• BrianW
    999
    Why would a placebo work? And what does it mean for the mind-body-behaviour relationship when drugs which interact directly and empirically with the body also cause similar effects?

    This is where I got the question: https://www.youtube.com/watch?v=csAjZ1MwhPE
  • petrichor
    322
    In at least some cases, it is probably just regression toward the mean, a phenomenon that often fools us.
  • BC
    13.6k
    Why would a placebo work? And what does it meanBrianW

    Why placebos 'work' along with actual pharmaceuticals is something of a mystery, especially when the number of people affected by a placebo is significant.

    We don't have to be terribly concerned if 4% or 5% of a large experimental group who received a placebo experienced benefit. It's more a mystery when 10 or 15% of placebo recipients experience benefit.

    "Mind over matter" is not much of an explanation. Perhaps belief in the drug mobilizes the immune system in some way. By chance, some people will get better for unknown reasons. Some people (a minority) have recovered from diseases that we would not have expected them to recover from. If we go back to the time before anti-biotics and anti-sepsis (1940 for antibiotics, 1870 for antisepsis) it's still true that some people benefitted from treatment that should not have worked.

    Medicine was not very scientific prior to the 18th century. Still, some people recovered from the diseases, probably In spite of treatment, rather than because of treatment.
  • SophistiCat
    2.2k
    I don't really understand why the placebo effect is regularly trotted out in the context of the philosophy of mind. What is it that calls for a philosophical explanation here? That mind and body interact should not be a surprise to anyone. Can you do something at will, e.g. move your hand? Well, there you go. The placebo effect is interesting in that your mental attitudes have effects that we do not usually expect them to have. But then most of us know very little about how the mind works, so the fact that something does not meet our expectations in this context is not particularly significant. What is it specifically about the placebo effect that philosophy of mind ought to address? Does it vindicate or go against some philosophical theory?
  • Tzeentch
    3.8k
    The brain is master of the body. Everything that happens inside the body is caused by signals from the brain, and almost all of this happens subconsciously. Theoretically, if our minds could control these signals we could control all processes in the body, including many illnesses. Indeed, a lot of illnesses and ailments are caused by the body or brain itself, and not by an external source. For an example, think of all the symptoms associated with stress.

    The placebo is an attempt to tell the subconscious brain to stop initiating a certain process. Clearly, influencing the subconscious brain is not easy. For example, if the person in question is convinced their condition will kill them, that message to the subconscious brain is potentially much more powerful than the placebo. In addition, there are probably factors beyond our knowledge.

    What does it mean? It should make us aware of the immense power the brain has over the body, and the possibilities that lie open if we would be capable to control the brain on a more conscious level.

    What is it specifically about the placebo effect that philosophy of mind ought to address?SophistiCat

    The fact that the brain has such a large influence on the body lends credibility to the claim that the brain is master over the body. If we take the concepts of subconsciously influencing the brain, but instead make the influence conscious, we may state the mind becomes master over the brain, and thus over the body. And thus we arrive at the famous phrase "Mind over body". I think such ideas are relevant within the philosophy of mind. Don't you?
  • SophistiCat
    2.2k
    The fact that the brain has such a large influence on the body lends credibility to the claim that the brain is master over the body.Tzeentch

    Are we talking about the same thing here? The placebo effect suggests that the mind has slightly more influence over the body than most of us had credited it with, although this extra influence manifests itself in rather obscure and capricious ways. "The brain is master of the body?" Please...
  • Tzeentch
    3.8k
    "The brain is master of the body?" Please...SophistiCat

    Everything the body does has it's origin in the brain. This is scientific fact and as far as I know not up for debate. Do spare me the condescending "Please..." at the end of your messages. I'll converse with you, but not if you cannot show a modicum of grace towards people you may not agree with.
  • SophistiCat
    2.2k
    This is scientific fact and as far as I know not up for debate.Tzeentch

    Lawyers have a saying: "If you have the law on your side, pound the law. If you have the facts on your side, pound the facts. If you have neither on your side, pound the table."

    The facts in question do not support your position, so you resort to pounding the table. You think it's graceful?
  • Tzeentch
    3.8k
    Dear writer, our lawsuit hasn't even started and yet you already accuse me of pounding the table. It would behoove you to take a look in the mirror.

