Consider hypnosis. We engage in a relatively brief exchange with a stranger who possesses some measure of authority. As a result, we become capable of feats that are usually considered impossible: parts of our body are “anesthetized,” and surgery can be performed without pain; untreatable warts and congenital skin disorders disappear; wounds heal faster; surgical blood loss is greatly reduced. We undergo auditory, visual, and proprioceptive disorientation, experience visions that are perceived as real and lose our sense of volition. Suggestions can be made under hypnosis that we subsequently enact, post-hypnosis, but attribute the impetus for the actions to ourselves, with no memory of it having been suggested.
Almost everything we hold sacred and inviolate about ourselves is upended in hypnosis. The sinews that hold us together are all severed: our sense of continuity in time (i.e., memory), our grounding in the material world (i.e., perception), our compelling sense of personal agency (i.e., volition), and the boundaries of our physical capacities (i.e., pain tolerance, wound healing, curing skin disorders). What is the cause? An interpersonal exchange. That’s it. The lack of a physical cause that can be objectively measured is why hypnosis has been rejected by the biomedical profession for 250 years—hypnosis is not considered a “real” phenomenon. Rather, it is all shamming, trickery, hocus-pocus, all in your mind, etc. Name calling for 250 years that avoids the fundamental challenge posed by hypnosis to our basic understanding of ourselves: our assumptions about the relationships among body, psyche, I, we, mind, and “reality”.1
Hypnosis and Placebo
The hocus-pocus, all-in-your-mind conclusion about hypnosis was, ironically, given support in 1784 by the first scientific placebo-control study. Mesmer (from whose name the word mesmerize is derived) asserted that he could channel an invisible physical fluid, which he called animal magnetism, to cure multiple ailments, produce remarkable effects on mind and body, and anesthetize patients to perform surgery. Mesmer posed a grave challenge to the medical profession and to the social order in France, so the King of France commissioned a group of eminent scientists, led by Benjamin Franklin, to discredit Mesmer.
The Commission examined the claims of Mesmer using two groups: an experimental group that received Mesmeric treatment, and a second that received, unknowingly, a sham treatment. The sham treatment proved to be as effective as the Mesmeric. The Commission concluded that animal magnetism is not real; that the effects resulted from imagination and imitation and, therefore, should be dismissed. Mesmer was discredited, left Paris in disgrace, and the Royal Society of Medicine issued a decree obligating all physicians to sign an official statement rejecting the practice of animal magnetism. Failure to do so would result in dismissal from the ranks of physicians.
Note that the effects of the Mesmeric treatment were not disputed. Only the presumed cause. This did not stop practitioners, often outside the medical community, and people suffering from various ailments from using Mesmeric procedures. Animal magnetism later came to be called hypnosis, which continues to experience a similar fate—rejected or viewed with deep suspicion because of a lack of objective physical cause and, perhaps, a professional threat for offering cures that lie outside the biomedical corridors of power and financial remuneration.
It is revealing that this methodology, first used in 1784 to discredit hypnosis, was not used to test the efficacy of standard medical practices, including purgatives, evacuants, humectants, vesicatories, and spoliative bleedings. This would be a pattern for the next century and a half: Blind and double-blind placebo control experiments, as they were later to be called, were only used to investigate threats to traditional medical practices.
Randomized Clinical Trials (RCT), which include placebo control groups, only began to be systematically used in medical research in the 1950’s and is now the standard experimental methodology for demonstrating that a physical treatment has an effect that is not the result of placebo. Although this is a step forward, the conclusion that a placebo effect is a measure of failure of a physical effect, not a documentation of the remarkable power of a placebo, continues this long history whereby objective, physically caused effects are real, while psychosocial causes are just “in-your-mind.” Let’s flip that script and briefly review several recent findings about the placebo as documentation its startling effects.
Placebo pills afford the same measure of pain relief as 75% of pain medications submitted for FDA approval that must undergo clinical trials. Most of these do provide measurable pain relief, but not significantly more than a placebo, so they are not approved. But the pain relief is real, for both the placebo and chemically active medications. Furthermore, the rate of FDA rejection of pain medications undergoing clinical trials has recently risen to over 90%—but only in the US, not in Europe. Why? Cultural differences of some kind are likely at play.2
The way a treatment is administered also makes a difference. Trust, honesty, kindness, and the appearance of competence increase the effects of a placebo. Bedside manners matter. Indeed, what gives a sugar pill, or any faux treatment, its power is the sociocultural context in which it is enacted. The rituals and contexts associated with treating illnesses—the scripted drama of healing—can prompt the body to respond in a healing manner, and the scripts vary from culture to culture.
