Phenomenology: The Placebo Effect

From where do placebo powers start and end? As peculiar as it might sound its effectiveness can be extended to cases of severe, enervating pain where the causative agent is anatomical in nature and acquired through injury. We know for a fact that pain deriving from structural defects to bone and cartilage has nothing at all to do with the mental faculties of imagination or autosuggestion, and that no amount of wishful thinking can alleviate the nagging discomfort, or can it? This is exactly what health practitioner Dr. Bruce Moseley of the Baylor School of Medicine wished to set straight with an experimental study about the role of belief in postoperative recovery. Moseley divided his subjects, all of which were suffering from arthritic knee pain, into three test groups. The first two were treatment-based, and received one of two standard operating procedures for pain relief–damaged cartilage was surgically cleaved from the problem area in some patients while others had material at the root of the agonizing inflammation flushed out. The third category were led to believe that they had been operated on when in reality Moseley had simply gone through the motions of sedating, incising, and knee-washing without as much as modifying a hair follicle. The postoperative agenda for all three groups involved an exercise regimen intended to strengthen the knee joint and augment kinematic recovery. In what might be described as a temporary lapse into Mad Hatter mode, it was found that the treatment efficacy was tantamount for all three groups. Surgery had been effective in alleviating pain, but in a direct transcendence of all logic the placebo had been equally operative in doing the same. When asked about this unprecedented development, Moseley admitted that, “My skill as a surgeon had no benefit on these patients. The entire benefit of surgery for osteoarthritis of the knee was the placebo effect.”[1] With the commodities of cost-efficiency, timeliness, and stress-free manner built into its design, the scalpel of the mind trumps the metallic variant used in surgery by a mile.          

Let’s move along now to the psychopathology of schizophrenia, a word literally meaning, “Split mind.” Recently, the auditory hallucinations that form a core symptom of the condition have achieved scientific coherence through the hemispheric model of psychosis. This particular model pairs primary (brainstem and limbic, mostly autonomous and unconscious) with the right hemisphere and secondary (cortical, conscious) processes with the left hemisphere, and then goes on to reason that the ego-dystonic and intrusive hallucinations frequently reported by schizophrenics are explainable as aberrant intrusions of information held by the right hemisphere into conscious awareness. Put differently the critical and reprimanding ‘voices’ heard by psychotics are simply emotional aspects of one’s own self–desires, beliefs, appraisals, and what not–which remain unconscious in the rest of us, thanks to our dominant left hemispheric interpreters which either suppress, inhibit, or extirpate them from our inner worlds.

Could psychotics somehow program themselves or alternatively allow themselves to be programmed so that they stop hearing voices? In the early 1970s a clinical psychologist by the name of Arthur H. Weingaertner wished to ascertain exactly that–if the hallucinatory reality of a schizophrenic could somehow be conditioned. He divided forty-five male patients up into three groups. The first two were given unusual gadgets with switches that could be fitted around the waist with a belt and advised to press the switch when they could feel the onset of a psychotic episode as to administer an electric shock. Those familiar with the humble beginnings of behaviourism should be getting explicit flashes of Ivan Pavlov with his salivating dogs about now! Incidentally the electric shock wasn’t an experimental feature of the second group; their gadgets were inoperative. The third group were alleviated of the burden of carrying around contraptions but were obliged to complete an array of interviews and surveys. All patients, contraption-wearers or not, were led to believe that their voices would decline in frequency.

Should Pavlov himself have been allowed to hypothesize before Weingaertner collated his results, he would have confidently deduced improvements in only the first group receiving the negative stimulus, the jolt. But for all his faith in the scientific spirit of predicting outcomes based on past research, he would have been wrong. When Weingaertner published this study in the Journal of Consulting and Clinical Psychology under the heading of, “Self-administered Aversive Stimulation with Hallucinating Hospitalized Schizophrenics”[2], he ceded that there had been significant improvements in all three experimental groups. Some stopped hearing voices completely. This phenomenon speaks volumes for the power of suggestion, especially when it comes from an individual perceived by the patients as a commanding authority, a God-figure if you like. It also speaks volumes for psychoneural evolution; standing a developmental tier above the primary consciousness[3] of mammals, the higher-order consciousness[4] of human beings can transcend in-built mechanisms of conditioning reflexes that impound the former. Being in a position to exert some level of control over the biochemical matter within our own bodies means we are in possession of a much greater freedom than they are.  

