Placebo Effects and Healing through Belief System - Thesis Example

?Placebo Effects and Healing through Belief System Introduction A common unintended outcome of positive belief or faith in clinical practice or medical treatments, the ‘placebo effect’ serves an important function in all therapeutic processes. Although a universal and simple fact, placebo effect is difficult to define, partly due to its absurd character (Proctor, 2005, p. 294). However, the ‘void’ of the placebo is not really a ‘void’ at all: it is the effect of the cultural setting, meaning, expectancy, hope, belief, and faith on healing. Placebo effect is defined by anthropologist Daniel Moerman (2000) as “desirable psychological and physiological effects of meaning in the treatment of illness” (as cited in Winkelman, 2008, p. 358). It has been thoroughly proven to contribute to all therapeutic practices and to be a very important component of traditional healing methods, particularly religious or spiritual healing, where symbols (e.g. objects, images, words) commonly comprise major therapeutic elements. A potent healing tool, the placebo effect does not comprise all non-biomedical treatment, several of which include medication and other particular treatments (Rajagopal, 2006, p. 186). This paper argues that the placebo effect is a real and very effective healing instrument, extensively, liberally, and ingeniously used in local and traditional healing practices all over the world. The effectiveness of the placebo effect is not simply ‘psychological’; its power emanates from one’s belief system. The cultural model of medical anthropology stresses the effectiveness of ethno-medical practices, referring to a broad array of findings that they alleviate illnesses. This alleged efficacy of ritual healing indicates that belief system in some way has the capability to heal. In fact, anthropologists have generally assumed that ritual healing is effectual in alleviating maladies (Dixon & Sweeney, 2000, p. 55). Singer (1989) condemned how some anthropologists supported traditional healing practices, viewing its continued existence a counteractive process intended to deal with the outcomes of the inability of societies to offer sufficient medical care (as cited in Harrington, 1999, p. 66). Scheper-Hughes (1990) proposed a different perspective: that both critical and clinical medical anthropology have been unable to cope with the issues raised by the ethno-medical practices against the materialist principles of biomedicine (as cited in Winkelman, 2008, p. 338). An unspoken approval of the ethno-medical practices of other cultures by anthropologists as being potent and effective may suggest that their system of practices can be integrated into the biomedical model. Scheper-Hughes asserted the importance of gaining knowledge of and appreciating other ethno-medical healing processes as requiring methods different from those stressed by biomedicine: “[I]f medical anthropology does not begin to raise the possibility of other realities, other practices with respect to healing the mindful body, who can we expect to do so?” (Winkelman, 2008, p. 338) Analysing the foundations for the legitimacy of such traditions is rationalised based on cultural relativism and through a recognition of their physiological outcomes. Traditional healing practices not merely create a meaningful knowledge or appreciation of health circumstances, they are also generally successful through various processes commonly tackled by biomedicine (Barnes, 2010, p. 54). Biomedicine has largely ignored or underestimated the efficacy of ritual healing practices, claiming that for the most part they offer positive outcomes through ‘suggestibility’—“self-fulfilling expectations of improvement somehow trick people into feeling that they are better when, in fact, they are not” (Winkelman, 2008, p. 338). Some could disregard the evident positive outcomes as placebo effects, but responses to placebo treatments are true; personal belief system and expectations can have major impacts on biological responses and mechanisms. Such placebo effects are still a challenge to ethno-medical models, demonstrating the capacity of the psychological level of meanings to influence physical mechanisms (Healy, 2007, p. 132). Moreover, among the best means to bring out placebo effects are through religious or spiritual meanings and symbols. The prevalent role of belief system in therapeutic encounters shows its capacity to bring out an array of healing outcomes and its specific contribution to human health. Moreover, religious healing includes components present in all therapeutic practices, including the impacts of meaning on biological or physiological reactions. The Placebo Effect of Ritual Healing Prior to antibiotics, herbal medicines and placebo were the best medications on hand. Psychiatric specialist Arthur Shapiro has claimed that the placebo effect is tied to humans’ ‘genetic inheritance’ (Harrington, 1999, p. 200). It was definitely beneficial that the Apaches held in the ‘nocebo effect’— the phenomenon where in substances or sheer suggestions produce unfavourable responses—a biological way of facilitating an aversion towards snakes and bears, at the same time as Apache culture held in the placebo