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Issue 90. Culturally Conditioned Response January 13, 2010

Posted by Bettina Hansel in Uncategorized.
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The University of Rochester Medical Center recently released a report of research headed by Dr. Robert Ader that tested the use of placebos as part of the treatment for psoriasis patients. Though many studies have found placebos to be surprisingly effective in the double-blind studies that are standard for medicines, this study looked at characteristics of the administration of the placebo as elements that lead to a conditioned response, like the salivation of Pavlov’s dogs when they heard the dinner bell, and considered how placebos could be used effectively as part of the treatment, with a focus on immune system diseases. Is a conditioned response less than a belief? Can we knowingly take placebos and still expect improvement because we believe in our conditioned response? Or would we start distrusting our medicine because it’s probably mostly placebo and therefore unlikely to be effective?

A few years ago I read an article in the New Yorker  about a color consultant named Leslie Harrington who studied 27 possible pill colors with populations in 12 countries. The consulting was related to selected the color that could be most effectively marketed in different countries, but perhaps if Ader’s research team is correct, Harrington’s marketing research is also likely to show which color pill will be more effectively medically as well.

Of course, other aspects of dispensing medicine are involved as well. Which would you trust more: a placebo that tastes bitter or one that tastes sweet? Would pills, capsules, liquids, or powders prove most effective as placebos? Can a placebo be too tiny to be effective? Certainly not in cultures where tiny grains of homeopathic medicine would commonly be used for many types of illness. All of these questions about perception and beliefs involve culturally-based assumptions about health.

This brings me to the fascinating article in the New York Times Sunday magazine by Ethan Watters earlier this week. In “The Americanization of Mental Illness,” Watters looks at the export of not just American medical treatments for mental illness, but also the symptoms as US and European psychologists, medical professionals and pharmaceutical industries make their science and products available around the world.  According to Watters’ article, research has long shown that “people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations.” An anthropologist named Juli McGruder from the University of Puget Sound looked into this question in her study of families of schizophrenics in Zanzabar who frequently believed their family member was possessed by spirits. This belief prompted them to do certain things to appease the spirits, so that the patients were “coaxed with food, feted with song and dance” all of which, it seemed, led to a better result in the long term for these patients than for their American counterparts, who are believed to have a chemical imbalance and whose families try to help them take full responsibility for themselves. Find time to read the whole article.   

Tuesday I took a yoga class as I often do. It provides a stretch of the body and a stretch of the imagination, and plays with the relationship between them. Mostly, it just feels good. But yoga itself is a complicated belief system about the relationship of health, energy, the heart, the blood flow, the mind, and much that is spiritual. I don’t pay a lot of attention to the explanations about how some posture massages my inner organs, or the explanations about how a posture with your feet up in the air helps the blood flow back to your heart. I keep thinking that the blood still has to get up to those feet when you’re upside down, and the inverted position of the feet and heart can’t be that important in the equation. But if I suspend these beliefs for the 60 or 90 minute lesson and try to follow the instructions of the teacher, I feel stronger, stand taller, and feel calmer. Maybe yoga is my placebo, or one of them.

I can’t help thinking that intercultural experiences also require this suspension of your own belief system and openness to another one. And it may also be true that in a similar way you can benefit from an action that is at odds somehow with your own beliefs, as long as you’re willing to loosen them a bit.