A Brief History of the Placebo
As the saying goes, desperate times call for desperate measures. When Harvard-educated American surgeon Henry Beecher was serving in World War II, he ran out of morphine. Near the end of the war, morphine was in short supply in military field hospitals, so this situation wasn’t uncommon. At the time, Beecher was about to operate on a badly wounded soldier. He was afraid that without a painkiller, the soldier might go into fatal cardiovascular shock. What happened next astounded him.
Without skipping a beat, one of the nurses filled a syringe with saline and gave the soldier a shot, just as if she were injecting him with morphine. The soldier calmed down right away. He reacted as though he’d actually received the drug, even though all he’d received was a squirt of saltwater. Beecher went ahead with the operation, cutting into the soldier’s flesh, making what repairs were necessary, and sewing him back up, all without anesthesia. The soldier felt little pain and did not go into shock. How could it be, Beecher wondered, that saltwater could stand in for morphine?
After that stunning success, whenever the field hospital ran out of morphine, Beecher did the same thing again: injected saline, just as if he were injecting morphine. The experience convinced him of the power of placebos, and when he returned to the United States after the war, he began to study the phenomenon.
In 1955, Beecher made history when he authored a clinical review of 15 studies published by the Journal of the American Medical Association that not only discussed the huge significance of placebos, but also called for a new model of medical research that would randomly assign subjects to receive active medications or placebos—what we now refer to as randomized, controlled trials—so that this powerful placebo effect wouldn’t distort results.1
The idea that we can alter physical reality through thought, belief, and expectation alone (whether we are fully aware of what we’re doing or not) certainly didn’t start in that World War II field hospital. The Bible is filled with stories of miraculous healings, and even in modern times, people regularly flock to places such as Lourdes in southern France (where a 14-year-old peasant girl named Bernadette had a vision of the Virgin Mary in 1858), leaving behind their crutches, braces, and wheelchairs as proof that they’ve been healed. Similar miracles also have been reported in Fátima, Portugal (where three shepherd children saw an apparition of the Virgin Mary in 1917), and in connection with a traveling statue of Mary carved for the 30th anniversary of the apparition. The statue was based on the description given by the oldest of the three children, who by then had become a nun, and it was blessed by Pope Pius XII before it was sent traveling around the world.
Faith healing is certainly not confined to the Christian tradition. The late Indian guru Sathya Sai Baba, widely considered by his followers to be an avatar—a manifestation of a deity—was known to manifest holy ash called vibhuti from the palms of his hands. This fine gray ash has been said to have the power to heal many physical, mental, and spiritual ills when either eaten or applied to the skin as a paste. Tibetan lamas are also said to have healing powers, using their breath to heal by blowing on the sick.
Even French and English kings reigning between the 4th and 9th centuries used the laying on of hands to cure their subjects. King Charles II of England was known to be particularly adept at this, performing the practice about 100,000 times.
What is it that causes such so-called miraculous events, whether the instrument of healing is faith in a deity alone or belief in the extraordinary powers of a person, an object, or even a place deemed sacred or holy? What is the process by which faith and belief can bring about such profound effects? Might how we assign meaning to a ritual—whether that ritual is saying the rosary, rubbing a pinch of holy ash onto our skin, or taking a new miracle drug prescribed by a trusted physician—play a role in the placebo phenomenon? What if the internal state of mind of the people who received these cures was influenced or altered by the conditions in their external environment (a person, place, or thing at the proper time) to such a degree that their new state of mind could actually effect real physical changes?
From Magnetism to Hypnotism
In the 1770s, Viennese physician Franz Anton Mesmer made quite a name for himself by developing and demonstrating what was considered at that time a medical model of miraculous healing. Expanding on an idea of Sir Isaac Newton’s about the effect of planetary gravitation on the human body, Mesmer came to believe that the body contained an invisible fluid that could be manipulated to heal people using a force he called “animal magnetism.”
His technique involved asking his patients to look deeply into his eyes before moving magnets over their bodies to direct and balance this magnetic fluid. Later, he found that he could wave his hands (without the magnets) to produce the same effect. Soon after each session began, his patients would start trembling and twitching before going into convulsions that Mesmer considered therapeutic. Mesmer would continue the fluid balancing until they were calm again. He used this technique to heal a variety of maladies, from serious conditions like paralysis and convulsive disorders to more minor difficulties, such as menstrual problems and hemorrhoids.
In what became his most famous case, Mesmer partially cured teenage concert pianist Maria-Theresia von Paradis of “hysterical blindness,” a psychosomatic condition she’d had since about the age of three. She stayed in Mesmer’s home for weeks as he worked with her and finally helped her to be able to perceive motion and even distinguish color. But her parents were less than overjoyed by her progress, because they stood to lose a royal pension if their daughter was cured. In addition, as her sight returned, her piano playing deteriorated because she now was able to watch her fingers on the keyboard. Rumors, never substantiated, began circulating that Mesmer’s relationship to the pianist was improper. Her parents forcibly removed her from Mesmer’s house, her blindness returned, and Mesmer’s reputation diminished considerably.
