The placebo effect is much misunderstood, seriously under-researched and full of peculiarities. I must admit I’ve assumed that the placebo effect is the body’s self-healing effect. I’ve always thought that’s an important point to make because otherwise people tend to think of the placebo effect as some kind of trick. Whatever it is, it’s real. Symptoms can be modified or even removed, and the “nocebo” effect (that’s the one where harm is caused) can cause real illness. It’s not a pretend effect, even if the intervention is deliberately a pretend one!
However, I’ve just read a short article on the Edge, where a psychologist muses about the placebo effect and raises an issue I hadn’t considered. If the placebo effect is the self-healing effect, why doesn’t the body just get on and do it without the placebo? That’s a good point. Where’s the advantage in waiting for a push? In the article, Nick Humphrey considers the phenomenon from an evolutionary biology perspective and there’s something in what he says, but I’m left with the nagging doubt that whatever the placebo effect is, it IS NOT the self-healing effect. It might be related to the self-healing effect. It might even have its impact by provoking the same, or similar pathways to the self-healing effect. But maybe it’s distinct and different from the placebo effect, not least in it kicking in and getting to work without the need for an external push.
We tend to use such concepts in un-thinking ways. One of the tricks we use to stop our thought processes is to name something and in so doing convince ourselves that we now KNOW it. It’s not true though. Sadly, often when we name something, that naming stops us from thinking – especially if the naming is judgemental. (I think it was Wendell Johnston, the General Semanticist, who said “Judgement stops thought”) After all, what exactlly IS the placebo effect? Spontaneous healing? The natural capacity to recover? A statistical trick? And what IS the self-healing response? How DO people get well? We know some of the components and pathways eg inflammatory responses, the immune system, various hormones and so on, but can all these components be considered together to constitute something called the “self-healing response”?
The answer is…….we don’t know. But don’t you think it would be a good thing if we did? (fields of research such as psychoneuroimmunology and psychoneuroendocrinology are exploring these questions – google them and see what comes up!) If we understood the self-healing system then we could develop the healthcare interventions which were not only designed to promote healing but which actually did stimulate and support it. Why do we concentrate on “disease management” and “symptom control” instead?
Heroes Not Zombies 
The essential part I was interested in was nic humphreys idea relating to delay and then the inititation of a ‘healing’ response.
This to me is the most interesting part of the equation and it takes a lot more than brain scans and pni to answer this.
I was really interested by Dan Moremans take on the ‘meaning response’ –if you haven’t read it the book and his ideas are fascinating. The above link is interesting particularly Moermans reply.
I am doing my project on biocultural aspects of placebo/meaning and the subject is fascinating. However the meanings we are commonly fed and are embedded -particularly relating to pain may result in common sources of nocebo medical interventions e.g the management of most musculokeletal disorders?
ian
thanks for the link Ian and for mention of Dan Moreman’s book. Haven’t read it but I feel I’ll want to! I wonder if he’s in agreement with the work of Brian Broom – see https://heroesnotzombies.wordpress.com/2007/05/14/meaning-full-disease/
Hi Bob,
I was reading Jeff Warren’s The Head Trip: Adventures on the Wheel of Consciousness (recommended) and came to a reference to Dylan Evans book, Placebo: Mind over matter in modern medicine. You may have read it.
I used to think of a placebo as a pill. The doctor gives it to you and off you go by yourself. As long as you believe it will heal you it will.
However, Evans seems to think of acupuncture and psychotherapy as pure placebo. Placebo’s work for some things and not for others. He does think doctors should pay more attention to evoking the placebo effect.
Clearly, the placebo is about belief, but more than that, I think it’s about connection. Bob, you take a long time with your patients. This connection with others matters so much for our health and well-being. Respect, caring, and empathy may be essential to creating the space for what we call self-healing. I think we humans crave connection and when we don’t get it, we get sick or worse.