At the risk of sounding foolish I’d like to tell you a true story. A few years ago I was playing my 12 year old son at tennis. Being a competitive Dad, I beat him, and relishing this superb victory over a child I attempted to leap the net.
You can guess what happened next. Pride usually comes before a fall and I failed to prove that principle wrong. My foot caught in the net, I crashed onto the concrete court and half an hour later I was in the emergency department of the local hospital. My son’s efforts to keep a straight face during this time were not very successful but I was in agony and failed to see the funny side until later.
Well, there’s nothing like going to the emergency department to make you feel like your accident is not an emergency. As I waited around for hours, managing to control the pain in my smashed arm though self hypnosis, I saw a small boy of about eight brought in by his mother. He was howling in pain and it became clear from what his mother was telling the nurses that he had sustained an injury during a football match. The little boy had to wait and his foot was visibly swelling. It was painful to see this child’s agony.
Then suddenly an Indian doctor strode out and, with his face beaming, bellowed: ‘What’s all this about?’ staring directly at the child. More than a little surprised, the boy stopped crying. ‘I’ll tell you what. I’m going to give you a magic pill!’ said the doctor, winking at the mother.
‘It will make you feel lovely and relaxed and soothe the pain very quickly. Would you like that?’ he asked. The boy nodded, still in shock and somewhat stunned by the doctor’s antics.
‘And best of all, it’s hidden inside a lovely piece of Turkish delight!’ the doctor went on. Many of the other patients were smiling by now.
‘Don’t go away now, I need to go and collect it from our special locked cabinet.’
The boy looked very expectant; something was being done for him. He could barely wait to be given this magical sweet. The doctor swept out of the admissions area and returned a couple of minutes later with a piece of Turkish delight on a plate. He had a serious expression on his face as if he were administering a life saving injection.
‘Are you ready for your medicine?’ He demanded. The boy nodded eagerly. The boy picked up the sweet and just before he put it into his mouth the doctor stopped him.
‘This will take about two minutes to work!’ The boy ate the sweet and the doctor left as quickly as he’d arrived. The youngster relaxed, looking at the clock on the wall… then he suddenly announced that his foot didn’t hurt any more but felt kind of numb. He looked much happier and began reading comics. We were still there an hour and half later. A nurse came out and noted with surprise how his swelling had gone down.
I had just seen a beautiful example of the famous placebo response in action.
So what exactly is going on here? The placebo response is the process whereby a patient recovers from an illness or pain purely though the power of expectation. So a so-called drug may in fact be made of sugar but if the patient believes it to be a powerful pain killer or anti-depressant then that belief itself can effect the cure.
Antidepressants work for around a third of the population, but about a third of people given a placebo believing it to be an antidepressant will also benefit! And if the depressed person prescribed the fake antidepressant is told it has side effects, they may even produce these side effects to the placebo. Such is the power of expectation!
So let’s look a little deeper.
The placebo response is really a post-hypnotic suggestion. Someone in great pain and shock is already in a fairly profound trance state. That is why if someone has been injured in a bad accident, you can often help them simply by telling them to stop bleeding, or that the sore part will go numb.
In our emergency room incident, the doctor first grabbed the boy’s attention, then narrowed it by talking loudly and staring at him. He was also obviously an authority figure, and thirdly, he delivered some very powerful suggestions to the boy, telling him precisely when the pain would get better.
The doctor even went off to collect the so-called medicine from another part of the hospital. All this produced greater expectancy in the boy and made it more likely the hypnotic suggestion for pain relief would be accepted and acted upon by the boy’s unconscious mind. The doctor was a skilled hypnotist, whether he knew it or not. He had given a clear set of instructions for the boy’s unconscious to act upon. If the boy’s mother had just handed him the sweet with the words ‘this might help’, then the placebo response would not have kicked in at all.
Once your unconscious mind has an expectation laid down, then your mind and body will do everything they can to fulfill that expectation. This is a very important point. What the placebo response demonstrates is that if you strongly expect something to happen, your mind and body will align themselves to produce it for you if they can. You might like to have a think about the ways in which you could use that!
Have you experienced the rather irritating phenomenon where you and a friend are desperately trying to recall the name of a famous actor? You can see them in your mind but can’t for the life of you recall their name, and because amnesia is infectious your friend can’t recall their name either!
It’s frustrating and feels more important than it really is because your emotional brain has now got an expectation it feels it needs to fulfill. You forget about it, but now your unconscious mind is doing a search for you. Hours later you might be mowing the lawn or in the bath and suddenly the actor’s name pops into your head. This is precisely the same mechanism as the placebo response. You’ve given yourself a post hypnotic suggestion to recall the name even though you didn’t know it. For a doctor to believe in the placebo response but not in the power of hypnotic suggestion shows a lack of wider understanding. The way a medical professional gives a medication may be just as important as what the medication is.
Let’s look at the similarities between the two processes. Your attention is narrowed by the need to recall the person’s name, your expectation is set to recall the name and your unconscious mind later produces the result for you.
Many people wake up a minute or so before their alarm clock. How? Because they expect to. Just before bed, they looked at the clock, made sure the alarm was set for the right time, thought how bad it would be if they slept in. These are all attention-narrowing, trance inducing activities – especially the bit where they worry. The time on the alarm clock gives their unconscious a clear instruction on when to wake up.
Knowing how to create expectation in others is a powerful personal tool and like any tool it can be misused. The evil twin to the placebo response is the ‘nocebo’ response; sometimes called ‘medical hexing’. Medical literature is full of incidents where patients were misdiagnosed with an illness, told they had six months to live and then died right on cue. But later it is discovered they weren’t ill at all. This, of course, is how witch doctors do similar things. Expectations and belief have hugely powerful effects on the mind and body.
And just before we finish, I’d like you to think about what this means for therapy or counselling. Many traditional schools of therapy focus on pain and what has gone wrong. The language is painful and upsetting and the expectations of the therapist are that therapy should be ‘painful and difficult’ and most commonly, that things should get worse before they get better! These are powerful suggestions and can have an impact when coming from someone seen as some kind of authority.
Happily, we now have brief solution-focused therapies that are rapidly being shown to be more effective and pleasant to undergo. Knowing about the placebo response, you can see why.
We are all suggestible, and placebo and nocebo work in all our lives. Knowing how expectation works means you can use it for good – as the Turkish delight doctor did. You can also be aware when people give you negative suggestions. They told me my arm would be very painful for many days – I chose to disbelieve them and – inspired by that doctor – bought some Turkish delight on the way home. I am also proud to have learned from my experience so I haven’t jumped over any tennis nets lately.