The National Health Service in the UK released figures last month showing it gave out 71 million prescriptions for anti-depressants in England last year, which is double the figure from a decade ago. Seven million adults (14% of the adult population) are now on anti-depressants, as well as 300,000 children. Anti-depressants cost the NHS around £9 billion a year, which is a large chunk of its £100 billion annual budget.
This expensive national habit keeps growing, despite the fact that study after study shows anti-depressants are only very slightly more effective than a placebo (see this article: http://blogs.discovermagazine.com/neuroskeptic/2018/02/24/about-antidepressant-study/)
A placebo means a fake pill, a pill that contains a non-active agent. Placebos are used in many randomized trials of medical treatments as controls, to test treatments against. What all these studies also reveal is that placebos are really powerful. Around 40% of depressed people treated with a placebo get better. That’s pretty impressive, for a free pill.
How and why do placebos work? There is, sadly, much less research on the power of the placebo than there is on the power of drugs. Pharmaceutical companies pay for expensive research into expensive drugs. Why should they pay for research into the equally impressive power of fake pills?
Yet some research exists. It suggests that the placebo effect works because of the power of belief and faith. People believe they are being cared for, and this activates a healing response in their mind, their emotions, and to some extent their body. Our physical healing is somewhat connected to our emotional state, through the auto-immune system, so if we feel cared for and optimistic about our recovery, we heal better. It’s not quite magic – the placebo effect probably won’t cure you from serious illnesses like cancer. But it can help.
The power of faith and belief is connected to ritual, performance and theatre. Better props make us believe more. That’s why the placebo effect is more powerful when using bigger fake pills. It’s more powerful if the fake treatment involves an injection. It’s more powerful if the person administering the fake treatment is wearing a white coat. All these theatrical props make us believe in the treatment more.
The placebo effect is also culturally specific. Fake blue pills work better than red pills as tranquillizers, unless you happen to be Italian. Researchers have speculated is because the Italian football team wears blue, so this colour excites Italians.
Our beliefs can also seriously harm not just our mental health, but our physical health as well – this is called the ‘nocebo effect. If you tell people a medical procedure will be painful, they experience more pain. There was a case in the 1970s where doctors diagnosed a man with terminal liver cancer, and he died. An autopsy revealed the doctors had been wrong – the tumour was tiny, but the man died anyway.
Both talking therapy and anti-depressants are effective treatments for depression, but most of the effect – around 90% – is the placebo response. That’s why Cognitive Behavioural Therapy is less effective in trials today than it was in the 1970s. In the 1970s it was an exciting new treatment, and the novelty of it may have strengthened people’s faith in it. See this article on that: https://www.theguardian.com/lifeandstyle/2015/jul/03/why-cbt-is-falling-out-of-favour-oliver-burkeman
It is likely that a large part of the miraculous results we now see for psychedelic therapy (such as 80% of people giving up smoking following a dose of magic mushrooms) is in large part the placebo effect, and this effect will decline as people get more used to psychedelic therapy and stop seeing it as the latest miracle treatment.
In the developing world, there is on the whole no access to anti-depressants, nor talking therapies. The main form of healing for mental (and even some physical) illness is faith healing. You go to your local shrine, or medicine man, donate some money and pray for a cure. And it probably works about as often as other placebo treatments.
Now there are problems with this form of treatment as well - you’re giving your faith and your money to a religious system that might be toxic, prejudiced and hierarchical.
Still, economically it’s a hell of a lot cheaper than giving £9 billion to pharmaceutical companies. That is a very expensive form of faith healing. One could pay a lot of shamans, build a lot of monasteries and shrines, or buy enough fake pills to last a century, for £9 billion. The annual expenditure for the Church of England is around £1 billion. That’s a bargain in comparison. And religions contribute a lot more to the arts, philosophy and community than pharmaceutical companies.
What a strange, impoverished faith-system materialism is – it tells us we are just machines, and our consciousness and thoughts have no real power. Then, when we get depressed (and why shouldn’t we, with such a worldview) we put our faith in expensive little pills to make us happier. We take the holy sacrament alone, in a totally privatized and atomized ritual. We do feel better, but ironically, it’s our mind that is doing most of the healing.
We don’t have to join any particular religion to tap into the power of the placebo. It’s in us, in our minds, not in pills, not in priests. The placebo effect suggests our minds are more powerful than we yet know or fully understand, more powerful than the faith-system of materialism suggests they are.
Perhaps one day we can stop giving away our power away to expensive third-parties (religions / pharmaceutical companies) and then buying it back from them at extortionate costs.