Placebo treatments can be effective even if the patient is informed that it is a placebo. The color of the pill also matters—blue, not red pills are more effective for pain relief. Placebo pills clearly labeled and (cleverly) marketed are for sale online. You can purchase 45 “Pure, Honest, Placebo Pills ” with “inert ingredients” “trusted by consumers, clinicians, researchers since 2014” for $25 (4.2 stars on Amazon). The scripted drama of healing at work.
Only recently have there been efforts to identify neurobiological mechanisms that might account for the power of the placebo. The quest is motivated by trying to prove that the placebo effect is, in fact, “real”; that there is a objective biological basis, and therefore it is a legitimate object for scientific scrutiny. This reasoning is baffling. First, the effects ARE REAL! The lack of objective physical cause does not render the obvious and profound effects of placebo “not real.” Second, the fact that the remarkable effects of placebo are evoked by social interactions exposes our faulty assumptions about what constitutes “real.” Third, of course there are biological factors of some kind that make this possible.
Our experience, including social exchange, does not float, untethered, from our biology. However, whatever the biological factors are, and research has recently begun to address this question, they enable the psychosocial influence. They do not cause it to occur. The cause resides in the interaction of biology with psychological expectancies, situational influences, cultural rituals, personal relationships, and prior conditioning that come into play in a sociocultural context of healing.3
Placebo and hypnosis are not panaceas. Hypnosis can alter our perceptions and subjective experiences, have an impact on some bodily functions, and remediate the effects of chemotherapy. Placebos can treat the nausea and pain associated with cancer treatment, heart disease, and ameliorate subjective experiences associated with illnesses. But hypnosis and placebos cannot cure cancer, Parkinson disease, and most other serious illnesses and diseases. These limitations, however, do not diminish what they can do, or the challenge they poses to our conventional understanding of ourselves.
Other “Family Members”
Hypnosis and placebo are the two most prominent members of a family of anomalies that defy traditional medical explanation. Others include: TikTok tics, a world-wide outbreak of tics induced by a TikTok posting that went “viral” (this is an appropriate name for it, as there are many instances of social contagions of a similar nature spreading like a viral contagion)4; conversion disorders, where individuals experience paralysis, blindness, deafness, and seizures but have no neurobiological impairments; and Dissociative Identity Disorder, often referred to as multiple personalities, where completely different personas inhabit the same individual, each without awareness of the others.
It’s All in Your Mind
Hypnosis, placebo, TikTok tics, and their “family members” startle and disturb because they undermine our conventional understanding about the relationships among body, psyche, I, we, culture, mind, and “real.” The assumption that girds this understanding is that there is a disjuncture between the body, which is a physical, biological entity, and therefore “real”, and psyche, social exchange, culture, and mind, which are viewed as incorporeal phantoms, and therefore not “real.” An accompanying assumption is that the body can influence these incorporeal phantoms, but they, however, can have no effect on the body.5
Are these anomalies simply curiosities that will eventually be explained with more research? I think not. Their peculiarity arises from the conceptual straitjacket we use to try to capture them. An alternative explanation can be summed up in a word—any word. A word, spoken (or written) is a nonsense sound (or marking) given signification by a communal, cultural agreement that confers its meaning.6 We are born into a cultural web of meanings, and propelled by our biological heritage to acquire words—any and all words, in any and all languages!!–from the earliest, first years of life. Words stretch from the biological to the interpersonal to the cultural, all seamlessly united in the act of communication.7 These “incorporeal phantoms” can evoke strong bodily reactions, from erotic to heart stopping, from gut retching to uncontrolled weeping.
Hypnosis, placebo, and TikTok tics are merely noteworthy examples of the primal power of human communication in its many forms. Mind is the looping networks of meanings that encompasses body, psyche, I and we.8 It is all in your mind! And it is, indeed, real!9