Expectation is the root of all heartache, according to Shakespeare, but when it comes to placebos used to treat headaches and toothaches – as well as various other aches, for that matter – studies show that expectation is the root of all success. That is, a patient’s expectation that a placebo will work, increases the chance it actually will.
The first evidence of this mind-body phenomenon happened quite by accident during WWII, when an army medic named Henry K.Beecher ran out of morphine. Concerned the injured patients would panic if he told them the truth, Beecher secretly began giving them a saline solution, but continued to tell them it was morphine. Surprisingly, it worked for 40 percent of them.
It seemed, and numerous studies later proved, that a combination of factors influenced the saline’s success. These included verbal suggestion, observational cues and patient conditioning. Beecher told patients he was administering morphine (verbal suggestion), they watched him do so (visual cue) and based on their prior conditioning – the process by which we learn that one thing naturally results from another – patients recalled experiences when actual morphine had successfully diminished or eliminated their pain and consequently expected the same result when they received the saline solution. This expectation of relief, then activated the injured soldiers’ brains to increase production of dopamine – the chemical linked to reward and pleasure and pain relief in the brain.
When people believe a placebo is actually a real drug – either because they’ve been told so by a credible source or because it appears so to their own eyes – their brains begin to produce more dopamine, a chemical that has a biological effect similar to what happens when a hungry person begins eating or his thirst is quenched by drinking.
Conversely, researchers found that placebos and legitimate drugs alike were less effective when administered to patients with mild to moderate Alzheimer’s disease possibly because they were unable to recall prior successful experiences with either and were therefore unable to produce a conditioned expectation – the key component required to produce a positive placebo effect. Moreover, the same patients also required higher doses of legitimate pain medications, indicating the possibility that positive expectation also influences outcomes with actual drugs.
In another study, mentioned in David R. Hamilton’s book, How Your Mind Can Heal Your Body, Harvard psychologist Ellen Langer aimed to test how individual perception of old age affected a person’s health and height, as well as memory. The 1989 study consisted of a group of male seniors all over 70 who participated in a retreat at a monastery recreated to mirror the year 1959. Subjects were measured at the outset for mental acuity, height, weight, finger length, strength and eyesight, as well as several other health-related metrics. Subjects were then instructed to behave as if it were 1959 and were even given a list of historically accurate current events topics to discuss. Additionally, they wore period clothing and played music and watched TV programs specific to the 1950s. After a week in this environment, researchers then measured participants again and compared the data to the initial measurements taken.
Results were dramatic across the board. They were stronger and more flexible, had lost weight and gained height. Things like posture, eyesight, hearing and even mental acuity had all improved. Additionally, they were more agile and just seemed physiologically younger – some by as much as 25 years.
While the underlying reasons surrounding the placebo effect are still fairly mysterious, neuroscientists have begun to discover significant clues. For instance, scientists previously believed the effect was only psychological – that relief was all in a patient’s mind. They now know, however, that it’s physiological. Placebos, when administered in a manner that combines the factors necessary to produce expectation, actually produce the same changes as conventional treatments in the brain and body. They, like the legitimate drugs they surreptitiously replace, stimulate the brain to release powerful chemicals that reduce or eliminate symptoms of pain and disease.
Take a moment to let the possible implications of that sink in. Could it be, for example, that all along it has been our own brains – not drugs or given procedures – that heal our bodies and shield us from pain? That our mere ability to expect our bodies to heal can actually cause them to do so? Furthermore, if the mind can heal disorder and disease, might it also be capable of creating it? Possibly. But given the wide gaps in our understanding of the effect, such claims are by their nature, controversial. And some question the ethics of treating real maladies with sugar pills and saline. To this end, Harvard professor of medicine, Ted Kaptchuk headed a 2010 open label placebo study in which 80 patients with irritable bowel syndrome were split into two groups: one group was given no treatment, while patients in the other were given a placebo with full knowledge that the pills were inert. To his surprise, patients who took the placebo reported relief of symptoms at twice the rate of those who were given no treatment, pointing toward the possibility that the mere ritual involved in treating illness can trigger the brain to produce chemicals necessary for healing.
Another open placebo study involving cancer survivors living with pain and fatigue is due this summer with Kaptchuk onboard to supervise, but until science better understands and can pinpoint the mechanism by which placebos affect the body’s ability to produce healing chemical reactions, we won’t know for certain.