Abstract: The placebo astonishes by working even in those informed that it has no biological effect. Jane Risen, a researcher from Chicago, explains it by taking Daniel Kahneman’s 2-system model of thought: the rational system 2 detects the superstitious error of the intuitive system 1 but does not correct it. This produces acquiescence, a wobbly conviction of the type: “I don’t believe it but you never know…”. Acquiescence is a very interesting concept but is not explained correctly by Kahneman’s double system since precisely it is a fusion of opposites. Which system synthesizes the other two if we reason in terms of independent networks? I offer an alternative explanation for the placebo effect, within the framework of Stratium theory, and extend it to the concept of hormesis, the idea that the organism is self-reinforcing in adversity and is encouraged to do so by care.
The placebo, a very common operation
Placebos work. Notice I didn’t say “are effective”. They work, that’s for sure. To ensure some success for healers and pseudoscientists —those who use phony interpretations of science, which is a lot, a lot of people on the net.
Where do they work? Not at the biological level. This is the very definition of a placebo. No biological effect found. The effects are linked to the therapeutic intervention, to the treatment. What recognizes the existence of care, in adults as in children or animals? The brain. Placebos do not have “biological efficacy”, they work on the brain.
Suckers and skeptics
At least on most of them. Not all. Would some humans have pigeon brains and others a technologically advanced command center with scam radar? It was a bit like the idea in the last century. There were suckers and rationalists who cannot be mistaken. The former stripped by charlatans, the latter treated according to the rules of the medical art.
In fact, we find in everyone’s brain pigeon and reason. What separates them is just a question of fame. The “pigeon” in us is in fact emotion, widely shared in the animal kingdom, and whose effectiveness remains incomparable to decide. Reason, on the other hand, which I call the inner Observer, knows how to make our mental scene much more sophisticated, but not to launch us into it as actors. Neurological accidents that disconnect the prefrontal cortex from emotional areas make people always perfectly rational but incapable of making a decision.
A lot of potential emotion in the treatment
The evolution of our personality is a series of impulsive acts retro-controlled by reason and which sediment in habits. The Observer slows down futile or counterproductive behavior more than it decides on new ones. It takes emotion to start a new business. These impulses mix with the predictions of the Observer to give meaning to our mental scene. A behavior is triggered. Let’s not forget that it is the scene that sets itself in motion. There is no director to shout “Action!”
Our emotional centers are the most receptive to healing. In return, they trigger effects on the body, secretion of endorphins, easier falling asleep, easier healing. So that there are indirect biological consequences of a placebo. But relatively limited and not necessarily those that interest us. A placebo user for osteoarthritis hopes her cartilage will be protected. But no, only her pain can subside.
The rationalist’s Observer tends to block these effects, which she considers illusory. Concretely, the rationalist forbids herself any benefit from a placebo by preventing her emotions from acting. She considers the benefits rather modest and of an emotional nature, which does not interest her much. She is rarely overwhelmed by her anxiety. But wouldn’t there be other profits to be expected? We have not finished discovering the field of possible effects of a placebo. Its limits are imprecise, not including only the simulation of biological effects. Music, meditation, sexual practice, enter into this therapeutic field, as dopamine secretors.
Admittedly, the placebo lacks a mode of action validated precisely in neuroscience. We can only reflect on the general principle behind it. This I will do in the next few paragraphs. We are entering the world of hypotheses.
Placebo and hormesis
The principle common to placebos is intuitive: the conscious workspace influences brain areas more directly connected to body physiology, stimulating its proper functioning. This physiology is indeed a dynamic, often on standby today in the absence of intense physical activity and traumatic events. The body is evolutionarily designed to conserve its resources. The contemporary, sedentary way of life hardly exhausts them. It loses its ability to adapt to adversity.
No hormesis. Hormesis is the assumption that the body grows stronger in adversity, as long as it does not reach impossible heights. Idea almost contrary to the precautionism that currently prevails in medicine: the body must be protected from any aggression. On the contrary, hormesis incites to stimulate its adaptive resources by measured aggressions. An example: intermittent sunburn would encourage the immune system to get rid of abnormal melanocytes and would be more effective against melanoma than avoiding all sun exposure.
Take care of your own existence
Hormesis is only an intuitive hypothesis, too, but based on bodily ontology. The organism is a self-organization. Each stage of its complexity becomes all the more stable as it has successfully traversed multiple different contexts. The small gaps weren’t too threatening. Its more reactive organization has become resistant to major deviations.
In this context, always hypothetical, I remind you, the role of the placebo would be to periodically awaken this reactivity of the organism in the face of uncomfortable or threatening situations. No doubt its variable effect comes from the variability of our lifestyles. Some already have very stimulating days, physically and intellectually. Hormesis is permanent for the body as well as the brain. This could explain the excellent longevity both of the countryman busy daily in her garden and of the scholar passionate about her books. The best placebo effect is to serve your work. To propose a work, mentally, is to take care of one’s existence.
Kahneman and Risen clarified by Stratium
In conclusion, I return briefly to Kahneman’s 2-system model, also a hypothesis, which Jane Risen used to explain the placebo. “I don’t believe it but you never know…” defines acquiescence, an irrational belief but not eradicated by reason. In fact, acquiescence is a very widespread phenomenon in the mind, even an elementary mechanism. Which concept does not merge foreign or contradictory elements? At the bottom of the complexity the image of an object merges geometry, color, texture. At the top, the image of a congener merges deliberately incoherent characteristics, nice in some circumstances, bad elsewhere. The reason is not there. And yet the image is unique. Acquiescence is everywhere. The reason/emotion mix about the placebo is banal.
Under the clarification of Stratium, Kahneman’s dual system of thought is the conscious interaction of the prefrontal Observer, provided with its reasons, with the unconscious propositions, strongly impacted by the emotions. This interaction is less a conflict than a hierarchical retro-control. The Observer reshapes unconscious propositions to improve the coherence of conscious thought. In the rationalist the emotions are already contingent on arriving at the conscious level. Not in the anxious. The reason/emotion integration does not take place at the same level, unconscious for the rationalist, conscious for the anxious.
Let’s close the hypotheses. I hope they will have an excellent placebo effect on you! Remember: even if they are wrong, they work. For our greatest benefit? Only on condition that we don’t turn away from a better reason…
Believe what we do not believe: acquiescence to superstitious beliefs and other powerful intuitions, J.L. Risen, Psychological Review 2020