What do shamans and holistic/alternative doctors have in common?
They both know how to perform well in front of their audience (patients).
Shamans use drumming, chanting, dancing, acrobatics, magic, and comedy to induce patients’ faith in their supernatural healing powers; holistic/alternative doctors use more subtle means of suggestive verbal and nonverbal communication to induce such faith and build rapport.
Faith in the healer’s powers creates an expectation to recover, which releases dopamine in the brain’s reward system. This elicits a placebo response—the patient gets better, beyond the natural course of his disease, just because he had faith in the doctor’s abilities (e.g., his magical touch) and in the means of recovery (e.g., ineffective homeopathics, bullshit supplements, overpriced herbs, or an actual medicine).
The placebo effect is quite complex: A placebo substance is more effective when injected than when taken orally, and sham surgery works even better; if you do take a pill, its color will largely affect your placebo response, and the larger the pill, the better. But let’s focus on performance again.
A recent experimental study by Czerniak et al. (2016) tested how a doctor’s performance style influences his patients’ placebo response.
After 122 healthy volunteers had undergone a pain test (put hand in ice-cold water until the pain becomes intolerable), they were given a placebo cream against pain; then they repeated the pain test. If they could endure the pain at least 30% longer than before, the placebo cream was effective.
The study found that, if the placebo cream was effective, the effect size depended on the doctor’s behavior (performance style) as he gave his patients the cream.
In scenario A, the doctor, who was actually an actor, spoke laconic and functional; he remained seated at his desk throughout the encounter, typing on his computer, keeping minimal eye contact, and not touching the patient at all.
In scenario B, however, the doctor/actor spoke warm and engaging; he walked around, gesticulated, was attentive to the patient, made frequent eye contact, and touched the patient, shaking his hand and physically examining it after the first pain test.
The placebo effect was stronger for participants who had interacted with the doctor in scenario B. They felt less pain after using the placebo cream than before and than those who had interacted with the colder, more distant doctor in scenario A. (The study also found that the pain tolerance was significantly higher for men relative to women, but that’s beside the point here.)
This result is interesting because it demonstrates how the placebo effect, which results from belief (i.e., the mind), is influenced by the social elements of verbal and nonverbal communication.
For some people, called “placebo non-responders,” the placebo effect doesn’t work. Are they mentally stronger, less susceptible, or less able to develop faith and trust? Although placebos clearly are a form of mind manipulation, consider also that the placebo effect is grounded in the ability to create positive expectations, which would be a mental strength.—So which is it?
Czerniak, E., Biegon, A., Ziv, A., Karnieli-Miller, O., Weiser, M., Alon, U., Citron, A. (2016). Manipulating the Placebo Response in Experimental Pain by Altering Doctor’s Performance Style, Frontiers in Psychology, Vol. 7 (874), doi: 10.3389/fpsyg.2016.00874.
- The Bayesian Brain: Placebo Effects Explained
- Mental Toughness, Expectations and My 72 Hour Fasting Challenge