Factors in the Placebo Response

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Factors in the Placebo Response
By Richard James
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Here is Johnny.
He feels well and at one with himself.
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Now he has a pain in his body.
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Not getting better, he consults an expert.
Who gives him some medicine
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The treatment is meant to tackle the problem.
But it also has side effects
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But Johnny believes in the expert and the
treatment.
So that helps.
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However, Johnny is not just a head and body.
Mind
Spirit
Body
Emotions
Let us consider four facets of his being.
And some of their positive aspects.
They do have negative aspects as well, but lets
concentrate on those which might help healing.
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This point is the focus of Johnnys attention.
M
S
B
E
It moves around within his being from moment to
moment.
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Of course the expert is human too. Here are some
of the relevant characteristics
Mind
Spirit
Body
Emotions
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And the two of them are in relationship. Lets
keep it simple by looking at just those
interactions between similar aspects of the two
individuals.
S
S
M
M
E
E
B
B
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Here is some detail of the interactions.
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Now lets consider the context in which these
interactions take place.
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Important features of the micro-context include
Symbols
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So issues arising in the interaction might be
Intimacy
Responsibility
Control
Power
(em)Power(ment)
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Important features of the macro-context include
Religion
Archetypes
Experts social background Professional
enculturation
Johnnys social background Subculture
Pharmacotopia
Broader social norms
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Various phenomena can arise from the interaction
of micro- and macro- contexts
The expert or treatment can act as a Symbolic
Bridge, via which Johnny can find Meaning in his
dis-ease.
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The Controlled Trial is a special case of context
interaction.
in which the values of the pharmacotopia are
imposed on the therapeutic relationship
The focus is on a single factor, usually the
External Agent, to the exclusion of all other
variables.
Pharmacotopia
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But the question is what kind of Control
procedure
CONTROLLED TRIAL
can adequately substitute for the complexities
described above?
Pharmacotopia
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Another question is what kind of symbolic bridge
is a controlled trial?
Belief is a nuisance The body is a
machine Individuality is unimportant The
expert is in charge
and how does this impinge on the healing process?
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Yet another question is can we really consider
all this to be non-specific?
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Taking acupuncture as an example, we can focus on
specific techniques of sensory stimulation
The point The stimulus
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We can even develop control procedures.
CONTROLLED TRIAL
But what about the other factors are they
integral to the practice of acupuncture?
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Consider the following
x
When a patient gives up on an approach which has
not helped them and goes to an alternative
therapist, how important is the incongruence of
the micro-context?
How does the language and imagery of Traditional
Acupuncture act as a symbolic bridge, giving
meaning to the dis-ease?
When carrying out sensory stimulation, what is
the relevance of the quality of touch?
When carrying out a specific needle treatment,
what other aspects of the interaction contribute
to the specific effect?
How does the Chi-model of the person affect the
role of the practitioner, and the form of the
relationship?
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People as energy fields
If we think from this perspective, is it still
valid to consider Body and Mind (and Emotion and
Spirit) as separate entities?
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Summary
Social background Professional enculturation and
training
Social background subculture
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The end.
Thank you.