Armand-Marie-Jacques de Chastenet, a French aristocrat known as the Marquis de Puységur, observed Mesmer and took his ideas to the next level. Puységur would induce a deep state that he called “magnetic somnambulism” (similar to sleepwalking), in which his subjects had access to deep thoughts and even intuitions about their health and that of others. In this state, they were extremely suggestible and would follow instructions, although they had no memory of what happened once they came out of it. Whereas Mesmer thought that the power was in the practitioner over the subject, Puységur believed that the power was in the thought of the subject (directed by the practitioner) over his or her own body; this was perhaps one of the first therapeutic attempts to explore the mind-body relationship.
In the 1800s, Scottish surgeon James Braid took the idea of mesmerism still further, developing a concept he called “neurypnotism” (what we now know as hypnotism). Braid became intrigued by the idea when one day he arrived late for an appointment only to find his waiting patient calmly staring in intense fascination at the flickering flame of an oil lamp. Braid found the patient to be in an extremely suggestible state as long as his attention remained so locked, thereby “fatiguing” certain parts of his brain.
After many experiments, Braid learned to get his subjects to concentrate on a single idea while staring at an object, which put them into a similar trance that he felt he could use to cure their disorders, including chronic rheumatoid arthritis, sensory impairment, and the various complications of spinal injuries and stroke. Braid’s book Neurypnology details many of his successes, including the story of how he cured both a 33-year-old woman whose legs were paralyzed and a 54-year-old woman with a skin disorder and severe headaches.
Then esteemed French neurologist Jean-Martin Charcot weighed in on Braid’s work, claiming that the ability to go into such a trance was possible only in those suffering from the condition of hysteria, which he considered an inherited neurological disorder that was irreversible. He used hypnosis not to cure patients, but to study their symptoms. Finally, a rival of Charcot’s, a doctor named Hippolyte Bernheim at the University of Nancy, insisted that the suggestibility so central to hypnotism was not confined to hysterics but was a natural condition for all humans. He implanted ideas in subjects, telling them that when they awoke from their trance, they would feel better and their symptoms would disappear; thus he used the power of suggestion as a therapeutic tool. Bernheim’s work continued into the early 1900s.
Although each of these early explorers of suggestibility had a slightly different focus and technique, they were all able to help hundreds and hundreds of people heal a wide variety of physical and mental problems by changing their minds about their maladies and about how those illnesses were expressed in their bodies.
During the first two world wars, military doctors, most notably Army psychiatrist Benjamin Simon, used the concept of hypnotic suggestibility (which I’ll discuss further later) to help returning soldiers who suffered from the trauma that was first labeled “shell shock” but is now known as post-traumatic stress disorder (PTSD). These veterans had suffered through such horrible war experiences that many of them numbed themselves to their emotions as a form of self-preservation, developed amnesia surrounding the horrific events, or, worse, kept reliving their experiences in flashbacks—all of which can cause stress-induced physical illness. Simon and his colleagues found hypnosis extremely useful for helping the veterans face their traumas and cope with them so that they wouldn’t have to resurface as anxiety and physical ailments (including nausea, high blood pressure and other cardiovascular disorders, and even suppressed immunity). Like those practitioners in the century before them, Army doctors employing hypnosis helped their patients alter their patterns of thinking in order to get well and reclaim their mental and physical health.
These hypnosis techniques were so successful that civilian doctors also became interested in using suggestibility, although many did so not by putting their patients into a trance but by occasionally giving them sugar pills and other placebos and telling them that these “drugs” would make them better. The patients often did get better, responding to suggestibility in the same way that Beecher’s wounded soldiers responded to the belief that they were receiving shots of morphine. This was, in fact, Beecher’s era, and after he wrote his groundbreaking 1955 review calling for the use of randomized, controlled trials with placebos for testing drugs, the placebo became a serious part of medical research.
Beecher’s point was well taken. Initially, researchers expected that a study’s control group (the group taking the placebo) would remain neutral so that comparisons between the control group and the group taking the active treatment would show how well the active treatment worked. But in so many studies, the control group was indeed getting better—not just on their own but because of their expectation and belief that they might be taking a drug or receiving a treatment that would help them. The placebo itself might have been inert, but its effect was certainly not, and these beliefs and expectations were proving to be extremely powerful! So somehow, that effect had to be teased out from the data if that data was to have any real meaning.
