THE PLACEBO EFFECT: IF ONLY IT WERE SO SIMPLE

This article was first published in volume 12 of the 'Skeptical Intelligencer', 2009, p3.

These days, most of my anecdotes begin with 'Many years ago'. Hence they are susceptible to all the distorting influences of long-term recall. They are also subject to the criticism 'You can't rely on anecdotes'.

Nevertheless. I increasingly find myself relying on anecdotes when writing, for the simple reason that anything else I might have to say is often based on information that is available to everyone on the Internet. Anecdotes don't usually suffer from this problem.

Here's an anecdote that is relevant to one of the papers in this issue of the Skeptical Intelligencer, namely Dr Martin Wallace's account of the placebo effect. Many years ago a woman wrote to me to ask if I could give her some hypnotherapeutic treatment for psoriasis. She had read an article by a medical doctor in the newsletter of an organisation for people with this condition. The doctor had some experience of treating psoriasis with hypnosis and he believed it to be beneficial.

To be frank, the research literature on psychological approaches to the treatment of psoriasis was pretty limited at that time and the outcomes hardly impressive. However on enquiry it transpired that this woman's condition only appeared when a close relationship ended several years previously (cue for Freudians to dip their oars in here). There is some evidence that certain medical conditions that appear to be associated with emotional distress may respond favourable to (though not necessarily be cured by) a course of relaxation and anxiety management.

After reading her letter I rang this lady to explain that I could not see her immediately but it was possible that a colleague would be able to do so. She then told me that since reading the article and writing to me, her psoriasis had been much better. She could hardly believe it and was obviously delighted. Of course, some conditions wax and wane over time so it might just have been that, purely by coincidence, she was going through one of her better periods. With this in mind I told her that I would speak to my colleague and if he was willing to see her I would get back to her.

The next time I rang her she revealed that her psoriasis had all but cleared up! This had never happened in all the years she had had the condition. She felt so confident about this that she declined the offer of any treatment but we left it that she could contact me again if the problem recurred. I did not hear from her again, but that in itself tells us nothing.

I recall only one similar case, a woman with insomnia who rang me before her appointment saying that since receiving her appointment letter she had been sleeping well. We nevertheless agreed it best that she should attend, and when I saw her she was delighted to tell me that her progress had been maintained.

So, psychological therapy is just placebo? At one of the early European Skeptics congresses I attended, an American Professor of Psychology gave a talk in which he opined that psychotherapists are 'placebo practitioners'. I recall that at the outset of his talk he informed us that some of his ideas were the outcome of useful discussions with his university colleagues over coffee in the academic common room. I believed him.

I can honestly say that for the most of the hundreds of patient and clients I have seen over the years, 'the placebo effect' has been an unanswered prayer. Take this typical scenario. Mrs Smith comes to you full of worry, anxiety and unhappiness. You spend the session listening to her and saying what you can to give her some hope. Next week she comes back smiling and says that since talking to you she has felt a lot better. Placebo effect? Maybe, but don't let all this go to your head. You spend the session planning what you are going to do and what the expectations and goals will be. The third session comes: 'How are you Mrs Smith?' 'Dreadful! Everything's gone wrong this week. Do you think I should try acupuncture?' Oh well! Fourth session: no Mrs Smith. Fifth session: Mrs Smith turns up, starts to tell you about Mr Smith and pours her heart out. Sixth session: Mrs Smith is inconsolable but full of rage; she has discovered that Mr Smith has been seeing someone else.

And so it goes on, two steps forward, one step back; one step forward, two steps back. But if you both stick at it Mrs Smith might arrive at the point where she can look back and say, 'I never thought I'd have the confidence to be doing all this (venturing out more on her own, holding down a part-time job in a shop just down the road, going to aerobics with a friend…).

Oh, by the way: Mr Smith is now seeing a psychiatrist.

Maybe Mrs Smith would have achieved all of this without seeing you. But let's not explain it all away as 'placebo'.