Archive for December, 2008

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?

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You’ve probably read somewhere the advice that you live today as if it were your last day on Earth. It’s a common counsel, and it’s supposed to get you to better appreciate the present. The argument goes that we tend to live unconsciously (like zombies), dreaming about better tomorrows or ruminating over worse yesterdays, and if we would only wake up (like heroes), and appreciate our moments of living as we live them, then our quality of life would be increased. We would be more alive to this present moment.

Certainly it’s true that if you were to think about how you might choose to spend today then you may well make different choices if you knew you had less time left to live than you had previously assumed. Some people make this an explicit exercise and consciously influence their choices on the basis of an assumption that this really is the last year they have to live. It’s something of this idea behind the movie, The Bucket List (Jack Nicholson and Morgan Freeman) – what would you put on your list to do before you “kick the bucket”?

The French philosopher, Pierre Hadot, writes about this in his “N’oublie pas de vivre”, but takes it to another level, I think. He suggests you reflect at the end of each day and see if you can say “Today, I have lived”, or “Today, I’ve had all the pleasure I could have hoped for” (he means in the context of this day, not the whole of life). In other words, knowing that you will never live this day ever again, can you say you have lived it fully? It’s about understanding just how precious this day is, and then being grateful for it. This is where he then takes the idea to a different level by combining it with the concept of “emerveillement” – of wonder and amazement. As well as living this day fully as if it were your last opportunity to do so (which it is!), approach the day as if you’d never lived it before (which you haven’t!). This latter concept is about not losing what we all had as children where the ordinary everyday was filled with wonder, where tastes were new, colours, shapes and sounds were whole worlds to be explored.

I think this is a powerful combination of concepts which can increase the intensity of the present, and in so doing, make us feel more alive.

Live life consciously, engaging with every day as if it were your first and your last, because, this really is your first and your last chance to experience today!

Rainbow over the Carse

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