effect means to cure the disease seemingly brought about by ghost and bears and snakes (Harrington, 1999, pp. 200-201). The evolutionary root of the placebo effect remains a mystery until now. Nevertheless, what remains obvious is that healing and disease, although they definitely involve neurobiology, also involve a culture, because cultures furnish both the material and immaterial aspects that influence human health. In fact, a culture greatly influences and alters human experience, even though they defy its impact (Kuby, 2003, p. 18). This explains the fact that the whole placebo effect theory will essentially be biocultural. The Cultural Aspect of Religious Healing Across cultures, most types of healing possess a powerful ritual element. The physical context or environment where in these rituals occur—whether a faith healer’s house, hospital, or a physician’s clinic—can be likened to a film studio filled with script and props. This ‘script’, based on the physical context or culture itself, is generally familiar to majority of the participants (Nasrallah, 2011, p. 19). It dictates their behaviour, their experience, and their expectations. It helps legitimise the healer, and the effectiveness of their healing techniques. Hence the physical context itself is in no way inert or passive. It constantly influences the entirety of the process of healing, and hence also the placebo effect. A vital feature of this mechanism is the application of ‘ritual symbols’ (Van Schaik & Thompson, 2011, p. 188). Majority of healing processes, in various cultures, use an entire set of these symbols. They could be not just particular items, ornaments, or texts but also specific homogenous forms of clothing, dance, movement, and body language. In every situation, they have a particular function, mostly symbolic. Their major function is to produce a proper context for the placebo effect (Kurtz, 2012, p. 101). They communicate essential information to patients, and to individuals surrounding them, about the healer, the process, belief system, and cultural bases of the healing capacity. From the point of view of anthropology, majority of the symbols summoned in ritual healing serve this purpose. As reported by Turner (1969) about the symbols exercised in ritual healings of Zambia’s Ndembu tribes, “almost every article used, every gesture employed, every song or prayer, every unit of space and time, by convention stands for something other than itself” (as cited in Peters, 2001, p. 6). Every symbol exercised in these ritual healings functions as a ‘storage unit’ within which is the largest sum of information about the fundamental cultural ideals of that community (Peters, 2001, p. 6). At moments of instability, risk, and illness, diffusion of this information is critical, because it involves means to reiterate and communicate the integral principles of daily existence, to comfort the ill, depressed, or hopeless individuals that in spite of their malady the world still holds something good for them (Koenig, 1998, p. 72). And that, as well, is an important element of the placebo effect. Not every existing symbol could truly be applied in any specific ritual healing. Several of these symbols, like stacks of professional books, or overwhelming certifications on a doctor’s office, will have no useful role in either treatment or session. They function more like a stimulus, vital to a specific procedure, but without being vigorously drawn in it (Ellison & Levin, 1998, p. 709). Their role is to ‘build the context’ and contribute to the formation of expectations and beliefs in all those involved. Hence, for a proponent of medical anthropology, a more profound knowledge of placebo effect should include the ‘deciphering’ of the information or meanings embedded within the rituals and symbols related to it (Idler et al., 2003, p. 330). In order to appreciate the placebo effect of belief system one should appreciate the community where in it takes place. This is due to the fact that the symbols that contribute to its preservation are both based on, and legitimised by, the broader sociocultural context. Traditional Healers Traditional healers are the chief proponents of the placebo effect in most non-Western countries. Similar to Western physicians, these traditional healers operate within a particular setting—both sociocultural and physical—using particular symbols, rituals, and methods, and a particular place and time, so as to boost faith in their power to heal (Pruyser, 1981, p. 8). These traditional healers, even when they use physical medications, like massage or herbs, seem to be more responsive to the placebo effect of belief and expectations than Western physicians. Usually they view the belief system of their patients as a vital partner in the healing process, rather than as an adversary, as something innate to the healing process, which has to be manipulated and used (Solomon, Fan, & Lo, 2012, p. 80). Therefore they are more eager to encourage the participation of their patients and their family in the different healing rituals. On the contrary, numerous Western physicians tend to consider their patients as more submissive, and scientific documents generally mock what they refer to as ‘just a placebo effect’ (Harrington, 