“If the placebo effect operates by fooling the brain, why does it require deception if the brain can supposedly resolve the problem independently?”
In: Biology
Placebo effects can improve how you feel based on believing you’ll get better. It’s almost like the ‘amount of belief’ is like the ‘dosage’ of medicine for how much you’ll feel better. There are different ways to increase that ‘belief dosage’ but one of the strongest ways is through deception, by telling or somehow showing you that you are taking a powerful treatment. It doesn’t just have to be a medication: placebo surgery or injections can have quite a strong placebo effect because they ‘show’ us how strong the treatment must be.
However, the ‘dosage’ is not actually based on deception, that just happens to be a convenient way to get a strong belief, but you can also get that without deception, which is sometimes called ‘open placebo’. This involves telling people truthfully that they’re taking a placebo, but also telling them correct information about how incredibly strong placebo effects can be and explaining how they work in the mind and body, particularly if that’s supported by an expert person presenting real evidence of studies or videos from people explaining that it really does work. Don’t forget, the ‘dosage’ is the belief, it’s just that usually telling people they’re receiving a placebo reduces rather than increases belief. There’s evidence this works well for some situations (like IBS, pain, or other symptoms) and may not work so well in others (like wound healing) although more research of actually generating a strong belief without deception is needed (that’s quite hard to do, including for the scientists doing these studies).
There is another way to generate placebo effects that can be very strong too: ‘conditioning’, which means learning by association. For example, a study gave people a weird drink with a strong medicine and then measured their blood: as predicted, they had measurable immune changes when taking the drug, but they ALSO showed measurable changes in their blood after they did this for a while then had ONLY the weird drink without the actual drug.
Belief (whether deceptive or open) and conditioning are just two proposed mechanisms for placebos to work and there may be other reasons too. Also placebos are complex and it’s still unclear how much they lead to just feeling better vs measurable body changes, though there is certainly evidence of physical changes to the body in some specific situations.
Long ago (which means I may not recall the story correctly, and I can’t link to it or otherwise verify its veracity), I was told about a study that examined the placebo effect directly. Rather than breaking the test subjects into three groups (control, placebo, actual drug), it was broken into four (control, placebo but they didn’t necessarily know it, placebo but they told them it was placebo, actual drug). What they found is that the placebo group did do better than the control group, and it didn’t really matter whether they knew the medicine was actually just a sugar pill or not: those who received care did better than those who didn’t. (I don’t recall if the medication worked.)
The study’s authors speculated that there was something about official medical care, the trappings of lab coats and clipboards and stethoscopes and such, that for some reason inspired healing that didn’t happen to people who didn’t receive this care.
I have a theory. I have never heard anyone else say this theory, so it’s possible it’s entirely my own, and therefore possible I’m entirely full of shit. But I theorize that, in a social species, always getting better no matter the cost isn’t the most adaptive way to respond to illness or injury. It matters whether the cost to the larger community is going to be greater than or less than what will be gained after the individual recovers. If the individual is only of marginal value, better to just die quickly rather than consume resources attempting to get better. If the individual is of high value, better to hang in there and get better.
The community signals this relative value through the administration of care. Of course, it is helpful if the specifics of care have additional medical value. But the mere fact that an important person’s time (a doctor’s, or a shaman’s, or whoever’s) is being consumed to help this person get better signals to the body that the community would prefer they recover.
This isn’t a memetic thing, and so the mind need not be fooled. So long as the emotional content is correct, the signal will be sent, and a switch will be flipped that induces the recipient of care to “try harder” to get better, rather than die quickly and get out of the way.
But as I said, this is just my personal theory, which is based upon a study that may not actually have ever been done, at least as I remember it.
Because what you THINK matters.
You’re not just fooling the person’s brain, your fooling the person’s mental state. What usually happens is Your BRAIN is influencing YOU, but when putting someone under placebo, you are forcing the person to influence their brain.
Think about it like this: If I were to throw sand at you, and your hands are tied, what do you do? You tense up and close eyes. Why? Because you anticipate the sand coming in, you aren’t telling your body to tense up, but its doing it anyways because of the anticipation.
If I were to emotionally throw sand at you, and you didn’t know it was fake movement, you will still do the same things, because of anticipation.
Similarly with Placebo, the person “believed” that they have taken the pill, and is basically telling the brain: “bro, change is coming” and the brain preps the body for the change.
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