Category: Rituals

Placebos as “meaning responses”

We define the meaning response as the physiologic or psychological effects of meaning in the origins or treatment of illness; meaning responses elicited after the use of inert or sham treatment can be called the “placebo effect” when they are desirable and the “nocebo effect” when they are undesirable…

Insofar as medicine is meaningful, it can affect patients, and it can affect the outcome of treatment. Most elements of medicine are meaningful, even if practitioners do not intend them to be so. The physician’s costume (the white coat with stethoscope hanging out of the pocket), manner (enthusiastic or not), style (therapeutic or experimental), and language are all meaningful and can be shown to affect the outcome; indeed, we argue that both diagnosis and prognosis can be important forms of treatment.

— Daniel E. Moerman and Wayne B. Jonas, Deconstructing the Placebo Effect and Finding the Meaning Response, The Placebo: A Reader

Ted Kaptchuk on “legitimate healing”

Besides clinical and scientific value, the question of enhanced placebo effects raises complex ethical questions concerning what is “legitimate” healing. What should determine appropriate healing, a patient’s improvement from his or her own baseline (clinical significance) or relative improvement compared with a placebo (fastidious efficacy)? As one philosopher of medicine has asked, are results less important than method? Both performative and fastidious efficacy can be measured. Which measurement represents universal science? Which measurement embodies cultural judgment on what is “correct” healing? Are the concerns of the physician identical to those of the patient? Is denying patients with nonspecific back pain treatment with a sham machine an ethical judgment or a scientific judgment? Should a patient with chronic neck pain who cannot take diazepam because of unacceptable side effects be denied acupuncture that may have an “enhanced placebo effect” because such an effect is “bogus”? Who should decide?

— Ted Kaptchuk, The Placebo Effect in Alternative Medicine: Can the Performance of a Healing Ritual Have Clinical Significance?, The Placebo: A Reader

Fabrizio Benedetti on the neurobiology of placebos

Here is Fabrizio Benedetti, professor of physiology and neuroscience at the University of Turin Medical School, giving an introduction to the neurobiology of placebo effects. This gets into technical details of chemical names and brain anatomy, but a lot of it is also stated in a more general, accessible way.

I was especially interested in their discussion of which conditions are more influenced by placebo effects (pain, anxiety, Parkinson’s), and Benedetti’s distinction between conscious/expectation effects and unconscious/conditioning effects. This is my first encounter with the idea that different kinds of rituals can affect different systems in the body.

This is also my first time thinking about Pavlovian conditioning as a type of placebo response, and it is giving me ideas about ritual magick. I mostly think about meaning and significance as things that give rituals power and have effects on my body, which would fall under Benedetti’s conscious, expectation-based effects. It makes a lot of sense to me that repeating rituals could make them more potent, both because of the conscious effect of familiarity and expectation, and perhaps  also because my body is being conditioned to respond in ways that I’m not conscious of.

Placebos as a science of rituals and spells

In exploring possible meanings of “critical magick”, I find myself collecting perspectives on magick from many different fields, many ways of knowing. Placebo researchers use the words “magic” and “ritual” more than you might expect from scientists. Here is Ted Kaptchuk, professor of medicine at Harvard Medical School, giving an introduction to placebo studies. He explains a definition of placebos not as fake treatments, but rather as the impact of all the cultural and relationship stuff that happens along with treatments.

‘Placebo effects’ is a way of quantifying and measuring everything that surrounds pills and procedures, mainstream or alternative. They’re about the rituals, the words, the engagements, the costumes, the diplomas, and those special things you get when you go to a healer.

A ritual template from sex magic

Perhaps strangely, the rituals I have found most accessible and least scary are sex rituals. Partly because I’ve only done them with people I’m very close with, and partly because sex rituals have a big advantage if you want to find rituals that don’t feel like going through superstitious motions. Your body will let you know whether your ritual for creating sexual connection and ecstasy is powerful or not.

Longtime sex activist Barbara Carrellas, in her book Urban Tantra (byoa, as always), gives a series of steps and associated intentions for sex rituals that I have been applying to sex for almost ten years:

  1. Set the stage (to prepare the space)
  2. Chill out (to relax and get present)
  3. Warm up (to engage your body)
  4. Come together (to get connected)
  5. Rock and roll (to enjoy some ecstatic activities)
  6. Afterglow (to cool down and bask)

I really appreciate the order of stages 1-4: space, mind, body, connections. They build on each other in practical as well as symbolic ways.