Putting healing in context As Harrington points out, healing is often most effective when it takes place in an atmosphere conducive to nurturing. How doctors administer a patient’s treatment is crucial. “Now we are beginning to have a sense of the biological power of the bedside manner, listening skills and the environment,” Harrington says.
In fact, Kaptchuk proposes that the use of the word placebo, with its host of negative associations, be laid to rest. More helpful, he says, is the term “contextual healing,” which speaks to the importance of a healing environment. This includes the caregiver’s tone of voice, how long she spends with you, how reassuring the healing environment is—all those variables of the clinical encounter that can promote healing, rather than the specifics of a particular treatment. Researchers call this the therapeutic ritual, and this may lie at the heart of a placebo’s power.
As a more nuanced understanding of placebos evolves, scientists are starting to figure out ways to measure the effect of empathy on healing. In 2008, Kaptchuk designed a study on three different components of the placebo response for treating irritable bowel syndrome (IBS). He divided the participants into three groups: One group got left on a waiting list; another received sham acupuncture but no attention; and the third group got sham acupuncture and copious attention, which consisted of a friendly manner, active listening, empathy, confidence and positive expectations. The groups that were given fake acupuncture alone did significantly better than the waiting list; but the group that got both acupuncture and attention reported improvements comparable with the improvement rate in “successful” clinical trials of drugs commonly used for IBS.
Alternative medicine and integrative practitioners have led the way in prioritizing contextual healing. “Why is it that natural healers have the devoted clientele that they do?” asks Harrington. “People don’t just come in for specific treatment from these kinds of healers, but because they believe that they will be recognized as whole people.” Brewer has long incorporated an attentive approach in his practice. “It’s all about how it’s presented. I talk to patients from a positive point of view. I tell them, ‘You’re a very bright, smart person—if you can make changes that positively affect your business, you can do it with your body.’ Then they get jazzed about their treatment, and they feel empowered to help heal themselves.”
Harness the power of placebos So how can one attempt to use the healing potential of the placebo effect in their own journey to health? Many say positive thinking, which eliminates a placebo’s dependence on an authority figure and suggests optimism itself, is the place to start. However, according to Gordon, neither placebo nor positivity gets it right.
“‘Don’t follow leaders, watch the parkin’ meters,’” says Gordon by way of explanation, quoting Bob Dylan’s 1965 hit song “Subterranean Homesick Blues.” “The best way to maximize the placebo response is not by an authoritarian system, which encourages you to believe in the omniscience of the prescriber. Better to give people more confidence in their own power to heal,” Gordon adds. To do that, Gordon teaches his patients simple techniques, such as breathing exercises, which offer concrete proof of their own abilities to regulate their nervous systems. It’s a way of giving people the tangible experience—not just the belief—of their capacity to bring about change. Gordon’s aim? To convey the reality of self-healing—the benefits, that can be viscerally felt, of meditation, biofeedback and group support. Particularly with depression, for which doctors zealously and often irresponsibly prescribe antidepressants, says Gordon, we underestimate people’s ability to help themselves.
So when it comes to placebos, which is it? Faith in your doctor or rugged self-reliance? Ultimately, it’s both. Lean too much toward blind acceptance of your doctor’s creed, and you risk surrendering your own wisdom; trust the power of positivity too much and it can lead to a kind of romantic unrealism that can undermine your ability to get the help you need.
Illness can be a lonely road. Doctors and healers who offer personal involvement, rather than systematic detachment, are vital to our recovery. Our own beliefs, and the changes we make for the good, prove equally crucial. Educate yourself on what ails you, and map out your own healing strategy. Avail yourself of modalities deeply attuned to mind-body principles, such as yoga, tai chi and meditation. Recognizing that healing runs two ways, from outside and within, opens you up to possibilities that go far beyond medication. The best placebo on the quest for health, it turns out, is a mind open to healing that comes from all directions—both expected and unexpected.