To that end, and heeding Beecher’s petition, researchers began making the randomized, double-blind trial the norm, randomly assigning subjects to either the active or the placebo group and making sure none of the subjects or any of the researchers themselves knew who was taking the real drug and who was taking the placebo. This way, the placebo effect would be equally active in each group, and any possibility that the researchers might treat subjects differently according to what group they were in would be eliminated. (These days, studies are sometimes even triple blind, meaning that not only are the participants and the researchers who are conducting the trial in the dark about who’s taking what until the end of the study, but the statisticians analyzing the data also don’t know until their job is done.)
Exploring the Nocebo Effect
Of course, there’s always a flip side. While suggestibility was garnering more attention because of its ability to heal, it also became apparent that the same phenomenon could be used to harm. Such practices as hexes and voodoo curses illustrated the negative side of suggestibility.
In the 1940s, Harvard physiologist Walter Bradford Cannon (who had in 1932 coined the term fight or flight) studied the ultimate nocebo response—a phenomenon that he called “voodoo death.”2 Cannon examined a number of anecdotal reports of people with strong cultural beliefs in the power of witch doctors or voodoo priests suddenly falling ill and dying—despite no apparent injury or evidence of poison or infection—after ending up on the receiving end of a hex or curse. His research laid the groundwork for much of what we know today about how physiological response systems enable emotions (fear in particular) to create illness. The victim’s belief in the power of the curse itself to kill him was only part of the psychological soup that brought about his ultimate demise, Cannon said. Another factor was the effect of being socially ostracized and rejected, even by the victim’s own family. Such people quickly became the walking dead.
Harmful effects from harmless sources aren’t restricted to voodoo, of course. Scientists in the 1960s coined the term nocebo (Latin for “I shall harm,” as opposed to “I shall please,” the Latin translation of placebo), referring to an inert substance that causes a harmful effect—simply because someone believes or expects it will harm her.3 The nocebo effect commonly pops up in drug studies when subjects who are taking placebos either just expect that there will be side effects to the drug being tested, or when the subjects are specifically warned of potential side effects—and then they experience those same side effects by associating the thought of the drug with all of the potential causations, even though they’ve not taken the drug.
For obvious ethical reasons, few studies are designed specifically to look at this phenomenon, although some do exist. A famous example is a 1962 study done in Japan with a group of children who were all extremely allergic to poison ivy.4 Researchers rubbed one forearm of each child with a poison-ivy leaf but told them the leaf was harmless. As a control, they rubbed the child’s other forearm with a harmless leaf that they claimed was poison ivy. All the children developed a rash on the arm rubbed with the harmless leaf that was thought to be poison ivy. And 11 of the 13 children developed no rash at all where the poison had actually touched them.
This was an astounding finding; how could children who were highly allergic to poison ivy not get a rash when exposed to it? And how could they develop a rash from a totally benign leaf? The new thought that the leaf wouldn’t hurt them overrode their memory and belief that they were allergic to it, rendering real poison ivy harmless. And the reverse was true in the second part of the experiment: A harmless leaf was made toxic by thought alone. In both cases, it seemed as if the children’s bodies instantaneously responded to a new mind.
In this instance, we could say that the children were somehow freed from the future expectation of a physical reaction to the toxic leaf, based on their past experiences of being allergic. In effect, they somehow transcended a predictable line of time. This also suggests that by some means, they became greater than the conditions in their environment (the poison-ivy leaf). Finally, the children were able to alter and control their physiology by simply changing a thought. This astonishing evidence that thought (in the form of expectation) could have a greater effect on the body than the “real” physical environment helped to usher in a new era of scientific study called psychoneuroimmunology—the effect of thoughts and emotions on the immune system—an important segment of the mind-body connection.
Another notable nocebo study from the ’60s looked at people with asthma.5 Researchers gave 40 asthma patients inhalers containing nothing but water vapor, although they told the subjects that the inhalers contained an allergen or irritant; 19 of them (48 percent) experienced asthmatic symptoms, such as restriction of their airways, with 12 (30 percent) of the group suffering full-blown asthmatic attacks. Researchers then gave the subjects inhalers said to contain medicine that would relieve their symptoms, and in each case, their airways did indeed open back up—although again, the inhalers contained only water vapor.
In both situations—bringing on the asthma symptoms and then dramatically reversing them—the patients were responding to suggestion alone, the thought planted in their minds by the researchers, which played out exactly as they expected. They were harmed when they thought they’d inhaled something harmful, and they got better when they thought they were receiving medicine—and these thoughts were greater than their environment, greater than reality. We could say that their thoughts created a brand-new reality.
What does this say about the beliefs we hold and the thoughts we think every day? Are we more susceptible to catching the flu because all winter long, everywhere we look, we see articles about flu season and signs about flu-shot availability—all of which reminds us that if we don’t get a flu shot, we’ll get sick? Could it be that when we simply see someone with flu-like symptoms, we become ill from thinking in the same ways as the children in the poison-ivy study who got a rash from the inert leaf or from thinking like the asthmatics who experienced a significant bronchial reaction after inhaling simple water vapor?
