The Placebo Effect and its relationship to psychogenic illness.

The Placebo Effect and its relationship to psychogenic illness.

by Ashton Prescott

A psychosomatic illness, by definition is one with physical manifestations without any known or identifiable physical cause. As Dr. Andrew Weil has expressed in his book Health and Healing, a more accurate term for this condition (or experience) is psychogenic illness; which is physical symptoms directly caused by the mind. On a basic level, virtually everyone will scratch their head if you tell them a story about a child with head lice, and a large number will feel nauseated or worried about themselves when hearing about someone else’s food poisoning experience. These are psychosomatic reactions. When we experience these situations regularly there is a physical manifestation in the form of chemical reactions in our brains triggering physical response. We can literally think ourselves sick, or well for that matter.

The mind has a powerful and direct influence over the body; this power is often referred to as the power of suggestion. It is quite possible to feel extremely ill without any physical reason. This is quite common in people with anxiety disorders. Worrying over their physical symptoms exacerbates them, leading the patient to a physician for reassurance that there is a physical cause for their suffering. If this type of negative thinking is not treated in some way, it can make a perfectly healthy person completely debilitated; not to mention, will eventually lead to autoimmune dysfunction and chronic depression which is all to often fatal. A placebo or sugar pills are used quite often with patients suffering from panic attacks while going through therapy with an impressive success rate. The theory is that if you are able to talk yourself into a panic attack, then you are more susceptible to a positive reaction from a placebo. Patients who are given a placebo are more likely to keep their appointments with their health care providers, continue long term therapy, and make a full recovery when they have a positive response to a placebo; alleviating them from physical symptoms presents them with the opportunity to concentrate solely on the psychological root of the symptoms. A psychogenic illness will generally improve once this reassurance is delivered, by negative test results. Many allopathic doctors dismiss the symptoms of a patient who has been diagnosed with an anxiety disorder on these grounds without any further treatment other than verbal reassurance. If the illness is genuinely psychogenic this may be sufficient; however, it can also be extremely dangerous thing to do since many serious illnesses such as cardio-pulmonary disease and some forms of cancer begin with vague symptoms sometimes mimicking anxiety or depression. On the other hand, treating a psychogenic illness as a physical one, can have serious consequence of its own. Not only will the patient not improve, but may

become much worse from improperly prescribed drugs. In 2001 a New England Journal of Medicine study showed that there had been a 68.5 R> increase in anti-depressant/anti-anxiety drug prescriptions written for women, from the previous decade. Moreover, the most alarming content of this study was that (after further study) 28 of those women had serious illnesses unrelated to anxiety or depression. There have been times in our country’s medical history when almost any illness suffered by women was considered hysteria, while the conditions of men were treated aggressively because it was believed that men did not suffer from this type of psychosis. This view has changed greatly since World War I, when men were returning home with an illness coined Shell Shock Syndrome. There were no apparent physical abnormalities despite the soldier’s symptoms. Only after a long struggle by pioneering, as well as, prominent psychiatrists in the late 1920s was it acknowledged that men could suffer from hysteria; now referred to as psychosomatic/psychogenic illness. Many illnesses previously thought to be hysteria are now regarded as serious health problems; such as, asthma, allergies, and migraine headaches. Illnesses such as multiple chemical sensitivity and Gulf War Syndrome are still currently under debate. The placebo effect is considered today by most allopaths, the phenomenon that a patient symptom can be alleviated by a fake or sham treatment because the individual expects or believes it will work. The naturopathic community however believes this to be a remarkable aspect of human physiology and positive thing. Unfortunately, some on both sides still consider it to be an illusion arising from the way medical experiments are conducted, in order to manipulate marketing results. If patients complaining of back pain are administered only a placebo for example, typically about 25f them will report relief or diminution of pain. Remarkably, not only do patients report improvement, the improvements often are objectively measurable, and the same improvements typically are not observed in patients who did not receive the placebo. Because of this effect, government regulatory agencies approve new drugs only after tests establish that patients not only respond to them, but also that their effect is greater than that of a placebo (by way of affecting more patients, by affecting responders more strongly, or both). This type of clinical trial is now called a placebo-controlled study. Since a doctor’s belief in the value of a treatment can affect what his or her patients believe, such trials are generally conducted in a double-blind fashion: that is, not only are the patients made unaware when they are receiving a placebo, the researchers are also unaware. Recently, it has been introduced that mock surgery may have similar effects as the sugar pill, and that some surgical techniques are now being studied within placebo controls, (rarely though in the double-blind fashion for obvious reasons.) The size of the placebo effect is controversial, just as the extent of physical manifestations with psychogenic illness. A part of this controversy may be due to the fact that patients who have been given a drug (or a placebo for that matter) will often time report improvement earlier and more eagerly in order to please or thank their care givers. The patients may even do this when there is no real physical improvement attained; hence, the uncertainty over the exact impact of the placebo effect. An often-quoted number is that about one-third of patients improve on a placebo, but a recent study has called that number into question, claiming the effect is much smaller, if it exists at all. This of course, was not a double-blind study, giving further support to the 30nbsp; The 30 percent figure derives from a paper by Henry Beecher, published in 1955 (Beecher Hk, The Powerful Placebo. Journal of the American Medical Association 1955; 159:1602-6). Beecher was one of the leading advocates of the need to evaluate treatments by means of double- blind trials and this helps to explain why it has been so widely quoted. It has been argued that the placebo effect may be simply an experimental artifact that arises because the patients in any study are selected to show a particular characteristic (symptom of illness). Since the sample is thus initially skewed away from the mean, it is likely that during the course of the study there will be a natural tendency for the sample to revert towards the mean - i.e. show better than average levels of recovery. A recent study also questioned the placebo effect. The authors found that in many studies where a control group was used that did not get any treatment at all, the effects in the no-treatment group were almost equal to the effects in the placebo group. Most studies however only use a placebo group as control. The authors concluded that the placebo effect is overrated, and that studies in the future should have a no-treatment group when possible, to make sure that effects would not be attributed to a placebo effect while they are totally natural effects that would have occurred anyway.

