ harvesting, but as a strong critique of the perversion of liturgy in medicine. He goes so far as to call it ersatz liturgy. In the framework I am exploring, the practices Kornu describes as ersatz liturgies would instead be examples of divergent liturgical practices. They could represent radically different perspectives on what medicine is and what its teloi are.
Medicine’s liturgies of effectiveness are biopolitical, often—as in the case of brain death—in high relief, but they exist in less charged situations as well, such as FMLA paperwork, exact time of birth, etc. There are emerging debates where the biopolitical power of medicine is not fully tested, such as taking positions on mandatory vaccination laws. Most tellingly, liturgies of effectiveness exist because of the secular priesthood of medicine, which itself exists, at least in large part, because of our collective desire to somehow enshrine science in the role of arbiter of ultimate meaning, a task destined to leave all unsatisfied.