Are we more likely to suffer from arthritis, stiff joints, poor memory, flagging energy, and decreased sex drive as we age, simply because that’s the version of the truth that ads, commercials, television shows, and media reports bombard us with? What other self-fulfilling prophecies are we creating in our minds without being aware of what we’re doing? And what “inevitable truths” can we successfully reverse simply through thinking new thoughts and choosing new beliefs?
The First Big Breakthroughs
A groundbreaking study in the late ’70s showed for the first time that a placebo could trigger the release of endorphins (the body’s natural painkillers), just as certain active drugs do. In the study, Jon Levine, M.D., Ph.D., of the University of California, San Francisco, gave placebos, instead of pain medication, to 40 dental patients who had just had their wisdom teeth removed.6 Not surprisingly, because the patients thought they were getting medicine that would indeed relieve their pain, most reported relief. But then the researchers gave the patients an antidote to morphine called naloxone, which chemically blocks the receptor sites for both morphine and endorphins (endogenous morphine) in the brain. When the researchers administered it, the patients’ pain returned! This proved that by taking the placebos, the patients had been creating their own endorphins—their own natural pain relievers. It was a milestone in placebo research, because it meant that the relief the study subjects experienced wasn’t all in their minds; it was in their minds and their bodies—in their state of being.
If the human body can act like its own pharmacy, producing its own pain drugs, then might it not also be true that it’s fully capable of dispensing other natural drugs when they’re needed from the infinite blend of chemicals and healing compounds it houses—drugs that act just like the ones doctors prescribe or maybe even better than the drugs doctors prescribe?
Another study in the ’70s, this one by psychologist Robert Ader, Ph.D., at the University of Rochester, added a fascinating new dimension to the placebo discussion: the element of conditioning. Conditioning, an idea made famous by Russian physiologist Ivan Pavlov, depends on associating one thing with another—like Pavlov’s dogs associating the sound of the bell with food after Pavlov started ringing it every day before he fed them. In time, the dogs were conditioned to automatically salivate in anticipation of a meal whenever they heard a bell. As a result of this type of conditioning, their bodies became trained to physiologically respond to a new stimulus in the environment (in this case, the bell), even without the original stimulus that elicited the response (the food) being present.
Therefore, in a conditioned response, we could say that a subconscious program, which is housed in the body (I’ll talk more about this in the coming chapters), seemingly overrides the conscious mind and takes charge. In this way, the body is actually conditioned to become the mind because conscious thought is no longer totally in control.
In the case of Pavlov, the dogs were repeatedly exposed to the smell, sight, and taste of the food, and then Pavlov rang a bell. Over time, just the sound of the bell caused the dogs to automatically change their physiological and chemical state without thinking about it consciously. Their autonomic nervous system—the body’s subconscious system that operates below conscious awareness—took over. So conditioning creates subconscious internal changes in the body by associating past memories with the expectation of internal effects (what we call associative memory) until those expected or anticipated end results automatically occur. The stronger the conditioning, the less conscious control we have over these processes and the more automatic the subconscious programming becomes.
Ader started out attempting to study how long such conditioned responses could be expected to last. He fed lab rats saccharine-sweetened water that he’d spiked with a drug called cyclophosphamide, which causes stomach pain. After conditioning the rats to associate the sweet taste of the water with the ache in their gut, he expected they’d soon refuse to drink the spiked water. His intention was to see how long they’d continue to refuse the water so that he could measure the amount of time their conditioned response to the sweet water would last.
But what Ader didn’t know initially was that the cyclophosphamide also suppresses the immune system, so he was surprised when his rats started unexpectedly dying from bacterial and viral infections. Changing gears in his research, he continued to give the rats saccharine water (force-feeding them with an eyedropper) but without the cyclophosphamide. Although they were no longer receiving the immune-suppressing drug, the rats continued to die of infections (while the control group that had received only the sweetened water all along continued to be fine). Teaming up with University of Rochester immunologist Nicholas Cohen, Ph.D., Ader further discovered that when the rats had been conditioned to associate the taste of the sweetened water with the effect of the immune-suppressing drug, the association was so strong that just drinking the sweetened water alone produced the same physiological effect as the drug—signaling the nervous system to suppress the immune system.7
Like Sam Londe, whose story was in Chapter 1, Ader’s rats died by thought alone. Researchers were beginning to see that the mind was clearly able to subconsciously activate the body in several powerful ways they’d never imagined.
