Posted by Marty on August 15, 2008, at 14:18:39
In reply to Re: Placebo in Psychiatric Clinical Trials, posted by bleauberry on August 13, 2008, at 19:13:45
This post is long but I think it's worth the reading as it present a very different hypothesis of the placebo effect in depression in the context of a very representation of what situational depression really his.
Many things has already been suggested and make sense in this thread. But I'd like to offer a more 'mechanical/systemic' hypothesis that I gave some thought some time ago.
For the sake of simplicity my hypothesis which is in the form of an representation/analogy will limit itself to a SITUATIONAL depression and will not account in details for the types which involve some profound biological pathology like Bipolar Type 1. The 'placebo effect' in the hypothesis/analogy will be described as 'Confidence/Optimism/Hope' and can't be explain without explaining some major parts of this hypothesis. So please stay with me for 10 minutes and I think some of you will find this perspective interesting: What is the placebo effect in the specific context of depression.
PS: While reading the whole thing before posting, I've found it way more interesting/entertaining imagining George Carlin voicing it in my head. You may want to try that!
[ (the basic lines of) The Government Hypothesis of Depression ]
The brain is acting like a government which governs a body (analogy: country/enterprise) and you, the consciousness, would be his submissive executive president. This goverment work toward some objectives which include survial and reproduction. And that's why :
1. When things ain't going well: Parts of the governement thinks it's because of you or MAYBE IT'S NOT BUT maybe you could do something about it and so, based on that logic, here's the politics/strategies of the government in those instance:
1.1: Pressure in the form of sanctions(mental pain/discomfort) are put upon you to punish you for what you shouldn't never do again OR/AND make sure you do something about the current situation/aftermath. Evaluating IF you can actually do something about it isn't something the government do as well as you, the executive president (consciousness), you are the one who usually can evaluate something as complex because of your higher intelligence but in this case your input about if you can do something isn't very much taken into account for that the government confidence in you is pretty low in those circumstances.. and so no chances are taken and pressure will be systematicly put on you to make sure you will do everything you can as fast as possible: systematic pressure in the form of pain is the strategy that millions years of evolution found out to be the best in those case. After all, without pain.. you wouldn't be that fast to remove your foot on the nail you just stepped on, right ?
1.2: The situation being bad and prospect of a better future not currently forseeable by the government, extreme budgeting mesures are taken to increase survival chances AND confidence toward your abilities to lead being very low, your executive powers/influence on the government and body are inhibited as to reduce the risk that you agrave further the situation. Your executive powers/influence being reduce also contribute to reduce your ability to reverse the extreme bugeting mesures.
---> 1.1 + 1.2 = Situational Depression: Lost of confidence + Pressure on you + Inhibition of your powers/leadership + ressource budgeting.
Now to the point: where is the placebo effect in this hypothesis ? The government feels that you may well have found a solution to the situation in the form of 'X' treatment (let's say a new pill) to the crisis. And that's because of one of the very simplistic way he allow himself to evaluate possible solutions -> Possible pain reduction. The government consider that the ->president evaluation<- of what could reduce pressure on him (pain) is a good marker of a possibly good solution. ... AND NOW THAT THE GOVERNMENT THINKS THAT YOU MAY WELL BE ABOUT TO IMPROVE THE SITUATION -> A CONFIDENCE BOOST IS IN ORDER (LESS PRESSURE IN THE FORM OF PAIN) AND PARTIAL RESTABLISHMENT/DESINHIBITION OF YOUR EXECUTIVE POWERS IS ALSO IN ORDER TO INCREASE YOUR CHANCES OF SUCCESS IN YOUR PURSUIT OF YOUR 'POSSIBLY GOOD' SOLUTION.
SO in summary: The depression being voluntary induced upon itself and the consciousness (you) by the brain.. The prospect of a possibly good solution (the pill that is in fact a placebo) being applied or soon to be applied leads to a ->strategic relieves<- of the depression symptoms. After a while, depending if you used that relieves to *really* improve the situation or not, the brain gradually or quickly catch up to the fact that nothing really improved in your ability to attain his objectives and so depression is, usually, reintroduce fully.
Did you really read to that point ?! ;)
Let me think what you think of this representation point of view. What doesn't fit ?BTW, the analogy with president and government is used to simplify the way mother nature possibly made us. I'm not seing the whole thing as simplistic as that in my head, obviously.
/\/\arty
Poorly rated C.E.O of the "United Systems of /\/\arty" which responsabilities includes the successful reproduction and survival of the "USM" genes by mastering every life variables judged by the goverment to be markers of improved chances of success.... damn, I'm not paid enought for that job !!!! ..maybe that explains why I sometime flirt with the idea of **resignation** ..........
poster:Marty
thread:845869
URL: http://www.dr-bob.org/babble/20080814/msgs/846417.html