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Posted: July 01, 2005

Spiritual Caregiving

The Strengthening Power of Companionship

(Editor's Note: Placebos, along with good old fashioned companionship, may sometimes be the best medicine -- for real reasons. And support groups -- why do they work? Companionship, again? Writer Anne Harrington has a couple of thoughts on these topics.)

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Rx for a Real Miracle Cure

By Anne Harrington 

Given that many researchers downplay the role of placebos or even deny their existence, it is fascinating to see how much work has been done to establish their effectiveness.  

Dosage: Research has shown that placebos are moderately effective when given as little white tablets, but much more effective as big red capsules -- and still more effective when the patient has to roll up his sleeve and get an injection! In other words, the visible signs of medicine seemed to have various potencies. Two sugar pills evoke a stronger placebo response than one -- even though both are inert -- because two is more than just one and therefore "means" greater potency.  

Such representations are also important for real medicines. A researcher in Italy, Fabrizio Benedetti, found that a painkilling injection -- not a placebo but a real drug -- is markedly more effective when the patient is conscious of receiving treatment than when the drug is administered covertly.  

The Doctor-Healer: We know that the best predictor of a good response to an experimental treatment is not the patient's reported level of confidence, but the doctor's. A skeptical doctor, an indifferent or detached doctor, a sympathetic but apparently ill-informed doctor, all send strong tacit messages to patients that influence the outcome. The same is likely to be true for a parent giving medicine to a child: The more confident the parent, the more effective the medicine.  

Conditioning: In the 1970s, Robert Ader at the University of Rochester gave rats water containing a powerful immunosuppressant drug, cyclophosphamide, and saccharine. Then he removed the cyclophosphamide and found that the sweetened water continued to suppress the rats' immune systems. In other words, Ader had conditioned the rats' immune systems to act as though they were being bombarded with a powerful drug. Some of the rats died from the sweet water.  

Since then, a number of elegant studies have shown conditioning effects to be powerful in humans as well as rats. One source of conditioning is the environment. For example, when you enter a clinic for treatment, the incidental features of your previous experiences, such as the doctor's white coat, or entering a hospital, or taking pills of a certain size or color, may help to condition a response toward healing. When you're giving a pill to a child, the right room, spoon, teddy bear, and other factors may all contribute to healing. 

Expectations and Beliefs: Other studies have taught us that our expectations can radically change what we experience. For example, people get drunk on placebo alcohol in the way that their culture has scripted the drama of getting drunk. Thus getting drunk may or may not have much to do with the actual sedative effects of alcohol. There is also evidence that expectation can sometimes override the pharmacological action of substance: A case was reported some decades ago of a severely nauseated pregnant woman who was given an emetic, ipecac. Although ipecac is actually given to induce vomiting in people, the patient was assured that this medication would help her. She believed her doctor, and, within minutes, her nausea went away and a balloon in her stomach showed that her stomach was contracting normally. All of this suggests that when giving a medicine, tell the patient what good result is going to happen and when. That expectation will probably improve the chances.

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The Awesome Power of Groups

By Anne Harrington 

Some 18 years ago, my colleague David Spiegel at Stanford University reported in The Lancet that women with advanced cancer who participated weekly in a specific kind of emotionally intense support group may live on average twice as long as women in the control group. But the women were never formally asked for their opinions of the study's scientific rationale. So a few years ago, I went to California to interview some of them.  

The group I interviewed was having a difficult time. They had lost six members to cancer in the past 18 months, and several of those remaining would not live much longer. One of them had recently been diagnosed with a brain tumor and was so fatigued that she could hardly hold up her head; another had a morphine drip pinned under her shirt. And yet they had all roused themselves to come to the group. It was very moving. So I said, "The doctors think that by participating in these group sessions, you are going to live longer. Do you think that's true? Is that why you come?" A kind of snort went around the table. "We know better," one of them said. "We've seen too many of our group die." 

And then they began to ask themselves, well, why did they come? They knew, but had trouble saying. Finally one woman looked at me and said, "Well, if you eliminate the concept of time, then I guess we live longer." My mouth dropped open. And then another one tried to explain further. "Things become precious." Then the others said it too: "Things become precious." 

At the other end of the spectrum is a phenomenon called voodoo death, first described 50 years ago by physiologist Walter Bradford Cannon as "the fatal power of the imagination working through unmitigated terror" -- the victim is so isolated from the community that feels he is already dead. In Cannon's words: "All people who stand in kinship relation with him withdraw their sustaining support .... The organization of his social life has collapsed and, no longer a member of a group, he is alone and isolated. The doomed man is in a situation from which the only escape is by death." 

Back when Cannon was writing, voodoo death seemed an exotic, even esoteric, phenomenon associated with primitive societies but not relevant to us. But in the late 1980s, Sanford Cohen brought it squarely into our own world. Cohen offers the example of a story of a mother who learned on the same day that her son was gay and had AIDS. Her response was to begin a vigil outside the intensive care unit, praying that her son would die because of the shame he had caused her. The patient could hear his mother praying. One hour later he died, much to the surprise of his physician, who did not think the patient was terminal.


This article originally appeared in Spirituality & Health magazine, www.SpiritualityHealth.com. For subscriptions call 1-800-876-8202 or see www.SpiritualityHealth.com/subs. Editor Stephen Kiesling and his staff contribute weekly columns, features and articles published every Friday as "Spiritual Caregiving" at www.caregivershome.com. Contact staff directly via email at ASKspirituality@spiritualityhealth.com.

© 2005 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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