Placebo Part 2: Roots in Symbolism, Shamanism

Fabrizio Benedetti is one of the world’s leading researchers of how placebos work in the human brain, and he traces their effects back to ancient shamanism.

A physician, he also is a professor of physiology at the University of Turin Medical School, a consultant for the Placebo Project at the National Institute of Health in Bethesda, Maryland, and a member of the Mind-Brain-Behavior Initiative at Harvard University. He writes:

The placebo-nocebo effect represents an amazing example of how the mind-brain unit interacts with the body. Whereas placebos have to do with positive symbols that anticipate clinical benefit, nocebos are linked to negative symbols that induce expectations of clinical worsening. Positive symbols can range from empathic doctors and smiling nurses to trust-inducing complex medical machines and apparatuses. Likewise, there are a variety of negative symbols, ranging from shabby doctors to a pain-anticipating dentist’s drill.

From an evolutionary perspective, these symbols, and indeed their interpretations by the patients, have evolved from ancient shamanism to modern medicine, whereby the patient’s expectations and beliefs in the healing power of the doctor play a crucial role. By studying placebo and nocebo effects, today we are beginning to understand how medical symbols affect the patient’s brain or, in other words, how positive or negative psychosocial contexts can change the brain and body functioning of the patients.

According to the Wired article posted above, Benedetti, 53, first became interested in placebos in the mid-'90s, while researching pain. He was surprised that some of the test subjects in his placebo groups seemed to suffer less than those on active drugs. But scientific interest in this phenomenon, and the money to research it, were hard to come by.

"The placebo effect was considered little more than a nuisance," he recalls. "Drug companies, physicians, and clinicians were not interested in understanding its mechanisms. They were concerned only with figuring out whether their drugs worked better."