    You talk about my position and my facts, but I haven't done more than introduce my view on the matter. The only fact that has gotten attention in our brief and so far unpleasant encounter is the fact that the brain controls (and thus is master of) the body. You seem to disagree. We can discuss this.

    I am curious what positions you think I have taken and what facts you think I have brought to bear to support these, because I'm trying to understand what has gotten you so riled up. I cannot imagine that a disagreement over the degree to which the brain influences the body (as per your first response) is what invited all this hostility.
  • unenlightened
    9.2k
    We don't have to be terribly concerned if 4% or 5% of a large experimental group who received a placebo experienced benefit. It's more a mystery when 10 or 15% of placebo recipients experience benefit.Bitter Crank

    What about when it's 80- 90%?

    What’s the difference between a homeopath and a surgeon? It’s a question that sounds like a joke, and it won’t have many surgeons laughing. Homeopathy is the scientifically implausible idea that diluted substances can somehow treat disease: it has never been shown to work and any effect is, at very best, a placebo effect. It’s a world away from the glinting scalpels and cut-and-dried logic of surgery. See a problem, cut it out, sew it back up. Right?

    Well, it is until you start looking for evidence of effectiveness for some operations, and then you’re left thinking that the line between the two is not as clear as you first thought.

    https://www.theguardian.com/science/2017/aug/20/when-surgery-is-just-a-stitch-up-placebo-effect

    So we know that faith healing works, to an extent, and it is supposed to be the foundation of medicine that it works better than faith. But the supposition is faith, and disentangling that faith from 'real' medical benefits is only possible if you question that faith.

    https://bmjopen.bmj.com/content/5/12/e009655
  • BrianW
    999


    I'm reading some stuff from the net and I'm seeing ranges of 20-60%, depending on the test, and it's increasingly mystifying.
  • SophistiCat
    2.2k
    Look, first you say that the placebo effect is interesting because it evidences brain's (and thus mind's) control over the body. Then you say that the brain's total control over the body is a "scientific fact" and "not up for debate." You can't have it both ways. If the placebo effect evidences brain's control over the body, then (also according to you) this doesn't tell us anything we don't already know for a fact. What makes your argument even worse is that the placebo effect is just about the weakest manifestation of the brain's effect on the rest of the body that we know about.

    BTW, I am not a medical man, but does anyone else think that "Everything the body does has it's origin in the brain?" That is news to me.
  • bert1
    2k
    BTW, I am not a medical man, but does anyone else think that "Everything the body does has it's origin in the brain?" That is news to me.SophistiCat

    I know which part of my body most of my actions originate from.
  • SophistiCat
    2.2k
    So we know that faith healing works, to an extent, and it is supposed to be the foundation of medicine that it works better than faith. But the supposition is faith, and disentangling that faith from 'real' medical benefits is only possible if you question that faith.unenlightened

    That is what clinical testing is supposed to tease out, no? Which is also how we know about the placebo effect in the first place.
  • BrianW
    999
    I think mind over matter is an apt way of representing this phenomenon but, as Alan Wallace seems to insist (from the video link), given that we know little about what the mind is, it may be a gross dismissal of a significantly predominant phenomenon. He (Alan Wallace) asks us to see the relationship between mind and brain as a co-relation instead of any particular dependency.

    For those who want to think that it's all about the brain, a purely physical phenomenon, consider that the mind might have a distinct effect on brain chemistry from beyond the domain of neuron activity, for example, https://brainworksneurotherapy.com/what-are-brainwaves, which states that, "Gamma is also above the frequency of neuronal firing, so how it is generated remains a mystery. It is speculated that gamma rhythms modulate perception and consciousness, and that a greater presence of gamma relates to expanded consciousness and spiritual emergence." However, it is impossible to think that it relates to the physical brain without a physical mechanism. So, perhaps, it's a matter of 'we'll eventually discover the connection'.

    Personally, I like to think that both mind and brain participate in the phenomenon we call a mental state, somehow like how electric and magnetic capacities interact in metals. They are both distinct phenomena which can best be said to co-relate.

