What roles do emotion, psychology and spiritual outlook play in disease and its causes/treatments? Western medicine admits very little. Meanwhile, these annoying placebo studies have moved from sugar pills to invasive surgery. What next chemotherapy? Organ transplant? Joint replacement?
Consider, after all, how far "modern" medicine has not progressed from the patient's perspective, where the power of placebo resides. For the Houston study, imagine the surgeons as Paleolithic shamans. You've got a demon in your knee that's driving you nuts. You go to the special healing cave, where you are ritually cleansed, gowned and otherwise "prepped" by anonymous attendants. In comes the witchdoctor in his distinctive costume, complete with mask. It's only a surgical mask, but it serves the modern imagination every bit as well as the fanciful museum pieces.
You undergo a change in consciousness, in this case the twilight sleep of light anesthesia. You awaken to find marks of sacrifice on your body. Ritual bloodletting, a staple in medicine well into the 19th century, remains potent. The demon is expelled, thanks to your blood sacrifice and the secret knowledge and power of the shaman. (Substantial bloodletting occurs when the doctor's bill arrives.) You have paid any guilt debt to the gods for even unwittingly entertaining knee demons. Or, had you been enchanted, your incision scars show where your magic overcame your enemies. Scarification, tattoo, anything unique, and preferably permanent, will suffice.
An impressive, preferably nasty experience is essential, even, perhaps especially, when you've slept through most of it. (Even "sugar pills" are rarely made of sugar.) The marks become indispensable in this case, since you don't remember any pain. For conscious patients, physical discomfort is mandatory. You need to know you've been "physicked." To evoke placebo, the experience must be imposing, and pain insures this while reinforcing the demands of sacrifice.
Patrick O'Brian, who studied early 19th-century British naval medicine for his 20 superb period novels, relates how sailors demanded the most foul-tasting medicines possible, often containing asafoetida, camphor, etc., not for any therapeutic function, but purely for their vile taste and smell. The letting of blood was, of course, a perennial.
Another popular treatment was the use of explosive laxatives. Laxatives did something. Powerful "purges" were the only actual pills taken on the Lewis and Clark Expedition of 1804-5. The Corps of Discovery's trail West can be traced to this day by digging up their latrine pits for telltale traces of mercury from Dr. Rush's "Thunderclappers," dispensed by Lewis (even for diarrhea!). The expedition lost only one man during two years in the wilderness.
"Patent medicines" were all the rage well into the 20th century, marketed under the broad moniker of "snake oil." What other product could prosper under such a deliberately-unappetizing name? Nor is this penchant for rigor some peculiarly Western fetish. I have had acupuncture, and I can tell you some applications hurt. One in particular (the "Flower Stone," I believe) involves three deep penetrations of the ball of the foot. I recall stepping on a nail as a child, and this was far worse. My acupuncturist smiled at the myth of painless acupuncture, relating how overly-gentle American acupuncture students in China are often dismissed by indigenous patients.
Like patients everywhere, Chinese need to know they have been treated, and, in a practice involving lots of needles, pain is the obvious signal.
Since Einstein, physics has repeatedly proven that matter is energy. The bold assert that energy is thought. The syllogism is tempting. Recall that, however inconvenient for mainstream Christians, Christ was an enthusiast for miracles of healing, and not just his own: "Greater works than these shall ye do." There's even raising of the dead and removing mountains with mustard seed-sized parcels of "faith." Perhaps this faith could as well reside in aromatherapy. Or small incisions about the knee.
How much medicine is, in truth, placebo? Do we really want to know? If, as in "The Wizard of Oz," we finally pull back the curtain on placebo, will we destroy a power that depends on mystery? So far, after centuries of rationalist assault, placebo prospers.
Conversely then, can we harness placebo so that it can be reliably employed as needed? Maybe. "Take two aspirin and e-mail me in the morning" may ultimately prove as effective as all the elaborate panoply and terrifying expense of modern medicine. S
Travis Charbeneau is a freelance writer who lives in Richmond.
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