Chapter

Placebos, Deception, and Self-Deception

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/9780199239504.003.0006

Series: International Perspectives in Philosophy & Psychiatry

Placebos, Deception, and Self-Deception

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This chapter began with an important but speculative question which has attracted relatively little scientific inquiry and even less epistemic and conceptual analysis: Is the placebo response incompatible with the patient's knowledge or awareness of placebos? Do patients and experimental participants who are placebo responders know that they are responding to placebos if they have not already been informed about them—or do they remain in the dark, as willing or unwilling victims of strategies of intentional ignorance? Is the placebo response less effective if patients know they are responding to placebos rather than to active treatments? If the analogy between placebo treatments in medicine and placebo treatments in clinical psychology holds, then these questions are also relevant for psychodynamic psychotherapy: Do clients who respond to insight and interpretation placebos, for example, know that they are responding to placebos, or do they mistakenly take them to be authentic or valid? Is the placebo response less effective if they know they are responding to insight and interpretation placebos?

On the face of it, it seems obvious that either people know that their response to a treatment is a response to placebo, or they remain in the dark (because they have been deceived); and it seems that if people know that they have been given placebos, then there can be no placebo response. But the situation is much less obvious than meets the eye. It was argued that it is not always as simple a matter as patients either knowing or not knowing that they are responding to placebos. In some unusual cases, patients neither straightforwardly know that they are responding to placebo, nor straightforwardly remain ignorant or deceived by others about it; and in some cases, patients believe that they are responding to an active treatment, and yet they somehow know that they are not. They have convinced themselves of something that they know is not the case. Some part of the placebo response, in other words, could be attributable to self-deception rather than to deception from another.

Despite its counter-intuitive nature, something like this unusual situation might be found in the psychodynamic psychotherapies: it is, at least, a conceptual possibility. Some clients might believe that the interpretations and insights they have acquired are authentic, and yet somehow they know that they are little more than psychological sugar pills. They might, for example, have convinced themselves that their psychological explorations are truth-tracking, despite knowing that they are deeply context-sensitive, suggestion-prone, or vulnerable to bias. Or they might come to believe things about their psychology, behavior, or childhood during the course of the treatment that they also know are false, or are explanatory fictions, or have good grounds for rejecting.

What this means is that placebo-responsive clients in psychodynamic psychotherapy are not always victims of intentional or inadvertent deception, as Grünbaum's (1984) account of pseudo-insight in classical Freudian psychoanalysis suggests, and as some of the standard theories of placebo response hold. Clients are not always genuinely unaware of the presence of these suggestive forces, or blind to their own vulnerability to placebo effects, or sincerely oblivious to the epistemic contamination to which their exploratory activities are subjected. Some clients are in epistemic bad faith. They have had a hand in the deceptions or errors that have led them astray, believing things about themselves that they also somehow know are false. Their placebo responsiveness is in part a function of self-deception, a kind of lying to themselves. This may not be too far-fetched: the placebo has been described as the lie that heals (Brody 1982). Self-deception may be the lie clients tell to themselves to help to rally the mind's native healing powers.

Chapter.  10284 words. 

Subjects: Psychiatry

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