Wednesday, May 25, 2011

Jedi Mind Tricks? Or Placebo Effect?

Our brains are the most complex living machine on the planet. They receive coordinated feedback from all the senses in order to determine what is going on around the body. Sometimes they cope well, but other times, they’re pretty screwed up. Our brains are easily fooled, mostly when the feedback from all the senses is not coordinated.

You’ve probably heard of phantom limb syndrome, a really interesting phenomena that occurs after a limb is amputated. The affected person feels pain in the missing limb. Well, actually, it’s the brain telling the person that there’s pain in the affected limb. No amount of telling yourself there’s no limb, hence no pain, will change your feeling of pain. (In his book Phantoms of the Brain, Dr. Ramashandran describes a simple technique to relieve this common problem for amputees)
You’ve probably heard of false memory syndrome as well. Maybe someone has told you a story about when you were a kid that you don’t recall, but the more the story is told to you, the better you can remember it – even if it never happened. It explains the dearth of “I was abused by a Satanic ritual club” stories in the 80s.
People are biased. They see information and will interpret it based on their pre-existing views. “If we believe something about the world, we are more likely to passively accept as truth any information that confirms our beliefs, and actively dismiss information that doesn’t. This is known as “motivated reasoning.” Whether or not the consistent information is accurate, we might accept it as fact, as confirmation of our beliefs. This makes us more confident in said beliefs, and even less likely to entertain facts that contradict them.” (Joe Keohane, How Facts Backfire –Boston Globe, online edition, June, 2010) Why else would a mountain of scientific evidence and admissions of falsifying evidence still not cause people to change their minds about the vaccine/autism connection?

These are just a few of the many ways our minds can play tricks on us. Not all tricks are bad; some are pretty cool, actually (especially those visual illusion ones, you know, is it a vase or two people?). And we have an enormous capacity to learn. Those two things combine to allow us to deal with any number of difficult situations, physical or mental.

In the case of phantom limb syndrome, Dr. Ramashandran had patients sit with the intact limb facing a mirror so it appeared the patient had two intact limbs. Just seeing a “normal” appearing limb and feeling an unpainful limb where they knew there shouldn’t be one because of the amputation was enough to lessen or remove the pain from the phantom limb. The patients knew they still had a missing limb, and they knew that what they saw was a mirror image of their intact limb, yet their brain saw two intact, healthy limbs. Nifty, eh? So the patients had a relatively easy way to relieve a common and painful condition, just by fooling their brains.

There was an episode of MASH a number of years ago that left a big impression on me. In this episode, the medical unit was very low on painkillers for soldiers recovering after surgery. They were awaiting fresh supplies, but in the meantime, they had to ration what little they had and come up with a creative way of dealing with what was very real pain for the patients. The doctors had a meeting and came up with the idea of using a placebo. They would tell the recovering patients that they were trying a new painkiller medication, but it was so powerful that it could only be given in small doses. They were actually administering sugar pills, a placebo. It worked for most of the patients. I realize that this was a TV show but it demonstrated what has long been known about placebos. We can use them to fool our brains.

A placebo effect is an action unanticipated by theory or known scientific data. It is a well-documented and expected part of scientific research. They are many factors involved in the effectiveness of a placebo. The relationship between the patient and the caregiver and the patient’s expectancies of the effectiveness of the treatment are two of the more important ones. In university I recall a paper I wrote about the effects of LSD on human behaviour. People who had “bad” trips on LSD were anxious about their reaction to the drug before they took it or they didn’t know they were being given the drug. People who had “good” trips, had a different outlook before they took the drug. They were looking forward to the mind altering experience and expected it to be a pleasant one. This demonstrated to me (and others), that a person’s perception of what might happen was very important for the drug to be effective in a positive way. If perception was positive, so was the experience. If the perception was negative, so was the experience.

All of this to say that perception and attitude are two of the biggest determining factors in a placebo effect and in how someone will deal with what happens to them in life. You’ve heard the term “think positive”. You’ve met people whose mindset is one of positivity. They’re the ones who find the silver lining in every cloud, the ones who make lemonade when life hands them lemons. The ones who get on our nerves. (And yes, I am usually one of those people – but not always)
The positive ones trust the people they surround themselves with – because they surround themselves with only people they can trust. Like doctors or caregivers. Or spouses. You get the idea. They have a good relationship with their health care professional and they have a positive attitude. They are perhaps more likely to follow health care advice in general and do so with a smile on their face. They are compliant with medication and look at side effects as a minor inconvenience or perhaps a sign that the meds are working. They get better, or live longer, or seem happier than the patients with negative attitudes.

Remember all the hoopla around the book, The Secret? Positive thinking was all it was about. It was Norman Vincent Peale but without all the God stuff. Norman Vincent Peal was a little ahead of his time. He had described cognitive behavioural therapy (albeit on a religious level) long before the therapy was developed. CBT is highly effective for people motivated to change their way of thinking and their behaviour. By changing your thought processes, you can change your behaviour. Think positive! Sounds simple doesn’t it? It’s not. It’s a lot of hard work, but it can be done. One simple example: someone compliments you on what you are wearing. Do you smile and say Thank you? Or do you frown and say This old thing? The first response is the one that gives you a lift because someone noticed that new sweater and it gives the complimenter a lift when you acknowledge it. You have just exchanged gifts. The second response is a put down to the complimenter, suggesting their taste isn’t all that great and you have made them feel bad by implying it. See if that person ever compliments you again.

Let’s go back to the placebo effect. Surround someone with lots of people and outings for them to go to where they have been limited before because of their illness. They’re moving around, talking and engaging with people, they’re the centre of attention for a while, they’re the focus of a bunch of people fundraising for their “treatment” that the bad ole government won’t pay for. Have them watch videos on Youtube about others who’ve had the same treatment and see how well they are now. Now send them to a foreign country, give them a treatment and tell them it might “liberate” them, where nothing else has worked well before.

Many of these folks have been isolated because of their illness or their attitude about their illness. They are not active because of their illness or their attitude. A bunch of anecdotes showing them that this treatment will work increases their expectations that it will work. And so it appears to work. This is what the doctors mean by placebo effect. As you can see there are a number of things happening, from expectations, to simple want, to bias.

I spoke with a health care provider last year and she told me a neurologist she once spoke with told her he estimated 25% of his MS patients in wheelchairs, didn’t need to be in them. Their attitude is what kept them in the chairs. “I have MS. My life is over. Woe is me.” That’s what I mean by attitude.

I’m not sure if this post helps you understand the placebo effect and why some drugs or treatments can appear to work. I found an enormous amount of really interesting stuff on the brain and how it’s fooled, on the placebo effect in general, and why it is expected to occur as part of scientific studies. I could have written for a couple of more days about the topic, but instead, I’ll suggest you type How does your mind play tricks on you? into Google and do a search.


1 comment:

Cathy said...
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