The placebo effect has been observed for centuries, but researchers only recently began to study it more closely. In the past 50 years, there has been an increase in the placebo effect.
The word “placebo” (pluh-SEE-bo) in Latin means “I shall please.” And its cousin, “nocebo” (no-SEE-bo) means “I shall harm.”
While the placebo effect is typically associated with positive outcomes, it can also have negative consequences. For example, if a person believes they are receiving a dangerous or toxic substance, they may experience adverse side effects. This is called the nocebo effect, as I illustrated in my post, PSYCHOSOMATIC: A Picture Made Me Sneeze.
In medical research, one group of patients gets the medicine (M) that is being tested to see if it works to treat some conditions. And another similar group of patients gets an identical looking pill (P) that does not contain any of the medicine (a sugar pill or placebo). Although patients give permission for all this, nobody knows who is getting what, not the patients or the doctors. Of course, somebody has the reveal code in this so-called “double blind” setup.
All is revealed after the study is completed. If the people getting M have better results than the people taking P, then that is a sign that the medicine M really works: it is better than placebo. Thus placebo gets a reputation in the general public for being something fake or false or not valid or valuable.
But the above leaves out something, namely the “placebo effect”. A lot of improvement usually occurs in the people taking P. They improve on average by about 30% or more. They may be a lot better than they started. Of course, the M pill also has this 30% placebo effect, so it has to work really hard to be any better than the placebo. And sometimes it isn’t any better. To get a new medicine approved, a drug company must show that M is better than P in at least 2 different trials.
The above simplified story leaves out a lot but is a prelude to the question:
How and why does the P pill placebo actually produce its very positive effects?
We may say, “It’s all in the head,” but what are the details of what goes on in the head or brain to actually produce improvement in some disease? The details of how the trillions of brain synapses and networks accomplish the placebo effect haven’t yet been worked out.
It seems that the brain wants to predict what will happen next so that we will be prepared. Swallowing a pill given by a knowledgeable, trusted helping person produces a positive expectation or prediction. The rest of the body follows the lead. Is this best described as conditioning (previous experience)? Or persuasion or psychosomatic factors? Or the result of human connections and cooperation?
Whatever you call it, the placebo effect seems to be present in most psychiatric treatment situations- whether through a pill, an injection, or psychotherapy. Prior to late 20th century medical developments, almost all healing was primarily the placebo effect. The placebo effect is extremely helpful. We should try and maximize it, rather than devalue or stigmatize it. It is part of being human, and we might as well make the most of it.