As the stories in the last two chapters illustrate, when we truly change our state of being, our bodies can respond to a new mind. And changing our state of being begins with changing our thoughts. Because of the size of our enormous forebrain, the privilege of being a human being is that we can make thought more real than anything else—and that’s how the placebo works. To see how the process unfolds, it’s vital to examine and review three key elements: conditioning, expectation, and meaning. As you’ll see, these three concepts all seem to work together in orchestrating the placebo response.
I explained conditioning, the first element, in the discussion about Pavlov in the previous chapter. To recap, conditioning happens when we associate a past memory (for example, taking an aspirin) with a physiological change (getting rid of a headache) because we’ve experienced it so many times. Think about it like this: If you notice that you have a headache, essentially you become aware of a physiological change in your inner environment (you’re feeling pain). The next thing you automatically do is look for something in your outer world (in this case, an aspirin) to create a change in your inner world. We could say it was your internal state (being in pain) that prompted you to think about some past choice you made, action you took, or experience you had in your external reality that changed how you were feeling (taking an aspirin and getting relief).
Thus, the stimulus, or cue, from the outer environment, called the aspirin, creates a specific experience. When that experience produces a physiological response or reward, it changes your internal environment. The moment you notice a change in your inner environment, you pay attention to what it was in your outer environment that caused the change. That event—where something outside of you changes something inside of you—is called an associative memory.
If we keep repeating the process over and over again, by association the outer stimulus can become so strong or reinforced that we can replace the aspirin for a sugar pill that looks like an aspirin, and it will produce an automatic inner response (lessening the pain of the headache). That’s one way the placebo works. Figure 3.1A, Figure 3.1B, and Figure 3.1C illustrate the conditioning process.
Expectation, the second element, comes into play when we have reason to anticipate a different outcome. So, for example, if we have chronic pain from arthritis and get a new medication from the doctor, who enthusiastically explains to us that it’s supposed to alleviate our pain, we accept his suggestion and expect that when we take this new medication, something different will happen (we won’t be in pain anymore). Then, in effect, our doctor has influenced our level of suggestibility.
Once we become more suggestible, we’re naturally associating something outside of ourselves (the new medication) with the selection of a different possibility (being pain-free). In our minds, we are picking a different future potential and hoping, anticipating, and expecting that we’ll get that different result. If we emotionally accept and then embrace that new outcome we’ve selected, and the intensity of our emotion is great enough, our brains and our bodies won’t know the difference between imagining that we’ve changed our state of being to being pain-free and the actual event that caused the change to a new state of being. To the brain and the body, they are the same.
In Figure 3.1A, a stimulus produces a physiological change called a response or a reward. Figure 3.1B demonstrates that if you pair a stimulus with a conditioned stimulus enough times, it will still produce a response. Figure 3.1C shows if you remove the stimulus and substitute a conditioned stimulus—like a placebo—it can produce the same physiological response.
Consequently, the brain fires the same neural circuits as it would if our state had changed (if the drug worked to relieve the pain) while it releases similar chemicals into the body. What we’re expecting (to be pain-free) then actually happens, because the brain and the body create the perfect pharmacy to alter our internal condition. We are now in a new state of being—that is, the mind and body are working as one. We’re that powerful.
Assigning meaning, the third element, to a placebo helps it work, because when we give an action a new meaning, then we have added intention behind it. In other words, when we learn and understand something new, we put more of our conscious, purposeful energy into it. So, for example, in the study about the hotel maids from the previous chapter, once the maids understood how much physical exercise they were doing every day just by performing their jobs, as well as the benefits of that exercise, they assigned more meaning to those actions. They weren’t just vacuuming, scrubbing, and mopping; they realized they were working their muscles, increasing their strength, and burning calories. Because the vacuuming, scrubbing, and mopping had more meaning after the researchers educated them about the physical advantages of exercise, the maids’ intention or aim as they worked wasn’t just to complete their tasks—it was also to get physical exercise and become healthier.
And that’s exactly what happened. The members of the control group didn’t assign the same meaning to their tasks, because they didn’t know that what they were doing was beneficial to their health, so they also didn’t receive the same benefits—even though they were performing exactly the same actions.
The placebo works the same way. The more you believe that a particular substance, procedure, or surgery will work because you’ve been educated about its benefits, the better your chances of responding to the thought of improving your health and getting better. In other words, if you place more meaning behind a possible experience with a person, place, or thing in your external environment in order to change your internal environment, then you’re more likely to be successful at intentionally changing your inner state by thought alone. In addition, the more you can accept a new outcome related to your health—because you’ve been educated about the possible rewards of what you’re doing—the clearer the model you’re creating in your own mind, and so the better you’ll be at priming your brain and your body to replicate exactly that. Simply said, the more you believe in the cause, the better the effect.
