The Power of Placebo

This will blow your mind

You came back! Wow.

I first want to thank you all for your incredibly generous, effusive response to my maiden post - I was absolutely blown away by your kindness. In the past year, I’ve made a real effort to let people know when I think nice things about them. It seems many of you are compelled by a similar resolution… Whether you “liked” the post, reached out privately or simply sent me good energy last week, I felt it. You guys are freaking awesome.

I’m imagining this newsletter as a proxy for some of those third, thin places we discussed last time - a space where we can mimic some of the conversations we would have were we posted up together in a cozy pub, or sat by a lakeside campfire (in this fantasy there are no mosquitos). So pretend we happen upon each other at our local tavern. And I come barging in, huffing and puffing. “YOU… WOULDN’T… BELIEVE…” (punctuated by sharp inhales - buy into the imagery, people) “what-I-learned-in-class-today…”

And then I launch into a piece of wisdom that I consider to be pure magic.

This week I want to delve into some of the most profound learning I received through my recent education. Alongside the pursuit of my Master’s in Counseling, I was enrolled in the Institute for Integrative Nutrition (IIN). I completed the program with a health coaching certificate - one I have yet to “use” in its intended sense. While I enrolled with the intention of eventually launching a clinical private practice that leveraged a holistic approach to mental health (still a possibility!), I was also on a journey to understand and demystify my own diagnosis of PCOS (Polycystic Ovary Syndrome), and mitigate my physical and mental ailments through a functional approach.

This journey I allude to was one for which I possessed no roadmap. We in the Havian-Jarvis clan tend to favor your conventional, western medical practices; we’d slather on snake oil no questions asked if the recommendation came from a Square (or Boomer) in a white lab coat with an acronym after their name - imagine! Even in my broader circle, no one seemed to entertain the validity of eastern modalities - Chinese medicine, Ayurveda and the like. The term “woo-woo” is one I’ve only recently attempted to abolish from my vocabulary, in an effort to stop undermining my newfound, “unconventional” knowledge of functional medicine and spirituality.

But brooooo hear me out - I get off on empirical data as much as the next guy! In fact, if we were to tally up my most commonly-uttered phrases of the past 27 years, right at the top would be “pass the sour cream,” shortly followed by “but, why??” I have come to realize that it is very challenging for me to adopt a new behavior, or change my mind - no matter how highly a given suggestion is touted - without knowing the mechanism by which it works.

Take saunas: the most readily-available image I have for this activity is some sweaty dude in a wool hat inside a tiny wooden chamber on his Instagram Live, professing how “high” he is off his “own supply.” It wasn’t until I found research documenting its benefits - increased parasympathetic response, increased heart rate and circulation translating to cardiovascular health, improved lung capacity - that I felt open to the idea of trying it out. Such practices get so sensationalized (and commodified, bleh) that the skeptic lot of us backs away slowly, closed off to their merits. The antidote to this knee-jerk reticence, for me, has been studying credible data.

I wish I didn’t require 56 pages of Times New Roman text to convince me of a good thing, but I just feel like we can’t trust people’s recommendations anymore, which absolutely fucking blowwwws, man. I wish I were the type of girl who could just Take Your Word For It *bats eyelashes* but I never will be. I’ve marched to the beat of my own drum since preschool ballet class (insert video of me bossing around my peers in a tutu with massive sunflower affixed to a headband - I’m surprised my pointer finger didn’t become permanently extended.)

My Attempt at Changing Your Mind

With that said, I want to share DATA with you. From one smart cookie who, herself, was a skeptic, raised by skeptics. Dr. Lissa Rankin was a guest lecturer for my IIN curriculum. She was trained in conventional western medicine, and over the course of her career, started to question the medical establishment. In her lecture, she addresses our body’s autonomic nervous system, which is comprised of two divisions: the sympathetic and parasympathetic nervous systems. The former (SNS) is responsible for our “fight-or-flight” response, kicking into gear in instances of stress or perceived danger. The latter (PNS), commonly referred to as the “rest and digest” system, is a network of nerves responsible for our body’s relaxation and reparative abilities. Her lecture highlights the profound impact parasympathetic activation has on healing, and the threat posed by consistent sympathetic activation.

In her words, “the medicine I had been trained to practice didn’t support the idea that you can think yourself well or make yourself sick with the power of your thoughts and emotions.” Doctors, she says, are trained to believe that they know your body better than you do, but over the course of the first twelve years of her career, she was privy to myriad cases of spontaneous remission, or healing occurrences that couldn’t be explained by science. This, in conjunction with her own health challenges, prompted her to do a deep-dive into the body’s innate ability to self-repair, and what factors promote or hinder that power.

