On the front page on section D, The Wall Street Journal has serendipitously placed an article about health insurance companies in the South charging $100 “co-pays” (note the distance from Canada) above an article about doctors trying to use placebos as medicine. It makes perfect sense: If a doctor’s patients can’t afford real medicine, she might as well prescribe sugar pills.
The placebo effect is fascinating because it shows how authorities and institutions can mobilize forces within an individual’s body that the individual cannot summon himself. Placebos seems to work because they give a patient a sense of recognition, of having been paid attention to and of having the story of their symptoms respected, acknowledged. The doctor performs a quasi-religious benediction, after hearing the patient’s crypto confession in the form of symptoms, and then works the scientific equivalent of casting out demons by prescribing magic pills — the logic by which the pills are supposed to work isn’t often explained; the implication is they work because you believe. A chart accompanying the Journal’s article shows that the placebo effect typically occurs in those nebulous conditions with no clear causes: depression, irritable bowel syndrome, impotence and migraines. That so many people suffering these conditions can have their symptoms alleviated by insitutional recognition makes them seem like they are ultimately social disorders — the suffering individual has lost their sense of their place in the society, and the doctor or similar authority figure steps in and nudges them back toward having a place, to having a rationalization for living the way they do, for why society is the way it is. Concentrated personal attention must have an effect on relieving stress, which in turn allieviates these disorders. The doctor visit is a ritual designed to induce a patient to release stress, to surrender responsibility for how they feel in some crucial way that leads to recovery.
In the article, the reporter describes how researchers are hoping to induce the placebo effect through Pavlovian repetition, so like dogs, patients will have certain physiological responses when the sugar pill is a dropped on their tongues. The idea is to induce a real reaction with actual medication, than replace the actual medication with a simulacrum. This is basically how much of pop culture functions: certain relaxing responses are conditioned through repetition so that the sound of a laugh track can trigger a comforting reduction of stress. Culture-industry-manufactured entertainment is another form of institutional intervention to provide the relief of placebos. Seeing a film or a TV show can be like visiting a doctor’s office; it conforms to a routine and it leverages an enormous amount of social power and collective energy and focuses it seemingly on you personally. This may be why entertainment is intentionallly vacuous, free of any real substance. It is meant to be a placebo, delivering nothing real but eliminating stress by its very form, by the very ritual of its consumption. When I’m feeling wound up and I’m trying to go to sleep, I often put on the same DVD of Casablanca or The Maltese Falcon and immediately become soothed; something in Bogart’s voice, I guess, has the same effect on me that a doctor’s has on someone with irritable bowels. I’m usually asleep before Archer gets shot.