Chapter

Placebos and Placebo Effects

David A. Jopling

in Talking Cures and Placebo Effects

Published on behalf of Oxford University Press

Published in print May 2008 | ISBN: 9780199239504
Published online February 2013 | e-ISBN: 9780191754579 | DOI: http://dx.doi.org/10.1093/med/9780199239504.003.0004

Series: International Perspectives in Philosophy & Psychiatry

Placebos and Placebo Effects

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To summarize, the placebo effect occurs if and only if: 1) the patient is a thinking, experiencing, conscious, belief-holding subject; 2) the patient is a member of a culture; 3) the patient has symptoms; 4) the patient stands in a special relation with others who are recognized by the surrounding culture, and by the medical culture, as expert healers or medical authorities; 5) the patient is administered a treatment for his or her disease or disorder by a medical authority or expert healer; 6) the patient's disorder or disease is changed; 7) the change in the patient's disorder or disease is not caused by the hypothesized characteristic factors of the treatment; 8) the change in the disorder or disease is caused by the incidental factors of the treatment.

There are several advantages of this definition over Shapiro's, Grünbaum's, and Brody's. First, it recognizes (with Bootzin and Caspi [2002]) the synergistic, multidimensional, and interpersonal nature of the placebo effect. A placebo is not a static and discrete thing like a sugar pill; it is more like an event than a thing. Moreover, the placebo effect is not, strictly, ‘inside the head’ of the patient. It is a culturally situated and interpersonally constituted event; no one responds to placebos in a social and cultural vacuum. Second, the defini tion preserves the centrality accorded to patients’ beliefs in the placebo effect, while also emphasizing (unlike the other definitions) the role of patient affect and conscious awareness; the placebo effect is made possible by the complex interplay of belief, hope, expectation, and emotions, among other variables. Third, the definition is more explicit than the other definitions in what it rules out as possible placebo responders. Anything that is not a conscious, experiencing, belief-holding and culturally situated subject is not a placebo responder. Fourth, the definition offers a more robust and detailed account of what Grünbaum sparingly calls patients’ ‘life processes’ and what Brody sparingly calls ‘healing context’.

Chapter.  17487 words.  Illustrated.

Subjects: Psychiatry

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