THE HEALING POWER OF YOU
Harnessing Self-Belief
RICHARD MÖDL HAD RECENTLY BROKEN HIS HEEL, but in 2003 he was determined to complete his first pilgrimage from Regensburg to Altötting, Germany. It was agony to walk at all, let alone endure the 135 kilometres that thousands of believers trek each year to behold the Black Madonna of Altötting. But Mödl had a deep faith in the Virgin Mary’s ability to deliver him. “When you are on your way to Altötting, you almost don’t feel the pain,” he says.
Today, at 74, Mödl has a warm smile and a wir y frame. Since his foot healed, he’s made the pilgrimage 12 more times, and he’s a passionate believer in its transformative power.
Mödl is not alone in his belief. Whether it takes the form of a touch of the Holy Spirit at an evangelical revival meeting or a dip in the water of the Ganges, the healing power of belief is all around us. Studies suggest that regular religious services may improve the immune system, decrease blood pressure, add years to our lives.
Religious faith is hardly the only kind of belief that has the ability to make us feel inexplicably better. Ten thousand kilometres from Altötting, another man experienced what seemed to be a medical miracle.
At 42, Mike Pauletich was diagnosed with early-onset Parkinson’s disease. For years he struggled with the disease and with depression, as talking and writing became ever more difficult.
Then, in 2011, Pauletich turned to Ceregene, an American company that was testing a new gene therapy. Parkinson’s is the result of a chronic loss of the neurotransmitter dopamine. Ceregene’s experimental treatment was to cut two holes through a patient’s skull and inject neurturin, a protein that had been shown to halt the progress of the disease in monkeys, directly into the brain.
EXPENSIVE PLACEBOS WORK BETTER THAN CHEAP ONES. BUT FAKE SURGERIES SEEM TO BE THE MOST POWERFUL OF ALL
Af ter the surgery Pauletich’s mobility improved, and his speech became markedly clearer. (Today you can hardly tell he has the disease at all.) His doctor on the study, Kathleen Poston, was astonished. Strictly speaking, Parkinson’s had never been reversed in humans; the best one could hope for was a slowdown in the progression of the disease.
In April 2013, Ceregene announced that the neurturin trial had failed. Patients who had been treated with the drug did not improve any more significantly than those who had received a placebo treatment – a sham surgery in which a doctor drilled ‘divots’ into the patient’s skull so that it would feel as if there had been an operation.
Poston was crushed. But then she looked at the data and noticed something that stopped her cold. Mike Pauletich had been given the placebo.
IN A SENSE Pauletich and Mödl participated in a performance. And just as a good performance in a theatre can draw us in until we feel we’re watching something real, the theatre of healing is designed to draw us in by creating powerful expectations in our brains. These expectations drive the so- called placebo effect, which can affect what happens in our bodies as well.
When Paulet ich exper ienced improvement in his symptoms, it wasn’t just because of the divots he could feel in his head or what the doctors told him about the surgery. It was the whole scene he’d experienced: the doctors in their white coats, stethoscopes around their necks; the nurses; the check-ups and tests.
This stagecraft extends to many aspects of treatment and can operate on a subconscious level. Expensive placebos work better than cheap ones. Placebo suppositories work better in France, while the British prefer to swallow their placebos. Often fake injections work better than fake pills. But fake surgeries seem to be the most powerful of all.
Most astonishingly, placebos can work even when the person taking them knows they are placebos. This was reported in a 2010 paper published by Ted Kaptchuk, a researcher at Harvard Medical School, and his team. After 21 days of taking a placebo, people with irritable bowel syndrome felt markedly better when compared with people who received nothing, even though those who reported feeling relief were told that they were receiving placebos.
A supportive patient-practitioner relationship was key in creating belief in a successful outcome. Patients were told that the placebo pills had been shown, in rigorous clinical testing, to induce meaningful self-healing.
“Deal ing with expectat ion is very tricky,” says Kaptchuk, who has spent his life studying placebo effects. “We’re dealing with very imprecise measuring of a very imprecise phenomenon. And a lot of it’s nonconscious.”
Karin Jensen, one of Kaptchuk’s former colleagues who now runs her own lab at the Karolinska Institute in Stockholm, designed an experiment to determine whether it was possible to use subliminal cues to condition subjects to experience a placebo effect.
During the conditioning phase of the experiment, subjects viewed alternating faces on a screen. Half the subjects received subliminal cues: the faces appeared for just a fraction
“WITHOUT THE EXPECTATION OF PAIN RELIEF, YOU CAN’T HAVE A PLACEBO EFFECT,” SAYS PROFESSOR HOWARD FIELDS
of a second – not long enough to consciously tell them apart. For the other subjects, the faces appeared long enough for them to be consciously recognised.
During this first phase, varying heat stimuli were delivered to the subjects’ arms along with the facial cues: more heat with the first face, less heat with the second. In the testing phase that followed, the subjects, including those who saw only the quick-f lash subliminal cues, reported feeling more pain when they saw the first face, although the heat stimuli remained moderate and identical for both faces. The subjects had developed an unconscious link between greater pain and the first face.
