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About the cover

  D e s e r t   E x p o s u r e   July 2010


Here, Have a Placebo

It could get you through childhood — but then what?

By Bina Breitner

We all know about the "placebo effect" in medicine: The doctor gives you a sugar pill, but, because you think it's real medicine, you feel better.

"Well, it's only a placebo," you say, "not real medicine." The assumption is that only your belief in it makes you better.

placebo image

Wait a minute. "Only" your belief in it? Isn't that belief powerful and "real"? And isn't the fact that you feel better "real"? Of course the answer is yes, and the more we learn about the interaction of mind/body/spirit, the more we recognize the power of belief. For centuries, healers have known that trust, belief and ritual are powerful interventions, in and of themselves. Placebos have consequences, and the placebo effect is real.

Even as adults we maintain a medicine chest of placebos. We want "comfort food," or we reach for a drink, a cigarette, the TV remote or some special activity that relieves our distress. The magic isn't in the ice cream, the shopping, the sex, the game or the TV show; it's in our associations with it, the trance-state it provides, and our trust that it will make us feel better. So it does, at least for the moment. Of course, there are physical effects from any of these activities, but our belief in their power is part of the benefit.

For children, there are two kinds of placebos. The obvious placebo is adorable — a favorite stuffed animal or special blanket. The snuggle, the familiarity, the scent and the softness calm them when they're feeling lonely or unhappy, or just looking for the reassurance of ritual.

The other is an unconscious placebo that can follow people into adulthood — and get in their way. Children create this placebo when they're in deeper trouble. They happen upon it because it helps them when they're helpless, and they hold onto it for years. By the time they've grown up, they're clinging to something that used to be comforting. Unfortunately, it's now restricting their intimacy and their enjoyment of daily life.

Ed grew up in a chaotic family, and he figured out during his childhood that he could feel better if he measured everything by whether or not it was reasonable. Reason doesn't sound like a typical placebo. It isn't even physical; it was "only" in his mind. But when his brother was high on drugs, acting crazy and scaring him, Ed protected himself by becoming super-reasonable. "Scottie's high," he'd tell himself. "Just leave the room and wait for him to get clear again. You don't have to take seriously anything he says or does. It's the drugs talking." Immediately, he felt better. He was here and Scottie was over-there.

The distancing quality of analytical reason was so helpful that Ed started wanting his whole life to be reasonable. He tried to "understand" everything, sought justification for all actions, and explained everything to himself and others. Eventually, even the simplest raw feeling made him anxious. By the time I saw him, he truly didn't know that people could express something strongly in the moment without being out of control or crazy. Emotion without the context of reason felt dangerous to him.

So when Ed's wife, Sally, talked to him about her feelings, he got nervous. He insisted she stay reasonable, explain or justify what she felt, and stop being so "irrational." If she couldn't explain what she felt, it wasn't valid. Worse, even when she did explain, Ed decided whether or not her feelings were valid. As Sally complained to me, "Why can't he just accept that I feel hurt, instead of trying to analyze it to death or decide whether my hurt is justified in his mind?"

She was deeply angry, insisted that everything was "about him," refused to have sex, and was thinking divorce might be a relief. She still loved him, but she couldn't take it any more. He was baffled and close to panic because her emotions were getting "out of control."

Ed's (obviously irrational) attachment to reason was the defense mechanism he'd learned in the presence of his hopped-up brother. But it was more than a defense mechanism; it was also a placebo. Because he had this tool (reason), he felt stronger. In reality, his brother might have clobbered him any day of the week, but Ed felt protected. Such was the power of his placebo.

There are more of these mental placebos than people realize. One of the most common is the leftover childhood belief: "It wasn't such a big deal. I can handle it." Of course it was, but believing it wasn't "a big deal" made it easier to manage. I get more concerned when I hear, "I can get through anything." That belief, which helps people through hard times, can lead to very poor judgment about their own limits, sometimes with harmful physical, emotional or financial results. Then there are people for whom any little slight feels like disrespect. Their exaggerated outrage reassures them of their existence and their rights. They figure (incorrectly) that the offensive defense will prevent their being hurt. All these mind-game placebos make people feel stronger than they actually are.

Consider another example, this time with a physical placebo: Irene was raped in childhood by her teenage cousin. She turned to food for comfort. In her mouth, the food distracted her from her distress; the pleasure of it calmed her; it provided solace in solitude. She was far away from the event and from people who cared more about maintaining family relations than they did about her welfare.

Irene's husband, her friends, her nurse practitioner and Irene herself all worried about what the extra weight was doing to her health. It affected her blood pressure, her cholesterol, her triglycerides — as well as her freedom of movement, her self-esteem and her energy. Everybody, including Irene, agreed that she should lose weight.

What none of them saw was that, in her turbulent childhood, Irene had been required to take full responsibility for maintaining her psychological balance, and she'd found a "medicine" that worked. It wasn't realistically related to her sexual abuse — since when does a mouthful of pasta cure a rape? — but it did soothe her. There was no "real" medicine to be had, so she invented one. Without it, she might have given in to despair, "failed to thrive," started hurting herself, or otherwise been unable to carry on.

(An old "Pardon My Planet" cartoon shows two chic women at a cafe. The one with a big piece of cake in front of her confesses, "It always seems like this is it — this is the piece of three-layer chocolate brandy torte that changes everything.")

As we talked things over, Irene began to admit her earlier helplessness. She saw that the food-placebo was a pathetic effort to deal with her pain. She also saw that it was intended to help her, not to hurt her. She could stop blaming herself for overeating. She didn't lack "will power" — on the contrary, it was her strong will that had found a "medicine" for her pain and had kept her going, ever-hopeful of finding relief from her anguish.


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