1999, p. 196): a nonessential or minor phenomenon which is difficult to explain, predict, or quantify, and which for that reason is not ‘true’. From a contemporary point of view, it seems evident that besides their ability to cure injuries and administer herbal medications, Native American healers successfully utilised the placebo effect (Wahlberg, 2008, p. 83). A powerful placebo effect is somewhat expected because patients and healers hold a common belief that healing and disease both had a mystical basis. Among the Apache tribes, the power of the shaman originated either through a divine gift from a deity or through ownership of a holy item. The rituals and services had as their particular objective the casting out of malevolent spirits and the summoning of healing spirits (Kurtz, 1991, p. 114). Native American healers, contrary to the scientific, impersonal clinical practice of early modern Europe, worked directly on the patient’s body, usually by forceful and extensive periods of exorcism. This direct contact was intended directly to draw out the evil spirit. It is difficult to associate such remedies with anything besides the placebo effect (Wahlberg, 2008, p. 84). Unluckily, these traditional practices were defenseless against foreign communicable illnesses, mainly tuberculosis and smallpox, that exterminated the Native American population. Symbolic Healing A great deal of the placebo effect is merely a component of an observable fact called by anthropologists ‘symbolic healing’, defined as “all those forms of healing that do not rely on any physical or pharmacological treatments for their efficacy” (Moerman, 2002, 88). They comprise psychoanalysis and psychotherapy, and also other healing techniques like counseling and exorcisms used in different religious and corresponding treatments. Generally they try to mend relationships between individuals that have been impaired by hardship or ill health (n.a., 2008, p. 20). Most types of ‘symbolic healing’ try to be comprehensive—to generate social, psychological, and physical outcome. Nevertheless, one can distinguish between curing—alteration in physical condition—and healing—change in spiritual, social, cultural, or emotional state. Numerous religious and traditional healers differentiate these two kinds of effect (Cobb, Puchalski, & Rumbold, 2012, p. 60). According to Fergusson (2009), their main objective is to heal their patients’ social, emotional, and spiritual illness, although they cannot really cure their physical illness. Anthropologists have attempted to identify and explain the general attributes of all kinds of symbolic healing, to determine how belief or faith in a specific treatment or medication is truly formed in the therapeutic encounter. Anthropologists explains specific major phases in this mechanism (Porterfield, 2005, p. 49). Healers should have a certain logical process of explanation to identify and clarify the nature and root of the malady, and how it can be addressed. It could be related to psychoanalysis, but could be one of exorcism or witchcraft. This belief system should involve a symbolic connection between cultural messages, social relationships, and individual experience (Van Schaik & Thompson, 2011, p. 189). Specifically, sick or hopeless people should be able to make sense of their own condition, and its remedy. When patients go to healers, the latter try to activate this symbolic connection, specifically, to make patients believe, at least mentally, that their own difficulty can be understood and addressed in terms of the symbols of the belief system. Once healers and patients have attained this agreement, the healers have also to make patients mentally and emotionally ‘involved’ in the belief system—to attach their worries, expectations, and hopes to it. The patients have to develop self-consciousness, and should be emotionally engaged in the process of healing itself (Boehnlein, 2008, p. 93). For instance, they have to be convinced that their problem is because of the possession of evil forces, which if left untreated could really take their life. Therefore, healers have to facilitate therapeutic outcome by controlling the symbols of their belief system. For instance, faith healers, having persuaded patients that their suffering are brought about by evil spirit possession would undergo a rite of exorcism. After that they would inform them that the evil force has abandoned them—and they can now carry on with their lives (Harrington, 2011, p. 273). Thus, the patients learn to reevaluate their new experience in accordance to the belief system of the healer. Besides being ‘healed’, patients have now attained a new means to understand their experience symbolically, and a new means to live. In addition, they have attained a new story, a narrative that reminds and illustrates to them what they went through, and how the healer successfully healed them. This series of events, common in numerous placebo occurrence, is true both inWestern and non-Western medicine (Jopling, 2008, p. 39). In every situation, the healer uses different dramatic methods, such as the application of ritual symbols, as a portion of the process of healing. Such symbols based on the framework of the local culture, and contribute to the legitimation