Reconsidering the Placebo Response from a Broad Anthropological Perspective

Department of Anthropology, University of Arizona, Tucson, AZ 85721-0030, USA.
Culture Medicine and Psychiatry (Impact Factor: 1.29). 03/2009; 33(1):112-52. DOI: 10.1007/s11013-008-9122-2
Source: PubMed

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 underresearched 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 overemphasis 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.

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Available from: Mark Nichter, Sep 28, 2015
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    • "Based on this analysis, a model of Q'eqchi' healing may be the inverse of a " symbolic " perspective: sensorial processes which directly affect the lived experience at the existential immediacy of the body can, in turn, impact the mind and " thinking too much " of a person, producing a plethora of illness narratives that accompany these embodied alterations as the preobjective is made objective. Indeed, " what is initially embodied and sensorial may, over time, become cognitive, as narrative, explanation and meaning become attached to the experience " (Thompson et al., 2009, p. 114). It is the body, then, and a rich conceptualization of how sensorial processes can induce alterations in illness experiences that have been marginal or limited in previous models of " symbolic healing. "
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    ABSTRACT: Theory and research on the healing practices of Indigenous communities around the globe have often been influenced by models of "symbolic healing" that privilege the way patients consciously interpret or derive meaning from a healing encounter. In our work with a group of Q'eqchi' Maya healers in southern Belize, these aspects of "symbolic healing" are not always present. Such empirical observations force us to reach beyond models of symbolic healing to understand how healing might prove effective. Through the extended analysis of a single case study of rahil ch'ool or "depression," we propose to advance understanding of forms of healing which are not dependent on a shared "mythic" or "assumptive world" between patient and healer or where therapeutic efficacy does not rely on the patient's ability to "believe" in or consciously "know" what is occurring during treatment. In this we demonstrate how the body, as a site of experience, transformation, and communication, becomes the therapeutic locus in healing encounters of this kind and argue that embodied mediums of sensorial experience be considered central in attempts to understand healing efficacy. © The Author(s) 2015.
    Transcultural Psychiatry 09/2015; DOI:10.1177/1363461515599328 · 0.99 Impact Factor
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    • "Expressions of hopefulness may further serve as personal reminders of the importance of maintaining hope, staying positive, and embracing the magical power of words (Tambiah 1968). Hope is also associated with embodied ways of knowing, memories of past treatment experiences, and quite possibly with evolutionarily patterned responses to adverse circumstances (Hahn and Kleinman 1983; Thompson et al. 2009). The phrase ''ways of knowing'' has been used to describe the acquisition and application of knowledge, understanding, and embodied experience (Aickin 2010; Geurts 2002; Polanyi 1962; Polanyi 1969; VanMannen 1977; Yorks and Kasl 2006). "
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    ABSTRACT: In this paper, we explore hope in the context of living with chronic pain. Individuals with chronic pain from temporomandibular disorder(s) were interviewed four to five times over the course of their 18-month participation in a clinical trial investigating the effectiveness of Traditional Chinese Medicine. We sought to understand shifts in participants' descriptions of expectations and hopefulness, particularly with regard to the work involved in counterbalancing positive thinking with buffers against disappointment. We found hope to be a dynamic and multifaceted mindset as distinct from being a single entity to be measured. Drawing upon Polanyi's concept of tacit knowing, we explore how different ways of hoping emerge and index one another in participant narratives. We offer a working typology of hope and raise as an issue the manner in which the paradox of hope-hoping enough to carry on while keeping hopes in check to avoid the ever-present possibility of despair-complicates simplistic notions of the relationship between positive thinking and the placebo response.
    Culture Medicine and Psychiatry 07/2015; DOI:10.1007/s11013-015-9465-4 · 1.29 Impact Factor
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    • "It is also clear that in all societies healing modalities have developed to maximize the placebo response in an attempt to overcome assaults to well being. This raises the question as to whether the placebo response, like other self-healing mechanisms, may be an evolutionary adaptation.’1 "
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    ABSTRACT: Placebo appears to be a real neurobiological phenomenon that has evolved through the selection pressure to be able to heal ourselves. The complex language and social structures of humans means that we can attribute meaning to therapeutic encounters with culturally sanctioned authority figures and we can use our attachment to such figures to generate hope for recovery. Different mechanisms may be involved in the neurobiological aspect of placebo including anxiety, learning, conditioning as well as individual genetic variation. Examination of the published work shows that while some trials do seem to indicate a specific mode of action for homeopathic remedies other trials do not and this is an issue that needs to be addressed at the trial design stage. A clinical trial that includes both a placebo group and a non-participating control arm is the most powerful design for separating the non-specific and polymorphic placebo effect from the specific effects of trial medication. The control variables in a trial of homeopathic medication should also include the process of consultation as this may assume a meaning for the individual that can also be associated with a placebo effect.
    08/2013; 4(9):2042533313490927. DOI:10.1177/2042533313490927
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