The Placebo: Anatomy of a Thought
If the placebo effect is a function of how a thought can change physiology—we could call it mind over matter—then perhaps we should examine our thoughts and how they interact with our brains and our bodies. Let’s begin with our own personal daily thoughts.
We are creatures of habit. We think somewhere between 60,000 to 70,000 thoughts in one day,1 and 90 percent of those thoughts are exactly the same ones we had the day before. We get up on the same side of the bed, go through the same routine in the bathroom, comb our hair in the same way, sit in the same chair as we eat the same breakfast and hold our mug in the same hand, drive the same route to the same job, and do the same things we know how to do so well with the same people (who push the same emotional buttons) every day. And then we hurry up and go home so that we can hurry up and check our e-mail so that we can hurry up and eat dinner so that we can hurry up and watch our favorite TV shows so that we can hurry up and brush our teeth in the same bedtime routine so that we can hurry up and go to bed at the same time so that we can hurry up and do it all over again the next day.
If it sounds as though I’m saying that we live a huge part of our lives on autopilot, that’s exactly right. Thinking the same thoughts leads us to make the same choices. Making the same choices leads to demonstrating the same behaviors. Demonstrating the same behaviors leads us to create the same experiences. Creating the same experiences leads us to produce the same emotions. And those same emotions then drive the same thoughts. Take a look at Figure 3.2 and follow the sequence of how our same thoughts create the same reality as usual.
How we create the same reality by thought alone.
As a result of this conscious or unconscious process, your biology stays the same. Neither your brain nor your body changes at all, because you’re thinking the same thoughts, performing the same actions, and living by the same emotions—even though you may be secretly hoping your life will change. You create the same brai
n activity, which activates the same brain circuits and reproduces the same brain chemistry, which affects your body chemistry in the same way. And that same chemistry signals the same genes in the same ways. And the same gene expression creates the same proteins, the building blocks of cells, which keep the body the same (I’ll go into more on proteins later). And since the expression of proteins is the expression of life or health, your life and your health stay the same.
Now take a look at your life for a moment. What does this mean for you? If you’re thinking the same thoughts as yesterday, more than likely, you’re making the same choices today. Those same choices today are leading to the same behaviors tomorrow. The same habitual behaviors tomorrow are producing the same experiences in your future. The same events in your future reality are creating the same predictable emotions for you all the time. And as a result, you’re feeling the same every day. Your yesterday becomes your tomorrow—so in truth, your past is your future.
If you agree with me up to this point, then we could say that the familiar feeling I just described is “you”—your identity or your personality. It’s your state of being. And it’s comfortable, effortless, and automatic. It’s the known you who, quite frankly, is living in the past. When you keep this redundant process going on a daily basis (because you wake up in the morning and anticipate and remember the feeling of “you” every day), in time that known state of being can drive only the same thoughts that will influence you to crave the same automatic cycle of choices, behaviors, and experiences in order to arrive back at that familiar feeling that you think of as “you.” So everything stays the same about your personality.
If this is your personality, then your personality creates your personal reality. It’s that simple. And your personality is made up of how you think, how you act, and how you feel. So the present personality who is reading this page has created the present personal reality called your life; and that also means that if you want to create a new personal reality—a new life—then you have to begin to examine or think about the thoughts you’ve been thinking and change them. You must become conscious of the unconscious behaviors you’ve been choosing to demonstrate that have led to the same experiences, and then you must make new choices, take new actions, and create new experiences. Figure 3.3 shows how your personality influences your personal reality.
Your personality is made up of how you think, act, and feel. It is your state of being. Therefore, your same thoughts, actions, and feelings will keep you enslaved to the same past personal reality. However, when you as a personality embrace new thoughts, actions, and feelings, you will inevitably create a new personal reality in your future.
You must observe and pay attention to those emotions that you’ve memorized and that you live by on a daily basis, and decide if living by those emotions over and over again is loving to you. You see, most people try to create a new personal reality as the same old personality, and it doesn’t work. In order to change your life, you have to literally become someone else. Stay tuned for some sound science to support this process. Take a glance at Figure 3.4 and follow the sequence again.
How we create a new reality by thought alone.
So if you understand this model, then you should agree with me that your new thoughts should lead to new choices. New choices should lead to new behaviors. New behaviors should lead to new experiences. New experiences should create new emotions, and new emotions and feelings should inspire you to think in new ways. That’s called “evolution.” And your personal reality and your biology—your brain circuitry, your internal chemistry, your genetic expression, and ultimately your health—should change as a result of this new personality, this new state of being. And it all seems to start with a thought.
