My son posted this link to a video on youtube that reminded me of what I love about the way our minds work:
A placebo is basically a therapeutic hypnotic suggestion in physical form. As the video said — the better the physical form of the placebo, the greater its effect. So, the more powerful the suggestion that a little pill of nothing is really a little pill of something — the better it should work.
Hypnotic suggestion is not a difficult thing — there are definite skills involved, and it takes practice; but therapeutic hypnosis is an absolute and learnable skill-set. I suspect that if the prescribing doctor were skilled at hypnotic suggestion (as opposed to just skilled at acting or lying,) a placebo would work even better. It would be like getting a double dose, so to speak.
Let me be clear — I’m not talking about swinging watches and stage hypnosis that makes people cluck like chickens or wind their watch whenever the hypnotist says “Elvis.” I’m talking about the hypnosis that helps children who have seen their parents shot to death both survive the trauma and help identify the shooter. These are two kinds of hypnosis, practiced by two kinds of people and for two altogether different reasons. These kinds of hypnosis are related — like sister skill-sets — but they are not identical twins. Intention is all important. It’s more like the relationship between ballroom dancing and tap. They are both forms of dance — and they might occasionally have some crossover points — but they are not the same.
It would be an interesting study to take a control group of freshly ordained medical students who knew nothing about hypnosis — and another group who had been skillfully trained in the techniques of Milton Erickson or other noteworthy therapeutic hypnotists — and give both groups of physicians a month-long schedule of appointments with similar patients whose complaints might benefit equally from placebos and the placebo effect — and see which group of physicians was most successful.
Of course, it would mean that the physicians would all have to be non-skeptics about the benefits of placebos, and that the group trained in hypnosis would need to be non-skeptics about the benefits of therapeutic hypnotic suggestions. Why? Because measuring the comparative effects of placebos/hypnotic suggestions when the physicians believe vs when the physicians do not believe is another question, and should be studied separately. To make this comparison legitimate, all the physicians would have to be equally convinced and therefore equally congruent about their prescriptions.
If you seriously think a patient can’t tell when the doctor doesn’t believe what s/he is prescribing will work — you need to rethink your preconceptions about the doctor/patient relationship. Some people will believe anything their physician tells them — just because of the social assumptions of authority and education. Likewise, some people will challenge anything their physician tells them — just because of the social assumptions about bureaucracy and human error.
There’s a lot of difference between “Here — try this. It’s worked for all my patients with this condition…’ and “Here — try this. It doesn’t do much, but maybe it will help a little….”
A good actor or liar might be able to get a positive placebo effect — but what we want to know is if a doctor who knows the potential of placebos and/or therapeutic hypnosis, who gives the placebo along with a subtle and powerful suggestion about its effects can make the effect stronger or better.
It might work to have third and forth groups of new doctors who are absolute skeptics and non-believers in placebos and hypnotic suggestions. — But that starts to get a little sticky. The chances of a placebo or a placebo+suggestion working their magic on pain, or insomnia, mild depression, stomach ache, or irritability are in question — and so would involve leaving patients in the lurch of being totally unmedicated (whether by real drugs or sugar pills) and therefore caused actual harm by the study.
If they thought their problem was bad enough to go to a doctor in the first place — we wouldn’t want them to suffer needlessly. At least I wouldn’t.
That’s a medical study I’d like to see.
There’s so much that doctors know about how the body works — especially when compared to what they knew 50 or 150 years ago. It has only been in that time period that the idea of germs and a sterile field have been recognized as part of true medical study. The pool of knowledge expands daily.
It’s only been in this last few decades that the play between the mind and the body has begun to be studied — so assuming our medicine has done anything more than open a crack in the door is arrogance. The placebo effect has been at work since shamans, witch-doctors, and medicine-men made their appearance in the tribe — we’re just now beginning to figure out the scope and potential of their practice.
The internet doesn’t help — since anyone can go online and read the full data sheet on any medication out there, as well as see a picture and a description of the pill. This is good in some ways — we can all check to make sure our pharmacist didn’t make one of those human errors we all hear about. But it also opens up a chasm in what doctors (and medicine-men) can accomplish.
If that gaping hole gets filled by psychiatrists, psychologists, and counselors; chiropractors; aroma therapists; fortune tellers and tarot card readers; massage therapists; herbalists; acupuncturists; gurus; wise-men/women; therapeutic hypnotists; story-tellers; dietitians; priests, monks, preachers, mullahs and rabbis; and others who can mix in a little magic with their common sense, experience, and wisdom — so be it. Faith and belief are not the disease — they’re part of the cure. Any and all of the categories listed above — and dozens more — are possible tools in the toolbox that potentially makes us healthier, gives us hope, and provides a sense of well-being that is essential to life. Making the unbearable — bearable is as powerful a medicine as any anti-biotic.
Let me be clear — I want great doctors from great medical schools, with steady hands, creative minds, and deep memories tending to and working on me and my family. No questions and no doubts about that. But I also want open-minded doctors who leave room for the truths they don’t yet know, tools they haven’t considered, and evidence they haven’t yet seen. I don’t want to trade Shamanistic Studies or ancient healing methods for a good solid internship program, but at least a basic knowledge of herbal pharmaceuticals, NLP, basic psychology, massage therapy, and nutritional medicine might be useful.
The human body/human mind/human spirit are all part of a single self-amending system (see nomics on this blog for more discussion about self-amending systems, including the body) — with an interplay that is continuous and holographic, and comprises a complexity we only begin to understand.
If the placebo effect is “all in the mind” — then let’s just bow to the mind and treat it with the respect and care it deserves. Good medicine treats the whole person with any and all methods available — at least we hope it does.