West Meets East
By this time, the Eastern practice of Transcendental Meditation (TM), taught by Indian guru Maharishi Mahesh Yogi, had caught on in the United States, fueled by the enthusiastic participation of several celebrities (starting with the Beatles in the 1960s). The goal of this technique, which involves quieting the mind and repeating a mantra during a 20-minute meditation session performed twice a day, is spiritual enlightenment. But the practice caught the attention of Harvard cardiologist Herbert Benson, who became interested in how it might help reduce stress and lessen the risk factors for heart disease. Demystifying the process, Benson developed a similar technique, which he called the “relaxation response,” described in his 1975 book by the same title.8 Benson found that just by changing their thought patterns, people could switch off the stress response, thereby lowering blood pressure, normalizing heart rate, and attaining deep states of relaxation.
While meditation involves maintaining a neutral attitude, attention was also being paid to the beneficial effects of cultivating a more positive attitude and pumping up positive emotions. The way had been paved in 1952, when former minister Norman Vincent Peale published the book The Power of Positive Thinking, which popularized the idea that our thoughts can have a real effect, both positive and negative, on our lives.9 That idea grabbed the attention of the medical community in 1976, when political analyst and magazine editor Norman Cousins published an account in the New England Journal of Medicine of how he had used laughter to reverse a potentially fatal disease.10 Cousins also told his story in his best-selling book Anatomy of an Illness, published a few years later.11
Cousins’s doctor had diagnosed him with a degenerative disorder called ankylosing spondylitis—a form of arthritis that causes the breakdown of collagen, the fibrous proteins that hold our bodies’ cells together—and had given him only a 1-in-500 chance of recovery. Cousins suffered from tremendous pain and had such difficulty moving his limbs that he could barely turn over in bed. Grainy nodules appeared under his skin, and at his lowest point, his jaw nearly locked shut.
Convinced that a persistent negative emotional state had contributed to his illness, he decided it was equally possible that a more positive emotional state could reverse the damage. While continuing to consult with his doctor, Cousins started a regimen of massive doses of vitamin C and Marx Brothers movies (as well as other humorous films and comedy shows). He found that ten minutes of hearty laughter gave him two hours of pain-free sleep. Eventually, he made a complete recovery. Cousins, quite simply, laughed himself to health.
How? Although scientists at the time didn’t have a way to understand or explain such a miraculous recovery, research now tells us it’s likely that epigenetic processes were at work. Cousins’s shift of attitude changed his body chemistry, which altered his internal state, enabling him to program new genes in new ways; he simply downregulated (or turned off) the genes that were causing his illness and upregulated (or turned on) the genes responsible for his recovery. (I’ll go into more detail about turning genes on and off in the coming chapters.)
Many years later, research by Keiko Hayashi, Ph.D., of the University of Tsukuba in Japan showed the same thing.12 In Hayashi’s study, diabetic patients watching an hour-long comedy program upregulated a total of 39 genes, 14 of which were related to natural killer cell activity. While none of these genes were directly involved in blood-glucose regulation, the patients’ blood-glucose levels were better controlled than after they listened to a diabetes health lecture on a different day. Researchers surmised that laughter influences many genes involved with immune response, which in turn contributed to the improved glucose control. The elevated emotion, triggered by the patients’ brains, turned on the genetic variations, which activated the natural killer cells and also somehow improved their glucose response—probably in addition to many other beneficial effects.
As Cousins said of placebos back in 1979, “The process works not because of any magic in the tablet, but because the human body is its own best apothecary and because the most successful prescriptions are filled by the body itself.”13
Inspired by Cousins’s experience, and with alternative and mind-body medicine now in full swing, Yale University surgeon Bernie Siegel started to look at why some of his cancer patients with poor odds survived while others with better odds died. Siegel’s work defined cancer survivors largely as those who had a feisty, fighting spirit, and he concluded that there were no incurable diseases, only incurable patients. Siegel also began writing about hope as a powerful force for healing and about unconditional love, with the natural pharmacy of elixirs it provides, as the most powerful stimulant of the immune system.14
Placebos Outperform Antidepressants
The profusion of new antidepressants that appeared around the late 1980s and into the ’90s would next ignite a controversy that would ultimately (although not immediately) increase respect for the power of placebos. In researching a 1998 meta-analysis of published studies on antidepressant drugs, psychologist Irving Kirsch, Ph.D., then at the University of Connecticut, was shocked to find that in 19 randomized, double-blind clinical trials involving more than 2,300 patients, most of the improvement was due not to the antidepressant medications, but to the placebo.15
Kirsch then used the Freedom of Information Act to gain access to the data from the drug manufacturers’ unpublished clinical trials, which by law had to be reported to the Food and Drug Administration. Kirsch and his colleagues did a second meta-analysis, this time on the 35 clinical trials conducted for four of the six most widely prescribed antidepressants approved between 1987 and 1999.16 Now looking at data from more than 5,000 patients, the researchers found again that placebos worked just as well as the popular antidepressant drugs Prozac, Effexor, Serzone, and Paxil a whopping 81 percent of the time. In most of the remaining cases where the drug did perform better, the benefit was so small that it wasn’t statistically significant. Only with severely depressed patients were the prescription drugs clearly better than placebo.
