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Last year, I interviewed a mother whose son had been diagnosed with Duchenne muscular dystrophy (DMD). She was knowledgeable, articulate, well-connected with other DMD families on social media, and careful in describing the medical journey: the genetic testing, the clinical consultations, gene therapy, exon-skipping medications, etc.
But at one point, she randomly (and unsolicited) shared something that didn’t fit into any of the “rational” categories of behavior we usually code for in marketing research. She explained that her son had a pair of sneakers he wore on the day they first received encouraging test results. From then on, those shoes became a talisman: he wore them to every hospital appointment. “It just feels safer when he has them on,” she told me. When he outgrew them, she couldn’t bring herself to give them away; they stayed in the closet, a reminder of “the lucky pair.”
And this wasn't the first time that I've had a patient or caregiver mention something like this: a lucky piece of clothing, a ritual - like avoiding certain days for clinic visits - or other behavior they've espoused as part of their treatment journey.
It isn't religion. It isn't science. It's magical thinking -- the human tendency to create meaning and patterns in the face of the inexplicable. And, in the case of the DMD Mom, it was as real a driver of her behavior as fear, hope, or trust in her doctor.
In behavioral psychology, magical thinking is defined as the belief that one’s thoughts, actions, or rituals can influence events without a causal link. It’s not restricted to “superstitious” people. In fact, it’s something all of us do -- knocking on wood, avoiding the number 13, saying Gesundheit! when someone sneezes, saving a “lucky” pen for important meetings.
Why? Because our brains crave order. Faced with uncertainty or danger, we (consciously or unconsciously) reach for explanations. When science and medicine don’t offer clarity -- or when the answers feel incomplete -- we build our own frameworks. We strive to complete the picture. These frameworks may look irrational from the outside, but for the person holding them, they somehow empower us by providing psychological safety, structure, and agency.
For patients and caregivers, magical thinking often becomes most pronounced when confronting unanswerable questions:
When medicine doesn’t provide closure, magical thinking steps in.
Patients aren’t the only ones. A recent article in Medscape explored the persistence of superstition among HCPs themselves (https://www.medscape.com/viewarticle/why-do-so-many-doctors-embrace-superstitions-and-rituals-2024a100060b?_gl=1*1ufb24h*_gcl_au*MjEwNjkzODc3NC4xNzU1NTI3OTk5). At Lehigh Valley Hospital in Pennsylvania, there is no “Operating Room 13.” It’s labeled “OR M,” a quiet nod to the long shadow of unlucky numbers. Surgeons avoid saying the word “quiet” during shifts for fear of tempting fate. One colorectal surgeon described a two-hour ritual before every operation -- same food, same shoes, same route to work.
Why do highly trained, science-driven professionals engage in such practices? As surgeon Lester Gottesman observed: “Superstition lies in the space between what we can control and what we can’t. We rely on it because we are smart enough to know we don’t have all the answers and that life works in mysterious ways.”
If even surgeons -- at the apex of evidence-based medicine -- rely on magical thinking, how much more powerful must it be for patients navigating the uncertain ups and downs of serious illness?
For patients and caregivers, magical thinking fills the space left by medicine’s unanswered questions. It provides:
If insights professionals fail to recognize and/or acknowledge this layer, we risk:
The challenge is that respondents rarely share these beliefs unprompted. They may feel embarrassed or apprehensive about being judged. To uncover them, researchers need to help normalize magical thinking as a common, even expected, human response to uncertainty.
Here are some questions that can help surface these beliefs:
These questions give permission for disclosure, framing magical thinking not as oddity but as part of the shared human response to uncertainty.
Accounting for magical thinking isn’t about validating every belief, it’s about acknowledging and respecting the authentic psychological landscape in which patients reside.
Superstition and magical thinking are not peripheral quirks. They are central, truly human ways of navigating the uncertainty of illness. Patients construct systems of meaning not because they are irrational, but because they are searching for order in the face of chaos.
As researchers, our task is not to dismiss these beliefs but to listen to them -- often because they are “ways in” to understanding the deeper psychology of the patient journey. And as marketers, our responsibility is to build strategies that allow and account for the unseen forces shaping decision-making.
Because whether it’s a boy’s pair of lucky sneakers or a surgeon’s Wonder Woman clogs, magical thinking is part of the fabric of healthcare. And that is a truth our industry cannot afford to overlook.
