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Placebo

Tentative Belief Can Lead to Real Change

What religion, hypnosis, placebo, and synchronicity may have in common.

Key points

  • In clinical hypnosis imagining change using metaphorical thinking can improve health.
  • Use of placebos can improve health even when people know they are receiving a placebo.
  • Perhaps we are wired to respond to our imagination as a way of rehearsing real-life events.
  • An individual's willingness to embrace a particular “as if” approach can render this approach a therapeutic tool.

I grew up in a non-religious Jewish family in which scientific thinking was valued, and belief in a God was not considered important. When I arrived at college, I was uncertain and nervous about my role in life, as is common for many older teenagers. I was intrigued when I met some Christian friends who seemed much more at peace with themselves than I was. They explained to me that their belief in God, as an active being in their lives, helped them feel more secure.

At that time, I started exploring religion and asking myself whether a belief in God would be beneficial to me. Despite talking to my Christian friends at length, and exploring Jewish religious belief in depth, I could not accept the idea that God exists for sure. However, I did become more aware that He might exist, especially given all the many inspirational and highly intelligent world leaders throughout history who based their lives on a belief in God.

I recall a conversation with one of my Christian friends in which I told her that I had been incredibly lucky in my life, as many important things fell into place for me. She said, “I don’t believe in luck. If my good fortune is just the result of luck, then it could turn at any given time.” She explained that her belief in God helped her feel more secure that she will continue to be protected. I liked her security, but was able to identify an alternative explanation for how my “luck” could hold out. Perhaps, it had to do with my knowing how to make good choices in life, rather than being attributable to God.

The Benefits of an ”As if” Approach

Thus, I characterized myself as an agnostic, i.e., as someone who does not know whether or not God exists. Nonetheless, I desired the peace manifested by my Christian friends. Therefore, I decided to live my life as if God existed. I reasoned that if I was wrong nothing would be lost, as long as my “as if” approach was helpful for me to live life in a way I felt to be good and meaningful. Indeed, I felt much more comfortable with an approach that allowed me to view some of life’s difficult moments in my work as a physician as being meaningful, rather than as meaningless tragedies.

Sunny Studio/Shutterstock
Source: Sunny Studio/Shutterstock

As I gained more life experience, I recognized that other “as if” approaches can be very helpful and even healing for people. Through the use of clinical hypnosis for more than two decades I learned that prompting people to imagine a fanciful event “as if” it represented resolution of their health problem, can be associated with a dramatic and lasting improvement in their health. For example, a patient’s abdominal pain resolved when she chose to imagine that an elephant decided to stop sitting on her when she gave it a peanut.

The placebo effect also falls into an “as if” category. Classically, many people who participate in studies involving a new drug demonstrate an improvement in mental and/or physical health, even if they are only given a sugar pill. Thus, they react “as if” they received a real drug (Kirsch, 2019). Incredibly, with some diseases such as irritable bowel syndrome and chronic back pain, when people are told they are receiving a fake drug, they also improve (Kaptchuk, 2010; Guevarra, 2020). In other words, similar to the response to hypnosis, people can benefit from therapy by responding “as if” it was real.

“As if” belief related to synchronicity can be helpful as well. Psychologist Carl Jung introduced the concept of synchronicity, which he defined as circumstances that appear meaningfully connected but seemed to have occurred independently of each other. For example, when two people who know each other meet in an unexpected location this might be termed a synchronous event. While many scientists believe that such events occur by coincidence, many people believe that synchronicity occurs as a result of forces that we do not understand, such as guidance by the spiritual universe. Even though there is no proof that such guidance is real, living “as if” it is real allows people to feel more confident and protected, similar to a belief in God. Such confidence can translate into a more successful life.

As I recognized the power of the “as if” approach, I thought again about religion and prayer. I wondered whether much of the power of prayer arises from the human ability to respond “as if” God exists. Of course, this does not preclude the possibility that God does exist. From a religious perspective, people can think of the tendency to respond to an “as if” proposition as a result of a God-given ability.

The Drawbacks of an ”As if” Approach

The human ability to respond to “as if” beliefs, can also lead to difficulties. For example, people who deal with anxiety react to their fears “as if” they are real. In this context, helping patients recognize that their beliefs are unrealistic can help them overcome their anxiety, as occurs in cognitive behavioral therapy. Similarly, people dealing with major depression often react “as if” they will never improve. People with hypochondria react “as if” they have a serious illness.

People with a negative outlook can consider their religious doctrine or synchronous events “as if” they portend poor outcomes. Our propensity to react to “as if” in unhelpful ways also is demonstrated historically and within some of the current vitriolic political discourses in the world, as large groups of people have thought and reacted “as if” something they believed in is absolutely true. This has led to some terrible outcomes.

Thus, we should consider which of our beliefs might be of an as “as if” nature. Once we identify our possible “as if” beliefs, we should ask ourselves if they are leading us to manifest our lives in a good way.

Why Do we Respond to “As if”?

Why do people respond to “as if” beliefs? I think that we are wired to do so because this allows us to rehearse for real life situations. As children, we engage in pretend play to prepare us for adult roles. Since early in human history, we have rehearsed how we would respond in hunting or dangerous situations. Today, we rehearse what we would do in unexpected situations while driving a vehicle. We train pilots and astronauts by rehearsing in flight simulators.

Many adults do not like to play “pretend” games, as they did when they were children, because they feel these are not real. However, they do respond to an “as if” suggestion. A possible reason for this observation is that pretending requires an active decision to suspend disbelief.

In contrast, acting “as if” something is real represents a more passive thought process, which may be more acceptable to adults. Returning to the placebo example, if an adult patient is told to pretend a placebo is real they might respond that this is a ridiculous suggestion. On the other hand, patients are more accepting when told that a placebo can help “as if” it is real.

Sometimes, “as if” beliefs can evolve into firmer beliefs, which is a process that may be related to confirmation bias. In this setting, acting “as if” something is real can cause us to interpret new evidence as confirming our “as if” belief. For example, based on my many experiences with hypnosis and synchronicity I have become more confident in the existence of a guiding force in the universe.

Takeaway

Choosing to live with appropriate “as if” scenarios can prompt beneficial change in people’s lives including help them deal better with life challenges.

An individual patient’s willingness to embrace a particular “as if” approach can help define its utility as a therapeutic tool for that patient. For example, some patients benefit from thinking about life experiences “as if” their mental health issue has been resolved.

References

Guevarra, D. A., et al. 2020. “Placebos without deception reduce self-report and neural measures of emotional distress.” Nat Commun. 11, 3785.

Kaptchuk T.J., et al. 2010. “Placebos without deception: A randomized controlled trial in irritable bowel syndrome.” PLOS ONE. 5:e15591.

Kirsch, I. 2019. “Placebo effect in the treatment of depression and anxiety.” Front Psychiatry. 10:407.

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