The placebo effect and the diagnosis effect

There is an article in the Dec. 19 edition of The New Yorker magazine about how the placebo effect is gaining new found respectability. The Power of Nothing: Could studying the placebo effect change the way we think about medicine? The subject of the article, Ted Kaptchuk, Director of the Program in Placebo Studies and the Therapeutic Encounter at Harvard’s Beth Israel Medical Center, believes that if the patient gets better, not because of a drug, but due to the placebo effect, shouldn’t the placebo be considered a useful took in the medical tool kit, as useful as any drug?

The article states that simply believing in the treatment can be as effective as the treatment itself. In several recent studies, placebos have performed as well as drugs that Americans spend millions of dollars on each year.

The New Yorker article started me thinking about how the placebo effect, which we all tend to positively associate with healing, could also be used in the opposite sense – being told you are not going to get better. The placebo effect is often used to demonstrate how amenable the human mind is to suggestion – if people believe they are going to get better, they often do. What then do we make of the mental illness diagnosis, the label that the psychiatrist hands out? The mental health diagnosis, critics charge, opposes the expectation of recovery. The worst mental health diagnosis, the one with the least prospect for recovery (for people who believe what the doctor tells them) is a diagnosis of schizophrenia.

Patients are told by the doctor that they have a life long illness, that can be managed by drugs. They are told there is no hope of being cured. Therefore, the patient correctly internalizes the diagnosis and his actions henceforth tend to uphold the diagnosis. It is my experience that people who reject the diagnosis and/or do not succumb to the medical model of the so-called disease are the ones who cure themselves. Looking at recovery incentives in the hard nosed context of money, the article states: In several recent studies, placebos have performed as well as drugs that Americans spend millions of dollars on each year, one might logically ask, well, why not give schizophrenia patients the equivalent of a placebo – the expectation of being cured? The patient’s mind will take over from there.

The diagnosis effect is much more sinister than the placebo effect, at least from what little we know of how the placebo effect is being manipulated in drug trials so far. The New Yorker article IMHO shows that in the future, it is possible that the placebo effect can be manipulated for noble and not so noble ends. The diagnosis effect, when it comes to a mental health label, casts a spell over the patient, his family, and anyone who connects the diagnosis to the patient.  I have heard people parrot exactly what the doctor tells them — that schizophrenia is life long, that not taking meds leads to relapse, that the disease itself, not the effect of the meds or the natural course of the illness at a certain point, dulls the mind. The family begins to treat the patient as a mental and emotional cripple. Whatever the patient may believe about the course of his condition is negatively reinforced every day by the family and others who believe that the original diagnosis is scientifically factual, and not something that can be tweaked by the power of suggestion.