Do you remember learning about the placebo effect?
I remember a few references to it in high school biology, and a few jokes about it in various TV shows, but it just seems to be one of those concepts you learn by osmosis and never question.
But it is insane!
IT’S GETTING STRONGER
We have powerful drugs to change our brain chemistry, how our guts work, and how our immune systems heal, and we must very carefully design studies to account for the fact that none of them measure up to the power of eating a sugar pill that you’re told might make you better.
And even then, sometimes the effect that you think is the drug turns out to also be placebo. Sedatives are less effective if the pill is red or yellow and more effective if they’re green or blue. Was it the drug or the color?
Not only that, but the placebo effect is getting stronger. The more time goes on, the harder it is to get an efficacious drug passed because every drug we have is measured not against a baseline of people taking nothing, but against people spontaneously improving by believing they can. (If that is indeed the effect that’s happening. More on that in a second.)
Then it gets even weirder because there’s another study that shows the effect works even if people know it’s the placebo effect. You can give someone sugar pills, tell them it’s sugar, and they will still see an improvement.
IT WORKS IN REVERSE
Then there’s its terrible opposite, nocebo, where people can cancel out the effects of extremely powerful medication if they truly believe it’s not going to work. Worse, they can give themselves side effects like nausea and fatigue if they expect to experience them.
It’s not just drugs. You can get drunk by believing in alcohol. There are studies that show most feelings of intoxication may be placebo, just for fun; If you expect to get drunk, you can get there on juice if you think it’s alcohol. (Though your level of impairment remains objective.)
This brings me to the dangerous part of believing anything.
PLACEBO IS NOT A LACK – IT IS THE PRESENCE OF STORY
I’m not a medical doctor, I’m an English major. My interest is not scientific, but story. Two researchers, Jones and Moermon call the placebo effect a myth, and suggest we rename it the “meaning effect.”
| They write: “Rather than simply using placebo-controlled research to eliminate what is “not real”—a consequence of the placebo myth that has left us with a paucity of proven therapies for chronic disease—research on how the meaning response works opens us up to an abundance of discoveries that can be immediately applied in practice. What is now dismissed as the placebo response could be used as the basis for inducing optimal healing that is personalized to the patient and their culture and context.” |
AN ACTUAL TREATMENT?
This is fascinating to think about: placebo is not fooling ourselves with the lack of real treatment, but an actual legitimate treatment made of story, specifically a new setting, a ritual, and perhaps a trusted leader. It’s just another treatment, with its efficacy, limits, advantages, and disadvantages like any other.
Moermon goes on to say that calling it the meaning effect is “to make it more evident that our physiology was responding to the context and rituals that imbued meaning to a treatment rather than to a substance, inert or otherwise.”
WE CAN’T PLACEBO OURSELVES
Why do we need the story, the ritual, or a leader at all? If our beliefs affect our illness, why can’t we just change our minds ourselves?
Dr. Laurence Sugarman, MD asks this question: how can it be an advantage, evolutionarily speaking, to believe that we are not in control of our own minds? That other people can fix us? When did that start?
WILLING TO BE INFLUENCED
Sugarman is a clinical hypnotist, who calls hypnotism an ethical use of placebo. He says, “Hypnosis is not about the trance, it is about willing to be influenced by the other person.”
Even the people who supposedly are using placebos on themselves are using other people’s remedies, rituals, or ideas. So there is still influence from someone else.
PART OF OUR STRESS RESPONSE?
We are herd animals. There’s increasing evidence that when something upsets us, before flight or fight, we tend and befriend. We look around to higher-powered members of our groups and family, and if they are not upset, our own biology calms.
In many circumstances, we believe the herd over ourselves. It may be this simple: in a herd, the ability to influence and even control other members of the herd so everybody goes in the same direction whether some of them want to or not may be the smallest seed that has blossomed into the full-blown placebo effect. You can convince someone of almost anything if you surround them with enough authority and caring.