The reverse effect, sometimes referred to as the Nocebo Effect, is the result of negative expectations by the patient. Some patients who believe that they should be ill can exhibit genuine symptoms of illness, pain, or decreased immune function. The Nocebo Effect may or may not be distinguished from older concepts such as sociogenic illness or psychosomatic illness. In any case, distinguishing between these effects can be a difficult problem for medical semiotics, or the study of how to interpret the patient's description of their ailments. The strictest definition would be the negative effect produced by an expectation that a medicine or treatment does not

work in general or for the patient in particular. Sociogenic illness and psychosomatic illness might therefore be broader terms where a known or unknown cause with cultural or psychological factors is involved. For example: I believe that cough medicine does not work. I suffer, therefore, from the Nocebo effect--the medicine is less effective for me than for a patient who believes the medicine actually prevents coughs. Furthermore, in a clinical study at the University of Michigan’s Psychology Department, they found that the experience of pain arises from both physiological and psychological factors, including one's beliefs and

expectations. Thus, placebo treatments that have no intrinsic

pharmacological effects may produce analgesia by altering expectations. However, controversy exists regarding whether placebos alter sensory pain transmission, pain affect, or simply produce compliance with the suggestions of investigators. In two functional magnetic resonance imaging (FMRI) experiments, we found that placebo analgesia was related to decreased in brain activity in pain-sensitive brain regions, including the thalamus, insular, and anterior cingulated cortex, and was associated with increased activity during anticipation of pain in the prefrontal cortex, providing evidence that placebos alter the experience of pain. (University of Michigan). In conclusion, it is quite apparent that as more scientific curiosity, in these fascinating phenomenon’s arise; it will further the way for more experimentation by both the allopathic as well as the naturopathic communities in the future, further proving the fascinating and undeniable relationship between our mind and body and the effective role it plays in our health.

Henry Beecher, published in 1955 (Beecher Hk, The Powerful Placebo.

Journal of the American Medical Association 1955; 159:1602-6).

New England Journal of Medicine November 2001

Dr. Andrew Weil Health and Healing

University of Michigan’s Psychology Department [PNI Blind Trial] 2004

Medicine: A History of Healing Roy Porter 1997

~This article originally published September 2016 by the Alternative Press~

2020 Edit by author Ashton Prescott