Empathy + Placebo = Healing?

By Neuroskeptic | September 8, 2013 6:58 pm

Psychotherapy, voodoo, and complementary/alternative medicine (CAM) are all cut from the same cloth; they are ‘healing methods’ that relieve symptoms because they provide two key things: empathy and the placebo effect (E&P).

That’s according to Belgian physicians Mommaerts and Devroey in a new paper: From “Does it work?” to “What is it?”

They say that, given that E&P are a powerful psychological force, it makes little sense to ask of any particular CAM, “Does it work?”.  So long as it provides non-specific E&P, just about any intervention will work – there is nothing surprising about the fact that any particular CAM does.

We can ask whether the specific aspects of the treatment do anything, but the answer here is almost always “no”, and often “obviously not”, as in the case of homeopathy.

Even in psychotherapy, it is debatable whether any therapy is specifically effective although many have prima facie plausible theories behind them.

E&P is often the only thing people need. But it can be hard to find it in mainstream medicine. The authors write:

CAM represents a failing of scientific medicine, in that CAM seeks to address patients’ needs that are lost in the technologically focused interactions of modern medicine. CAM represents many patients’ search for empathy.

Perhaps there’s a solution: more empathy in mainstream medicine, or in general, some kind of ‘pure’ E&P that doesn’t rely on unscientific foundations? This is what the authors suggest.

They even discuss the possibility of a future “profoundly rational EP treatment”.

But I have to wonder, could this work? Can empathy and hope (placebo) ever be purely rational, or are they only able to enter the human mind by stealth, not through the front door?

To put it another way, if you set up shop and sold sessions of Empathy and Placebo, would anyone pay for it? Wouldn’t that lack the romance that makes the whole thing work…?

Interestingly, Jean-Luc Mommaerts is himself in the healing business. Here’s his vehicle for E&P: Aurelis® (“AUtosuggestion RELaxation Inner Strength”) product.

ResearchBlogging.orgJean-Luc Mommaerts, & Dirk Devroey (2013). From “Does it work?” to “What is it?”: Implications for Voodoo, Psychotherapy, Pop-Psychology, Regular, and Alternative Medicine Perspectives in Biology and Medicine, 56 (2) DOI: 10.1353/pbm.2013.0015

  • freecell0sd

    So the things likely to lead to response bias are the same things which make these interventions effective? Sounds like there’s a real danger of exaggerating the likely benefits here, unless there’s an attempt to use more objective measures of disability than just self-report questionnaires. (If it’s a health problem associated with economic costs, these could be used as one of a trials outcome measures. For a symptom like fatigue, actimeters could be used to measure patient’s activity levels).

    Some people seem to be pushing the remarkable powers of empathy and placebo as a way of covering up for the fact that their expert driven treatments do badly in appropriately controlled trials. CAM merchants were laughed at for this, and we shouldn’t lower our standards for ‘mainstream’ medicine.

    It’s important that exaggerated claims of expertise are not inflicted on patients, particularly when it comes to interventions intended to alter how people behave or think. Personal autonomy and freedom is important, and can be undermined by those in authority claiming that they know certain approaches to life lead to improvements in health, when the evidence does not show this to be the case. If homeopathy is as effective as CBT, it’s also likely to have fewer side-effects.

    Also, informed consent is important, and clinicians wanting to make money from ‘hope’ should not be able to do so without explaining to patients that this is what they are doing.

    • Daniel

      This poses an interesting question.
      Let’s say that you could develop a blood test that measures psychiatric symptoms like depression quantitatively. Let’s imagine that the test correlated beautifully with severity of depression. Now imagine that a treatment resulted in full remission of symptoms, but no change in the parameter of the blood test. What would that mean? Would you trust the patient or the test?

      • freecell0sd

        Difficult to say, as I think that the two components of your hypothetical dilemma are in tension with one another. If a blood test correlated beautifully with psychiatric symptoms, then it would necessarily change as a result of a treatment which consistently led to full remission of symptoms. Generally, I think it is best to try to measure and assess a range of different outcomes that can be used as proxies for subjective symptoms.

