Abstract

Magical thinking is the attribution of the origin or relationship of events without causality to certain events. Some aspects of magical thinking persist into adulthood due to ontological confusions. In university students, some beliefs related to magical thinking continue that are in contrast with their higher studies. In medical students this contrast influences the approach to the beliefs of their patients. This work sought to comprehend the presence and characteristics of magical thinking in students who are in their first year of medical school. A cross-sectional study was conducted in 1,521 students of first year medical career, from a public university in Mexico City. An instrument to evaluate magical thinking consisting of 5 one-dimensional scales was modified and validated: Supernatural beliefs, supernatural experiences, psychic powers, animism, and skepticism. 36% believed in supernatural events, 32% said they had had supernatural experiences, 10% believed that psychic powers existed and 18% believed in luck, 71% considered that these beliefs were the product of ignorance and deception. The study of beliefs and practices related to magical thinking is fundamental to practice a culturally competent medicine.

1. Introduction

Magical thinking has been conceptualized, within the cognitive theory, as the attribution of unjustified origins or relationships to certain events, when in fact there is no relationship or causality that can be associated ¹.

It has been proposed that magical thinking is observed in early childhood, during of the development of said individuals, which is characterized by the fact that the mind is unable to discern what is real from what is symbolic ².

In adults, it has been found that cognitive styles can be related to the presence of different profiles of unusual beliefs ³.

Brashier and Multhaup ⁴ reported that elders had less agreement in magical beliefs of any kind compared to young people, particularly regarding superstition. Although the elderly who participated in their research had higher schooling than the young, this did not explain the difference observed.

Guerrero et al. ⁵ conducted a study in the Mexican population in which they found that age and socioeconomic status were variables that determined differences in magical thinking. Young participants of low socioeconomic status scored higher on magical beliefs than youth of high socioeconomic status.

As for the effect of higher education on magical thinking, in the research of Lindeman et al. ⁶ it was observed that university students accepted paranormal explanations that contrast sharply with scientific explanations. Subbotsky ⁷ found that British university students showed practices related to magical thinking only in conditions in which they were personally and emotionally involved, even though their culture background had already abandoned those thoughts.

In a study with 143 students of Health Sciences from eight higher institutions in Paraguay ⁸, they found that, although 80% accepted the scientific method to understand reality, 60.1% believed in the existence of paranormal activity, even if this was against their own rational and intellectual formation. In another study with 229 university students from Latvia ⁹, it was identified that their magical thinking was related to the need for control in a largely uncontrollable environment in which they live.

As for factors that may be related to the presence of magical thinking in college students, Cardenas et al. ¹⁰ presented a review study of psychology students' beliefs in the paranormal and found that the “non-religious group of students “exhibited less ingrained paranormal beliefs than the “religious” group.

Farkas ¹¹, examined whether university students subjected to academic stress made use of magical strategies to cope with it, and found that: (a) they used certain objects, accessories or clothes as a way to have good luck and magically achieve the desired result; (b) those with a lower academic performance, used these strategies more frequently, regardless of the level of stress experienced or the degree of control over the situation; and (c) careers that chronically caused high levels of stress were associated with increased use of magic strategies.

Wilson ¹², just like Garret and Cutting ¹³, found that agnostic or atheist college students manifested fewer paranormal or pseudoscientific beliefs than those who self-identified as religious; moreover, those who attended religious services only at major celebrations had fewer paranormal and pseudoscientific beliefs than those attended services several times a year, monthly or weekly. Another relevant finding was that women scored higher in paranormal or pseudoscientific beliefs, particularly in precognition, spiritualism, witchcraft, superstition, psychic powers, and alternative medicine.

Specifically in the medical career, Gómez-Alcalá et al. ¹⁴ found, in 50 eighth-semester students, predominantly skeptical (94%) and rational (100%) thinking, with no significant differences between men and women. When comparing between Catholics and non-religious, they observed that the former had higher scores in magical thinking. The types of magical thinking that stood out were analogy (22%), adualism (50%) and animism (34%). Ladson et al. ¹⁵ propose that, since cultural competence —understood as the congruent behaviors, knowledge, and attitudes of professionals to work effectively in cross-cultural situations— is an essential part of modern medical practice and influences patient adherence to treatment, it is desirable that courses be implemented, so that students learn to recognize and respect beliefs from cultures other than their own. In their research they found that older students show a better attitude towards other cultures.

Medical students share the beliefs related to magical thinking of the society in which they live, these beliefs are contrasted with the knowledge they gain during their higher education. This contrast will shape the way they deal with the situations their patients present them. Therefore, the interest of this study was to know the presence and characteristics of magical thinking in first year medical students.

