Reconsidering the Placebo Response from a Broad Anthropological Perspective

Abstract

This paper considers how the full range of human experience may catalyze a placebo response. The placebo effect has been characterized as something to control in clinical research, something to cultivate in clinical practice, and something present in all healing encounters. We examine domains in which the term 'placebo' is used in discourse: clinical research, clinical practice, media representations of treatment efficacy, and lay interpretations of placebo-an under-researched topic. We briefly review major theoretical frameworks proposed to explain the placebo effect: classical conditioning, expectancy, the therapeutic relationship, and sociocultural 'meaning.' As a corrective to what we see as an over-emphasis on conscious cognitive approaches to understanding placebo, we reorient the discussion to argue that direct embodied experience may take precedence over meaning-making in the healing encounter. As an example, we examine the neurobiology of rehearsing or visualizing wellness as a mode of directly (performatively) producing an outcome often dismissed as a 'placebo response.' Given body/mind/emotional resonance, we suggest that the placebo response is an evolutionarily adaptive trait and part of healing mechanisms operating across many levels-from genetic and cellular to social and cultural.

Beyond the placebo: understanding the therapeutic context

“…Essential components of the total context are the doctor's attitude, especially his or her communication skills, the doctorpatient relationship, the way the doctor applies therapeutic procedures or rituals, and, ultimately, the doctor's ability to create trust. [3][4][5][6] …”

“…Over the past 20 years, much empirical research has shown impressive symptommodulating effects, not only from the placebo pill, but also from the context surrounding the encounter between patient and therapist (including therapists practising complementary and alternative procedures, for example, acupuncture). 4,5,7 In addition, new types of scanning technology have allowed us to study the biological processes in the brain intensively during the past 10 years, and these processes have been demonstrated to be strongly influenced by a variety of contextual factors. The biological processes and the variations in the context-mediated effects in the brain have now been scientifically proven.…”

“…3 Therefore, it might be better to simply forget the word 'placebo' and replace 'placebo effect' with 'context-mediated effect' when we define this effect or describe the effect of the total care experience encompassing the treatment, for instance, the specific effect of analgesics. 4,5 …”

The characteristics of the relationship between patients and therapists in relaxing massage as complementary treatment - the author's own experience

“…Jeśli pacjent nie chce rozmawiać w trakcie masażu, terapeuta nie powinien inicjować rozmowy. Zawsze warto pamiętać o tym, że najgłębsze oddziaływanie masażu relaksacyjnego ma miejsce wówczas, gdy pacjent zasypia w trakcie zabiegu [15].…”

“…If the patient does not want to talk, the therapist should not initiate the conversation. It is always worth remembering that best results of relaxing massage are achieved when the patient falls asleep during the procedure [15]. 3.…”