Thursday, December 30, 2004

The Placebo Effect

Here is a (fairly crudely argued) essay I wrote in 1992, which sparked my interest in all things panexperiential:

Mind, Body and Affect: A Reconceptualisation of the Placebo Effect

It is commonplace to say that the placebo effect and related phenomena constitute a nexus at which the natural and social sciences converge. Like psychosomatic disorders, ‘Voodoo Death’, Culture-bound reactive syndromes and so forth, the placebo effect provides valuable material for interdisciplinary research. Yet the inherent mind-body dualism of all the sciences has hampered such research to date. The purpose of this paper is to put forward an alternative conceptual model for analysing these phenomena.


One of the most practical methodologies for studying placebo phenomena from a medical anthropological perspective is exemplified in a paper by Hahn and Kleinman (Hahn and Kleinman 1983). Starting from the observation that beliefs have the power to heal and kill, Hahn and Kleinman develop a model which posits that all events have both physical and mental aspects. Thus, any disease process possesses some accompanying physiological component while conversely, all mental events have a physiological correlate. This approach is summarised with the principle ‘the mind is embodied, the body mindful’. Hahn and Kleinman thus conceive of the mind-body relationship as being a dialectical process in which each influences the other and neither operates in isolation. Using this approach, the placebo effect can be explained as the result of the affective components of the patients belief system altering the physiology of the disease.

The above methodology is obviously more efficacious in explaining placebo phenomena than a crude sociological or biological reductionism which denies any interaction between mind and body. But the model is hampered by the fact that it does not make explicit that which is implicit within it. If the body is ‘mindful’, then questions arise concerning at which stage, if any, the mind-body relationship becomes inert matter. Or, equivalently, does the mindfulness of the body include outer extremities such as the hair? And if so, at what stage does a balding man’s departing hair ‘lose it’s mind’? Such oddities suggest that the model of Hahn and Kleinman has not been fully progressed.

In Hahn and Kleinman’s model, the placebo effect is analysed in terms of the emotional content of beliefs affecting the body. Hence, mind and body have fundamental ontological status and emotion is the bridge which links them. The apparent problems alluded to that arise from this framework can be resolved if this model is inverted; that is, if one takes affect to be the fundamental phenomenon. What this inversion means, for example, is that the feeling of anxiety and palpitations of the heart are not separate things. Rather, the rapid expansion and contraction of the heart and associated physiological correlates is, quite literally, the emotion of anxiety. This may initially sound preposterous, but demands some further consideration.

To elaborate, the thesis here is that one of the fundamental properties of physical existence is emotion. To take it one step further, one could say that emotion is the fundamental property of matter, and that matter is in some sense synonymous with emotion. The atomic quanta which constitute matter can thus be redesignated as primitive preconscious affect consisting, perhaps, of basic forms of attraction and repulsion. Human self consciousness can be seen as a highly evolved form of affect, but one which is not different in essence from ‘inert matter’. On this model then, all physical existence is a spectrum of emotional events, ranging from preconscious matter in simple elemental or compound form to complex, neurally based self consciousness. Thus the extension from Hahn and Kleinman’s model is that instead of mind and body being reciprocally related, they are a unity.

The application of this model to phenomena such as the placebo effect are self evident; instead of seeing medical therapy as having a ‘psychological’ and a ‘physical’ component, therapy can be seen as operating upon an affective continuum. All forms of therapy involve the interaction of affect with affect. These therapies vary depending on how physicalised (preconscious) or mentalized (self-conscious) the therapeutic affect is. Thus, at one end of the continuum would be the administration of drugs to a patient who is not consciously aware he or she is being given them. At the other end of the continuum would be highly intellectualised therapies such as psychoanalysis. In between these two extremes, in approximately increasing order of physicality, would be psychotherapy, ritual and ceremony, massage and ‘touch’ therapies, placebo drug therapy, surgery and conventional drug therapy. The physicality or mentality of these therapies is by no means fixed or absolute, nor directly correlated with the physicality or mentality of these therapeutic effects. Rather, therapeutic effects depend on the affective affinity between the therapy and the various arrangements of atomic-affective quanta which constitute the body organs. Thus, psychotherapy and psychotropic drugs affect the brain in a similar manner even though they come from different poles of the affective continuum.

Affect and the Natural Sciences

Having sketched an outline of the ‘matter as emotion’ model, it is apposite to explore some of it’s implications for the natural sciences. The model does not undermine the rigour, precision or validity of the methods of the natural science, although it does alter the relation of these to the social sciences and the humanities. This can be explained in the following way:

Because human beings’ bodies are built upon the same basic structure of atomic-affective quanta configurations, it can be said that humans live in the same sensual and perceptual world. That is, the physical constitution of the human organism means that all humans inhabit the same affective domain. But this does not yet solve the problem - the preconscious ‘ground of being’ is constantly melded with affects associated with self consciousness. That is, while humans may live in a world that is roughly the same for all, the problem remains of how the human community can have consistent and accurate knowledge of this world.

This issue can be resolved if the objective approach used by the experimental scientist is not regarded as a robotic, affect-free state, but as an affect in itself. That is, objectivity can be seen as an emotion of calm, concentrated non- volatility. From this, the character of the natural sciences becomes clear. A scientist’s observations and theorising are the result of the interaction of his or her atomic-affective quanta with the atomic affective quanta of the ‘external’ world (mediated through the sense organs). As all competent scientists undertake their work with the same objective mood, they all perceive essentially the same world. This explains why experiments are replicable and have predictive success - they are all dependent on the experimenters sharing the same affective state.

It could be argued that this model means science must renege any claims that it may have had that it’s object is a ‘reality’ that exists behind perceptual appearances, as both what is observed and what ‘is’ would be dependent to some extent on how one feels. But this in no way debases the validity, rationality and utility of the sciences. Or to put it more vibrantly- just as the world appears grey when one is depressed, bright and beautiful when in love, so too is it ordered and manipulable when one is feeling objective.

Reference

Hahn, R and Kleinman, A. ‘Belief as Pathogen, Belief as Medicine; ‘Voodoo Death’ and the ‘Placebo Phenomenon’ in Anthropological Perspective’. Medical Anthropology Quarterly V.14(4):16 -19 (1983).

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