Des O’Neill: Christmas, South Park, health, and pluralism

Desmond O'NeillWhen the largest 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 (not as yet figuring in many medical school curricula) 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 (a programme of stupefying poverty of taste), 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 gesture to the season of goodwill, it also is the first episode where Kenny avoids death.

An awareness of religious beliefs, practice, and sensitivities should form a part of the fabric of health care, regardless of the personal beliefs of practitioners. 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” 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. From Gadamer’s concept of our shaping by “historically effected consciousness” to 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 – an appreciation of these deep under-currents is important.

While not for the faint-hearted or easily-offended, there is much food for thought (and a roller-coaster of entertainment) in this episode, and an impetus to ensure that we work out how to 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.

Desmond O’Neill is a consultant physician in geriatric and stroke medicine, Dublin.