of a belief system, and the healer that embodies it. There are various common features of all therapeutic practices. These relate to a patient’s commitment to social and symbolic relationships. Such relationships are rooted in a universal explanatory principle (e.g. psychoanalytic theories, religious beliefs, or superstitions) that determines the nature of illnesses and chances of healing (Kroger, 2008, p. 75). Healing is assissted by a culturally and socially respected person who has different known abilities that bring about an expectation of alleviating the malady. Such therapeutic relationships endow patients with social and emotional support, boosting their self-concept and confidence. A key feature of all healing practices involves the capacity of the interaction to draw out ‘endogenous healing responses’ (Winkelman, 2008, p. 431) derived from natural mechanisms like tranquility or relaxation. These involve the responses of patients to placebo effects, emotional improvements, hope, optimistic expectation, suggestion, and psychological outcomes like catharsis, dissociation, and guilt (William, 2005, p. 132). Belief system, or, religion, particularly, has been a primary instrument by which such and other symbolic responses are used to improve human health. Religion uses several processes through which meaning and symbol influences physiological reactions (Solomon et al., 2012, p. 82). Identifying these mechanisms encouraged a cognitive transformation in psychology that is supplanting the behaviorist models with a new theoretical paradigm derived from the knowledge of top-down causation. This includes mechanisms where in higher psychological functioning influence lower physiological functioning., like when a person’s anxiety create physiological trauma. Such symbolic impact on physiological reactions raise inconsistencies for the materialist and reductionist viewpoints of biomedicine (Proctor, 2005, p. 112). They also create a foundation for a new model that takes into consideration the impact of psychological processes on the physical domain, particularly the human body. Such psychological impact on health are more largely manifested in the impact of cultural components on biological functioning and shown in phenomena like placebo effects, stress responses, and religious or ritual healing (Nasrallah, 2011, p. 20). Components of socialization present numerous processes through which the belief system can influence wellbeing through the learned connections of social, psychological, and symbolic mechanisms with physiological and emotional functioning (Koenig, 1997, p. 59). Connections of symbols and culturally prompted emotions and experiences acquired during socialization connect natural and symbolic mechanisms, allowing ritual and symbolic stimulation and control of emotional and physiological reactions. Components of socialisation relate symbolic mechanisms to the brain’s neurological functioning, offering means for symbolic healing mechanism (Batson, Schoenrade, & Ventis, 1993, p. 127). Ritual is a meaningful practice, practices that influence individuals at cognitive, social, emotional, and physical levels. The ubiquity of religious or spiritual healing reveals its potent therapeutic outcomes. Such outcomes reveal the effect of social and symbolic aspects on human reactions to stress by creating a sense of confidence or faith concerning health (Braden, 2009, p. 19). Social support and relations serve a crucial function in sustaining health and improving recovery through various means. Research on the connection among illness, stress, and culture provides substantiation on the health impact of cultural outlooks and beliefs and social network. Placebo Effect and Expectancy Another issue is the role of expectancy in creating and modifying behaviour. This relates particularly to expectancies concerning instinctive or spontaneous behaviour. Hence, the expected anxiety of becoming anxious produce fear, whilst belief that one will not be anxious weakens it (Alladin, 2013, p. 253). In a similar way, negativity about not having the capability to surmount loneliness generates greater unhappiness, whilst the belief that the loneliness is only temporary and will disappear soon has a reverse outcome. In expectancies, individuals have a psychological way to identify and make use of the placebo effect as a treatment alternative. The capacity of expectancy to modify behaviour, particularly spontaneous behaviour, helps explain why various psychological treatments can have positive outcomes, as can different types of religious or spiritual healing (Alladin, 2013, pp. 253-254). The forms of religious healing that occur within particular circumstances stem from the participants’ culturally based expectancies and beliefs, as well as from the experience’s emotional power. This is contrary to the supernatural or mystical forces to which individuals themselves ascribe transformation (Peters, 2001, p. 104). Torrey (1986), for instance, underlines the value of a shared belief system of the healer and the patient, the healer’s personal attributes, and the patient’s knowledge and experience as vital components alongside his/her expectations (as cited in Shapiro & Shapiro, 1997, p. 105). Placebo Effect and Faith