I have asked hundreds of my college students in my courses on health and medical psychology, abnormal psychology and loss and trauma seminaries “What is a placebo.” Their answers invariably include the notion “Something that is not real.” In research courses, when investigators are comparing treatments (drugs or psychotherapies), a placebo is an annoyance; something extra that they do not want and that interfereses with finding a true effect. These beliefs result in 'throwing out the baby with the bath water'.

Placebo effects occur in part because of the individual's beliefs and expectations. They can add to and enhance other effects. It is a well-documented observation that when new drugs are first on the market, they seem to work better than they will after they become familiar. This is true because both the doctor and the patient believe that this new chemical agent will work well. This belief adds to the chemical / biological effect. The belief produces a beneficial and enhancing, additional, chemical / biological effect. Something changes in the body. This is real; this is placebo.

Very powerful place effects occurring from interpersonal encounters. The very important doctor-patient relationship is a placebo effect in good part and is a chemical / biological phenomenon. Good research shows that positive experiences cause an increase in the neurotransmitter dopamine in the brain. When our experience with someone is positive, the good feelings we have are in part a result of this physiological occurrence. In the opposite situation, a negative experience results in a drop in dopamine. And the negative is, unfortunately, a much more powerful effect.

The effect in relationships changes brain chemistry which affects the outcome of medical care and patient compliance. It occurs because of the beliefs and expectations that the patient has towards the doctor and the positive fulfillment of those thoughts. It is place based on beliefs and expectations, which may or may not be ratione or have any basis in reality regarding the doctor's competence.

Brief interpersonal encounters with all manner of medical personnel may also produce powerful reactions based on beliefs and expectations and the emotional state of the patient (anxicous and vulnerable when going to the doctor, hospital or clinic). The same dopamine reaction often occurs in very fleeting Micro Relationship encounters (a few seconds or minutes) with the myriad of 'patient extenders' (medical assistants, technologists, phlebotomists, office clerks, etc.) that the patient interacts with in most visits. The effect is real and memorable-the negative encounters even more so. It is placebo. It is real. It is psychological. It is biochemical.

So what is a placebo?
• It is a real effect.
• It is psychology (beliefs, expectations, mental and emotional states creating real experiences.
• It is biochemical (primarily changes in brain chemistry).
• It occurs in interpersonal relationship experiences (extensive and brief).
• It can contribute to positive positive and negative memories of encounters.
• It can be beneficial and contribute positively to medical care -a useful tool.

If you think psychology and biochemistry are not real, then you will erroneously conclude that the place effect is not real.

Copyright © 2012Ralph Schillace, Ph.D.