        I don’t think that this is about not trusting patients so much as recognising that it’s possible to manage people so that they fill questionnaires in more positively without really helping them. It is only when treatments have been shown to be more effective than homeopathy that it is acceptable to start selling them to patients.

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  • Björn Brembs
    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      This was an interesting study (I blogged about it here) but note that, although not deceptive, the administration of the placebo was not without a deliberate air of mystery:

      They said:

      “placebo pills… have been shown in rigorous clinical testing to produce significant mind-body self-healing processes.”

      This is “marketing speak” really – true but with a definite spin on it.

  • noorty

    “…CAM represents a failing of scientific medicine, in that CAM seeks to address patients’ needs that are lost in the technologically focused interactions of modern medicine. CAM represents many patients’ search for empathy…”

    CAM is always making claims about “treating the whole person” and their client centred and empathetic approach in comparison to mainstream medicine. The problem is that they highlight a difference that often doesn’t exist. The whole emphasis on medical training and delivery in this country over the last few decades has been on patient communications and taking a broad view of where a patients illness situates them be it occupationally, socially, sexually, emotionally and so on.

    When I see my GP I am not treated as levers, cogs and wheels but with a real respect and concern about helping me through an illness.

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  • TannerNorth

    Placebo is a sham it might make a person think they are feeling better so then they act like they are feeling better. Placebo is a fake substance that has no known direct effects. I don’t think that empathy + placebo would actually heal but is more along the lines of making someone appear insane by thinking they are well when in fact they are not.

    • http://blogs.discovermagazine.com Michael Syroid

      IMHO, you’re grossly underrating the uber significant *power* of ‘belief’ itself, aka the placebo effect.

  • MrJones

    A white coat and stethoscope is as much a stealth placebo as a witch doctor’s nose bone. I bet doctor’s who dress in a “doctory” way have better patient outcomes.

    • istvan

      That’s just how the brain and cognition works. Prediction is based on observed correlations. White coat treatment is correlated with healing, so the white coat will also induce the expectation of healing, and it should!
      But we also know that expectations can also cause (some of the) healing, so there is a self-fulfilling element. You need some core of truth but then layers of secondary (and ternary etc) effects also come in. (Ternary being when you know the white coat also helps, so you have even higher expectations, so the placebo works even better). And if you start without any core of truth, this process still builds a fairly good amount of placebo layers.

      In any case where expectation changes the outcome, there will be self-strengthening or self-destructing prophecies.

  • Kirsten

    In my psychology class we are studying placebo’s and I find it very interesting that people really believe that they are getting help with medicine,a treatment, or a procedure when really its all in their head. If the person who is taking this pill or receiving some sort of treatment believes it is helping them it will in fact work. So yes this placebo effect can work. Plus if a patient goes to see a doctor and the doctor is in a lab coat the patient is more likely to believe what he says, and take what he prescribes only because of his professional appearance.

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  • Buddy199

    Why is it that so many patients experience a “placebo” cure with CAM that they do not get after visiting their medical physicians?

    • http://blogs.discovermagazine.com Michael Syroid

      A greater *belief* in its efficacy.

  • AbdelAlquam1

    My name is Abdel Alquam, and I am a
    student in a general psychology class for Saint Charles Community College. My
    credentials are not extensive, yet I feel I can shed light from another
    perspective on said subject matter.

    In my course textbook, Discovering
    Psychology, 6th Edition, by Hockenbury and Hockenbury, chapter
    one seems to thoroughly explore concepts involving pseudoscience. So, when I
    read this article, it all seemed to fit together for me – like one, giant,
    mental jigsaw puzzle.

    If any of you are familiar with
    oncology, then you are aware of the steps necessary to achieve virtually total remission
    of said cancer. Along the way through chemo treatment, patients will suffer
    from nausea, depression, light-headedness – and, of course, hair loss. If we
    look at it from a psychological viewpoint, it is fair to assume that a person
    with a terminal disease, who is suffering from the aforementioned symptoms, is
    going to have a hard time staying positive. That is where I think pseudoscience
    comes into play – with a little twist of empathy and placebo as explained in, “Empathy
    + Placebo = Healing?” by Neuroskeptic.