Not surprisingly, Kirsch’s study caused quite an uproar, although many researchers seemed quite willing to throw the placebo baby out with the bathwater. While most of the fracas focused on the fact that these drugs weren’t any better than the placebo, the patients in the trials did, in fact, get better on antidepressants. The drugs did work. But the patients taking placebos got better, too. Instead of seeing Kirsch’s work as proof that antidepressants failed, some researchers chose to see the glass as half-full and pointed to the data as proof that placebos succeeded.
After all, the trials provided stunning proof that thinking that you can get better from depression can actually heal depression just as well as taking a drug. The people in the study who got better on placebos were actually making their own natural antidepressants, just as Levine’s patients in the ’70s who had their wisdom teeth out made their own natural painkillers. What Kirsch had brought to light was more evidence that our bodies do have an innate intelligence that enables them to serve us with a chemical array of natural healing compounds. Interestingly enough, the percentage of people who improve while taking placebos in depression trials has gotten greater over time, as has the response to active medication; some researchers have suggested that this is because the public has greater expectations for the antidepressant drugs, which in turn makes the placebos more effective in these blind trials.17
The Neurobiology of the Placebo
It was only a matter of time before neuroscientists would start using sophisticated brain scans to take an intricate look at what happens neurochemically when a placebo is administered. An example is the 2001 study on Parkinson’s patients who regained motor skills after receiving only an injection of saline that they thought was medication (described in Chapter 1).18 Italian researcher Fabrizio Benedetti, M.D., Ph.D., a pioneer in placebo research, did a similar Parkinson’s study a few years later and, for the first time, was able to show a placebo’s effect on individual neurons.19
His studies explored not only the neurobiology of expectation, as with the Parkinson’s patients, but also the neurobiology at work with classical conditioning—what Ader had been able to glimpse years previously with his nauseated lab rats. In one experiment, Benedetti gave study subjects the drug sumatriptan to stimulate growth hormone and inhibit cortisol secretion, and then without the patients’ knowledge, he replaced the drug with a placebo. He found that the patients’ brain scans continued to light up in the same places as when they were getting the sumatriptan; this was proof that the brain was indeed producing the same substance—in this case, growth hormone—on its own.20
The same was seen to be true for other drug-placebo combinations as well; the chemicals made in the brain closely tracked those that the subjects initially received via drugs that were given to treat immune system disorders, motor disorders, and depression.21 In fact, Benedetti even showed that placebos caused the same side effects as the drugs. For example, in one placebo study using narcotics, the subjects suffered the same side effects of slow and shallow breathing when taking the placebo, because the placebo effect so closely mimicked the physiological effects of the drug.22
If the truth be told, our bodies are indeed capable of creating a host of biological chemicals that can heal, protect us from pain, help us sleep deeply, enhance our immune systems, make us feel pleasure, and even encourage us to fall in love. Reason this for a moment: If a particular gene was already expressed so that we made those specific chemicals at one point in our lives, but then we stopped making them because of some type of stress or illness that turned off that gene, maybe it’s possible for us to turn the gene back on again, because our bodies already know how to do that from previous experience. (Stay tuned for research to prove this.)
So let’s begin to look at how this happens. The neurological research shows something truly remarkable: If a person keeps taking the same substance, his or her brain keeps firing the same circuits in the same way—in effect, memorizing what the substance does. The person can easily become conditioned to the effect of a particular pill or injection from associating it with a familiar internal change from past experience. Because of this kind of conditioning, when the person then takes a placebo, the same hardwired circuits will fire as when he or she took the drug. An associative memory elicits a subconscious program that makes a connection between the pill or injection and the hormonal change in the body, and then the program automatically signals the body to make the related chemicals found in the drug. . . . Isn’t that amazing?
Benedetti’s research also makes another point very clear: Different types of placebo treatments work best with different goals. For example, in the sumatriptan study, initial verbal suggestions that the placebo would work had no effect on the production of growth hormone. To use placebos to effect unconscious physiological responses by associative memory (such as to secrete hormones or alter the functioning of the immune system), conditioning gets results, whereas to use placebos to change more conscious responses (such as to relieve pain or lessen depression), a simple suggestion or an expectation works. So there isn’t just one placebo response, Benedetti insisted, but several.
