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In the glorious fifties, that yearned-for destination of MAGA time travelers, my mother’s gynecologist prescribed Valium for her nerves. As a kid, I watched her slowly, shakily, pry herself free of them. It took years. In her seventies, the anxiety came back full force, so she nibbled tiny pieces of the lowest dose of Xanax, terrified of becoming addicted again and hating how dizzy it made her. I came so close to urging her doctor to prescribe her a placebo. My mom was so suggestible, she developed any symptom somebody else had out of pity and panic. I felt sure the placebo would “work.” But surely suggesting it would betray her trust and the doctor’s professional integrity?
Now it is too late—she is gone—and doctors are cheerfully prescribing open-label placebos, something I never dreamed could work. I thought the mind had to be fooled. Turns out, it can fool itself. Your doctor tells you that the prescription may or not be a placebo, or even that it is a placebo but has been shown to help. You pop that sugar pill with alacrity. And it works. In one study, placebos, offered openly, helped irritable bowel syndrome; in another, major depression; in a third, chronic low back pain.
“Placebo” comes from the Latin placere, to please. Traffic engineers give us crosswalk buttons just to make us think we are speeding our crossing; non-functional office thermostats give an illusion of choosing one’s comfort; unopenable hotel and office windows let us think fresh air is within reach. Even the illusion of control is invaluable. Patients use less morphine when given their own pump because they have control over the dosing. Knowing help is available gives us the courage to try a challenging project on our own. And a placebo that gives us hope can influence our brains.
Placebos do not cure cancer or repair heart valves. They address the miseries—real miseries, not hypochondriacal inventions—that are regulated in the brain. Pain, seasonal allergies, menopausal hot flashes, ADHD, depression….
So do they help by affecting the body or by persuading the mind? Probably both. Because they work in the gray where the two intersect.
When researchers scanned the whole brains of 600 participants, they saw that placebos reduced pain-related activity in many different parts of the brain.
Another study showed that if you activate the neurons that get switched on by anesthetic drugs, you teach the body to associate that environment with a reduction in pain. The study was done with mice, who were placed in a particular box. Pain relief returned whenever they were in that box, even without further neural stimulation.
In a study of dental pain, patients were given morphine, and it helped their pain. Not surprising. But others were given saline placebos, and they, too, had less pain. Those who suffered were those given naloxone, which blocks the effect of opioids. So were the placebos triggering the brain’s release of natural opioids?
These and other studies “support the emerging concept that drugs and placebos share a common mechanism of action,” says Dr. Fabrio Benedetti, a neuroscientist and placebo expert at the University of Turin Medical School. That sounds clean and tidy. Yet “a placebo pill has almost no effect when administered by researchers who do not care about the placebo effect,” writes an academic who keeps his blog anonymous, “but the exact same pill has an enormous effect larger than all existing treatments when administered by a researcher who really wants the placebo effect to be real.” His conclusion? That it is the attention paid by the researcher, not the placebo itself, that makes the difference.
Social, physical, psychological—does it matter? I would have happily introduced my mom to a caring researcher whose attitude could calm her. How different is that from feeling less pain because your husband is holding your hand? Studies have demonstrated that bit of common sense, too.
Simone Weil said attention is a form of prayer. Annie Dillard said what we pay attention to is the sum of our life. Mindfulness has become the automatic prescription for nearly any distress. But what about the attention of others? It is the scarcest commodity, with all of us overbusy and distracted. More people live alone, cut off from any direct attention to their daily worries and mishaps. We automate as many of our interactions as we can. People do not even give their fast-food orders to a person anymore; they slide their finger around a tablet instead. I loathe that change—I like the over-the-counter repartee. But if I have a complaint and can fill out the contact form instead of calling customer service, I will jump at the chance. The prospect of an attentive interaction with a stranger often feels daunting, now.
One of the great puzzles of healing is the way some kids survive abusive parents better than others, emerging more whole and relatively unscathed. As best we can tell, this has to do with whether there was a witness, a caring adult who saw what the child was going through, acknowledged their pain, and let them know it was not their fault. Somebody, in other words, who paid attention. Babies wail for it. Teenagers hate to admit how much they crave it. Ninety-year-olds turn petulant because they know they are now easy to ignore.
The need for attention explains the inordinate prices people pay at hair salons. It may also explain the 2024 election, because a particular kind of attention was paid to the deepest fears and resentments of a large swath of the electorate, and they felt seen and heard.
If we took closer care of one another, our politics might be saner, and the pharmaceutical companies’ profits might shrink to reasonable numbers. Regardless of the mechanism, a caring human is the best placebo of all.
Read more by Jeannette Cooperman here.
