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Depression and the Placebo Effect

The headline on the May 7, 2002, edition of The Charlotte Observer was: “Depression Study: Placebos Work, Too.”  The story went on to say that after millions of prescriptions for Prozac, Paxil, and Zoloft and tens of billons of dollars spent on these prescriptions that treat depression, the jury was finally in.  Anti-depressant medications work; and so do sugar pills.

The new analysis being reported concluded that in the majority of anti-depressant drug trials done by drug companies over the past ten to twenty years, sugar pills or placebos had worked just as well – or better than – anti-depressants.

What’s more, because of improvements in brain imaging, researchers are able to show that placebos cause profound changes in the same areas of the brain affected by anti-depressant medication.

A trial in April on Zoloft and the herbal remedy, St. John’s Wort, found that St. John’s Wort relieved the depression in 24%, Zoloft in 25% and the placebo 32%.  This does not mean anti-depressants don’t work, what it highlights is that there is more than one way to change brain chemistry that has become maladaptive.

In fact, physicians have long understood the importance of the placebo effect.  The country doctor in the past, who made the house call, knew that his confident smile and reassurance to the patient that everything would be all right were just as important as the medication he might provide.  Our modern system of managed health care has practically destroyed the type of physician-patient relationship, which allows the positive thinking of the doctor to boost the sense of well being of the patient.

When a primary effect of an illness is on a person’s sense of well being, the patient’s attitude and beliefs are particularly important.  Drugs have become the reflexive treatment for the vast majority of Americans receiving medical attention for depression.  And, as the studies show, they work.  But what is being neglected are the other ways to change the brain neurochemistry that work just as well or better.  Studies show that those patients who take medication and also receive psychotherapy do better than patients who only take medication.  Some of what happens in a therapy session over time helps change brain chemistry.

The placebo research also suggests that the more firmly one believes something will help, the more likely it will.  Timothy Welch, a psychiatrist at Columbia University, recently found out that the placebo effect for sugar pill anti-depressants has grown over the past twenty years.  He believes this has occurred because of all the widespread use and advertising of anti-depressants, a reduction in stigma about treatment for mental illness, and a greater perception by the public that anti-depressants work.

In treating those diseases, like depression and alcoholism, where the part of the organism affected by the disease includes the part that perceives it and our beliefs about those perceptions, this research about the placebo effect takes on ever greater importance.

To use a computer analogy, if our software has a virus, if our thoughts and beliefs have become maladaptive: how can we use the fact that a belief in something outside ourselves (a sugar pill) has the power to be healing.  Suppose we all come with human software ego 3.0.  As we grow up, all our defenses, all our ways of dealing with difficulties, become learned as part of human 3.0.  E.g. when we grow up in a conflict avoidant household, we learn skills of manipulation to get around the unpleasant feeling of conflict – these are ego defenses and fit into 3.0.  For the alcoholic, all his defenses of needing to mood alter so he won’t feel uncomfortable become a part of his 3.0.  As his alcoholism progresses, if he wishes to stop his disease, he must get an upgrade from 3.0 – he must find a way to get beyond his addictive disease’s emotional ways of coping.  So while his addiction-fed 3.0 defenses might have been important survival skills for emotionally coping when he was young – if he continues to use them, they will eventually kill him.  The same thing is true with depression.  If one has used the survival mechanism of repressing uncomfortable feelings in order to deal with them, chances are at some point you are going to get depressed.

So the question is how do you get an upgrade?  How do you move from human 3.0 to 4.0?  The insight from the placebo effect research is that 3.0 cannot upgrade itself.  It is like 3.0 has a virus.  3.0 can’t cure itself.  The cure for the virus or the upgrade must come from outside.  The ego defenses cannot, of themselves, transform themselves.

The only way people are able to upgrade 3.0 is from something outside themselves – somehow they must get a sugar pill, be connected to the net or a new disk or some outside software source to get their upgrade.  Now 3.0 can be very analytical, it can run virus scans on itself, it can boot and reboot, but it can’t upgrade without a connection to something outside of itself.

Somehow when the alcoholic surrenders to the fact that he is caught in the rat maze of 3.0, that he can’t by himself upgrade his defective 3.0, he opens the window of opportunity to a connection outside of himself that will allow an upgrade to occur.  He might surrender to his therapist, his AA group or his sponsor or to his belief in God.  If the alcoholic or the depressive can develop a real relation to something healing outside himself, the alcoholic or depressive can potentially upgrade his 3.0.  He can bring in new software that replaces his old ego defenses that supported his addiction or depression.  The ego will not let go of its own defenses – it would be like psychic suicide; the outmoded defenses can only be released when something better in the software has upgraded to replace them.

This is very hard for lawyers.  The lawyer ego wants to be in control and to control by understanding and analyzing.  As long as I stay in the position of observer in my own psyche, I can’t really surrender and my mind can think of a hundred good reasons such surrender doesn’t make sense or seems an inferior way of being.  But we live in the age of penicillin.  I still remember when it was called a “wonder drug.”  We have a belief in, faith in the efficacy of pills, even in experimental trials, where those in the trials know half the patients are getting sugar pills.

It seems that for those diseases that effect our own mental perceptions, that our belief systems are particularly important parts of any treatment.  Belief systems are like Heisenberg’s Uncertainty Principle – the characteristics of the particle depend upon where the particle is being observed from.  All belief systems look flaky from the outside.  You actually have to participate in one for it to work.  We live in a post-modern, reductionist society, so having a belief system is not popular.  What is in, is criticizing everyone else’s.

Thomas Merton helps us understand this dilemma.  Merton, an American Trappist monk and priest, made a life’s work of surrendering his beliefs.  Merton intuitively understood the need to surrender his human 3.0 software – to die to his false self.  As he did this he came to understand that through his belief in his need to do the will of the God he would become free from the ego constraints of human 3.0 – he would be made whole and become free.  Because Merton was such a prolific writer of his own journey – it becomes possible to see his progressive healing, and at the same time, to observe the increasingly larger contribution he made to the world.  His belief system anchored him in a way that allowed successive layers of human 3.0, 4.0, 5.0 etc. to become outmoded and dropped.

The same principle that applies to the spiritual growth of this twentieth century spiritual giant is the principle in the placebo effect.  The most straightforward use of this principle occurs in Alcoholics Anonymous or Depression Anonymous, where in seeing other people gain sobriety, well-being and sanity, even lawyers come to believe that if they give up their need to control, human 3.0 can be changed, not by thinking and analyzing, but by taking certain actions; the new actions help change beliefs, and with new beliefs come different attitudes.  With an attitude free from self-pity, fear, resentment and anger, we physically become most susceptible to healing.  We live in a place where the placebo effect is real and constant.

– by Don Carroll

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