Posted by dlende on April 15, 2008
I have been wanting to write a post about the placebo effect for some time, after finding a wonderful YouTube video about getting drunk without being drunk. And then today I saw a very different “placebo effect” that also drives home Dan Moerman’s point when he says that the placebo effect is better thought of as “the meaning response.” (Moerman is an anthropologist, of course.)
The video, How to Get Drunk Without Drinking, shows Derren Brown demonstrating “a method I used at university which allows people to recreate any drug state, adrenaline, alcohol, you name it, without actually taking the drug.” (If it doesn’t play, you can go directly to the YouTube version.) What is so striking about the video is Brown’s use of imagination, embodiment, practice, suggestion, and memory to accomplish the effect, and the ability of the brain to then switch between such different states so quickly. It’s also quite funny!
The other piece, The Cure by Sarah Manguso, is adapted from her forthcoming memoir The Two Kinds of Decay. Manguso writes of being twenty-one, her life in danger from an auto-immune disease, and her desire to make love to someone. Her own antibodies were attacking her body, as she wryly notes, “trying to destroy my nervous system — a misperception that caused me a lot of trouble.” She returned to college with a huge tube sticking out of her chest, a necessary part of the regular blood treatments she needed.
“My blood was removed and cleaned and put back more than 50 times. After that, my hematologist tried another treatment: massive gamma-globulin infusions. The second infusion kept me going for three months, and it was decided I wouldn’t have to have my plasma replaced again. My neurologist said I’d turned a corner, so after 11 1/2 months, my central line was pulled.”
“I believed, though, that I would stop secreting antibodies only after I had sexual intercourse. And though I looked worse than I ever had in my life, thanks to the steroids — I was fat and swollen, covered in acne, and had a gruesomely round face — I thought my legendarily promiscuous musician friend might still be interested.”
Manguso relates in simple yet elegant prose, “Finally, getting up from the bench we’d been sitting on, my friend said, ‘Your place?’ And we went to my dorm room, which was a single suite I had all to myself, with my own bathroom, because my neurologist had written a note to the university. We sat on my futon, drinking out of a plastic bottle of vodka. Eventually he said, ‘Do you have any other rooms in this place?’ and walked me to the bedroom, and lay me on my bed, and had intercourse with me. Then he asked me about the scabs on my chest from where the line had just been pulled out and listened to the things I told him, and held me very tightly.”
The two friends then wrote letters over the years. “Our letters were intimate, but I didn’t get around to explaining to him that I recovered from my disease only because he had selflessly had intercourse with an ugly version of a girl he once had a crush on. A little less than seven years after I was cured of my disease through the mystical power of intercourse, my friend died of a sudden illness. I never told him about my magical cure, his sweet medicine. And I wish I could have saved his life. I hope he knew somehow that he had saved mine.”
Daniel Moerman has a 2002 paper with Wayne Jonas entitled “Deconstructing the Placebo Effect and Finding the Meaning Response” (pdf version). As they declare quite rightly in the beginning of their paper, “The one thing of which we can be absolutely certain is that placebos do not cause placebo effects. Placebos are inert and don’t cause anything.”
Having discarded that rather large red herring, Moerman and Jonas redefine the placebo effect as the meaning response. These placebo responses comprise the “physiological or psychological effects of meaning in the origins or treatment of illness.” These are not “non-specific” effects—meanings are concrete and “are often quite specific in principle after they are understood.” The two authors then back up their argument with examples from surgery, pharmacological treatment, and more.
Moerman and Jonas bring up culture, for culture, “rich skeins of connected understandings, metaphors and signs,” plays a fundamental role in meaning. We can also add human’s penchant for magical thinking, whether described psychologically, explored personally in Joan Didion’s The Year of Magical Thinking (as much a reflection on grief as magic), or examined in-depth in the classic anthropological text Witchcraft, Oracles and Magic among the Azande by E.E. Evans-Pritchard.
Moerman and Jonas end their article by writing, “we have impoverished the meaning of our medicine to a degree that it simply doesn’t work as well as it might.”
In contrast, Derren Brown’s magical drunk and Sarah Manguso’s magical intercourse stand as direct testament to the power of meaning.