Chapter ThreeThe
Placebo Effect in the BrainIf you’ve read my previous book,
Breaking the Habit of Being Yourself,you’ll find that this chapter reviews much of that material. If you feel that you already have a good command of that information, you may choose to either skip this chapter completely or skim it to brush upon those concepts as needed.
If in doubt, I recommend that you read this chapter,
because a thorough understanding of what is presented here will be necessary to fully understand the chapters that follow.
As the stories in the last two chapters illustrate, when we truly change our state of being, our bodies can respond to anew mind. And changing our state of being begins with changing our thoughts. Because of the
size of our enormous forebrain, the privilege of being a human being is that we can make thought more real than anything else—and that’s how the placebo works. To see how the process unfolds, it’s vital to examine and review three key elements
conditioning, expectation, and
meaning. As you’ll see, these three concepts all seem to work together in orchestrating the placebo response.
I
explained conditioning, the first element, in the discussion about
Pavlov in the previous chapter. To recap, conditioning happens when we associate a past memory (for example, taking an aspirin) with a physiological change (getting rid of a headache) because we’ve experienced it so many times. Think about it like this If you notice that you have a headache, essentially you become aware of a physiological change in your inner environment (you’re feeling pain. The next thing you automatically do is look for something in your outer world (in
this case, an aspirin) to create a change in your inner world. We could say it was your internal state (being in pain) that prompted you to think about some past choice you made, action you took, or experience you had in your external reality that changed how you were feeling (taking an aspirin and getting relief).
Thus, the stimulus, or cue,
from the outer environment, called the aspirin, creates a specific experience. When that experience produces a physiological response or reward, it changes your internal environment.
The moment you notice a change in your inner environment, you pay attention to what it was in your outer environment that caused the change. That event—where something outside of you changes something inside of you—is
called an associative memory.69
If we keep repeating the process over and over again, by association the outer stimulus can become so strong or reinforced that we can replace the aspirin fora sugar pill that looks like an aspirin, and it will produce an automatic inner response (lessening the pain of the headache. That’s one way the placebo works. Figure A, Figure Band Figure 3.1C
illustrate the conditioning process.
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