Page 66 - Time Special Edition Alternative Medicine (January 2020)

ALTERNATIVE MEDICINE MINDS MATTER

but “it is also a melting pot of neuroscientific con-
cepts and ideas” that raises questions about psychol-
ogy and physiology, not to mention challenges to
current medical practices.
Placebos (Latin for “I shall please”) are most
commonly defined in terms of what they lack: ac-
tive ingredients. But that is exactly the wrong way
to look at them. “Placebos are not inert substances,”

wrote Benedetti and his colleagues in a recent paper.
“They are made of words and rituals, symbols and
meanings, and all these elements are active in shap-
ing the patient’s brain.” And although the neurosci-
ence is new, the knowledge that the mind can fool
the body into feeling better has been a go-to tactic
of healers for millennia.

What has changed is our modern need to put a
label on that process, says Jon Tilburt of the Mayo
Clinic. Doctors are trained to want cause-and-
effect explanations. They want to be able to define
the mechanisms of improvement, to see “some-
thing” rather than “nothing.” But most patients,
says Tilburt, whose research focuses on relation-
ships and values in medicine, “are pragmatists, not
ideologues. They want to feel better, and they don’t

much care how that is achieved.” Placebos represent
one of the paths by which patients have always come
to feel better. Call that path what you will, says Til-
burt, “but it is definitely not nothing.”

The neuroscience is new,
How do placebos work?

neuroscientists, on the other hand, are but the knowledge that
eager to dive into the complexities of those path- the mind can fool the
ways. The key to understanding the mysteries of
place bos, says Benedetti, author of The Patient’s body into feeling better
Brain, is that there is not one effect, but many. And has been a go-to tactic of
to understand that, it’s first important to recognize
what placebos are not. Some people get better by healers for millennia.

themselves. Some seem to improve because they ini-
tially appeared to be sicker than they really were.

And sometimes both patients and doctors kid them-
selves into seeing improvement when there isn’t any. survival value in that.” Healing value too. Expecta-
These are not placebo effects. Real placebo effects tions can activate the same neurochemical pathways
are genuine psychobiological phenomena in the triggered by our pursuit of food, water and sex. They
brain that produce measurable changes in the body. can also drive the body’s ebb and flow of stress hor-
Consider the clout of expectation. What we expe- mones. In short, expectations produce real, physi-
rience depends partly on what we expect to experi- ological change, often at the speed of thought. And

ence, consciously or not. “Expectations,” says psy- it doesn’t matter that those expectations might be
chologist Jane Metrik of Brown University’s Center activated by a sugar pill. When a placebo works, it
for Alcohol and Addiction Studies, “help us to rec- doesn’t mean a patient’s symptoms (whether they
ognize and classify all sorts of stimuli. There is great are pain, depression or anxiety) aren’t real. It just

62