Another interesting observation regarding the placebo relates to the unconscious. When the patient’s unconscious remains a tabula rasa, clear of any preconceptions about the collective imperative regarding the nature of his or her illness, the projective worth of medical intervention is substantially amplified. The success rate is amplified even further when the unconscious minds of the two protagonists, the healer and the one wishing to be healed, are in fundamental harmony with one another. Testifying to the empirical validity of these statements is an exceptional case of a teenage boy suffering from fish-skin disease, a grotesque condition whereby black warts and horny skin are omnipresent on the body.  After successive skin grafts had failed to yield improvements to the horny skin texture, the treating physician referred him to an anaesthetist, a certain Dr. Albert A. Mason in hope that hypnotherapy might help where surgery had failed. Mason had successfully cured warts and other skin conditions before, so there was no reason to believe that this specific case should be any different. After placing the young chap in a hypnotic trance, he suggested that the leathery skin on his left arm would drop off in a few days, which it did. Mason’s triumph was met with an incredulous stare on the part of the surgeon, who had recently discovered that the boy was suffering from a rare genetic disorder called ichthyosiform erythrodermia. If the diagnosis was correct, and sources suggest it was, then any treatment method was hopeless. How could the horny coat resembling an arachnid’s exoskeleton soften and fall off to reveal a layer of soft, pink-coloured skin beneath when the oil-forming glands responsible for such were absent? It was supposed to be impossible, and yet Mason succeeded in dematerializing most of the morbid warts and improving the boy’s physical appearance. Being able to venture out in public worked wonders on the boy’s mentality and self-image, and he even scored a job as an electrician’s assistant! The hypnotic cure was nothing short of a miracle.

Published in the British Medical Journal in 1952, Mason’s results instigated a medical furore. Individuals suffering from fish-skin disease, something long decreed by traditional medicine to be both rare and lethal, suddenly found themselves gasping at the straws of a visible lifeline again. They began turning up at his doorstep, demanding that he administer treatment. At this stage Mason was shrewd enough to realize that ceding to their requests was a formidable way of maintaining professional integrity and virtue, and he swiftly set about trying to program suggestions into his patients’ minds through hypnotic induction. It soon became apparent that former success would not be replicated. Whereas previous sessions had been carried out in a highly spirited and undaunted frame of mind, Mason now found that knowledge of the official diagnosis and prognosis was pinching him out from the realm of eternal viabilities and confining him to the sharp cubic metres of fatalism, worthlessness, and doubt. He understood the deflating qualities of doubt in the context of belief–that it was like a mental poison, an acidic agent at the root of these successive failures; doubt was diminishing the hypnotic trance, it was projecting into the patients’ unconscious minds and then manifesting in the guise of hyperactivity and anxiety, and above all, it was marring his overnight reputation as a miracle worker. Mason later told the Discovery Health Channel that the optimistic attitude he’d maintained out in public since the publication of the study was a complete farce; the collective imperative created by the medical establishment had simply quashed all his faith that a healing response was achievable. Doubt had truly ruined everything.

The most tangible evidence we have supporting the seminal role of collective unconscious suggestions in the mobilization of the placebo effect is hypnosis, and specifically its successive transformations in complying with the cultural egregore (thought form) of a particular time and place. Anybody who has studied this protean state of consciousness in some depth knows that epiphenomena of induction will always mirror the inductee’s preconceptions and the inductor’s expectations. Its most striking feature is the paralogical submission to a reality facilitated verbally by an external narrator, a reality defined by declarations about people, the world, and its processes taken at face value.  If we were to grasp Franz Anton Mesmer’s early theory of animal magnetism from this vantage point, it would seem his tremendous success rate with healing all types of organic conditions had more to do with unwavering trust in the process rather than artificially driven alterations in magnetic tides between people. In the early nineteenth century, a time when hypnosis came to be viewed as a voguish tool psychiatrists, parapsychologists, and philosophers used to explore a subliminal co-consciousness or self, individuals would flit out from lucid trances wherein they had answered questions and followed commands complaining of psychogenic amnesia. The newfound tendency to forget everything in the trance state accorded with what was then believed to be true about dissociative systems of functioning and switching between multiple nuclei of consciousness. Later, when the yoke between hypnosis and healing had been firmly established, trances suddenly became intuitive spaces offering up diagnostic information about one’s medical condition. From what we can see the hypnotic always reflected the expectations and biases of her hypnotist.  

By the mid-1850s the bizarre discipline of phrenology began to gain traction in the scientific universe. Phrenology was a localizationist and encephalic model seeking to inferentially localize some twenty-seven mental functions with brain anatomy by assigning them to specific regions on the outer surface of the skull. During this time pressure administered to an area of a hypnotic’s scalp would spur the exhibition of qualities and behaviours in congruence with its phrenological association. For example, if a hypnotist caressed the posterior region of the skull connected to destructiveness, the hypnotized individual might scurry around the room in a frenzy, breaking and tearing things. Then again the subsequent hybridization of Mesmerism and phrenology between 1820 and 1850 forged hypnotic epiphenomena of a different sort–the positions of mental capacities, perceptions, movements, and anything that had hitherto been attributed to skull conformations by phrenology could be reversed during a hypnotic trance by fastening magnets to either side of the body. As irrational, ludicrous, and incredulous as many of these epiphenomena sound, they actually came to pass. Why? Simply because the subjects came to believe that they were engendered by hypnosis and paradigmatic of hypnosis.