    The placebo effect may also go beyond our mental states and have a far reaching physical effect, for example, it can boost immunity which can have a drastic impact on harmful microorganisms in our bodies, which I think is quite an improvement from the usual psychosomatic conditions like stress-related migrains.
  • Moliere
    4.7k
    I think that it's a problematic example for eliminative materialism to deal with, at least of the sorts that tends to see the world as arising from the bottom -up. Not that one couldn't, necessarily, only that it's problematic -- because there is some effect occurring that is not a result of the chemical being ingested. So if that effect is not the result of the mind, given that the mind does not exist, then what bottom-up physical process is it an effect of such that things like belief are eliminated?
  • SophistiCat
    2.2k
    If you mean that the fact that our mind has some control over our body has implications for eliminative materialism, then the placebo effect would not seem like the best example. A far more obvious and uncontroversial example would be a volitional action, such as moving your hand, etc.

    Of course, I would expect that eliminative materialists would already have a response to something as obvious as that.
  • Tzeentch
    3.8k
    I think I see where the disconnect happened. I distinguish between three things. Mind, brain and body. For simplicity's sake I will define 'mind' as conscious thought. Through the brain, the mind can influence the body, for the body is controlled by the brain. I thought this was generally accepted, but without a connection to the brain(stem), the human body cannot function. With a notable exception namely the inner sinus node in your heart which regulates your heartbeat. This can function autonomously from the brain for some time.

    The mind's control over the brain is another matter, since many of the brain's functions happen unconsciously. Influencing these processes is a lot harder, because it requires the mind to become conscious of unconscious proceedings within the body. However, it is possible. Think for example of using breathing techniques to slow the heart rate, or meditation to influence thermoregulation.

    And this brings us to the placebo. This is an example of the conscious mind influencing the unconscious part of the brain. The conscious action and thought from mind to brain: "I took a pill that will help me." and the unconscious signal from the brain to the body: "We are being helped so calm down/stop whatever you're doing." The reason the placebo-effect is so interesting is because it shows the mind's ability to influence unconscious processes in the body.

    This gets us to the question I raised earlier: To what degree can the mind influence the body? Can mind become master over the brain and thus become master over the body? We have seen the mind can control conscious as well as unconscious processes, so can it control all of them? You seem skeptical, but personally I believe the influence of the mind, with practice, can become very significant. We can discuss that, but we should first make sure we understand each other to avoid a repetition of our earlier situation.
  • BrianW
    999
    And this brings us to the placebo. This is an example of the conscious mind influencing the unconscious part of the brain. The conscious action and thought from mind to brain: "I took a pill that will help me." and the unconscious signal from the brain to the body: "We are being helped so calm down/stop whatever you're doing." The reason the placebo-effect is so interesting is because it shows the mind's ability to influence unconscious processes in the body.Tzeentch

    https://listverse.com/2013/02/16/10-crazy-facts-about-the-placebo-effect/ Check out number 8 on the list. How does the conscious mind impair itself without administration of actual alcohol?
  • praxis
    6.5k
    How does the conscious mind impair itself without administration of actual stimulants.BrianW

    By the brain releasing particular neurochemicals, I would guess.
  • BC
    13.6k
    homeopath

    quack, quack.

    See a problem, cut it out, sew it back up. Right?

    I agree that some kinds of surgery are frequently ineffective. Surgery for lower back pain, for instance, seems to be frequently ineffective at reducing lower-back pain (opinion based on medical journalism). Osteoarthritis (something I have) seems to be pretty variable on a day to day basis. Some days no pain, other days major pain. I have found that certain activities guarantee more pain, some activities seem to reduce pain. Living with a bone spur on a toe is probably a better strategy that surgery, unless the pain is unbearable.

    I don't classify chronic neck pain with headache as psychosomatic, but short of cancer, I wouldn't volunteer for surgery or heavy-duty medicine to fix it. My guess is that chronic dissatisfaction with the details of life (chronic tension) is a major factor, not curable by medicine or surgery.