    One of the biggest aspects of cancer
    recovery is, quite simply, empathy and placebo. Again, let’s keep a
    psychological mindset when considering this. A depressed patient wakes up one
    morning, and her hair begins to fall out as she prepares to take a shower. Fear
    overwhelms her. However, her fiancée then walks in carrying flowers and
    chocolates – for her. That’s the key
    to all of this. Stress has been medically shown to be a disastrous catalyst in
    unhealthy subjects. The empathy shown by the loved ones of the cancer patient
    enact a psychological placebo on the patient – making them try to be as strong
    as possible for the loved ones who have taken the initiative to be there for
    them in these dire days.

    So, yes, I do believe that the
    make-shift equation proposed by Neuroskeptic is plausible; and that’s with only
    exploring one theoretical option.

  • Danielle

    The E&P could be a very effective method of treating certain
    patients. Now I am not saying its the cure for cancer but for a self
    inflicting illness. It has been shown that the placebo effect alone can
    cause real responses with the physical body. As an example in
    Discovering Psychology 6th Ed. it mentioned a study on the placebo
    effect. In this study the participants were exposed to fake poison ivy. Some of the participants had felt pain and itching and even broke out into rashes. The Empathy and Placebo could become a very good method for treating and healing patients if we can learn the scientific principles behind it.

  • http://blogs.discovermagazine.com John Be

    A quick thought experiment dispels this notion fairly quickly. If all that matter is that Empathy & Placebo are provided, then trying providing a fatal dose of arsenic along with E & P. Does that seem too hyperbolic? Well, then it would have to be conceded that we have to exclude harmful treatments in this thought experiment. But wait, what happens when a layperson suddenly has a depressed person in their “office” who is experiencing a panic attack after enough empathy has allowed them to feel comfortable enough to recall a repressed memory? Would the layperson even realize that it’s a panic attack? Would the layperson know how to treat a client who suddenly had their PTSD symptoms fully emerge? Oh, wait, we skipped a step. The layperson would probably not be able to correctly identify that this person is suffering from PTSD. What happens when this imaginary layperson isn’t able to treat this Pandora’s Box? This could lead to a suicide, homicide, or even a much less benign result of simply not having improved symptoms. The very notion that all that is required of therapy is E & P would lead to results like this. Perhaps the physicians would argue that their argument doesn’t pertain to more serious mental illness, but this would be ignoring a great deal of what a therapist does. A therapist doesn’t know what causes a client’s depression beforehand. For those interested in the efficacy of psychotherapy, I suggest a Google search. There have been many studies which verify that it works for many people, using scientifically accepted measures of improvement (and for those arguing that those results could just be E & P, I refer you back to my original argument).

    • Taza

      “But wait, what happens when a layperson suddenly has a depressed person in their “office” who is experiencing a panic attack?”
      The Psychoanalytic practitioner would respond with complete indifference and continue to stare fixedly in silence at the client.
      The Behaviourist would wait until the panic attack was over and then administer a detailed questionnaire in order to develop a treatment programme.
      The Humanistic Practitioner would get their tits out and let the client have a good suck.
      I jest but just goes to show that the world of psychotherapy has about as much coherence as a fart in colander.
      …I’d advise the client that panic attacks are normal and commonplace and not to waste their money on cunts.

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  • Gustavo Pérez

    Evidently placebo is not exactly deception nor a substance as someone has pointed out. Placebo is about creating expectations, and therefore creating real, even objective change from there. What I think is the point here is that if you don’t tailor everything to fit the person that is going to create those expectations in his/her mind, then it might not work at all. Thus, listening, understanding the other’s language and models and beliefs, and somehow twisting the expectations to the right direction (through some kind of excellent marketing) is the key. The closest to placebo mechanisms is hypnosis (not to be confounded with obedient subjects, common in tv shows): just a flowing, soft redirection and amplification of expectations.

    • http://blogs.discovermagazine.com Michael Syroid

      Agreed. “tailor everything to fit the person” is crucial to a (+) placebo effect.

  • Mark Merrick

    You could set up a shop for Empathy and Hope. People would come for that.

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  • Jay Junior

    We are more than biochemical machines.



No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.


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