The Role of the Ritual

When we build insights, we are trying
 to elevate something that has been observed during anthropological fieldwork into something that has profound meaning for the design process and allows us to identify problems that can be addressed as we build a product or service. This is not always easy, because people are often looking for an “aha moment” that feels revolutionary or transformative. However, some of the most important in-field discoveries are actually far subtler; they are realizations that the people we study see very mundane things in slightly different ways than we do. In these instances, the role of the insight is not to highlight and observe a single issue or to identify an unmet need, but rather to allow the reader to see something that they already know in a completely different way.

The insight I have selected is a good example of this. It came from a project in which my team and I examined the experience of self-injecting medication. We went into the field and spoke with a large number of individuals who had to use hypodermic needles or injection pens (self-contained automatic injection devices that deliver a subcutaneous injection with the push of a single button) to take their medication without the assistance of a nurse or doctor. The purpose of the project was to try to make this experience better. What we found was that patients have a very different experience than their doctors and nurses think they do. We also found that there were some commonalities in the way people approached their injections, underlying what seemed to be idiosyncratic approaches. These commonalities became the key to articulating a set of insights that provide context for the entire act of self-injecting, rather than focusing on a particular need or problem to solve. These contextual insights provided a basis for the insights and observations that guided our ideation and design. Here, I present the most important one.

There Is Always a Ritual

The most profound way that people contextualize all aspects of their self- injection and bring this process into 
their lives is by building a ritual for injecting. This ritual can take days or seconds, and it can have any number of steps. Despite the variation in people’s rituals, the act of ritual itself is an important way that patients contextualize the meaning of everything they are doing when they self-inject. This makes it easier for them to manage their fear and incorporate 
the alien action of self-injection into their lives. The ritual provides structure and allows them to turn complicated actions into habits. It does this by allowing them to systematically make difficult actions simpler through repetition. This repetition also provides a context for these actions that helps patients think about other things and avoid obsessing about the injection. However, these rituals are not taught by healthcare practitioners; they are the product of trial and error, which can result in mistakes becoming permanent habits.

Implications

/ Rituals can be healthy or unhealthy developments.

/ Failure is a major component in the development of an injection ritual.

/ A ritual must be respected, because it is a carefully organized mechanism for managing oneself and one’s emotional wellbeing.

/ Most healthcare practitioners do
 not teach ritual in any meaningful way, and, as a result, patients’ rituals are not respected or supported by the healthcare system.

This insight is something that is true despite a great deal of variation. Because it is
 not the product of a single observation, its implications are deeper than just uncovering a need or alerting the reader to something interesting. It speaks about something structural that is universal. Because of this, it has the power to substantially change our thinking.

Understanding how humans build rituals of all kinds can profoundly change the design process. Rituals have a basic structure, and we can look to ethnographic literature for any number of examples. Following Arnold van Gennep’s work on rites of passage and Victor Turner’s 
work The Ritual Process, we know that rituals have a basic structure. There 
are roughly three major phases: the entry, the liminal phase, and the exit phase.
 The purpose of a ritual of any kind is to develop a liminal state, a new conceptual space that is outside of real life. In such 
a space, society’s rules are different. People speak a different way, we act differently, and we are able to do things that might be against the rules of our daily lives. For good examples, think about how people act on a Friday night
 at a club, during a carnival, or at weddings. Much of that behavior would be completely out of place when the 
sun is out. The entry and exit phases are transitional phases that help people 
both move away from real life and get back into it. We put on different clothes; we pump ourselves up. We even add stimulants like drugs or alcohol to change our conceptual state. The process is entirely devoted to behaving in a different way and socializing differently.

When it comes to ritual and self-injection, the difference between the liminal phase and real life is what allows us to do things like inject a metal needle into our bodies. Patients’ rituals are organized so that they can do something they otherwise would not do. This also means that we have to pay close attention to what patients do to get themselves into this liminal phase.

Any designed intervention into this ritual – be it a service or a new injection device – is actually a forced adjustment to existing rituals. Additionally, clinical training is actually ritual training. Nurses who help people learn to use self- injection devices are actually laying 
the foundation for an injection ritual.
 This means that if we make changes to the training or design a new service 
to help people eliminate something like site pain or improper injection technique, we are actually designing rituals.

The practical implications of this are easy to understand. As service designers, we have to make sure that whatever 
we build to help is part of building a good ritual. Any self-injection service has to help people with their entry phase; it has to make sense in the liminal state; and 
it has to help people return to their daily realities. Understanding that the ritual
 is the most important factor for understanding the successes and failures of the moment of injection helps us design
 with new information. Without an insight like this, we would be unaware that 
we are not designing an experience; we are designing for three discrete phases
 of a ritual process.

Each of these parts already has a 
logic that we all understand and use. The ritual process provides a guide 
for organization behavior. No ritual can be redesigned without serious thought 
and attention. This insight brings in a wider world of human behavior that
 will make the design process easier by focusing a designer’s attention onto 
a framework that they already know.
 With this information in mind, the entire design process can take a new
 direction and align itself with something that makes us all the more human.

the author

Paul Hartley

Paul Hartley is a former resident anthropologist at Idea Couture.