A recent piece of interesting research from Harvard(1) seems to show that the placebo effect does not depend on the patient believing that they are having a real, active treatment; even if they know they are receiving a placebo treatment, they may still benefit. This is interesting because, like most people, I had tended to assume that the placebo effect arises because we think we are being given an active treatment, and this belief somehow initiates a healing response – instead, even if we know we are just getting a placebo, we still show improvement!. One of the researchers suggests that what is important is what is called medical ritual.
The term medical ritual brings to my mind the ancient Greek healing centre at Epidauros, dedicated to the Greek god of healing, Asclepius. Here, apparently, the sick would be visited by Asclepius in their dreams and shown the way back to health. No doubt it was a highly ritualised process, a ritual which would probably include the journey to Epidauros, no small matter in those days of course; I think snakes were involved in some way also! With our modern sophistication we may dismiss such treatment as superstitious twaddle, but the research mentioned should give us pause with that.
Because, there is of course a highly ritualised element to most forms of medical treatment. If you go to see your GP, you wait in a special room with a few other nervous people, until you are admitted to the inner sanctum where the doctor is. The doctor has been initiated into the art of healing, and has a special title (‘Doctor’) and probably a lot of strange letters after his name as well, all of which is designed to impress you with his special powers. No wonder you feel a bit over-awed in his presence. You have a short interaction with the doctor, who then writes some strange and long words, words which he understands but which don’t mean very much to you, on a bit of paper which you take away with you and present to someone else in a place called a ‘pharmacy’. You then get given a special bottle of mysterious small circular things which you have to swallow. In some strange way which you don’t understand, this makes you better. (Let’s ignore the side effects for the time being!) It is all very ritualised. And, if the research mentioned above is to be believed, it might not matter too much what is actually in the little pills.
Therefore, we should not be too dismissive of those ancient Greeks, maybe they did get better. We should in fact be respectful of the importance of ritual in human life. When we are ill, especially if we are seriously ill, the healing process is in fact a ritual we need to undertake. Just as the ancient Greeks needed to journey to Epidauros and undergo their ritual dreaming treatment, we need to be doing something equivalent.
This reminds me that the clinic I work in is not just any old building. It is a place of healing, similar in its own modest way, to Epidauros. Even just coming through the door, the healing process has begun. In fact this reminds me of something new patients often say, that their symptoms have been a bit less troublesome on the day or two before they first came for treatment. Occasionally so much is this the case that they may feel a bit of a fraud, as if there is not anything wrong with them really anyway; but it may be rather that they have already started on their journey back to health by ringing up and making the appointment in the first place.
(1) “Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS One, 2010 Dec 22:5(12):e15591”