Taking Mind Over Matter into Your Own Hands
An astonishing new twist to placebo research came in a 2010 pilot study led by Harvard’s Ted Kaptchuk, D.O.M., that showed that placebos worked even when people knew they were taking a placebo.23 In the study, Kaptchuk and his colleagues gave 40 patients with irritable bowel syndrome (IBS) a placebo. Each patient received a bottle clearly labeled “placebo pills” and was told it contained “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body, self-healing processes.” A second group of 40 IBS patients, given no pills, served as a control group.
After three weeks, the group taking the placebos reported twice as much symptom relief as the no-treatment group—a difference that Kaptchuk noted is comparable to the performance of the best real IBS drugs. These patients hadn’t been tricked into healing themselves. They knew full well that they weren’t getting any medication—and yet after hearing the suggestion that the placebos could relieve their symptoms and believing in an outcome independent of the cause, their bodies were influenced to make it happen.
Meanwhile, a parallel track of studies that examines the effect of attitude, perceptions, and beliefs is leading the way in current mind-body research, showing that even something as seemingly concrete as the physical benefit of exercise can be affected by belief. A 2007 study at Harvard by psychologists Alia Crum, Ph.D., and Ellen Langer, Ph.D., involving 84 hotel maids is a perfect example.24
At the start of the study, none of the maids knew that the routine work they performed in their jobs exceeded the Surgeon General’s recommendation for a healthy amount of daily exercise (30 minutes). In fact, 67 percent of the women told the researchers that they didn’t exercise regularly, and 37 percent said they didn’t get any exercise. After this initial assessment, Crum and Langer divided the maids into two groups. They explained to the first group how their activity related to the number of calories they burned and told the maids that just by doing their jobs, they got more than enough exercise. They didn’t give any such information to the second group (who worked in different hotels from the first group and so wouldn’t benefit from conversations with the other maids).
One month later, the researchers found that the first group lost an average of two pounds, lowered their percentage of body fat, and lowered their systolic blood pressure by an average of 10 points—even though they hadn’t performed any additional exercise outside of work or changed their eating habits in any way. The other group, doing the same job as the first, remained virtually unchanged.
This echoed similar research done earlier in Quebec, where a group of 48 young adults participated in a ten-week aerobic exercise program, attending three 90-minute exercise sessions per week.25 The group was divided into two. The instructors told the first half, the test subjects, that the study was specifically designed to improve both their aerobic capacity and their psychological well-being. They mentioned only the physical benefits of aerobics to the second half, who served as the control group. At the end of the ten weeks, the researchers found that both groups increased their aerobic capacity, but it was only the test subjects, not the controls, who also received a significant boost in self-esteem (a measure of well-being).
As these studies show, our awareness alone can have an important physical effect on our bodies and our health. What we learn, the language that’s used to define what we’ll experience, and how we assign meaning to the explanations that are offered all affect our intention—and when we put greater intention behind what we’re doing, we naturally get better results.
In short, the more you learn about the “what” and the “why,” the easier and more effective the “how” becomes. (My hope is that this book will do the same for you; the more you know what you’re doing and why you’re doing it, the better results you’re bound to get.)
We also assign meaning to subtler factors, such as the color of the medicine we take and the quantity of pills we ingest, as shown in an older but classic study from the University of Cincinnati. In this study, researchers gave 57 medical students either one or two pink or blue capsules—all of them inert, although the students were told that the pink capsules were stimulants and the blue ones were sedatives.26 The researchers reported, “Two capsules produced more noticeable changes than one, and blue capsules were associated with more sedative effects than pink capsules.” Indeed, the students rated the blue pills as being two and a half times more effective as sedatives than the pink pills—even though all the pills were placebos.
More recent research shows that beliefs and perceptions can also affect scores in mental performance on standardized tests. In a 2006 study from Canada, 220 female students read fake research reports claiming that men had a 5 percent advantage over women in math performance.27 The group was divided into two, with one group reading that the advantage was due to recently discovered genetic factors, while the other group read that the advantage resulted from the way teachers stereotype girls and boys in elementary school. Then the subjects were given a math test. The women who’d read that men had a genetic advantage scored lower than those who’d read that men had an advantage due to stereotyping. In other words, when they were primed to think that their disadvantage was inevitable, the women performed as if they truly had a disadvantage.
A similar effect has been documented with African-American students, who have historically scored lower than whites on vocabulary, reading, and math tests, including the Scholastic Aptitude Test (SAT), even when socioeconomic class is not a factor. In fact, the average black student scores below 70 to 80 percent of the white students of the same age on most standardized tests.28 Stanford University social psychologist Claude Steele, Ph.D., explains that an effect called “stereotype threat” is to blame. His research shows that students who belong to groups that have been negatively stereotyped perform less well when they think their scores will be evaluated in light of that stereotype than they do when they feel no such pressure.29
In Steele’s landmark study, conducted with Joshua Aronson, Ph.D., researchers gave a series of verbal reasoning tests to Stanford sophomores. Some of the students were given instructions that primed the stereotype that blacks score lower than whites by saying that the quiz they were about to take was designed to measure their cognitive ability, while the others were told that the test was merely an unimportant research tool. In the group where the stereotype was primed, blacks scored lower than whites who had similar SAT scores. When the stereotype was not primed, performance of blacks and whites whose SAT scores were similar was the same—proving that the priming made a critical difference.
