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Magical Thinking: The Good, the Bad, and the Ugly

In health and medicine, it is important to have hope but acknowledge reality.

Albert Einstein is credited with saying, "Imagination is more important than knowledge. Knowledge is limited, whereas imagination embraces the entire world, stimulating progress, giving birth to evolution."

There is "magic" in imagination. When we use our minds to think of what is possible, that's "good" magical thinking. We create. We innovate. We challenge the status quo. We solve problems that may have seemed unsolvable. Magical thinking doesn't have to be grand. Every child is born with magical thinking because to a child, the entire universe is still undiscovered. We often grow up at the expense of our childlike minds which are full of wonder and discovery.

In medicine, magical thinking is what gives us hope: hope for what is possible. Imagination is the creativity behind our best discoveries.

But life is hard. No one ever promised any of us that our lives would be entirely care-free, easy, effortless, or painless. We all have to face some harsh, yet simple truths. We all die. Time passes. There are things that happen to us that are beyond our control. When we are confronted with these hardships, magical thinking can often become wishful thinking. When we start to believe our own wishful thinking without regarding at least some of the harsh truths of reality, that can be "bad." It can be bad because we can miss or deny opportunities to make a difference.

If we want something to be true hard enough, we run the risk of believing it is true, even if it is not. It is perhaps a debatable point: which is more important, truth or belief? Truth and belief are not mutually exclusive. When our beliefs are strong enough to motivate us to work, we can change things. We can do the work to make things different and make a new "truth."

But, Mother Nature often doesn't care what we believe. Nor do the laws of physics or the inevitability of biology and time.

When our magical thinking allows us to believe in what we want, and not what is actually true, we may become more childish rather than child-like. When our magical thinking gets in the way of doing things that may be helpful for our health, that's "bad." When our magical thinking adversely affects the well being of others, that's when it can get "ugly."

This paradigm, of course, can be applied to ourselves, our family, our community, and society as a whole. Although tempting to ponder how believing what we want to believe, even when untrue, can be bad and ugly for society, for now, I will take just a moment to focus on ourselves as individuals.

I am a preventative cardiologist. The moniker, "Silent Killer," was bestowed upon me as I mainly write about how our heart and circulation can change in ways we do not feel. A preventative cardiologist navigates the natural aging process so as to prevent heart failure and brain damage. Yes: brain damage. The brain is entirely dependent on having reliable blood flow. Without it, the brain will not work.

So, here's my stab at "good" magical thinking. Imagine a world where we can live past 100 and still have energy and clarity of thought. Imagine that there is (almost) no such thing as heart disease: it's just natural aging. Natural aging is a predictable, measurable, and manageable thing. Imagine that we don't have to develop senile or vascular dementia. Such magical thinking is not too far off the mark. Read the book You Can Prevent a Stroke, and you can see that much of what disables us is entirely preventable.

But we have all been told that the most important thing we can do is eat the right food, exercise, and above all, stay thin. That may be a terrific, child-like goal, but it can rapidly turn into magical thinking when we insist that somehow we are immune from our genetics or the effects of time. To be clear, our personal choices make a big difference, but no one is immune to time, and to believe otherwise is simply magical thinking — the bad kind.

And, it gets ugly when it gets in the way of good medical care, and people get hurt.

So, perhaps the best advice I can give is this: Remember Einstein. Imagine the possible. Believe that things can be better, and the future can be bright and healthy. Then remember Thomas Edison who said, "Genius is one percent inspiration and ninety-nine percent perspiration." Be ready to do the work to make your dreams come true. And look at yourself and the world. Acknowledge that there are some things you can't control. Science can help you reach your dreams, but you may have to adjust some of your magical thinking. And don't ever be ugly. Always try to make the world, even if only your small corner of it, a better place.

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