A Quick Look at How the Brain Works
Up to this point, I’ve briefly mentioned terms like brain circuitry, neural networks, brain chemistry, and genetic expression without giving you much explanation of what they mean. So for the rest of the chapter, I want to outline some simple scientific understandings of how the brain and body work together in order to build a complete model of how you really can become your own placebo.
Your brain, which is at least 75 percent water and is the consistency of a soft-boiled egg, is made up of some 100 billion nerve cells, called neurons, that are seamlessly arranged and suspended in this aqueous environment. Each nerve cell resembles a leafless but elastic oak tree, with wiggly branches and root systems that connect and disconnect to other nerve cells. The number of connections a particular nerve cell might make can range from 1,000 to more than 100,000, depending on where in the brain the nerve cell resides. For example, your neocortex—your thinking brain—has about 10,000 to 40,000 connections per neuron.
We used to think of the brain as a computer, and while there are certainly some similarities, we now know there’s much more to the story. Each neuron is its own unique biocomputer, with more than 60 megabytes of RAM. It’s capable of processing enormous amounts of data—up to hundreds of thousands of functions per second. As we learn new things and have new experiences in our lives, our neurons make new connections, exchanging electrochemical information with each other. Those connections are called synaptic connections, because the place where the cells exchange information—the gap between the branch of one neuron and the root of another—is called a synapse.
If learning is making new synaptic connections, then remembering is keeping those connections wired together. So in effect, a memory is a long-term relationship or connection between the nerve cells. And the creation of these connections, and the ways they change over time, alters the physical structure of the brain.
As the brain makes these changes, our thoughts produce a blend of various chemicals called neurotransmitters (serotonin, dopamine, and acetylcholine are a few examples you may recognize). When we think thoughts, neurotransmitters at one branch of one neuron tree cross the synaptic gap to reach the root of another neuron tree. Once they cross that gap, the neuron fires with an electrical bolt of information. When we continue thinking the same thoughts, the neuron keeps firing in the same ways, strengthening the relationship between the two cells so that they can more readily convey a signal the next time those neurons fire. As a result, the brain shows physical evidence that something was not only learned, but also remembered. This process of selective strengthening is called synaptic potentiation.
When jungles of neurons fire in unison to support a new thought, an additional chemical (a protein) is created within the nerve cell and makes its way to the cell’s center, or nucleus, where it lands in the DNA. The protein then switches on several genes. Since the job of the genes is to make proteins that maintain both the structure and function of the body, the nerve cell then quickly makes a new protein to create new branches between nerve cells. So when we repeat a thought or an experience enough times, our brain cells make not only stronger connections between each other (which affects our physiological functions), but also a greater number of total connections (which affects the physical structure of the body). The brain becomes more enriched microscopically.
So as soon as you think a new thought, you become changed—neurologically, chemically, and genetically. In fact, you can gain thousands of new connections in a matter of seconds from novel learning, new ways of thinking, and fresh experiences. This means that by thought alone, you can personally activate new genes right away. It happens just by changing your mind; it’s mind over matter.
Nobel laureate Eric Kandel, M.D., showed that when new memories are formed, the number of synaptic connections in the sensory neurons that are stimulated doubles, to 2,600. However, unless the original learning experience is repeated over and over again, the number of new connections falls back to the original 1,300 in a matter of only three weeks.
Therefore, if we repeat what we learn enough times, we strengthen communities of neurons to support us in remembering it the next time. If we don’t, then the synaptic connections soon disappear and the memory is
erased. This is why it’s important for us to continually update, review, and remember our new thoughts, choices, behaviors, habits, beliefs, and experiences if we want them to solidify in our brains.2 Figure 3.5 will help you become familiar with neurons and neural networks.
To get an idea of how vast this system really is, imagine a nerve cell connecting to 40,000 other nerve cells. Let’s say it’s processing 100,000 bits of information per second and sharing that information with other neurons that are also processing 100,000 functions per second. This network, formed from clusters of neurons working together, is called a neural network (or a neural net for short). Neural nets form communities of synaptic connections. We can also call them your neurocircuitry.
So as there are physical changes in the nerve cells that make up your brain’s gray matter, and as neurons are selected and instructed to organize themselves into these vast networks capable of processing hundreds of millions of bits of information, the physical hardware of the brain also changes, adapting to the information it receives from the environment. In time, as the networks—converging and diverging propagations of electrical activity like a crazy lightning storm in thick clouds—are repeatedly turned on, the brain will keep using the same hardware systems (the physical neural networks) but will also create a software program (an automatic neural network). That’s how the programs are installed in the brain. The hardware creates the software, and the software system is embedded into the hardware—and every time the software is used, it reinforces the hardware.
You Are the Placebo Page 9