The Placebo Effect

Professional evaluations of the efficacy of psychotherapy vary; few of the in-depth studies have pleased the psychotherapists. One major 1971 study concluded that “while some therapies produce positive client change, the majority either effect no change or lead to client deterioration.” Some recent studies indicate that in cases of neuroses and depression, almost any type of psychotherapy is better than none at all. This could well be due to the well-known “placebo effect.” The word is Latin, and means “I shall please.” It is defined as “a process or substance, of little or no known worth in itself, which is applied to a problem in order to produce an encouraging or ‘pleasing’ result.” A placebo effect takes place when a patient is exposed to a satisfactory “bedside manner” and/or when medication, manipulation, or other means (any or all of which may be entirely ineffectual in themselves, but are seen by the recipient as unique, special, or advanced) are applied to the problem. Such effects may also take place when the patient feels in control of his situation, or when he has surrendered that control to another in whom he has confidence. This is a simple case of what is known as “transference.” Encouragement leads to hope, and hope to better self-care and self-interest. Many types of chronic pain, because of the emotional condition of the sufferer, are associated with chronic anxiety. An efficient and caring physician, knowledgeable about the placebo effect, can largely alleviate that anxiety and thus improve at least the symptoms of certain ailments.

The Endorphin Effect

Without question, a positive attitude provides a somewhat better environment for healing, if for no other reason than that the patient nourishes himself better and is more willing to follow prescribed procedures. But it may go much further than that. Reflecting what is now a very questionable idea about the relationship of attitude and susceptibility to cancer, evangelist Oral Roberts declared in 1949 that the “greatest protection from cancer ... is to live a life free of tensions, fears, frustrations.” It appears that the Reverend Roberts does not follow his own sensible advice. No one, in recent years, has publicly exhibited more fear, frustration, and worry than this man. To hear him tell it, he is assailed by Satan, threatened by God, reviled in the press, and living under threat of bankruptcy. And he is constantly before us on television wringing his hands in despair over his unhappy circumstances. Leo Abood, a neurochemist at the University of Rochester, New York, Medical School, says he believes that it may be possible for external as well as internal factors to bring about the production of endorphins—organic chemicals that produce effects on the brain similar to opiates—in the body. If this is true, some of the faith-healers’ results could be due to certain neurological and/or biochemical effects of endorphin release, which, regardless of whether Abood’s conjectures are correct, is known to take place under stress or in highly emotional environments. Abood quotes research that showed almost one-third of more than 1,000 cases of simple illnesses (colds, angina, headaches, seasickness, anxiety, and post-operative pain) responded well to placebos. How long these effects will last, and whether such symptomatic relief is an unmixed blessing to the afflicted, however, are other questions that must be answered. Even Oliver Wendell Holmes had an opinion on this matterHealing is a living process, greatly under the influence of mental conditions. It has often been found that the same wound found received in battle will do well in the soldiers that have beaten, that would prove fatal in those that have just been defeated.

I would hope Holmes considered the possibility that a defeated army might have less effective medical treatment available than that afforded the winning side.