The Darn Placebo Effect

Human suffering can be reduced considerably but temporarily by the initiation of any intervention that the sufferer believes in. This is the ‘placebo’ effect. This is why the tooth immediately hurts a lot less as soon as the dentist appointment is made and one hangs up the phone. I have mentioned before how the placebo effect interferes with the study of Reich and Lowen therapy. I now come to see how it also interferes with the delivery of it.

There are two problems with the placebo effect: 1) it decays over time, and 2) it cannot work synergistically with growth strategies to relieve suffering.

There are two seductions (or assets, depending on one’s point of view) of the placebo effect: 1) It is immediate (unlike growth) and, 2) it is considerably stronger in effect initially than true growth effects.

The placebo effect is based on dissociation. Real growth is based on association (or re-association) In research, if another dissociative method (say a drug) is employed as the experimental condition, then the effects of that and the placebo may be additive. When the control group (which only has the placebo effect) is compared, the placebo effect subtracts out and demonstrates a treatment effect. Associative effects, however, are not additive to the placebo effect, in fact they may undermine it. Therefore, in testing something that leads to growth, when the experimental and the control group are compared, the shared placebo effect is like tall grass that hides what is happening on the surface, and no treatment effect is demonstrated. This is particularly true since studies tend to last less than 6 months, and the effects of growth in this arena usually take several years to manifest. This why effective ‘alternative’ treatments cannot be distinguished from ineffective alternative treatments by present day random-controlled trials—the subtle balancing and regulating effects (or their absence) are all hidden under the tall grass of the placebo effect.

In emotional well-being, the placebo effect is synonymous with what Alexander Lowen described as elation or illusion. As he often pointed out in his writings, the therapist’s ‘window of opportunity’ for change is often to prevent the client from ‘climbing back onto’ the illusion (and the placebo effect,) after a collapse.

Placebo effects are in fact part of healthy human adaptation for causes of suffering that 1) will pass on their own, or 2) cannot be addressed immediately but which will be effectively addressed in the near future (such as the tooth example above.) Where the cause of suffering is persistent, placebo effects support an increasing dissociation that covers a slowly depleting work and pleasure function.

Placebo effects have to be renewed periodically, by finding some ‘great new thing.’  This leads to a very disorderly approach to health where the sufferer travels from one type of practitioner to another, never really committing to the practices. The immediate positive placebo effects are mistaken for the treatment effects, but as the novelty wears off, the practices seem to stop working, and something new becomes overwhelmingly attractive. This is placebo abuse. In my practice as a therapist, it greatly interferes with forming a working relationship because new clients compare the subtle differences I am pointing out to the strong if temporary morale-boosting available through starting ‘something new.’

Michael Samsel

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5 Responses to The Darn Placebo Effect

  1. Jangali says:

    I see where you are coming from as regards psychotherapy, but it perhaps should be added that what you are saying does not appear to apply to medicine, where the power of the placebo effect really needs to be explained. This has been pointed out by Lissa Rankin in “Mind over Medicine”.

  2. mjsamsel says:

    If the mind and the body are the same, then I would think that the goal of health for psychotherapy and medicine would be the same. I would distinguish between innate healing capacities (which proceed unconsciously) and the placebo effect (which requires conscious recognition of the intervention’s intent by the ‘patient’) Innate healing and placebo effect can be working at the same time, they are not too antagonistic in the short run.

    The placebo effect is dissociative. If an effective solution is in the near-term offing or innate healing will just take care of it, then some dissociation as a bridge to the time that occurs can be beneficial. Denial is another dissociative phenomenon that can be useful also. But a life time of dissociation does not lead to health but rather the illusion of it. The Reich and Lowen tradition is based on re-association and combats excessive dissociation.

    As for mind over matter, such as conscious will and intentions healing the body, I think that is largely a ego delusion. The Reich and Lowen tradition is based on the opposite in fact, it is matter over mind. The ego needs to get out of the way, not participate in the healing, unless it is in a mature way using self-determination to bring about in the lifestyle conditions of healing

  3. Mauricio says:

    placebo abuse, lol. You surely at some point were on your way to become a writer. I actually “found” Wilhelm Reich through William S. Burroughs as he mentioned him so often in his books. But that aside, I guess placebo abuse is just as good as any other substance abuse. And as justified.
    There’s nothing wrong with it in my opinion. It’s a way of dealing with pain. not everybody is in a condition that can be fixed. We just “know” if it can be achieved or not. So the lucky ones can actually work on our conditions and see things improve and finally even become “restored”. The one’s that are unrepairably damaged have to find means to somehow soothe their way out. That’s why the old story “drugs kill you” is just propaganda. truth is: the respective people know they are being killed, and then use the drugs to sooth it. and why shouldn’t they? it makes perfect sense. It helps them. It reduces their pain on their inevitable way out.
    Only if we feel that our conditions can be fixed, it makes sense to compare growth strategies. for the rest, they should be allowed use their respective “painkillers”. Of course a whole lot of people probably fall in between: they just don’t “feel it” if their condition can be fixed or not. For them the best strategy could be: to find that out. That’s what a shaman’s job would be. But that’s of course an unrealistic approach in 2013.
    My bottom line: Not everything that’s broken can be fixed. And if it cannot be fixed, we shouldn’t give it a hard time.

  4. mjsamsel says:

    I certainly agree that if a person is close to the end of life, or close to the time when the problem will end by itself, then the placebo effect is the most economical and sensible solution.

    One problem is, the placebo effect is not durable. As one illusion crumbles another must be clung to, thwarting the possible creative direction of a life. Also as dissociation, if persisted in, it leads to mysterious problems in functioning that no longer can be consciously connected to the original injury.

    My experience with chronic opiate use is that those individuals develop more and more pain overtime even with escalating doses because of up-regulation and sensitization.

    Michael Samsel

  5. Mauricio says:

    Your body of work is amazing. It’s complete. It touches all relevant funtions of the mind and body. I was really impressed when I found your site, and still am. You found shortcuts through the physiological labyrinth that can help so many people out.

    To achieve this you probably needed the strong conviction that any condition can be addressed and fixed. My personal experience tells me otherwise. That’s what i wanted to say.

    Good luck and thanks for putting your energy into human physiology. I personally benefitted from it.

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