In her book, Mind Over Medicine, Dr. Rankin provides considerable data suggesting that the placebo effect can be an effective treatment for patients’ negative health symptoms. In her review of the literature she found, for example, that, “approximately 40 percent of people with headaches get relief when given a placebo,” and “when compared to morphine, placebos are almost equally effective at treating pain.”

She also stumbled across an article in the New England Journal of Medicine where a sham surgery was provided to people with “debilitating knee pain.” The results of the study found that those receiving the sham surgery had the same result as those who had, in fact, been operated upon. During this sham surgery, “the patient was sedated, three incisions were made in the same location as the real surgery, and the patient was shown a prerecorded tape of someone else’s surgery on the video monitor.” One-third of patients who received the sham surgery experienced relief - the same result as those who had gone through the procedure.

Let me pause here to make sure that sunk in. This research demonstrated that people who were cut into, received no treatment, and were closed back up (pardon the gruesome imagery) were just as likely to heal their knees as those who had received the surgery. This study was a “randomized, double-blind, placebo-controlled clinical trial published in one of the most highly respected [peer-reviewed] medical journals in the whole world” - the gold standard in western medicine.

But if that’s not enough to convince you of the power of placebo, here’s more:

Curious about her findings, Dr. Rankin went on to compile mountains of medical literature that suggest that one’s positive beliefs inform their ability to heal. She posited, “if it’s true that the mind can heal the body, there must be some way to demonstrate that the body is responding, not just with symptom relief, but in physiological ways that can be studied.” The research she found demonstrated that, “when given placebos, bald men grow hair, blood pressure drops, warts disappear, ulcers heal, stomach acid levels decrease, colon inflammation decreases, cholesterol levels drop.”

Given the issue of informed consent, patients are aware that it’s possible they may be receiving a placebo, “but many patients in a placebo group believe they are getting the real treatment when they’re not, which creates expectancy.”

I see this point as one of the most salient in her book: “Expecting you’ll get better, being nurtured by caring clinical researchers, and engaging in the ritual of a therapeutic encounter may also relieve psychological distress, known to predispose the body to illness, and initiate physiological relaxation, which is necessary for the body’s self-repair mechanisms to operate properly.”

None of this is “magic,” despite my claim at the beginning of this post - “when the relaxation response is elicited, stress hormones drop, health-inducing relaxation hormones that counter the stress hormones are released, the parasympathetic nervous system takes over, and the body returns to homeostasis.”

The Nocebo Effect: The Threat Posed by Negative Belief

On the flip side, Dr. Rankin presents data suggesting that negative health beliefs pose an impediment to healing. For instance, according to Dr. Herbert Benson, a Harvard professor and President of the Mind/Body Institute in Boston:

“Surgeons are wary of people who are convinced that they will die. There are examples of studies done on people undergoing surgery who almost want to die to re-contact a loved one. Close to 100 percent of people under those circumstances die.”

Dr. Rankin notes that, “scientists believe the nocebo effect is caused primarily by activation of the same stress response the placebo effect relieves.” In this event, a “hormone cascade is triggered by a thought or emotion in the mind, such as fear, the hypothalamic-pituitary-adrenal (HPA) axis activates, thereby stimulating the sympathetic nervous system to race into overdrive, pumping up the body’s cortisol and adrenaline levels.” And “while you can’t change your DNA, you may be able to utilize the power of your consciousness to alter how your DNA expresses itself” - this is known as epigenetics if you’re interested in learning more.

Dr. Rankin highlights the extraordinary power possessed by clinicians and practitioners to negatively (or positively) dictate their patients’ outcomes. This, she refers to, as “medical hexing:” “When we pronounce that clients have ‘chronic,’ ‘incurable,’ or ‘terminal’ illnesses, we may be programming their subconscious minds with negative beliefs and activating stress responses that do more harm than good.”

Takeaways for the General Public

Dr. Rankin suggests that anyone who receives a medical diagnosis Google, “[insert medical diagnosis] spontaneous remission.” This is a method for instilling hope, and allowing our minds to relax a little so that our bodies can follow suit and tap into their self-healing mechanisms. The research also makes a strong case for living a lifestyle that - insofar as possible - promotes the activation of our parasympathetic nervous system. Perhaps this looks like a daily meditation practice, or living in a natural environment, or removing those factors from our lives that (or “who,” wink wink) activate our sympathetic nervous system. There are many options, and it appears that anything we can do to decrease our stress response has the capacity to benefit our overall health and wellbeing.

As patients, it is of critical importance that we exercise discernment in our choice of practitioners - we need to vet those we let into our “Healing Roundtable,” allowing only participants who carry an air of healthy, calibrated optimism, and view us as partners.

