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Editor’s Note. This month, the lead article incorporates several recent studies and reflections on the role of ritual that would otherwise have been part of our “Research that Matters” section. The separate section will return next month.
On August 5, our family gathered in the Hill Auditorium at University of Michigan to celebrate a different kind of ceremony than a funeral, the kind of ceremony about which I usually write (Hoy, 2013; Lewis & Hoy, 2011). On that Sunday afternoon, we participated as 169 members of the incoming medical school class received a challenge to the vocation of medicine accompanied by the ubiquitous symbols of medicine—their white coats, pen lights, and stethoscopes.
 In this “rite of transition,” I was reminded again just how important ceremonies are for humans. They mark beginnings, endings and changes in life status and help us to derive meaning from these transitions. In her work on rituals among older adults, Myerhoff (1984) noted that ritual is “prominent in all areas of uncertainty, anxiety, impotence, and disorder” (p. 305). In reflecting on this work, Grudzen (2018) noted that Myerhoff analyzed ritual’s patterns with the accompanying predictability which result from engaging the participants symbolically (and often with the senses) and bypassing the rational faculties. The pattern and predictability are also tied in with one’s larger-than -personal history. This historical dimension may be cultural, religious, spiritual, or secular.
Taken together, ceremonies provide a powerful entrée into the making of meaning, an essential aspect of the work of bereavement as well as all other life transitions. Through their multi-sensory experiences, their use of the symbolic, and their invitation to reflection, ceremonies of all kinds provide essential threads in the weaving of the fabric of human life in community.
Effective ceremonies are multi-sensory experiences. In the University of Michigan Medical School “White Coat Ceremony,” we were treated to music, flowers, laughter, tears, speeches, and memorable experiences. Parents and families posed for photos and shared embraces as the congratulations flowed freely. In the same way as a “repast” in African American funerals provide food for the journey home, we were invited to enjoy sumptuous snacks including sugar cookies shaped like little coats and painted with white frosting, complete with the “M” on the lapels. Whether through sight, sound, touch, smell, or even taste, the ceremony encountered us on every sensory level.
Of course, good funerals and memorial services do the same. They give us the opportunity to hold hands, share embraces of support, see and smell the flowers sent as gifts of condolence, share in the food prepared by loving hands, and hear words of comfort for the bereavement journey ahead. The shared experience is—and should be, to be effective, a multi-sensory one.
 Good ceremonies effectively utilize symbols to communicate what words cannot. There are few symbols in the life of a physician that are more meaningful or representative than the white coat, stethoscope, and pen light. The “White Coat Ceremony” is a reasonably recent edition to the medical school rite of passage; most medical colleagues my age remember their start to medical school as little more than the unnerving first day of anatomy lecture, generally followed less than 24 hours by their introduction to their “first patient,” a cadaver in the anatomy lab. Those of us in medical humanities spend little time wondering how it is many physicians are focused on an organ system or “the illness” rather than a patient who happens to have an illness. The White Coat Ceremony has become a common experience at the start of medical school to help re-focus these physicians-to-be on their real role: treating patients.
But at least at Michigan, the symbolic runs much deeper. Embroidered into the collar of each white coat is the name of a physician alumni of the medical school who provided the funds to purchase the coat. Greg’s coat bears the name of its sponsor, Dr. Joseph Miller, a 77-year old surgeon from North Carolina who graduated from Michigan in 1967. As the coat was placed over Greg’s shoulders by one of the medical school’s deans, he was, in essence “cloaked” with this symbol of medicine bearing the name of one who has already “blazed the trail” of medicine. It is an incredible symbol of passing legacy from one generation to the next.
An effective funeral or memorial service must richly employ the symbolic because these symbols of life, death, and ritual communicate when words fail. Flowers speak the language of love that few other gifts seem to communicate; the casketed body shouts aloud, “death has occurred and this is not just another ‘celebration’ here;” the presence of incense and candles and holy water remind mourners that the journey in death is but one chapter in the life of faith (Hoy, 2013).