Something rarely mentioned by the holistic school is the remarkable competence with which the placebo effect facilitates spontaneous remission when it is complemented with the expulsion of repressed contents from the unconscious. Some of the finest examples of this healing mechanism are provided by transpersonal therapist Arnold Mindell in his wonderful book, Working with the Dreaming Body (2002). One fascinating case involves the hopeless condition of a male patient in the final stages of stomach cancer. Trapped in an altering cycle of excruciating pain and trance-like lethargy, Mindell affirms that the incapacitated man would pay little attention to anything save for his own deplorable state. When the pain emanating from the stomach tumour dampened as to allow for speech, the man readily confessed details of a prophetic dream seen immediately before his hospitalization about an incurable disease with an antidote that resembled a bomb. Employing a process-oriented approach whereby psychic and somatic phenomena combined are in effect concealed self-directives coming from a transpersonal source of wisdom, Mindell correctly interprets the bomb as a potent symbol of personal vice, an inability to articulate the emotional and sentimental self. “My problem,” he confesses to Mindell, “is that I’ve never expressed myself sufficiently, and when I do, it’s never enough.”[5]

Repressed for an indefinite period the patient’s psyche was left with no other avenue but to shuttle the proliferating discontent to conscious awareness through a dialectical opposition between psychic and somatic channels. The first manifested as the ticking time-bomb symbol in the dream, the second as a cancerous tumour with its trail of harrowing symptoms. You see, bomb and tumour were one–if there is any truth in to-down causation then disabling the bomb would alleviate most, if not all, the agonizing symptoms. And what better way to unburden the patient of the bomb’s hold on his life than by exploding it, right? Through sense perception of the pain, or proprioception if you like, Mindell urged the patient to amplify his symptoms in any way he could and thought appropriate. The verbal paroxysms erupted from within him in succession like seismic effusions of geothermal stress; he cried, laughed hysterically, howled, and shrieked at the top of his lungs without as much as a verbal or tactile cue. His revelation was evocative and meaningful, eliciting positive immunological responses that added some two to three years to his life. It appears that this particular man had to relish and explore the wisdom of this newfound state, the ability to express oneself freely, before permission to abscond the physical world could be bestowed.

For me the case that remains deeply etched in heart and mind involves a young girl suffering from a back tumour. According to Mindell, multiple surgical interventions aimed at clearing out the cancerous growths were unsuccessful and it seemed almost certain the girl would die. With the case relegated to the hopeless or ‘too challenging’ basket, the treating GP saw no harm in having a clinical psychotherapist step in and try his hand at eliciting some kind of sanguine response in what was evidently an overly despondent and depressed child. After the therapist succeeds in gaining her trust, the child opens up with a dramatic narration of an ominous dream in which her small hands relinquish their hold on the security fence guarding her lithe body from a deathly plunge into a deep lake. Then comes the expression of an unconscious wish; she prostrates herself on the floor, spreading her arms out to creatively simulate the act of flying. Mindell expedites her inner process by engaging in the fantasy play with appropriate dramatizations able to reduce even the most cold-hearted and detached of sentient observers to tears. Together they soar into the azure blue of the heavens, weave their way through a bulbous army of cotton-textured clouds, and take turns ascending into the highest striations of the atmosphere, close to outer space. Before long she enunciates the earnest desire to explore the greater cosmos: “I’m going away to another world, a beautiful world where there are strange planets.”[6]

Somewhat perturbed by the implications of this symbolic admission, Mindell assures her that the decision is solely hers to make: she may choose to fly away and explore the mystical dominions of space, or she may choose to descend and rejoin the other earthlings in the only world she knows. Initially she chooses the first, but subsequent cogitation of the blissful, nurturing, and empathic bond she’d just forged with an authoritative paternal figure casts a serious element of doubt in her mind. Now there was a social synapse on the horizon able to tap into the levitational wonders of altruistic and unconditional love, connectivity, and security where previously there had been none, now there was a reason to survive. The inherent fear that comes with the realization that these miracles of human relationship may never be savoured again was a decisive factor in bringing her back down to earth in both the symbolical and literal sense. “I’ll come down for a while just to be with you,” she tells Mindell.[7] By soliciting amplification of an inner process that transmuted from the kinaesthetic, to the visual, and finally to the proprioceptive mode of experience, Mindell was able to illuminate the formative and salvific power of loving human relationships, that fundamental key to a protracted meaningful existence which, for one reason or another, had been markedly absent from the girl’s life. The psychospiritual revelation of instant freedom, the idea that she could operate freely and independently in an empathic world, reversed her general disposition and drastically altered the biochemical mechanisms responsible for the back tumour. Slowly but surely the terminal illness abated, leaving the medical doctors flabbergasted as to how such an awe-inspiring case of spontaneous remission could have ever evolved from such a poor prognosis.