The experiment showed that a placebo response can be conditioned subliminally. Jensen points out that tiny cues as you walk into a hospital – many of which are experienced unconsciously – trigger responses in our bodies in a similar way. “Part of healing is nonconscious – something that happens instinctually,” she says.
Hospitals are just one common venue for the theatre of belief. There are hundreds of alternative medical treatments that harness our expectat ions – homeopathy, acupuncture, traditional Chinese medicines, vitamin infusions, sound healing, to name a few – all with varying levels of proven efficacy.
SO HOW DOES believing in something actually heal? One part of the puzzle involves conditioning, as Jensen has shown. Recall Pavlov’s dog, which drooled every time it heard a bell. That happened because Pavlov conditioned the animal to connect food with the sound.
The placebo effect’s conditioned response in reaction to pain is to release brain chemicals – endorphins, or opium-like painkillers. In 1978 two neuroscientists from the University of California, interested in how those internal opioids control pain, studied patients who had just had their wisdom teeth pulled.
The researchers first compared a placebo group to another group that received naloxone, a drug that cancels out the ameliorating effect of opioids. None of the subjects received or expected to receive morphine – and all of them felt miserable. Then the scientists told the patients that some of them would receive morphine, some a placebo and some naloxone.
This time, some of the patients felt better, even though they didn’t receive morphine. Their expectation of potential relief triggered the release of endorphins, which reduced the pain. But as soon as they got naloxone, they were in pain again. The drug wiped out the action of the endorphins that the placebo response had released.
“Without the expectation of pain
relief, you can’t have a placebo effect,” says Professor Howard Fields, one of the authors of the study.
It wasn’t until the early 2000s that scientists could watch how these effects play out in the brain. Tor Wager, then a PhD student at the University of Michigan, put subjects in a brain scanner. He applied cream to each subject’s wrists, then strapped on electrodes that could deliver painful shocks or heat. He told the subjects that one of the creams could ameliorate pain, but, in fact, neither cream had any pain-reducing qualities.
After several rounds of conditioning, the subjects learned to feel less pain on the wrist coated with the ‘pain-relieving’ cream; on the last run, strong shocks felt no worse than a light pinch.
The brain scans showed that normal pain sensations begin at an injury and travel in a split second up the spine to a network of brain areas that recognise the sensation as pain. A placebo response travels in the opposite direction. An expectation of healing in the prefrontal cortex sends signals to the brain stem, which creates opioids and releases them down to the spinal cord.
“The right belief and the right experience work together,” says Wager. “And that’s the recipe.”
The recipe is finding its way into clinical practice. Christopher Spevak is a pain and addiction doctor at the Walter Reed National Military Medical Center in Bethesda, Maryland. Every day he sees active service members and veterans with severe injuries.
When Spevak asks patients about themselves, he might learn that in childhood a person had a favourite eucalyptus tree outside his house or loved peppermints. If Spevak prescribes opioid painkillers, every time the patient takes one, he also has eucalyptus oil to smell or a peppermint to eat – whatever stimulus will resonate. Patients start linking the sensory experience to the drugs. After a while, Spevak cuts down on the drug and just provides the sounds or smells. The patient’s brain can go to an ‘internal pharmacy’ for the needed medication.
“We have triple amputees, quadruple amputees, who are on no opioids,” Spevak says. “Yet we have older Vietnam vets who’ve been on high doses of morphine for low back pain for the past 30 years.”
TWO YEARS AGO L eon i e Koban, a member of Tor Wager’s lab, tested the effect of other believers on a subject’s experiences of pain. The researchers delivered a burning sensation to their subjects’ arms and asked them to rate how strong it was. The volunteers also viewed a series of hash marks representing how previous participants had rated their pain. For the same stimulus, the subjects
reported feeling higher or lower levels of pain based on what they were told previous participants had felt.
Tests of the subjects’ skin responses showed that they were not just reporting what they thought the researchers wanted to hear; they were actually responding less to pain. Koban goes so far as to say that social information might be more powerful in altering the experience of pain than both conditioning and subconscious cues.
“Information we take from our social relationships has really profound influences, not only on emotional experiences but also on health-related outcomes such as pain and healing,” Koban says. “And we are only beginning to understand these influences and how we can harness them.”
NOWHERE IS THE POWER of group belief more evident than in religious pilgrimages – whether the Catholic trek to Lourdes, the hajj pilgrimage of Muslims to Mecca or the Kumbh Mela, which draws tens of millions of Hindus to cities along the Ganges. Or the pilgrimage to Altötting where I met Richard Mödl. The first documented healing in Altötting was in 1489, when a drowned boy was said to have been miraculously brought back to life. Today the Black Madonna attracts about a million visitors a year.
The pilgrims I joined were chatt ing happily on a cold Bavarian morning. I had been nervous about the trip because of ankle surgery I’d had three months before. But in that merry throng of believers, my pain faded away.
When we arrived in the Chapel of Grace, home of the Black Madonna, we found it covered with pictures representing miracles spanning hundreds of years. Propped against the walls were crutches and canes left behind by parishioners and pilgrims whose suffering was relieved by the Black Madonna. The expectation of healing continues unabated.
“There is a different way of thinking here,” said Thomas Zauner, a psychotherapist and deacon who moved to Altötting. “Prayer seems to actually work.”