2. Material and Method

Cross-sectional study carried out with 1,521, out of a total of 1,629 first-year medical students at a public university in Mexico City.

To learn about the magical thinking of students when entering the medical career, the original version of an instrument that was created to assess how young people tend to explain certain events based on criteria related to magical thinking or skepticism ¹⁶, was modified and validated for this study. The final version consists of the following five scales:

Supernatural beliefs. It refers to the representations that the individual makes of the information that remains in his mind (of the dead, ghosts, haunted places, myths, superstitions, etc.) as a product of his interaction with his social and cultural environment, or created by his desires or fears, throughout his life. This scale consists of five items, presenting a Cronbach’s alpha of .792 and a total explained variance of 55.1%.

Supernatural experiences. It alludes to the person that claims to have perceived phenomena that are not real. It includes three items, with a Cronbach’s alpha of .731 and an explained total variance of 65.7%.

Psychic powers. It refers to the different mental capacities of certain individuals that allow them to perceive phenomena hidden from the senses and manipulates the mind of other people. This scale consists of five items that presents a Cronbach’s alpha of .691 and a total explained variance of 45.4%.

Animism. It refers to the interpretation that the individual makes of everything that happens to him/her (for example, good or bad luck) and attributes it to whatever is the object of his/her beliefs. Consequently, he/she tends to use objects or practice rituals to which he/she attributes the power to ward off evil or attract good. This scale consists of six Items with a Cronbach’s alpha of .727 and a total explained variance of 43.1%.

Skepticism. People who manifest this outlook, are concerned with understanding how things really are and try to avoid the tendency of the human mind to explain reality based on fantasy and being able to reflect with an attitude that allows them to take charge of situations as they are presented. They know that one thing is what appears to be, and another what it may really be, so they are aware of the possible deception of their senses and thoughts ¹⁷, as well as the supposed magical powers of others. This scale consists of seven items, with a Cronbach’s alpha of .792 and a total explained variance of 44.8%.

The response options for each of the items of these five scales comprise in a Likert scale with the following values: 1=Strongly disagree, 2=Disagree, 3=Undecided, 4=Agree, and 5=Strongly agree; except for an item written in a negative way, where the score was assigned inversely.

After modifying and validating the original scales of the Magic Thinking Instrument ¹⁶, all first-year medical students were invited to answer it, clarifying –in writing– that their participation was voluntary and the handling of their data confidential.

This study was approved by the Research and Ethics Commissions of the Research Division of the educational institution where this work was carried out, under the project FM/DI/011/2019.

A descriptive analysis was carried out with frequencies and percentages; while the comparison by sex, age and religion was made through the Mann-Whitney U test, and the comparison by school of origin, where the student grew up and the mother's schooling, used the Kruskal-Wallis test.

3. Results

Of 1,629 first-year medical students that entered the faculty, 1,536 answered the questionnaire; 15 were eliminated because they did not answer completely, so that the study sample was finally constituted by 1,521 students (93.4% of the total population), whose general data are described in Table 1.

To evaluate the construct validity of the modified version of the original instrument designed by Petra-Micu and Estrada-Avilés ¹⁶, its factor analysis was carried out, by main components, with Varimax rotation; and the Cronbach's alpha of each of the scales was calculated to evaluate its internal consistency. Of 29 initial items, three were eliminated and 26 were distributed in the five scales explained in the section Measurement and whose psychometric characteristics appear in Table 2.

As a result of the descriptive analysis of the five scales, it was found that: a) approximately a quarter of the students or more believe in supernatural facts, such as the appearance of dead or ghosts, haunted places, myths or superstitions; b) more than ten percent, up to almost a third, report having had supernatural experiences, such as seeing ghosts or objects moving alone, among others; (c) one-tenth or less believe that they have psychic powers or that other people, such as fortune tellers or sorcerers, possess them; d) over ten percent believe in luck and associate it with the use of objects, garments or rituals; and e) about one third of the participants or more consider all of the above to be the product of the ignorance and naivety of those who believe it (Table 3).

When comparing the scores of each scale for all the sociodemographic variables included in this research, it was found that: a) although women tend to believe more in psychic powers and to be less skeptical of supernatural events than their male peers, they report fewer supernatural experiences; (b) pupils over the age of twenty are more skeptical than their younger peers; c) those who profess a religion believe in the supernatural and animism, to a greater extent than students who do not follow any religion, in addition to the fact that the former are less skeptical than the latter (Table 4); d) students who completed their baccalaureate in one of the Colleges of Sciences and Humanities (CCH) of the National Autonomous University of Mexico (UNAM) reported having more supernatural experiences than those who were in one of the National Preparatory Schools (ENP) of this same institution or in public or private schools in the country while the latter expressed greater skepticism than those who came from the CCH or the ENP (Table 5).

