Every time I go to the doctor, I have to decide—will I submit to the ritual weighing or will I resist? At this point, I’m thoroughly convinced that BMI is a flawed and pointless measure of my actual health (thank you for that,
). On the other hand, if I refuse, I get slapped with the ‘difficult’ label and no one wants that on their chart.I believe that my doctor should not be weighing me. The evidence that this isn’t a good predictor of any health outcome is strong, but still, he does. Taking a patient’s weight and height is a medical ritual, one of countless that we encounter every time we step into that examination room.
I’m thinking about rituals because I’m reading this book about rituals and finding it disappointing.1 Which is to say, it’s not the book I wanted it to be. Most negative reviews of books boil down to this—the person didn’t write the book you wanted to read. In this book, the author is marshaling a lot of cognitive psychology and evolutionary biology to explain why rituals are so ubiquitous in human society. As a sociologist, I feel like we already understand why rituals are so important, but no one believes sociologists.
Rituals are defined by anthropologists as activities that either have no stated purpose or have a stated purpose that has no causal relationship to the activity. The classic example—a rain dance is supposed to bring about rain, but we all know it doesn’t, which makes it a ritual. Simple, right?
By this definition, weighing patients is a ritual. It’s stated purpose is to make predictions about a person’s health. But the evidence shows that BMI doesn’t do that and also that the stigma caused by weighing people has negative health outcomes. So the activity—weighing a patient—has no causal relationship to the stated purpose.
A surprising amount of what happens in your doctor’s office is like this. Ritual, rather than evidence-based practice. If you doubt it, ask yourself whether the standard set of activities performed on a routine health visit have changed over the course of your lifetime. If doctors responded to scientific research about best health practices, wouldn’t the checkup visit change some over time?
In her book, Birth Control: The Insidious Power of Men Over Motherhood, (which I read about in an interview by
on ) Allison Yarrow outlines how little of what happens in a typical hospital childbirth is actually evidence-based. For example, electronic fetal heart monitoring doesn’t make childbirth easier or safer. It leads to more interventions like C-sections. But doctors still use it. Pelvic exams in late pregnancy don’t actually tell doctors much of anything useful. Besides being uncomfortable, they can also introduce bacteria, but doctors still do them.Most medical rituals are rituals of pain and debasement. I mean, hello, gynecological stirrups? Hello, hospital gowns? Hello, speculum, which is an instrument invented in the 19th century by the racist “father” of gynecology and hasn’t been significantly improved upon in the two hundred years since?
Experts can call massage or cranio-sacral therapy or reiki or acupuncture ‘alternative medicine’ or quackery or whatever they like. But like the doctor’s visit, they are simply a different kind of ritual. Unlike doctor’s visits, they are rituals of caring and compassion and comfort, rather than rituals of pain and debasement.
Getting a tattoo is also a ritual, or at least it is for me. It’s a painful ritual, but pain I chose for myself rather than a pain being forced upon me. I submit to oral surgery or a gynecological exam because people with authority and (hopefully) expertise tell me it’s necessary. No one tells me I need a tattoo. I get a tattoo because I want to enhance the my body’s beauty.
Tattooing is an old, old ritual, much older than anything a doctor does in their office. The rituals of acupuncture and massage and reiki are also older than Western medicine, which is another part of why I’m inclined to trust them just as much if not more than what my doctor tells me.
I’ve gotten most of my tattoos in the same place, the amazing Bananafish Tattoo Parlor in New Albany, Indiana. Most of the tattoo artists there are women, including the artists who’ve done my tattoos. One of those women is a former student of mine, an amazing young woman who was so bright in my introduction to sociology class as a first-year, already certain that she would major in art and become a tattoo artist.
The tattoos I’ve gotten are art. They’re gorgeous things. Honeysuckle and a pattern of leaves on my calf and most recently, a viny thing on my forearm, reaching onto my hand. They’re so beautiful I spend considerable time just staring at them, admiring their beauty. The tattoos are portable art I carry with me everywhere.
What is the purpose of getting a tattoo? In various cultures, tattoos confer magical power. Or they demonstrate initiation into a group. A tattoo can mark a rite of passage.
