“Thoughts have power; thoughts are energy. And you can make your world or break it by your own thinking”
- Susan L. Taylor (1946-), American editor, writer, and journalist
"What we think determines what happens to us, so if we want to change our lives, we need to stretch our minds."
- Wayne Dyer (1940-2015), American author
Your thoughts contribute to your successes and failures in life (to be frank, I’m going to argue they largely define these). You think things through and decide to achieve something challenging (learn to play bridge, for instance), or set some career goals (say, do a course to help position yourself for the next promotion), or resolve to sort out a family relationship (mediate Uncle Sam’s terrible fight with your mom).
But your thinking is so powerful it can also cure you of physical ailments. One of the great achievements of unraveling what thinking can do is in medicine, through the placebo effect. A placebo is an intervention (administering a substance or providing a treatment) with no effect – no therapeutic value, to use the jargon. Once you receive such an intervention it should not have any impact on you or your clinical condition.
Yet placebos can, and do. Placebos come in many forms, but frequently are admitted as inert pills in place of drugs (sugar pills), injections with no power to actually change anything (saline solutions, for example) or pretend (sham) surgery. They can alleviate symptoms, reduce pain, or make people feel better.
A 2013 study published by Finnish researchers in the New England Journal of Medicine shows the power of the placebo.
Patients in need of knee surgery (146 of them), because of a degenerative meniscal tear, were allocated to two groups. Half had real surgery, whilst the other half had sham surgery. The patients were all aware that they could receive this placebo. In the placebo group, doctors went through all the motions of the surgical procedure, timing the operation for as long as the actual surgery. They made the incision, called the assistants for the proper instruments, moved the knee in the way it would be moved and sounded the tools that would be used.
Both groups improved substantially, and at the same rate. After twelve months patients who received the placebo reported the same amount of reduced knee pain and better quality of life as those who had had the surgery. Members of both groups were as likely as each other to presume they had the sham procedure, so the results weren’t distorted because of the patients second-guessing.
In this study, patients were aware they could receive a placebo but were unaware if they had actually received it. We can go further. Other studies have shown that even when patients are aware they have been given a placebo, amazingly, it still works. If you are hearing this for the first time, that may seem nuts, but it’s true.
Say you have irritable bowel syndrome. (Many people do—about one in seven of us). You have regular gut pain, feelings of bloating, irregular bowel movements and general abdominal discomfort. What about if you were enrolled in a research trial and told you would receive a fake drug in a bottle marked “Placebo pills”? Do you think you would get better? Logic says no: it is non-functional treatment, and you know it is.
Researchers at Harvard (Ted Kaptchuk and colleagues) did just that. Two groups of people suffering from irritable bowel syndrome were compared. While one of the groups was given no treatment at all, the other got the placebo pills. Despite unambiguously knowing it was fake medicine, the latter group reported twice the symptom relief as the group who received no treatment.
Science calls this a psychobiological phenomenon and psychology talks about psychosomatic responses—all related phrases designed to try and capture what’s occurring here, but these are just fancy words. What is actually going on in the brain of the recoverer when the placebo operates? This is hard to fathom with current technologies and knowledge, but we are assembling some ideas.
In 2004, the Journal of Neuroscience published a pain reduction study that used placebo painkillers. Researchers found that the placebo triggered the part of the brain that administers a natural pain killer, dopamine. So although the brain may be being fooled into believing something is happening that’s not really true, at least to some extent it can experience an actual physical change that corresponds with the anticipated relief.
The patient plays a role as well. Individual personality, preferences and culture of the patient are all implicated. You might be prone to readily believe, or ultra receptive to strange ideas, or deep-down very skeptical. Much in fact, depends on the expectations of patients or groups and their levels of suggestibility. But perhaps surprisingly there’s regional variation. For instance, Europeans seem to respond better to a placebo pill, while Americans prefer a placebo injection.
The color of the drug matters, too. A study in the British Medical Journal reported that red, yellow and orange pills are associated with a stimulant effect, while blue and green pills tend to have a tranquillizing effect.
Placebo is not just about medical studies, either. A while back New Zealand researchers duped 148 undergraduate students into believing they were drunk. The room to which they were invited had bar staff, vodka bottles and the atmosphere of a pub. One group was told they were drinking tonic water and the other half that they were drinking vodka-and-tonic. All were actually drinking plain old tonic water. Later they were shown slides of a crime and asked about the story they were presented.
Students who were “drinking” were more impressionable than the others, were more readily swayed by misinformation and had reduced memory. The researchers had in effect shown that people could be induced to believe that they were affected by alcohol and that their memories could be readily distorted when in actuality they were as stone cold sober as everyone else in the room. A similar demonstration by Princeton students can be viewed on YouTube: http://www.youtube.com/watch?feature=player_embedded&v=rFCdhr6l3ls
All in all, the placebo effect is a complex phenomenon at the intersection of several factors. The type of intervention chosen, the behavioral responses, the activities going on in the brain, the patients’ characteristics and the cultural expectations of the group the patients belong to, all play a role. Boiled down, we are not able to map all the effects in the brain, but we can point to a tangible relationship of significance and strength between the mind and the body.
For some of us, this might be worrisome. We know of course, that thoughts and motivations develop in the mind mostly without you—the agent “in charge” of them—doing anything consciously to decide how they might affect you. That’s what seems to be happening even when you “know” in your heart you’ve been offered a placebo, and your mind and body respond as if the intervention is a real one. Mind and body are being triggered or manipulated by outside forces without you understanding what’s going on.
Some of us might not like not being in control. But in the end, it’s a small price to pay for contributions to a cure or alleviation of symptoms, free of charge.
Can you use this to your advantage? One way may be to take some vitamin pills. If you have a balanced diet, they are most likely of no additional benefit nutritionally. But they may actually help if you believe in them, either consciously or unconsciously.
For that matter, crazily enough, you could even take tablets in a bottle marked “Placebo tablets” which are in effect sugar pills, and you might do better than without them. I’m not recommending that, and if you feel unwell or any symptoms, go see your doctor for proper advice and care.
But the power of placebos, and your mind, can’t be denied. Perhaps Shakespeare’s Hamlet can have the final thought: “… there is nothing either good or bad, but thinking makes it so.”
Further reading:
Assefi, Seema L, Garry, Maryanne (2003). Absolut memory distortions: alcohol placebos influence the misinformation. Psychological Science 14 (1); 77-80.
De Craen, Anton JM, Roos, Pieter J, De Vries, A Leonard, Kleijnen, Jos (1996). Effect of colour of drugs: systematic review of perceived effect of drugs and of their effectiveness. British Medical Journal 313 (7072); 1624-1626.
Kaptchuk, Ted, Friedlander, Elizabeth, Kelley, John, Sanchez, Norma M, Kokkotou, Efi, Singer, Joyce, Kowalczykowski, Magda, Miller, Franklin, Kirsch, Irving, Lembo, Anthony J (2010). Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS ONE 5 (12); e15591.
Sihvonen, Raine, Paavola, Mika, Malmivaara, Antti, Itälä, Ari, Joukainen, Antti, Nurmi, Heikki, Kalske, Juha, Järvinen, Teppo, for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group (2013). Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. New England Journal of Medicine 369; 2515-2524.
Zubieta, Jon-Kar, Bueller, Joshua A, Jackson, Lisa R, Scott, David J, Xu, Yanjun, Koeppe, Robert A, Nichols, Thomas E and Stohler, Christian S (2005). Placebo effects mediated by endogenous opioid activity on μ-opioid receptors. Journal of Neuroscience 25 (34); 7754-7762.