What if it’s all in my Head?

I have been intrigued with the so called “placebo effect” for years and the more I learn about it, the more fascinating it is. In healthcare, we like things to have “proof” and we like to dissect out and study various aspects of patient care in isolation, to try to figure out what might be the result of a specific intervention and what might be due to a placebo effect. Unfortunately, benefits gained from aspects of care that are potentially due to a placebo effect and not a specific intervention, are often disregarded and minimized. It appears that in our efforts to determine what is the best and most efficient treatment for a patient, we have inadvertently lost sight of the main goal - to help someone feel better! Utilizing the placebo effect in healthcare does not involve persuasion, making bold claims, or lying. It simply involves understanding and embracing that we all respond in unique ways for unique reasons and that we are all more likely to respond favourably to things that we strongly believe in (either consciously or subconsciously). So let’s pull back the curtain a bit and peek at how the placebo factor is involved in virtually all of our healing journeys - whether we want to admit it or not! 

Often benefiting from something that may be considered a “placebo” effect, feels uncomfortable and even shameful. We are made to feel that if “that” could have helped us, then our illness or injury must also not have been “real”. It is suggested that either our positive results or our malady was simply just all in our head. I can’t count the number of times patients have asked me if a certain therapy, gizmo or supplement “works” - after they have already done it! In my opinion, if it is safe for the patient and those around them, then regardless of what I may think or what has been found to be “statistically significant” in peer reviewed studies, what’s most important is how the person in front of me actually feels! As a healthcare provider, when we tell someone that they shouldn’t feel better when they do, it is equivalent to telling a little kid who just spent hours colouring a picture, that it looks like a piece of trash. A bit deflating don’t you think? So when patients come into my office and proudly proclaim that they tried x-y-z and feel better, as long as we’re clear in the safety department, who am I to burst their bubble and convince them otherwise!

We are complex beings and perhaps sometimes the benefits we have experienced from some therapies or treatment interventions actually came from other factors: how comfortable we felt with the healthcare provider who did it or prescribed it, how much our friends have talked positively about it, what our past childhood experiences have taught us, or just our strong belief that “this is going to help me”. How we respond to treatments/therapies, remedies, strategies, and even pharmaceuticals, is unique to each of us and accounting for those differences may just come down to a little bit of the placebo effect. 

Without even realizing it, we have been “training” our body since childhood how to respond to our actions, beliefs, and behaviours. What generally makes us feel good and what generally makes us feel bad is often learned over years and experiences, and can even impact how we will respond to therapies and medical interventions in the future. I saw a documentary years ago that illustrated an example of a placebo effect that I believe shows how our actions can trigger a positive response in our body. Although I can’t recall all the details, I still remember the highlights. A group of people with irritable bowel syndrome “IBS”, were given sugar pills (aka placebo’s) to take for a period of time to see if it would help their symptoms. Now here’s the catch that impressed me, the experiment wasn’t blinded. That means that they were actually told that the pills they were going to take were placebos and not medication. However, they were still in a prescription bottle and had to be taken at certain times of the day. Wouldn’t you know it, to their own surprise, a lot of them felt better! Remember, they knew there was no medication in there. So what’s up with that?! Doesn’t the placebo effect only work when you’re tricked into thinking something? No sir, it can be triggered by subconscious patterns and actions as well. 

Think way back to when you were little and got sick. Think about what you have seen over and over again in society, on commercials, and with your loved ones. In general, most of us have seen that (even if we don’t like taking them), prescriptions can be helpful when we are sick. Now, think about what all of those past experiences have taught our body: “When I take this little pill out of this bottle that has my name on it on it and has to be taken at certain times, that means that these are the big guns. This is official, it’s been selected just for me and it’s going to make me feel better.” So, naturally, whenever we go through those motions of taking a prescription, we are messaging our body that we are doing something that we have learned makes it feel better - so that’s what we are expecting it to do! We have subconsciously engrained these strong pathways and in the case of this experiment, those patterns resulted in positive results - regardless of the knowledge that logically it shouldn’t help. I would be willing to bet that they would not have experienced benefits had those sugar pills been given to them in a sandwich bag with no instruction provided on when they were to be taken. In this example, it was the details of the delivery of those sugar pills, going through the motions of taking a “real” prescription, that set the stage - and the healing, in motion.

Now, do NOT just go swapping out your medication for Smarties!  As we know, before drugs can be approved for use, they need to show that the drug creates responses that are significantly stronger than the “sugar pill” group during trials. But just the fact that we need to study that is evidence that the simple act of opening that little bottle and following the directions at home is an opportunity for placebo to occur.  

Stay tuned, next time we’ll look at some of the other placebo phenomenon, but until then here’s one more prescription to ponder..Did mom often make a certain soup, home remedy or have you do a certain routine when you were sick? Does it seem like it’s ridiculously crazy now that you’re a grown adult and maybe know that studies have “proven” her method isn’t effective? But do you ever still do it - and secretly, deep down, does it still help…even just a touch? There’s nothing to be embarrassed about. In fact, good on ya and good on ol mom for training you and your body early on that chicken soup can make you feel right as rain ;)