Har­ness­ing Self-Be­lief

Reader's Digest Asia Pacific - - Front Page - BY ERIK VANCE FROM NA­TIONAL GEO­GRAPHIC

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.


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


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.”

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