Effective ceremonies provide an invitation for reflection on meaning. Perhaps ceremony’s most enduring contribution to human flourishing is the opportunity to pause and reflect. In a world that is busied by trivia, ceremony invites, yea requires, us to turn aside and hit the “pause” button on our lives. Ceremony is a departure from the mundane, ordinariness of life; it is out of the ordinary, and that in large measure, is what causes ceremony to work for we humans. In the pausing, we are almost required to reflect—on deeper meanings of life, purpose, mission, and priorities. In his charge to the matriculating class, Assistant Dean for Admissions, Steven Gay, M.D. told students that the typical comparisons made by medical students no longer applied. We invited you hear because of more than your MCAT scores and your GPAs, he told the students; if you think that is all that got you hear, then we chose wrongly. Those are strong words that communicated that character counts as much as traditional academic measures.
Make no mistake about it; University of Michigan did not rise to be one of the top five medical schools in the United States by being slack about its academic requirements. However, the point in Dr. Gay’s challenge to the students is that there are priorities and values that transcend those numerical estimates of a student’s abilities. The White Coat Ceremony marked the moment in time when one could transition from thinking about those measures to thinking about the true priorities of medicine. It was an inspiring challenge—and it made me think again about my role in equipping the next generation of students. Other parents I spoke with were equally challenged; one dad said it made him stop and think about the number of hours he was spending in his job and away from family.
 And is that not what ceremony gives us? Funerals, if they do nothing else, should cause us to stop and consider how we are spending our lives. They should force us to realize that life is finite and limited, that all of us has an “allotment of years” that will eventually run out. While I do not care for the euphemistic term for death often employed in health care, “he expired,” the reality is that we all have an expiration date imprinted on our packaging. I dare say that a memorial service has failed in one of its basic objectives if it does not challenge mourners to make adaptations to character in the light of the deceased’s life and death. Funerals call us to reaffirm our basic belief systems, to receive comfort from the faith that nourishes us, and to relinquish naïve beliefs like “parents don’t bury their children” that are simply too immature to sustain us in the vagaries of life.
From time immemorial, humans have gathered with one another in the face of life transitions—births, marriages, moving from the community, retirements, and deaths—to mark those occasions with ceremony. Perhaps our ritual-lite society could benefit from a reexamination of the ceremonial glue that binds us together and helps us find meaning in the midst of such transitions.
References.
Grudzen, M. (2018). Rituals as portals of transcendence in the lives of older adults. Journal of Religion, Spirituality & Aging, 30(2), 112-129. doi:10.1080/15528030.2017.1312725
Hoy, W.G. (2013). Do funerals matter? The purposes and practices of death rituals in global perspective. New York, NY: Routledge.
Lewis, L. & Hoy, W. G. (2011). Bereavement rituals and the creation of legacy. In Neimeyer, R.A., Thornton, G.B., Harris, D. & Winokuer, H.G. (Eds.) Grief and bereavement in contemporary society: Bridging research and practice (pp. 315-323). New York, NY: Routledge.
Meyerhof, B. (1984). Rites and signs of ripening: The intertwining of ritual, time, and growing older. In D. L. Kertzer, & J. Keith (Eds.). Age and anthropological theory (pp. 379–403). Ithaca, NY: Cornell University Press.
The Author: For more than three decades, William G. Hoy has been counseling with the bereaved, supporting the dying and their families, and teaching colleagues how to provide effective care. After a career in congregation, hospice, and educational resource practice, he now holds a full-time teaching appointment as Clinical Professor of Medical Humanities at Baylor University in Waco, Texas.
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At the 2016 ADEC Conference and while wandering the book fair I spotted this darling little book, it’s title and the crowd surrounding the little table, looked like good signs that this might be for me. I bought a copy and later that day I attended her Experiential Workshop excited to learn but with no expectation of “experiencing” anything. While I won’t share the entire story here, I walked away from that workshop deeply affected and felt like this little book was actually a very powerful tool.