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Essay

Backstory: Mind Over Matter

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Do you remember when you took the training wheels off your bike? At some point in the course of those first exhilarating two-wheeled joy rides, maybe you fell down, and maybe you banged your knee, and maybe you cried out for your mom. Who maybe, before she cleaned you up and sent you on your way again, kissed you where you hurt. For many of us, the mysterious healing properties of a parent’s kiss offer one of our first experiences of a placebo effect—“a change in a patient’s illness attributable to the symbolic import of a treatment rather than a specific pharmacologic or physiologic property,” according to one 20th century definition. Put more crudely: you believe you will get better, and so you do.

The word “placebo,”—“I shall please,” in Latin—was first used in English in the 14th century to refer to hired mourners at funerals. So named because their remunerated wailings often began with the psalm verse Placebo Domino in regione vivorum (“I shall please the Lord in the land of the living”), placebos were paid to enact the gestures of a grief not their own. Adapted to a medical context in the 18th century, the word today is most familiar to the average Jane and Joe for its application, for control purposes, in clinical trials. But remarkably, considering their ubiquity in the clinical landscape, there’s a lot about the mechanisms of placebos that even expert researchers don’t fully understand.

What we do know: the placebo effect depends on perception and expectation. “Mind over matter” might sound like mumbo jumbo in a medical context, but research increasingly seems to bear out that maxim. A patient who believes that her treatment will work experiences a measurably stronger placebo effect than one who is burdened with doubt. Correspondingly, the manner and bearing of the prescribing physician also plays a role. Patients receiving placebos report greater relief when they perceive their doctors as warm and confident. On some level, it seems what we seek in our doctors is a proxy for the all-powerful healing parent we remember from childhood; we want them to be gods. But amazingly, to whatever extent a doctor fulfills, or fails to fulfill, what could reasonably be categorized as a patient’s spiritual needs, it’s the body that responds.

Clinical research continues to demonstrate not only the great extent to which our minds are attuned to symbolism, but also the extent to which our bodies can express responses to stimuli more poetic than pharmacological. “Placebos are not only the archetypal sugar pills but can be anything with the power to impact on the patient’s expectations,” wrote Dr. Fabrizio Benedetti, one of the world’s foremost researchers of the subject, in a recent essay. “Placebos are made of words, symbols, rituals, meanings.” The size and color of placebo pills, for instance, have been shown to make a difference in patient outcome. Warm-colored pills (reds, oranges and yellows) make for better stimulants, whereas cool-colored pills (purples and blues) make better sleep aids. (Notably, a bizarre exception exists on that last score, in the demographic pocket of Italian men, whose unique non-responsiveness to blue sleep aids, Benedetti speculates, might be attributed to their associating the color with their national football team, the Gli Azzurri. Yes, really.) Capsules seem to work better than tablets, heaven knows why; larger pills work better than smaller ones; and sham injections outperform sugar pills, perhaps through some subliminal pain-gain equation. Even the perception of relative cost seems to make a difference. Research shows that the specter of a large price tag can increase the perceived effect of placebo pills, as though we’ve been culturally programmed to expect more bang for more bucks.

“Giving a placebo consists of essentially delivering a context without the substance,” explains Benedetti. “It is a wrapping devoid of content. Yet, the empty box itself acts subtly on the patient’s mind.” That is to say, though their basis is not chemical but symbolic, placebos are nonetheless capable of producing actual, measurable changes in the activity of the brain, “just as an active drug would do.” What fascinates me about this knowledge is the extent to which it reframes seemingly absolute concepts—the real and the bogus, the truth and the lie—in terms mystifyingly less certain. If our imaginations have the power to shape our experience at the corporeal level, well, what is a drug? Or, more to the point, what isn’t one? 

In a placebo-themed episode of Radiolab (worth a listen, by the way, if you’re interested in learning more), Dr. Daniel B. Carr, who researches pain and pain therapies at Tufts University, talks about reality as little more than a story our brains are telling us. “Scientists currently view our whole identity as something that we construct from one fraction of a second to another,” he says. “You are the unfolding of an ongoing narrative. But it’s not just a narrative in words. It’s a narrative that involves touch, color, odors. We use all those inputs to generate the next frame from the last frame.” The characters in Melissa James Gibson’s Placebo are all, in one way or another, trying to better understand—and so attempt to exercise control over—that mysterious narrative of self. Why do we want what we want? How can we be happy? Just how much of life is all in our heads?

Sarah Lunnie
Associate Literary Manager

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