SIMPLE SURVIVAL
We don’t trust our own minds, but we do trust someone with the trappings of authority because, in our ancient past, it was basic survival. “We’re all running this way! Oops, it’s a cliff. Sorry!”
This may also be the basis for most life coaching, self-improvement books, and seminars. We need ritual, belief, and caring from another person to calm us down and allow us to take a risk.
Take away the pageantry and our own loyalty, and our bravery disappears. One lone human telling themself it’s going to be okay is not reassuring. Even one lone human telling themself that in similar situations other people were okay will work better.
IT’S THE RELATIONSHIP
In mental health, we are beginning to acknowledge that the relationship between caregiver and patient is the primary thing that helps people.
Even supposedly “objective” therapies like Cognitive Behavioral Therapy are failing the test of objectivity. It turns out it may just be the relationship with a good clinician that people need, and the belief that it will work.
Ditto AA, where researchers have tried to figure out what in the 12 steps is efficacious, and couldn’t find anything either way. It turns out that the main differentiator between success and failure may be that it works for the people who believe it will, and it doesn’t work for those who don’t believe in it.
UNTIL IT DOESN’T WORK
There are so many stories of people believing in unproven, often New Age treatments or faith healing that are probably primarily placebo (which is to say story/meaning/ritual/leader interventions). And they work because Placebo works in a lot of cases, until it doesn’t.
Joe Dispenza even called his book, “You are the Placebo,” saying perhaps the quiet part out loud. (One I did not link to deliberately, because of the people who have been harmed by the limits of placebo that he does not acknowledge in any teachings.)
There is story after story of people seriously harmed by avoiding or seeking evidenced-based treatments far too late because they sought an unproven treatment or tried to think themselves well.
WHERE ARE THE LIMITS?
Unfortunately, because we view it as a trick and not as a treatment, we haven’t really studied where the limits of ritual start and medicine begin.
Things like surgery and antibiotics are very hard to replicate by wishing. Even if that wishing is surrounded by a very convincing ritual and a charismatic healer.
(But they also all work better if you go into them believing they will. So placebo won’t cure your infection, but will most likely increase the efficacy of the meds. Brains are SO WEIRD!)
RESPONSIBLE FOR WORLD DOMINATION!?!
There’s also increasing evidence that many cult leaders and high-demand groups use a form of the placebo effect to control their followers. Their ability to get followers to believe almost anything and change everything about their lives is a terrifying abuse of this.
Alice Grecyzn talks about this how placebo may be in effect during altered states of consciousness. Greczyn argues that our capacity for believing a story is what allowed us to dominate the earth. Because it allowed a level of cooperation heretofore unheard of.
Chimps cannot talk to each other, so they have to stay in contact. But humans can convince each other of things from across the globe. We can get on the same page about what we’re doing here and why.
We have two stories in two separate minds in two separate languages on opposite sides of the planet that allow us to still work together.
WHAT DO WE DO WITH THIS?
It’s not like we can suddenly kill off all belief, nor would we want to! And it’s not like this article settles the question. My deep dive into this phenomenon has left me with a hundred more questions not fewer, and it seems like researchers are at a similar place.
We know that it works, can be used for positive and negative effects, works even if you know it’s a sugar pill, and that having a leader involved, a ritual, a setting, and a belief makes it work the best. And we know it’s limited.
We don’t know why it works, exactly what the limits are, why it’s getting stronger, how to control it or stop it, or what exactly it is.
SO IN CONCLUSION… KIND OF, NOT REALLY
It’s made me appreciate how cobbled together, elegant, deeply weird, and fragile personhood and the world actually is.
It’s also made me more flexible about what is under my control and what isn’t, and how powerful the herd, leaders, ritual, and belief can be in my life. And how many, many, many unethical healers, coaches, gurus, and the like take advantage of this.
It’s also made me really appreciate the drugs that have been approved because it turns out beating belief is a really, really high bar.
It’s also made me more aware of the stories I am telling and being told – not just with words, but with setting and ritual and who I am speaking to, and how I am being influenced without even realizing it.
May you find a similar awareness in this age of endless influence.