We think of placebos as inert pills or sham operations that appear to improve a patient’s medical condition. But we have been baffled as we tried to fully understand how placebos work. Explanatory attempts have varied from expectancy theory and classical conditioning to denying that a placebo effect exists at all. Presented here is an explanation that placebos work by reversing the anxiety component of disease.
Normally when people are secure they feel secure so that feeling and being secure correspond. But they do not correspond when a placebo increases the feeling of security without increasing security itself. When security and security feelings diverge a false sense of security results. As explained in the essay, “An Evolutionary Theory of Everything,” which, like this essay, can be accessed through my website www.mdjaffe.com, medical placebos are produced when a physician ascribes imaginary powers to an inactive entity. When a physician suggests that the placebo has the power to heal, the patient, if he or she has faith in the physician’s medical expertise, will feel that help is on its way, and consequently will feel more emotionally secure. However, the patient will not be more secure if the placebo’s healing powers are imaginary.
Not explained in “An Evolutionary Theory of Everything” is that most medical conditions threaten a patient’s security so that anxiety, which is an emotional reaction to a threat to security, is a component of most medical conditions. For example, pain, which is recognized for its large anxiety component, readily responds to placebo treatment. Although placebos tend to reverse the anxiety component of disease, they do not reverse the pathological process underlying the disease. On the other hand, placebos, because they increase the patient’s feeling of security and, therefore, decrease anxiety, act to deactivate the physiological changes that are induced when anxiety activates the autonomic nervous system, as occurs with emotional, gastrointestinal, cardiac, and pulmonary conditions.
Patients may become depressed because of illness, thereby making depression, like anxiety, a component of disease. In addition to anxiety and depression being components of an illness, anxiety and depressed states may themselves be the illness. An anxiety state and a depressed mood often occur together and frequently respond to the same medication because both are emotional disorders related to security concerns: anxiety's threat to security and depression's loss of security. Placebos tend to offset the decreased feeling of security that occurs when anxiety and depression are components of a disease or when they are the disease.
Medical and religious placebos are analogous. They both produce a false sense of security. Medical or religious placebos occur when a medical or religious authority attributes imaginary powers to the placebo. In the case of medical placebos, the placebo’s imaginary powers decrease the anxiety component of illness by increasing the patient’s feeling of security. In the case of religious placebos, the placebo’s imaginary powers decrease the anxiety that results from threats to security consequent to life’s stresses.