Herbert Benson (1996), in his work Timeless Healing: The Power and Biology of Belief, illustrates how belief is not merely spiritually and emotionally valuable but “vitally important to physical health” (as cited in Chamberlain, 2008, p. 15). Benson has carried out numeorus studies on the biological aspect of belief in an effort to demonstrate how belief influences people’s physical health and wellbeing. He describes what he refers to as the ‘relaxation response’ as a physical tranquility that results in a reduction of heart rate and blood pressure. He claims that the relaxation response is the reverse of the widely accepted ‘flight or fight response’ to risk or threatening situations (Chamberlain, 2008, p. 15). Benson claims that there are empirical findings to substantiate the assumption that ‘remembered wellness’, or the capacity to recall the faith and composure related to bliss and health, is not restricted to psychological and emotional memory but involves physical recollection too. The concept of ‘remembered wellness’, which Benson applies as another term for placebo effect, is rooted in the assumption that it is faith in the therapy that determines the most successful results (Braden, 2009, p. 70). Indeed, he argues that “depending on the condition, sometimes affirmative beliefs are all we reall need to heal us” (Braden, 2009, p. 70). He claims that his analysis of related literature shows that remembered wellness is roughly 70% to 90% successful, an effectiveness two or three times of that which has constantly been associated with the placebo effect (Chamberlain, 2008, p. 15). Benson further claims that remembered wellness involves the hope, expectation, faith, and belief of both the healer and the client. He believes that the placebo has existed since time immemorial (Chamberlain, 2008, pp. 15-16): “early medicine and its cross-cultural cast of characters—priests, healers, sorcerers, medicine men, witch doctors, witches, shamans, midwives, herbalists, physicians, and surgeons—relied exclusively on scientifically unproved potions and procedures, the vast majority of which had no physical value in and of themselves, some of which did more harm than good”. He emphasises that a large number of patients were actually healed and that their successful recovery was attributable mainly to the nature of their illness, and to the power of their faith or hope that they will be healed, rather than to any natural capability of medicine (Chamberlain, 2008, p. 16). The medical field has considered the placebo effect as one of the most effective forms of treatment. It is widely documented in the scientific field that when a placebo (e.g. sugar pill) is administered as a medication to patients, they usually feel or see an improvement in their health because of their hope of a positive outcome. Usually people receiving a placebo experience the same changes as people receiving a real treatment (Lake, 2007, p. 71). Hence the placebo effect appears to be associated with the expectations of patients of improvement, their faith in the success of the placebo, and the expectations and abilities of the doctors concerned. Without a doubt the placebo effect happens when an individual expects improvement from a treatment that is actually inert in its outcome. The essential attribute of a placebo is that the person believes that the medication will bring improvement, and it is that hope that leads to therapeutic success. Numerous studies have discovered the impact of the placebo on the improvement of physical conditions (Kuby, 2003, p. 101). Numerous scholars argue that the placebo effect is associated with suggestibility. In order to successfully control this factor, researchers employ a general experimental design where in neither the research participant nor the researcher knows whether the treatment is a placebo or genuine (Wahlberg, 2008, p. 84). The fundamental psychological rules of placebo are hope, expectation, and belief, and apparently expectation and belief are also the vital components of faith, which is a vital component of religion. The placebo effect indicates only one of the numerous difficulties innate in any effort to determine how faith affects health and illness (Moerman, 2002, p. 91). Faith is commonly thought to be rooted in an element of transcendence: specifically, there is a belief that religion practiced is founded on more than a delusion or placebo, that the Supreme Being is working for the devout, that it is the heavenly interconnecting the human being with the divine that explains the favorable impact of religion on health and not merely the placebo effect (Koenig, 1998, p. 28). In his seminal work Persuasion and Healing, Jerome D. Frank (1973) emphasises how people with illnesses interrelate with society, culture, and family (as cited in Harrington, 1999, p. 11). When individuals are in poor health they have problems dealing with their emotions, which can result in interpersonal difficulty, a weakening of self-worth, and an increasing feeling of despair. Frank argues that despair or hopelessness can hamper positive results of a treatment and possibly quicken death. On the contrary, expectation, hope, and belief usually serve an important function in healing and cure and Frank discovers