Finally, no differences with statistical significance were found when comparing the scores of the scales by the place where the students grew up, nor by the level of schooling that their mothers had.

4. Discussion

The above results show that beliefs related to magical thinking are observed in first-year medical students. These findings coincide with Brashier and Multhaup ⁴, who found that magical thinking is more prevalent in young people and that higher schooling does not exclude it, as described by Lindeman et al. ⁶, Subbotsky ⁷ and Garret and Cutting ¹³ on the presence of magical thinking in college students. Therefore, it is important to create subjects, within the study plan, that allow students to be trained in the recognition and respect for the beliefs of their own culture and other cultures, so that their medical practice is characterized by an adequate cultural competence and favor a good doctor-patient relationship, as proposed by Gómez-Alcalá, et al. ¹⁴.

The figures of beliefs related to magical thinking obtained by this research are lower than that found by Quintana et al. ⁹, who observed in their population that up to 60% of students accepted the existence of paranormal activity compared to 36% of our population that shows supernatural beliefs. Although because they are Latin American countries, it would be expected that there would be greater coincidence in the propensity to believe in paranormal aspects between Mexico and Paraguay, Quintana et al. emphasize that, unlike university students from other nations, those of Health Sciences of Paraguay tend to believe more in paranormal, supernatural and pseudoscientific phenomena —especially related to the area of health—, even if this goes against their own rationality and intellectual formation. We also consider that these differences may depend as much on different cultural aspects as on the instrument to evaluate the magical thinking used in each study.

In the first-year students of the present research, it was found that around a third, mainly the older ones, considered that magical thinking is the product of ignorance and naivety like the study of Gómez-Alcalá et al. ¹⁴, with eighth-semester students, where 94% of them showed skepticism and 100% a thought of rational predominance. This may suggest that magical thinking changes based on career advancement or age.

Another relevant finding was that religious students believe more in psychic powers and are less skeptical, which coincides with what was reported by Cárdenas et al. ¹¹, Wilson ¹³ and Garret and Cutting ¹⁴.

It was also found that students who had completed their baccalaureate at College of Sciences and Humanities (CCH) of the UNAM, reported more supernatural experiences than the rest. The CCH is one of the two curricular modalities of baccalaureate at the UNAM, created in 1971 with the intention that the sciences and humanities converged, and that the student had an active role in the acquisition and generation of knowledge ¹⁸. Among the objectives of their teaching are the training of students: “As people suitable for undergraduate studies and also as citizens capable of understanding the problems of the country and participating in their solution in a solidary and committed manner” ¹⁹. One of the principles that guides its educational model is “learning to be”, through this principle it pursues that the student learns to be more humane and that his/her approach to knowledge does not exceed him/her since his/her training will be at the service of his/her country ²⁰. This formative approach can justify the openness of the students graduated from the CCH to the beliefs related to the magical thinking of their culture or of foreign cultural contexts.

Another finding was that those who did their baccalaureate in public or private schools outside of Mexico City, are less skeptical. A hypothesis not formally tested by this study but that is related to the differences between the high schools of origin proposed by Guerrero et al. ⁵, in terms of young people of low socioeconomic status obtaining higher scores in magical thinking than upper-class young people. When analyzing the profile of new students entering the Faculty of Medicine during the year 2019 ²¹, we observed that students who completed their baccalaureate in private high schools have indicators of a higher socioeconomic level than UNAM baccalaureate students (higher schooling of the mother and higher monthly family income).

To better contextualize this explanation, the degree of stress perceived by students and magical thinking relates to the idea that socioeconomic stress can also be positively associated to magical thinking according to Farkas ¹², who established a directly proportional relationship between them.

5. Conclusions

The study of beliefs and practices related to magical thinking, which the future health professional will find in the different cultural contexts in which he/she practices medicine is very relevant, since the doctor-patient relationship benefits when culturally competent practices are employed.

Given the difficulty of measuring outcomes in patients based on physicians' beliefs, so far, the authors have found no evidence that magical thinking limits medical practice; however, maintaining high standards in terms of critical thinking and scientific method is crucial to favor clinical reasoning according to current medicine, which favors an efficient resolution of patients' health problems ²¹.

Acknowledgments

We thank interns Zukeika Miroslawa Rodriguez Cazares and Jessica Elizabeth Tapia Lopez for their collaboration in research of previous studies.

References