Priming is, basically, when someone, someplace, or something in our environment (for example, taking a test) triggers all sorts of associations that are hardwired into our brains (that people grading this test think black students score lower than whites), causing us to act in certain ways (not scoring as highly) without being conscious of what we’re doing. It’s called “priming,” because it works just as priming a pump does. You have to have water already in the pumping system in order to pump more water out of it. So in this example, the idea or belief that others expect black students to score lower than whites is like the water that’s already in the system—it’s just there all the time. When you do something to stimulate the system (grabbing the pump handle or taking the test), you’re stirring up all those related thoughts, behaviors, or emotions, and you produce exactly what was waiting to emerge from the system all along—be that water, in the case of a pump, or lower test scores, if it’s a test.
Think about this for a moment. Most automatic behaviors that priming elicits are produced by unconscious or subconscious programming, which, for the most part, is happening behind the scenes of our awareness. Are we, then, primed to behave unconsciously all day long—without our even knowing it?
Steele replicated this effect with other stereotyped groups as well. When Steele gave a math test to a group of white and Asian men who were strong in math, the white men in the group who were told that Asians do slightly better than whites on the test indeed didn’t do as well as the white men in the control group who weren’t told that. Steele’s experiments with strong female math students showed similar results. Again, when the students’ unconscious expectation was that they would score lower, they, in fact, did.
The greater meaning behind Steele’s research, then, is quite profound: What we’re conditioned to believe about ourselves, and what we’re programmed to think other people think about us, affects our performance, including how successful we are. It’s the same with placebos: What we’re conditioned to believe will happen when we take a pill, and what we think that everyone around us (including our doctors) expects will happen when we do, affects how our bodies respond to the pill. Could it be that many drugs or even surgeries actually work better because we’re repeatedly primed, educated, and conditioned to believe in their effects—when if it weren’t for the placebo effect, those drugs might not work as well or at all?
Can You Be Your Own Placebo?
Two recent studies from the University of Toledo perhaps shed the best light on how the mind alone can determine what someone perceives and experiences.30 For each study, researchers divided a group of healthy volunteers into two categories—optimists and pessimists—according to how the volunteers answered questions on a diagnostic questionnaire. In the first study, they gave the subjects a placebo but told them it was a drug that would make them feel unwell. The pessimists had a stronger negative reaction to the pill than the optimists. In the second study, the researchers gave the subjects a placebo as well, but told them it would help them sleep better. The optimists reported much better sleep than the pessimists.
So the optimists were more likely to respond positively to a suggestion that something would make them feel better, because they were primed to hope for the best future scenario. And the pessimists were more likely to respond negatively to a suggestion that something would make them feel worse, because they consciously or unconsciously expected the worst potential outcome. It’s as if the optimists were unconsciously making the specific chemicals to help them sleep, while the pessimists were unconsciously making a pharmacy of substances that made them feel unwell.
In other words, in exactly the same environment, those with a positive mind-set tend to create positive situations, while those with a negative mind-set tend to create negative situations. This is the miracle of our own free-willed, individual, biological engineering.
While we may not know exactly how many medical healings are due to the placebo effect (Beecher’s 1955 paper, mentioned earlier in this chapter, claimed the number was 35 percent, but modern-day research shows it can range anywhere from 10 to 100 percent31), the overall number is certainly extremely significant. Given that, we have to ask ourselves, What percentage of diseases and illnesses are due to the effects of negative thoughts in the nocebo? Considering that the latest scientific research in psychology estimates that about 70 percent of our thoughts are negative and redundant, the number of unconsciously created nocebo-like illnesses might be impressive indeed—certainly much higher than we realize.32 This idea makes a lot of sense, given that so many mental, physical, and emotional health conditions seem to arise from nowhere.
Although it may seem incredible that your mind could actually be that powerful, the research of the past several decades clearly points to a few empowering truths: What you think is what you experience, and when it comes to your health, that’s made possible by the amazing pharmacopeia that you have within your body that automatically and exquisitely aligns with your thoughts. This miraculous dispensary activates naturally occurring healing molecules that already exist within your body—delivering different compounds designed to elicit different effects in any number of different circumstances. Of course, this raises the question: How do we do it?
The chapters that follow will explain how this all unfolds on a biological level and thus how you can apply this innate ability to consciously and intentionally create the health—and the life—that you want to experience.