Takeaways for Clinicians (if any of you are reading this)

As clinicians, it is necessary that we feel optimistic and hopeful for our clients/patients, because the research suggests that our belief that they will “get better” directly impacts their potential to improve. Therefore, I believe we need to constantly check in with ourselves to make sure that we are the best fit for our clients. If we are misaligned in ways that feel irreconcilable, we need to support clients and their healing by referring them to a clinician who can provide the positive belief they deserve.

I also believe that we need to be mindful in how we collaborate with other providers. This can look a variety of ways. Perhaps our client has a naturopath, and we aren’t completely aligned with that modality - we need to be able to honor their decision and the good that is born of that relationship, and withhold whatever judgment may come up. On the other hand, if a client comes to us having just received a terminal diagnosis from a pessimistic doctor, perhaps that’s an opportunity for us to instill optimism in them.

Note: In her book, Dr. Rankin does a great job outlining how to go about this in a way that’s not misleading to the client or that gives them “false hope.”

Final Thoughts

What I love most about this incredible finding is that it is, in theory, accessible to all. We know a healing environment supplemented by a loving community and gentle, unbiased practitioners is not easy to come by, particularly for individuals who have been discriminated against at the hands of the medical establishment. So, in light of that reality, do what you can to provide measured optimism for those around you, and for yourself. Any practice you can implement that gives the nervous system a moment of calm can help ameliorate symptoms.

But like I said, this isn’t magic, even though it can feel that way. I don’t want the takeaway to be “if you get sick and stay sick that just means you’re not trying hard enough.” Health and wellbeing are so nuanced, and to assume that there is no condition impervious to the interventions outlined here would be shortsighted.

AND, the power of nurturing care, loving touch, listening and healing intention cannot be overstated. And now you have science-backed evidence to prove it.

Knowledge doesn’t always beget action. In fact, I intellectually know plenty of shit I don’t enact - why do you think that treadmill’s collecting dust in the cornah?? *Ba dum chhh* So don’t be too hard on yourself when you can’t seem to don your yoga clothes. It’ll come, or it won’t, and that’s ok. Be gentle, baby.

Gosh, my mouth is dry after all that ranting. Someone buy me a pint!

I’m nixing the rose/bud/thorn thing and replacing it with this - The Butter Dish! I address the meaning behind this cute little name in this video (shoutout to my girlll Tori Munson), and I someday plan to do something legit with the title. But for now it’ll be the little holding place for our end-of-entry tastiness, just waiting for you at room temp on the kitchen counter.

Move with Heart: Hormones, Cycle Syncing, and Why We Should Celebrate Our Periods with Hormone Expert and Creator of the MyFLO App, Alisa Vitti (podcast episode)

this rocked my shit

If you are a person who menstruates you HAVE to listen to this episode. And if you’re not a person who menstruates, this education should be considered part of your Reparations. You’ll likely finish the episode filled with a renewed fury for our society’s patriarchal infrastructure and its fantastic failure to properly educate and advocate for women/menstruating people and their bodies, as I did. Let that rage fuel you to listen to and reclaim your body’s natural infradian biological rhythm!! And vote for a female President in November… fr.

Everything “Paige Wassel”

ugh swoon

I am so taken by this woman’s interior design abilities. I was introduced to her YouTube recently (thanks, TikTok), which is a treasure trove of inspiration. She’s a master curator of eclectic home decor that just freakin WORKS, man. Even the most unlikely of items end up “singing” together at her touch. Her most recent newsletter detailing her and her parents’ renovation of their lake house was fab, and the before/after pictures left my mouth agape! She also includes “This week’s thrifted finds” and “Kate’s paint color of the week” at the end of each send (Kate is her friend who does prop styling and interiors.) Here’s Paige’s YouTube, here’s her newsletter, here’s her Instagram. I’d say follow it all, if you know what’s good for ya.

“Turtle in a Skirt” Orange Wine (Raìca Aranzu Vermentino)

now you get the nickname

Dude this stuff liiiiterally tastes like gummy bears. It’s so delicious. They serve it at a local restaurant in Wellfleet (shoutout Ceraldi) and we’ve quickly become obsessed. If you can track it down near you, I’d highly encourage you to try some.

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I’m still learning on this platform, but algorithms tend to favor publications with high engagement, so if you if you would “like,” “comment” or “restack” (or all of the above!) at the bottom that would be greatly appreciated (sending you a virtual *consensual* forehead kiss). And I wouldn’t object to your sharing a post that really resonated on social media or privately - that is also a lovely way to support this (free) project.

Some of my favorite notes I received last week were lists of your own third, thin places. Keep ‘em comin!! Comment them below, tag me in photos of them on Instagram (I’d love to feature you!) or dm me :) It feels so much better to ground my experience of you as readers in YOUR experiences. Truly.

Okie doke, see ya next week. Kisses.