    My suspicion is that many people have heightened expectations of what their aging bodies should be like: beautiful, flexible, strong, pain-free. If that is what one has, great. But a lot of bodies--especially aging bodies--are no longer so beautiful, flexible, strong, or pain-free. Many people think there are fixes for all of their legitimate complaints. Some problems are fixable--like cataracts. Definitely worth doing. Back, wrists, fingers, hips, knees, and/or ankles hurt from arthritis? Accommodate it rather than forcing a 70 year old body to perform like a 35 year old one.

    I blame patients for some of the over-and-dubious treatment that is performed. A lot of people have unreasonable expectations for both life as we know it and for medicine/surgery.
  • BrianW
    999


    Could be true.

    And, "But the pendulum swings both ways — a fake-drunk subject could conceivably get a fake-hangover, Kirsch says, pointing to the "nocebo effect," where subjects taking a placebo experience negative side effects purely based on pessimistic expectation. In one extreme example, a participant in an anti-depressant trial attempted to commit suicide by overdosing on the pills he had been provided as part of his study." - https://psmag.com/social-justice/placebo-week-getting-drunk-beer-alcohol-expectations-92254 For the full explanation.

    How cool is that? (Scientifically cool, not suicide cool.)
  • Relativist
    2.6k
    The brain is master of the body. Everything that happens inside the body is caused by signals from the brain, and almost all of this happens subconsciously.Tzeentch

    I sympathize with your general position, but you have overstated it. The brain controls some things and merely influences others. The immune system is not controlled by the brain, but the efficacy of placebos is suggestive of the brain having a degree of influence.
  • Tzeentch
    3.8k
    I don't think the immune system is able to function when it is separated from the brain, but I'm no expert. I'd actually say the immune system is a great example for the case. The brain unconsciously influences it, for example through stress. The mind can consciously influence it by engaging in activities that strengthen it, like exercise, cold showers and eating healthy. Perhaps the immune system is a bit of an outlier, but it's one of the systems that's easy to influence.
  • praxis
    6.5k


    I recall reading about newer research that shows nerve connectivity between the organs responsible for immune function and the brain. They found more direct connections than previously believed anyway, if I recall correctly.

    It's said to have implications for how we deal with stress. For instance, if we interpret a stressor more as a threat then our body (including our immune system) will prepare for injury, but if we interpret it more as a challenge then our body will prepare for performance. Clearly more of the stressors in our modern lives would be better treated as challenges than direct threats of bodily harm.
  • SophistiCat
    2.2k
    Through the brain, the mind can influence the body, for the body is controlled by the brain. I thought this was generally accepted, but without a connection to the brain(stem), the human body cannot function.Tzeentch

    The human body cannot function without the liver either, but that doesn't mean that every process in the body is controlled and directed by the liver. But never mind, I don't think your point hinges on this position being 100% accurate.

    The reason the placebo-effect is so interesting is because it shows the mind's ability to influence unconscious processes in the body.Tzeentch

    OK, so I asked what relevance the phenomenon of the placebo effect might have for the philosophy of mind, and you just presented us with an example where the placebo effect has implications for a theory of mind that you support. To summarize, the theory says that the mind controls or influences bodily processes. But there are actually two minds: conscious and unconscious, and each of them has its own domain of influence. It might seem that there is little if any crossover between the two, but the placebo effect shows that the conscious mind has at least some degree of influence over the unconscious mind. The idea is that the placebo effect occurs when the conscious mind influences the unconscious mind, which in turn influences some processes over which the conscious mind normally does not have a direct influence.

    This is a good answer; I agree: within the parameters of your theory, the placebo effect is relevant and potentially significant. I'll just note that the theory of conscious vs. unconscious mind should not be taken as the received view among experts (I don't think there even is one such view), but rather sounds like a folk theory of mind. Also, the interpretation of how the placebo effect works (i.e. the conscious mind works through the unconscious mind) is not obvious even if the main premises of the theory are taken for granted. But, to repeat, if all of these premises are accepted, then your point is valid: the evidence of the placebo effect makes a difference.

    You seem skeptical, but personally I believe the influence of the mind, with practice, can become very significant.Tzeentch

    I am rather more skeptical of the whole conscious/unconscious mind theory, but I don't claim much expertise on this subject.
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