Friday, April 15, 2016

Hypnosis, placebo and meditation

In its recent package on The Power of Mind (issue no 3064, 12 March 2016), New Scientist includes an interview with Laurence Sugarman at Rochester.

Sugarman uses hypnosis in clinical settings. He says, “My colleagues and I propose that hypnosis is simply a skill set for influencing people. It involves facial expression, language, body movement, tone of voice, intensity, metaphor, understanding how people interpret and represent things.”

He observes that hypnosis is a medium for delivering placebo effects, and defines placebo as “the use of conditioning, expectation, social relationships and narrative paradigm to change a person’s physiology in a way that they attribute to an external intervention."

Interestingly, he believes that mindfulness meditation is an example of hypnosis. This prompted me to think of a story SN Goenka tells about a doctor giving a prescription for medicine to a sick man during the Day Three discourse of the 10 day vipassana course. It’s used to explain three kinds of wisdom:
"The man goes home, and out of great faith in his doctor, he recites the prescription every day; this is suta-maya panna [wisdom acquired by hearing or reading the words of another]. Not satisfied with that, the man returns to the doctor, and demands and receives an explanation of the prescription, why it is necessary and how it will work; this is cinta-maya panna [intellectual understanding]. Finally the man takes the medicine; only then is his disease eradicated. The benefit comes only from the third step, the bhavana-maya panna [the wisdom that develops within oneself, at the experiential level]."
Mr Goenka takes a hard line: only the medicine itself has any effect. Neither having faith in the doctor and the treatment, nor understanding rationally how the medicine works, has any benefit.

The emerging consensus on placebo seems to contradict this, at least as far as medical treatment goes. It suggests that the benefit does not only come from the story's third step, the actual taking of the medicine. Having faith in the doctor, and understanding how the medicine works, also helps.

For example, here are some excerpts from the article “Tap the placebo effect to unlock your body's healing powers” in the same New Scientist package:
"We now know that when a person is given a pill they’re told is a real medication, or any of a wide range of medical interventions, including surgery, their body creates a real physiological effect. In pain studies, placebos have been shown to dampen activity in the brain’s pain-processing areas and increase the production of the body’s own analgesic chemicals."
“One key to unlocking the body’s self-healing mechanisms seems to be the setting up of an expectation of improvement. And it works the other way too: if you think your drug has been replaced with a placebo, even a strong painkiller’s effects will be dulled.”
On why the “honest placebo”, i.e. telling patients ahead of time that their pills contain no medication, actually works: “One theory concerns the expectations set by the intervention itself. “It’s not just the drug, it’s everything that surrounds the drug,” says Kaptchuk [a placebo researcher]. Placebos are not inert substances: they are made of verbal suggestion, classical conditioning, and a lifetime’s associations learned about the cues of the medical ritual: the white coat, the office, the doctor’s manner. Any and all of these may cue the body’s healing powers.”

This suggests that faith in the effectiveness of a meditation technique, whether it’s blind faith or based on reason, is likely to strengthen the beneficial effects. Faith is obviously helps in remaining dedicated and motivated; however, it may go deeper than that. It also implies that rituals, which are often decried (not least by Mr Goenka himself), have value that goes far beyond their superficial appearance.