Thursday, May 28, 2009

The Care Effect

Dear Feelers,

Yes, I'm talking to you, people who feel, and I want you to ponder this post.

Throughout my education (I studied psychology at university) there was an enormous amount of discussion about something called the placebo effect. Let me explain this phenomenon:

When a person is unwell, and they go to a doctor to get medication for whatever condition it is that is affecting them, the expectation is that the medication will work to take away the symptoms of the condition, or that the meds will "cure" the condition. Sometimes, though, doctors have no cure for what ails you, and so they kind of throw a prescription at you, with both of you hoping it will work. You go home, take the pills, and lo and behold, a few days or a week or so later, you feel better. Was it the pills? If it wasn't the pills that made you better, what did?

What if your doctor gave you "sugar pills," tablets that look like medications, but are actually really just sugar, with no actual medicinal ingredients in them? What if these sugar pills DID relieve your symptoms?

When a person finds relief in their symptoms despite having taken a sugar pill, or a med that isn't intended to have an effect on their condition, that is known as the "placebo effect."

For some reason, I was taught that the placebo effect is kind of a bad thing. Let me give you an example to explain what I mean:

Depression is medical condition where pills are often prescribed to relieve symptoms. Surprisingly, if you look at the research on medications that treat depression, the studies show that the medications for depression are no more effective than a sugar pill. So basically, whether you take a sugar pill or a medication intended to treat depression, your chances of getting better are equal with both treatment options. (The caveat is that you have to think the sugar pills is a medication intended to treat depression, and your doctors can't intentionally lie to you.) And just for the sake of being a responsible writer, I want to make it clear that medications DO work to treat depression, and work BEST when they are combined with therapy as part of the treatment.

Often the placebo effect is used as a defense for people who take issue with using medications to treat conditions affecting the brain and behaviour (like depression). For people who don't want to or don't like to take medications, they generally say something like, "Well if people can get better on a sugar pill, why should a person have to take drugs? That's just big pharma trying to control us."

Another issue that the placebo effect brings up is the issue of personal control and power over the mind. Imagine taking part in a study on depression (assuming you had depression) where you were offered a pill every day. Imagine if you felt some relief of you symptoms over time, say six weeks, where you took a pill and had to measure your symptoms at the end of every week. What if at the end of six weeks, you reported that you feel pretty good, much better than when you first entered the study. Then, what if you were told that the medication you were taking was NOT a medication at all, but was a sugar pill. How would you feel? Conflicted? Duped?

People assume that we always have control over our minds; how we think, how we react, how we feel about things. I'm not sure this is true. In fact, I'm pretty convinced this is untrue, that we have control or will over all aspects of our mind.

I think the placebo effect is an interesting and subtle reminder that life has powerful undercurrents, and our brains, minds, thoughts, behaviours, respond to these undercurrents. One of the most underrated "undercurrents" is simple social interaction... talking to people, feeling like people like you, feeling like you belong among your tribe of humans.

Let's imagine that a person had depression. What are the symptoms? Lack of motivation? Feeling flat? Social isolation?

What is the effect of being in contact with people who are interested in hearing about what is happening to your body? What is the effect of being around professionals who understand the concept of "illness," that you feel unwell, unlike yourself, and that you wish you could feel like you did before? What does is the effect of being around a person who will listen to your worries and empathize with you clearly? What is the effect of simply being around people? Being cared for?

Placebo effect my ass; it's the care effect. And it's not a bad thing. We should all be able to benefit more often from the care effect.

Now should we prescribe medicinal pills in cases where a placebo is shown to be equally effective? I'm not sure what the answer is to that, but I know doctors aren't allowed to lie to their patients, and for a placebo to work, one needs to think it's a medical treatment. However, like in our example of depression, there is a treatment option that produces healthier people than taking a pill alone. So maybe we just need to rethink our concept of "care."

Popping my people pills,

1 comment:

T.Allen-Mercado said...

Interesting post. Since being diagnosed with clinical depression a long time ago, I have benefited from drug therapy but must concur that the biggest boosts have been from social interaction-in very small doses. For me the pills give me the energy to come out of the room/cave/trappings of my own mind and allow myself treatment.