Do my tattoos make me magical? I don’t know. Maybe. I scheduled my tattoo months ago, back in July, when my young adult novel was published. My initiation into tattoos began with a star to mark the publication of my first book, back in 2019. For years, I’d wanted a tattoo, but couldn’t decide on what to get. The idea that I would mark the publication of each book on my body made sense to me. Nothing fancy. Just a star that would remind me of what I’d accomplished because it’s so easy to forget our very real and important achievements. It progressed from there into larger and more elaborate tattoos. People really aren’t kidding when they say tattoos are addictive.
Since I booked the tattoo back in July, I’ve arranged my schedule around it. We had a department review this week, a mildly stressful and annoying process where people come from other institutions and pretend that it’s possible to grow or innovate in an institution that is hanging on by the skin of its teeth and largely indifferent to what you’re doing as a discipline. It was not something I was looking forward to.
On the way to get my tattoo, I got rear-ended while sitting at a traffic light. I was okay and the other guy was okay. My car was drivable. The guy didn’t have insurance. I thought about calling the police, but instead I got back in my car and drove to get my tattoo. How long would it take if I missed it to get a new appointment? Rituals are important. Rituals take priority.
Is it strange to confess that after being in a car accident, the tattoo was soothing? Getting a tattoo is always soothing. The buzz of talk of the other tattoo artists and their clients. The focus on your body. Getting the tattoo hurts, but not so bad and in the end, I know I will be transformed.
Here’s the problem with the book and that definition of what a ritual is—how do you really know what the causal relationship is between a ritual and it’s supposed purpose? Maybe the rain dance really does make it rain. How do we know for sure? The world is a complicated place. Causality isn’t as simple as it first appears. Chaos theory tells us that a butterfly flapping its wings could cause a hurricane on the other side of the world. Surely it’s also possible that a bunch of people dancing could make it rain.
Causally, I know that getting a massage or going to my cranio-sacral therapist does make me feel better while going to my doctor or gynecologist generally does not. I also know that I felt a lot better about the unpleasant experience of a departmental review because I had a new tattoo on my arm. My tattoo is a reminder that I’m much more than a college professor or an academic. I’m also a writer and an artist. A little bit of a rebel, not for getting a tattoo, because everyone’s doing that, but for getting my first tattoo at the age of 45. My tattoos remind me that I have reached the age where I don’t really give a fuck what you think about me.
Is that causality? Magic? I don’t know. What’s interesting about rituals isn’t how we’re confused about their purpose but how we understand on a deep level how multipurpose they are. The ritual of cranio-sacral therapy makes me feel better and it makes me feel cared for in a way the rituals of the doctor’s office never do. The ritual of getting a tattoo makes me feel like a part of a specific group and like a badass who can conquer anything. I don’t need cognitive psychology or evolutionary biology to understand that rituals are necessary to our survival not because they don’t do what they say they’re going to do but precisely because they do so much more.
Last event of the FAIR GAME book tour is November 10-11, at the Louisville Book Festival, in the Kentucky International Exposition Center from 10-6. I’ll be giving a talk at 12:00 on Saturday, November, 11, about cheerleading and gender segregation in sports.
Also, this week I got my author copy of Playing Authors: An Anthology. It is a beautiful little book (see the pics below). I’ve posted the first page of my piece, “Hemingway Goes on Book Tour.” I’m so proud of this story. I think it might be one of my favorite things I’ve ever written. If you want to read the rest of it, buy the anthology, here. It’s chock full of great writing, including a story by amazing Indiana writer, , who has an awesome Substack,
I don’t get specific about books I don’t like, because as an author myself, no one needs that. But if you really want to know the name to avoid, drop me a line and I’ll tell you.
I plan to get my first tattoo after I publish my first novel, too! I'm 42 now. If it's the novel I hope it will be, I already know what I'll get and where I'll put it. It's a memento from the story. 💜
I feel the same as you about alternative medicine. I see a chiropractor and a massage therapist because when I go to them, I feel like someone is paying attention to me and they're addressing my problems directly. Doctors want to throw pills at everything and usually they're not the right ones or even addressing the source of the problem. I also hate that I have to reintroduce myself and rehash my entire medical history every time I visit the doctor's office. They type it all into their little computer while not looking at me and then by the time I come back, all that history I fed them has magically disappeared and needs to be collected again. Makes me want to just make shit up one time and see if they notice. 😉
Oh wow. I've seen them all but haven't loved every one of them like I did season 3... and I meant the interactive movie. Because that literally happens... crazy show... not as great as others I've seen recently like Fall of the House of Usher. That was good but dark as it's supposed to be but I didn't find it scary so much as fun to watch and see what happens.