From the abovementioned it becomes clear that in many instances, certain external elements must accumulate in the immediate environment and present themselves in some configuration before the placebo effect can run its natural course. Just as water molecules and light must be present for life to evolve, so too must belief systems be buttressed by cognitive functioning in aggregates along with continued internal adjustments to the nature of external relations if they are to yield cathartical and transformative effects on our psyche-somas. Practitioners of traditional medicine bypass the placebo in treating their patients because they still dogmatically perceive a mind-body split in a mechanical universe where organisms are mutually exclusive biological systems, virtually ignoring the alchemical space formed by everyday human synergies that makes possible dynamic change on every conceivable ontology–spiritual, cognitive, behavioural, biological, chemical, physical, and so forth. Lacking this key insight into the monumental importance of human interconnectivity and interactions, they will place all their faith in abstract, methodical solutions that perceive the ailing individual as an isolated singularity, an approach most incongruent with the true interpersonal habitats from where our corporeal lives sprout like beanstalks and continue to grow. This is why all possible solutions that may be cognized by medical practitioners, a narrow path of predictable responses unable to veer from the wonderful world of surgery, x-rays, and drugs, frequently fall short of their intended mark.

Their erroneous approach brings to mind certain gaffes made in the nineteenth and twentieth centuries by practitioners in the fields of medicine and mental health. During this time it was quite common for autistic and mentally retarded infants, toddlers, and youngsters deemed unfit for communal life to be locked up in the Hadean-like rooms of obscure mental asylums out in the middle of nowhere, or for malnourished orphans suffering with so-called infectious diseases to be separated from one another and denied all human contact as to prevent contagion. In their reductive worldview complete isolation interspersed with the occasional impersonal touch of a doctor, a nurse, or a warden, and only then for the sake of administering a hypodermic injection or assessing symptomatology, was the best possible strategy for guiding these underprivileged children back to health. History has not been very kind in this respect, for recorded in pages and pages of nineteenth and early twentieth century clinical files from children’s cottages in the Australian state of Victoria is the sobering outcome, “DIED”.

There is overwhelming documentation in support of the notion that children abandoned in orphanages and mental asylums didn’t last very long. One would think that after examining a year’s worth of admission forms and death certificates it might occur to the superintendent that medical mandates were dismal failures, but alas, such a high moral, ethical, and philanthropic expectancy may be beyond what is possible for the average human being.  Had these unfortunate souls not been starved of authentic love, care, and mutually stimulating interactions, our natural birthright, a much more sanguine history with significantly lower mortality rates and happy endings would have written itself into the starry heavens.

In truth we know that nothing in the natural world exists as an abstract singularity; cells, multicellular organisms, fungi, bacteria, reptiles, birds, mammals, and every other phylogenetic taxonomy imaginable subsist on the earth as communities with the more evolved amongst them also expressing social hierarchies. Humans are not exempt from these unshakable laws of communal ecology. For the first few decades of our lives the dendritic and synaptic connections of our brains grow, wire, and prune according to the empathic wealth and worth of social interactions. If our formative years consist of social synapses formed by nurturing relationships within empathic environments we develop into healthy, level-headed individuals with unique psychosocial leanings and an authentic sense of self; if, on the other hand, the environment can offer no worthwhile relationships of attachment through which we may be able shield our lithe-bodied and unformed selves from external dangers, we enter a schizophrenic, persecutory space of selflessness, forever at the mercy of compulsions that erupt into consciousness without our choosing and behaviours enacted without the censorship afforded by introspection.

Children locked away in asylums and orphanages and the little girl treated by Mindell would have been casualties of the second order. Without love, security, and empathy, they inexorably suffered anaclitic depression, whilst the neurons of our brains become subject to premature apoptosis, or programmed cell death. The predominant nature of the higher ontology, the clinical depression, is reflected in the lower, the disintegration of neurobiological systems, and vice versa. What our extensive lessons in mind-matter synergy have taught us, if anything, is that causal order is insignificant. Our theoretical interest in which causes the other should not, under any circumstance, surmount our desire to eliminate the lethal phenomenon from the boundless continuum of human experience. I can think of no worse fate for an innocent and helpless child, a grown adult, in fact anybody alive on the planet, than to perish at the hands of wretched loneliness…  

 

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