SHAMANISM AND THE PLACEBO EFFECT
Gershom Zajicek (THE HEBREW UNIVERSITY )
Rationality on Friday
Friday, November 26, 2004
The talk took place in Elath Hall, Feldman building, Safra Campus, Giv'at Ram, The Hebrew University
Placebo and shamanism are two seemingly unrelated topics which have much in common. Let’s start with the placebo effect.
A clinical trial
A pharmaceutical company developed a drug for peptic ulcer and turns to the medical community in order to test it. The doctors recruit 100 volunteers with peptic ulcer. 50 get the drug and the rest a placebo. After some time the doctors end the trial and check what happened to the patients. It turns out that in about 60% the ulcer was cured with the drug, 30% were cured with a placebo. The rest did not get well and had to be treated with a different drug.
The pharmaceutical industry finds this outcome somewhat disappointing. An effective placebo is bad for business. The medical community simply ignores the placebo as non significant. Why should they ignore it? Suppose I would have treated a patient with a placebo. He would have a 30% chance to be cured without side effects. If within two weeks the patient would not get better, I would switch to the real drug. Unfortunately this approach which is regarded as fraud is forbidden.
What makes the placebo so powerful? Medicine has no answer and ignores it. Why not create a medical discipline, called placebology which would study the placebo effect scientifically? Medicine has specialists for all odds and ends of the organism except placebo. Why? Since medicine lacks some essential concepts for studying and appreciating the placebo effect. It regards the organism as a sophisticated machine. Disease is a malfunction, which has either to be corrected or replaced. Disease is a biochemical aberration which ought to be treated by chemical means and since biochemistry fails to explain how placebo functions it is ignored as non-scientific. Its effect is attributed to belief, suggestion or religion.
Medicine is stuck with the philosophy of Rene Descartes where placebo has no meaning. Suppose that you brought your car for repair and the technician suggests to treat it with a placebo, which illustrates why the placebo irritates doctors.
Additional reading: Medicine of Homo Faber
My interest in the placebo was awakened when studying patients with wide spread cancer. While the oncologist gave them only a few weeks to live, some seemed to ignore his forecast and continued living in good health for years. I wondered why did he err? And above all how did they make it? Medicine ignores these long survivors, attributing their good prognosis to good fortune.
The oncologist erred since failing to consider all factors operating in cancer. All along its evolution tumor and organism maintain an equilibrium. Disease progresses either because the tumor becomes more aggressive, or the organism weakens. Medicine opposes this notion. Equilibrium, or homeostasis, is an attribute of health, and in cancer this balance is disrupted. The equilibrium concept guided Hippocrates and his followers. It underlies Ayurveda and Chinese medicine, and was abandoned by modern medicine. A Cartesian machine does not maintain an equilibrium. The oncologist erred since ignoring this important facet of disease.
Cancer dormancy is another mystery which fails to attract the interest of doctors. Patients with widespread cancer may undergo a period of remission as if the disease faded away. In reality it was dormant and relapsed after some time. I became convinced that these long survivors with wide spread cancer carry a secret which might be applied to other patients as well. It turned out that many were apparently helped by the so called alternative medicine, which is regarded as placebo-medicine. I decided to study these methods and their underlying theories. Met with healers and learned their ways. “Alternative” is a misnomer. These methods ought to be labeled as Holistic medicine as opposed to Reductionistic medicine which was born during the Enlightenment.
These studies are reported in the Internet under the heading “A New Kind of Medicine." In order convey to you what I have learned I will briefly introduce the following concepts.
Despite its enormous complexity the organism maintains homeostasis in health and disease. How this balance is maintained beats our understanding. It is an attribute of life since loss of balance means death. We may regard this faculty as a wisdom of the body (WOB), which keeps us alive. WOB is a metaphor for the capability of the organism to control processes in the body and maintain an equilibrium during health and disease.
Two examples illustrate it; the new born baby and the patient in coma. Whatever a baby does is controlled by WOB. The same applies also to the patient in coma. WOB is akin to Aristotle’s “Soul” which is an attribute of plants animals and humans, and passes away when they die. The soul is mortal. For a millennium or so the Catholic Church rejected Aristotle and his Soul. They disliked also his view that the world is eternal. Finally Aquinas made the pagan Aristotle respectable, but first he immortalized the soul. Obviously this soul has nothing in common with WOB.
