Posted by atmlady on August 13, 2008, at 23:12:54
In reply to Placebo in Psychiatric Clinical Trials, posted by SLS on August 13, 2008, at 7:40:34
Here's an interesting except from an interview with Nicholas Humphrey, a "theoretical psychologist", about research he's involved with on the placebo effect:
"Recently I've been involved in research on the placebo effect, coming at it from a mixture of philosophical and evolutionary perspectives. The placebo effect is a very important aspect of all medicine. A large part of medical cures are effected by the patients themselves, when the medical procedure allows the patients to bring their own resources to bear to solve the problem. In the classical placebo case, you give a sugar pill and the patient uses this as an excuse to cure himself. But placebos are actually present in every kind of medical treatment. To the extent the patient believes the treatment is going to work, he allows himself to deploy his own healing resources in a way that he wouldn't have done otherwise.
How should we understand this? What questions should a science of the placebo effect be asking? Of course it's important to investigate the brain mechanisms that underlie these effects, and lots of researchers are already beginning to home in on the problem at the level of neurophysiology and immunology. But it's no less important to look at the bigger picture, and ask: Whatever is going on here, from a functional standpoint? If a placebo is releasing in people an ability to cure themselves, why don't they just get on with it? Why ever should anyone withhold self-cure? You'd think that when you're sick you should just get better if you can; you shouldn't need to wait for permission from a doctor, a shaman, or a psychotherapist to utilize your own resources.
It's this level of question that has set me looking for some possible evolutionary explanation. Why should humans and other animals hold healing resources in reserve? What can be the advantages of not getting better when you actually could? As I've looked further, I've found many examples of it.
People may die from cancer when they have immune resources still waiting in reserve which could have been deployed against the cancer. People die in head-on car collisions because they don't apply the brakes hard enough. When athletes are running a marathon, they may reach the end of what they can do and collapse from fatigue, when, in fact, their muscles still have significant reserves left in them.
What's going on?
You'll have guessed the way I want to go with this: my idea is that nature has designed us to play safe, and never to use up everything we've got because we never know what might still lie around the corner. When we reach the end of a marathon there may still be a lion waiting at the finishing post that's going to suddenly give chase. When we're sick with an infection and respond with an immune reaction, we may still be hit by a further infection the next day. Remember the story of the wise and foolish virgins and their lamps: it's always wise to keep something in reserve.
I'm now thinking in terms of there being what I call a "natural health management system", which does a kind of economic analysis of what the opportunities and the costs of self-cure will be what resources we've got, how dangerous the situation is right now, and what predictions we can make of what the future holds. It's like a good hospital manager who has to choose if and when to throw resources against this or that problem, to hold so much back, to decide if it's essential to build up this area or that area basically to try to produce an optimal solution to the problem of maintaining health with enough left over to meet coming challenges.
If this is right, it makes the placebo effect fit into a much larger picture of homeostasis and health management. And it converges with ideas being developed by researchers coming from quite different disciplines. I've been particularly struck by the work of the South African physiologist, Timothy Noakes, who has come up with the idea of there being what he calls "a central governor" in the brain which regulates just how far the body should be allowed to go in meeting the demands of extreme exercise.
These ideas are big, because they are producing a new perspective on how we and other animals have evolved to manage our internal healing resources across the board. But it already goes much beyond mere theory.
There's a phenomenon, well known to sports physiologists and athletes called "interval training". If you want to improve your prowess as an athlete, one highly effective method of doing it is to build up in the following way. If you're a sprinter, for example, you sprint for two minutes and then relax and jog for five minutes. Then you repeat this pattern again, and again. The result is that you soon find you can run about 15% better than you could before.
Why does this work? According to Tim Noakes, what may be happening is this. In order to improve peak performance you need to persuade your central governor to let you go beyond your own self-imposed limits, when otherwise "cautionary tiredness" would kick in and say, "No more." And one way of doing this is by teaching your central governor that the risks are not actually so great after all. Through interval training you can teach your own brain that you are not going to get into trouble by pushing yourself a little further than you might otherwise have done.
Noakes' theory is a clever way of looking at how to stretch the limits of athletic performance. But what about applying the same idea in other areas? In particular, what about the possibility that we could have interval training for the immune system? If people are not deploying their immune resources to maximum extent, so that they don't get better when they could have, could we teach them by a similar schedule of exercise for the immune system that it's safe to do so?"
Complete interview here:
http://www.edge.org/3rd_culture/humphrey04/humphrey04_index.html
When I was a teenager and was depressed, my mom used to tell me to "take a shower and put on some make-up" or "go take a walk" and I'd feel better, and sometimes it would actually work ('course, the depression always came back, later). This reminds me of the acting "as-if" of AA (I think it's AA). Act like you have ... whatever (love in your life, a reason to live) and eventually you WILL have it, will really have it, that sort of thing.
I wonder if sometimes just doing something different or just doing SOMETHING (changing a med, checking into a hospital, beginning therapy, etc) can release whatever it is that's been holding back our own healing powers (the inner anti-depressant). If that makes ANY sense at all.
poster:atmlady
thread:845869
URL: http://www.dr-bob.org/babble/20080805/msgs/846077.html