that “favourable expectations generate feelings of optimism, energy, and wellbeing and may actually promote healing especially of those illnesses with a large psychological or emotional component” (Frank, 1993, p. 132). Sigmund Freud himself believes that “expectation coloured by hope and faith is an effective force with which we have to reckon… in all our attempts at treatment and cure” (Frank, 1993, p. 146). Conclusions So how does belief system, or religion particularly, enhance human health? The answer to this question is complex, for it involves spiritual, psychological, and social aspects. Placebo effects could be of paramount interest in ritual, spiritual, or religious healing. Religious healing may be assumed to take place in several ways. Faith could be viewed as encouraging the physical functioning in the human body as would be done by any other form of healing. Faith or belief emanates directly from a heavenly source and does not rely entirely on mechanisms that scientific medicine can identify or explain. In spiritual healing through faith, the placebo effect may explain some and possibly all of the health improvements experienced. Faith could generate optimistic or favorable expectancies, and religious healing could be a potent basis of psychological strength. As long as there are people who believe that the human mind belongs to the natural domain, created and shaped by the same Maker who is in charge of all forms of heaing, it appears sensible that one would try to control the human mind’s power as portion of any form of healing that takes place (Humphrey, 2002, p. 26). Within this perspective, the placebo effect becomes a particular way by which a belief system can nurse back to health. In ritual healing by the divine way, it may seem on the contrary that if a person could prove that a placebo effect were taking place, that would rule out the likelihood of the assumed healing outcome. This appears specificially true for prayers, where in devout people assert that patients can recover from illness when people pray for them. In theory, no psychological or emotional outcome can be produced if the participants are entirely uninformed of the intervention. Hence, to assert that the outcomes of prayer are a placebo effect would be similar to refuting the effectiveness of prayer. Harold Koenig (1997), in his work Is Religion Good for Your Health?, presents a thorough analysis of the impact of religion on people’s health and illness. He claims that the findings show a connection between health and religion “although they do not prove beyond all doubt that mature religion causes better health” (Koenig, 1997, p. 119). Nevertheless he is ready to argue that “a strong religious faith and active involvement in the religious community helps prevent or reduce depression, anxiety, high blood pressure, stroke, heart attack, cancer, and may add years to life” (Chamberlain, 2008, p. 20). Therefore, any deeper knowledge of the placebo effect o a belief system necessitates an understanding of the setting—social, cultural, and physical—where in they occur. This is due to the fact that such settings are completely inherent to the formation and reinforcement of belief in the minds of the patient and the healer, and everyone around them. Healing as a cultural practice engenders in patients and physicians a powerful network of interrelated beliefs that reinforce all therapeutic relationships. The belief that physicians have extensive knowledge of disease generates in many patients an involuntary expectation of cure such that the simple presence of a doctor in a white coat, or other powerful cultural symbols of medicine, can generata a placebo effect. People learn to identify the cultural symbols that guarantee remedy, from medications to hospitals. Moreover, most individuals accept and use medical care within the framework of a cultural setting where in some are identified as healers and others patients (Ellison & Levin, 1998, p. 705). Therefore the placebo effect is part of a larger cultural framework where in individuals transmit their personal self-healing force to a priest or faith healer or physician, who provides relief through specific esoteric practices and treatments. In spite of the development of contemporary biomedicine, it is a tradition that has not evolved for centuries. It appears probable that in the foreseeable future the question of where the effectiveness of placebos comes from will be uncovered by neurobiologists; but similarly interesting from the point of view of a biocultural model is the unexplored question of why placebos are effective (n.a., 2008, p. 23). Obviously no one today has discovered the answer to this intriguing question, and it is highly probable that the placebo effect is merely a bizarre, primitive consequence of human evolution, without any purpose. But another perspective emerges, one where in the placebo effect, regardless of how it took form as an attribute of human biology, played a symbolic role in human survival. Thus, it may be assumed that it is still a part of human physiological functioning for it once fulfilled a valuable cultural function in the period before scientific clinical practice. References n.a. 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