WOB controls processes and maintains our life but it cannot get resources. For instance, it maintains our water balance. The baby sweats, loses water, and WOB loses control. By itself WOB cannot get water and has to signal its mother that it needs water. The WOB (baby) starts crying until its mother replenishes its resources. During infancy mother serves as an interface between WOB and the outside world. As the baby grows it develops its own interface with the outside world, the mind.
Mind is also a metaphor. Its first task is to get resources which WOB needs. When WOB loses water it sends a signal of thirst as if saying: “I lose control of the water balance, get me water” or when the blood sugar level declines WOB sends a message of hunger. When some processes get out of order WOB signals the mind a sense of dis-ease, as if saying:” get help!” and the mind asks the doctor to help. The mind listens also to messages by the society and transmit them to WOB. You may liken him to the Roman god Janus with his two faces, The face inward serves as WOB servant, and the face outward is turned to the society.
The mind of the patient in coma is turned off, and he is
mindless. Only WOB controls his organism. When losing
fluids WOB sends to the mind signals of thirst with no response since
the patient is mindless. Now the doctor meets WOB needs and supplies the
body with the resources which the WOB cannot get by itself.
We are unconscious of the processes which operate in us are. We are unaware of their functioning. This unconscious realm has to be distinguished from Freud and Jung’s “Unconscious” which reside in the mind. The mindless patient in coma is not bothered by the Oedipus complex and the like.
Shamanism accompanied humankind ever since it started living in groups. Shamans were the first healers, and their heritage guides also many healers today. What distinguished a shaman from other members of his tribe was his capability to alleviate suffering. His insight might have originated in a serious ailment from which he recovered. He then applied his experience to other members of his tribe. This is how the first healer may have appeared on earth. The shaman has the capability to communicate directly with WOB and boost its healing power. Shaman means “He who knows”.
Shamanism is an inborn faculty of our body
From the medical point of view shamanism is an inborn faculty of our body like animal behavior. Each species has a typical behavioral repertoire, known as ethogram that is innate and may be manifested at birth or later. Shamanism like animal behavior is an instinct.
The meaning of instinct has been recently broadened to include innate faculties which emerge during child development. Like the language instinct, which according to Steven Pinker is an innate capacity for language. Before applying these faculties the baby has to master its talking muscles and grow a mind.
The music instinct
The music instinct belongs to the same category. Mind connects certain forms of auditory signals with pleasurable sensations. Music inspires in us feelings of happiness, melancholy, and other emotions. It may even generate an intense pleasurable experience described as thrill. All this emerges from our innate faculty to enjoy music. It takes more than a music instinct to become a fiddler like Isaac Stern or Itzhak Perlman. This virtuosity requires an insight which many lack. However, without our innate faculty to enjoy music, Perlman’s virtuosity would be meaningless to us.
The Shaman instinct exploits the faculty of WOB to heal itself. Although we all carry the faculty of shamanism, not all of us gain the expertise of a shaman. The virtuosity of the shaman requires an insight into the nature of self healing which he applies to the sufferers. However, without our innate faculty of shamanism we could not benefit from the healing power of a shaman.
Shamanism in different form accompanied all civilizations. In ancient Greece it was practiced in the temples of Asclepius. From 300 BCE the cult of Asclepius grew very popular. It was practiced in healing temples called ascelepion. Hippocrates and Galen both started as asclepiads. For more then a millennium Hippocratic medicine and the cult of Asclepius practices medicine side by side.
Shamanism thrives on four ingredients: 1. The shaman, 2. The patient who believes in his powers to heal. 3. The society which watches and participates in the healing process. 4. The healing ritual. The shamanic instinct underlies several biological phenomena:
When I go to a concert hall my music instinct expects music. In the same way when I go to a doctor my shamanic instinct expects a ritual which the doctor refuses to practice. Nevertheless whatever the physician does will have shamanic repercussions on the patient. The placebo triggers this healing instinct. Instead of appreciating this powerful treatment modality medicine abhors the placebo (shamanism) and regards it is a non-scientific quackery. In reality, medicine is stuck with the philosophy of Descartes which in cancer has harmful consequences to patients.
More on Shamanism and the placebo effect:
1. Making Placebo respectable.
2.Scientific framework for the placebo effect.
3. Placebo and Cancer.
4. A history of God and disease
5. A shaman who treats cancer .