Placebos, Nocebos, and Hypnosis

“A mind is fundamentally and anticipator, an expectation-generator.” – Daniel Dennett, AI pioneer

In 1978, a young couple faced a crisis of conscience. As practicing Christian Scientists, they believed in the power of faith healing and eschewed modern medicine, but their infant son was gravely ill. With his life in the balance, the mother considered taking him to the hospital. Her Christian Science healer reminded her of God’s love for the boy and encouraged her to hold fast to her faith. Moments later, the boy’s condition turned around.

That young lad (Erik Vance) heard the story of his miraculous salvation many, many times during his formative years in the Christian Science community. Faith healing was the only form of medicine that he knew, and he witnessed its beneficial effects time and again. Though he eventually fell away from the church, his fascination with the practice stayed with him. He became a science writer and traveled the world to understand the physiological underpinnings of this seemingly magical phenomenon. He captured his findings in Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.

As noted in prior posts, our minds are not computers rooted in logic and facts. They are survival machines geared toward keeping us alive as efficiently and effectively as possible. Expectation serves as a primal survival skill – i.e., anticipating what lies in the immediate future and mounting a swift reaction. Experience guides our expectations. When missing information, we fill in the gaps and move forward, sometimes outside of conscious awareness.

placebo, noceboExpectation plays a substantive role in the body’s capacity for healing. When ill or injured, most of us have been trained to trust in medical professionals to make us well. In the Western world, we visit clinics where caregivers in scrubs and/or white lab coats discuss our ailments and then prescribe drugs, shots, or procedures to make us well. But it turns out that for certain conditions, we can generate the same degree of healing with sham medications and procedures. Scientists refer to that phenomenon as the placebo effect. So, why does it work?

Our brains are adept at pattern recognition; it feeds our “expectation-generator.” Famed neuroscientist Ivan Pavlov explored this capacity in canines by ringing a bell every time he offered them food. Pretty soon, the dogs would salivate whenever they heard the bell. Humans also experience conditioned responses. In one experiment, test subjects were given an immunosuppressant drug in a sweet drink to lower their immune response. After a few iterations, their bodies produced the same reduction in immune response with out the drug even though participants were told in advance that their drinks contained no pharmaceuticals!

Our brains can induce a gaggle of physiological responses without prescription drugs. We’re walking pharmacies with the capacity to produce effective treatments for certain conditions – notably, pain, anxiety, depression, irritable bowel, addiction, nausea, insomnia, and Parkinson’s disease. But several factors influence this healing effect:

  • We need conditioning, a credible backstory, and appropriate environmental cues to engender a belief in the treatment. [Note: Placebo injections prove more effective than placebo pills because we believe that they are more powerful. Likewise, sham surgeries work better than sham pills.]
  • We need a favorable emotional response to our circumstances. Hope yields positive results; despair exaggerates suffering.
  • Social pressure can lessen symptoms or speed recovery – e.g., “If it works for millions of people, it’ll probably work for me.” In fact, the peer pressure placebo effect is twice as strong as an individual placebo response. It feeds into our primal need to go along with the herd.
  • Our genetic maps may make us more (or less) susceptible to placebo responses. As a case in point, folks with the met/met variation of COMT (which, among other things, sweeps up excess dopamine) are far more placebo sensitive than those with the val/val or val/met variations.

Unfortunately, a susceptible brain can make bad things occur without cause – a.k.a., the nocebo effect. One’s mental state can cause physiological suffering. It’s generally driven by fear and can be initiated with a few well-placed words – a report of a contagious disease, a belief that one’s misdeeds will engender cosmic revenge, a curse levied by a supernatural being. A wise person blocks all aggressive suggestions that could cause harm.

Hypnosis represents another form of suggestibility that can drive real physiological change. Its efficacy relies upon the skill of the hypnotist in painting a picture of the magical place that relaxes the participant and opens the door to suggestion, using appropriate pacing and tone of voice to sustain the “trance,” and implanting a credible story that sticks. Roughly 10% of the population responds strongly to hypnosis. Early evidence suggests these folks have naturally higher theta and alpha brain waves than their busy-minded beta and gamma brain-waved counterparts. The latter benefit from meditation to calm their “monkey minds.”

So, what should we make of all of this?

Vance asserts that expectation and suggestibility are a part of all forms of healing. As he says; “Everyone’s door to expectation has a different key, and everyone is suggestible in a slightly different way. But once the door is unlocked, we have amazing power to heal ourselves.” His guideposts for leveraging this capability:

  • Don’t engender yourself. While some maladies may respond to self-healing, take advantage of modern medicine when you need it.
  • Don’t go broke. Be sensible and follow the evidence before emptying your wallet.
  • Don’t send any creature to extinction no matter how compelling the backstory. They have a right to live, and their sacrifice may do no material good.
  • Know thyself. “For most, suggestibility is a cocktail of genetics, personal beliefs, experience, and personality.” Figure out which pathways hold the most promise for you and be open to the power they hold