In 2004, researchers at the University of Turin in Italy conducted a compelling though controversial study. Thirty people who had recently undergone surgery — and also suffered from high anxiety — were given the drug diazepam, more commonly known as Valium.
Half of the people in the study were told they were receiving the drug via an infusion, while the other half were told they were not getting the drug through their IV. The researchers observed that within just two hours of the injections, there was a clear drop in reported anxiety among the people who knew they were getting diazepam but practically no difference in anxiety among the people who did not know that they had received the drug.
“The main finding is that when the patient is completely unaware that a treatment is being given, the treatment is less effective than when it is given overtly in accordance with routine medical practice,” the researchers concluded. The findings suggest that the drug’s effects are registered in the patient only when the drug is part of the ritual of treatment.
For centuries, people have practiced health-related therapies that may not pass modern-day clinical muster, meaning there are not randomized controlled trials that expressly prove their effectiveness. In the United States, nearly 40% of adults use some form of complementary and alternative medicine. Newer wellness trends in the past few years include CBD oil, crystals, and mindfulness meditation apps.
One shared aspect of these therapies is their direction for use — which is to say, use them consistently. Meditation is believed to be most effective if it’s a regular practice; nightly drops of CBD oil before bedtime is thought to potentially aid in sleep or anxiety; crystal enthusiasts recommend setting an intention each time you hold your stone of choice. Experts believe that the incorporation of routine into any antidote can make it more effective, as the Italian study showed. “Healing rituals involve a drama of evocation, enactment, embodiment, and evaluation in a charged atmosphere of hope and uncertainty,” writes Harvard researcher Ted Kaptchuk, whose work focuses on understanding the placebo effect, in a paper about placebo studies and ritual theory.
“It seems that if the mind can be persuaded, the body can sometimes act accordingly.”
Feelings of uncertainty may be common among many people in 2019, says Paul Grewal, MD, an internal medicine physician based in New York City. “Our human predilection toward daily ritual has been commandeered and preyed upon by the toxic 24-hour digest of news,” he says. “We desperately try to restore something of our social nature by ourselves, and the ritual of doing something for yourself might be a surrogate for someone doing something for you.”
Matthew Burke, MD, a neurologist and member of the Placebo Studies Program at Harvard Medical School, says the placebo effect is “the positive response that one can get from the context of a therapy, rather than the specific ingredient that might be in the therapy itself.” Scientists have shown in studies that even when a person is receiving sham treatment, there are measurable changes in their neurobiology, including changes in hormones and activated areas of the brain. Ritual appears to be an important facet in explaining why the placebo effect works and, therefore, is likely an important part of any therapy’s effectiveness.
Burke says what’s essential to effective healing rituals is the context in which they’re occurring. “If someone’s doing a ritual they’ve heard of or seen from someone they trust — whether it be online, conventional medicine, or an alternative care provider — it’s the first step to building that therapeutic context,” he says. “Then, of course, also important to the context is the delivery of the treatment itself.”
“What we do when we have a really bad cold is curl up on the couch and read a book,” Grewal says. “This is driven by ritual and physiology. You have these inflammatory cytokines that redirect our [body’s] resources towards healing. There’s really no such thing as a sick day anymore. It’s just a work-from-home day. We’ve been robbed of this very necessary sickness behavior, of which having a healing ritual is a part of.”
Leaning into the more ritualistic aspects of healing may work in our favor — like going for a walk each morning or meditating for a few minutes before work — as long as self-care activities don’t become a crutch. Spending $240 on pricey CBD oil to take each night before bed may feel easier than having conversations with doctors and friends about feelings of anxiety and trouble sleeping.
“Medicine has failed patients in many regards to adequately address many of the symptoms we’re trying to remedy, such as chronic pain, anxiety, fatigue, and insomnia,” Burke says. “We haven’t developed good answers, so people have naturally gone to other sources to try to address this, and the industry is booming, probably because of the placebo effects that these types of self-care things can induce.”
As Harvard’s Kaptchuk writes, “It seems that if the mind can be persuaded, the body can sometimes act accordingly.” Realizing that may be powerful medicine, if embraced responsibly.
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