Placebo! Much Ado About Nothing

Latin for “I shall please,” the Placebo Effect was first scientifically documented in 1955 by Dr. Henry Beecher who found that 30% of the soldiers in World War II who were unwittingly given saline solution for pain, instead of morphine, reported an analgesic effect.  That is, they got something from nothing.  It’s the Seinfeld of the medical world, a show about nothing that offers something very significant to everyone who watches it. 

The Placebo Effect is hard to categorize, and even harder to verify, yet it is involved in every scientifically based study and has, itself, come under considerable scrutiny in the last fifty years.  It’s an enigma in that it offers relief but, because of its complex interactive qualities, defies measurement.  Often reduced to cliché, the Placebo Effect is gaining increasing momentum as alternative forms of treatment use its effectiveness to substantiate the power of the mind in the healing process.

One thing that is beyond argument in the Placebo debate is that the mind exerts an enormous influence over how we experience the world.  In a study in Japan, children had a plant known to irritate the skin rubbed on one forearm and a nontoxic plant rubbed on the other.  Predictably, the arm with the poisonous plant developed a rash and the non poisonous arm did not.  Only later did the children find out that the plants were purposefully mislabeled.  The arm they thought was rubbed by the toxic plant was actually the placebo.  This simple experiment demonstrates the enormous impact of positive and negative thinking on the emergence of disease in our bodies.

A study at the Neuropsychiatric Institute at UCLA in 2002 showed that the brain isn’t fooled by a placebo, it just registers its effect differently.  The researchers wanted to know if brain activity could detect the effect of antidepressants in the body more quickly than waiting the requisite two weeks for subject self-reports.  They studied three groups; one was given Effexor, one Prozac and a control group was given a placebo.  The researchers were surprised to find that not only did all three groups report significant symptom reduction over time but they all registered activity in the prefrontal cortex of the brain where serotonin is produced.  The one difference was that subjects responding to the antidepressants had a decrease of activity in the prefrontal cortex while those responding to the placebo showed an increase in activity.  The results suggest that the Placebo Effect creates the same action (and result) as taking antidepressants, but in a different way.  Why then don’t we just learn how to “believe” ourselves into feeling better?  The answer is that for the Placebo Effect to work the subject cannot know that it is a placebo.  By not knowing we are taking a placebo we suspend all self-doubt, which is essential for the effect to occur.  Once doubt creeps into the equation the effect falls apart.  That’s the enigma of the placebo.

Yet, in spite of the fact that we can’t fool ourselves into believing something to be true if we know it may not be true, we can still use the Placebo Effect to improve our lives.  Because we are suggestible creatures (consider the parlor hypnotist who can humiliate you on stage with a snap of the fingers,) who are prone to conditioning (much like Pavlov’s dogs, we get better if we expect to get better), and can produce the results we expect (as soon as we find an aspirin we lose our headache), we forget that we can use this innate healing power with conscious intention to make our lives better.  We can condition ourselves to think positively, we can learn relaxation techniques such as breathing exercises and guided imagery, we can avoid negative thinking, which produces what’s called the Nocebo Effect, the creation of dis-ease through bad thought patterns, and we can consciously create a caring, nurturing and comfortable environment for ourselves.  If we can be hypnotized to quack like a duck then we can surely use the power of suggestion to create better outcomes where limitations now exist.  The mind is a powerful, and still highly mysterious, vehicle that can be groomed, conditioned and nurtured to promote our well-being.  The notion of “belief” is one of the main reasons that the therapeutic relationship is so powerful between a doctor and patient and a therapist and client.  Belief and relief have a causal relationship to each other as long as we have something to believe in.

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