Chatter

by Ethan Kross

  After concluding the investigation, Franklin and his commission published a damning critique of Mesmer’s methods. They wrote that the only healing power that they had observed was the one residing within the human mind: that people simply expecting to feel a certain way could produce a positive outcome—not “animal magnetism.” While Mesmer was indeed peddling a force that didn’t exist, more than two hundred years later we now know that he provided the world with a valuable peek into a unique tool for combating chatter, which scientific research has only recently caught up to: the magical-seeming power of what we believe, and the profound implications it has for our minds and bodies.

  Mesmer hadn’t discovered animal magnetism. He had simply administered a placebo.

  From Worry Dolls to Nasal Sprays

  Ask most people what a placebo is, and they’ll likely tell you that it is, basically, nothing.

  Placebos are commonly understood to be a substance—a sugar pill, in many cases—that is used in pharmaceutical research to gauge the effectiveness of an actual drug. In reality, though, a placebo can be anything—not only a pill, but also a person, an environment, even a lucky charm. And what makes placebos so intriguing is that they can make us feel better even though they have no active medical ingredients.

  We use placebos in research to verify that a new medicine or procedure has a clear medicinal effect over and above the simple power of suggestion alone. Doing so acknowledges that the mind possesses real healing potential, but placebos aren’t something generally thought of as substantial in their own right. They have long been understood as a tool serving a greater purpose, with no separate use of their own.

  This completely misses the point.

  Ben Franklin, of course, didn’t miss this point. He understood that the benefits Mesmer gave to his patients were real even if animal magnetism wasn’t. Yet his timeless insight about the mind’s role in healing was swallowed by the sensational story of Mesmer himself. This lasted until the mid-twentieth century, when scientists began to question the idea that placebos were merely a foil for research—in essence, nothing. We now know they are very much something: a remarkable testament to the psychologically intertwined nature of belief and healing, and a hidden back door for subduing chatter.

  Placebos are part of an ancient human tradition of endowing objects or symbols with “magic.” The mythical seal of King Solomon consists of two interlaced triangles and was believed, among other things, to ward off harmful demons. Likewise, long before it became synonymous with Nazism, the swastika was considered a symbol of good fortune. And still today in Guatemala, when children are scared, they are given a set of tiny figurines dressed in traditional Mayan garb called worry dolls whose job is to take their concerns away.

  Many people also develop their own idiosyncratic lucky charms. For instance, the model Heidi Klum carries a tiny bag filled with her baby teeth when she flies and clutches it during turbulence. (Weird, I know, but it helps her.) Michael Jordan wore his college shorts beneath his Chicago Bulls uniform during every game. Of late the healing practice of crystals has become big business—a billion-dollar business, in fact. In a broad sense, placebos are very common. We would be mistaken to write off people who cherish charmed objects as misguided. Scientifically speaking, it’s quite rational.

  Study after study demonstrates that simply believing that a placebo—a charmed object, healing human presence (like a shaman or trusted physician), or special environment—is going to make us feel better actually does. For example, fewer stomach cramps for irritable bowel syndrome patients, less frequent headache attacks for migraine sufferers, and improved respiratory symptoms for asthmatics. Though the amount of relief that placebos provide varies notably across diseases and patients—like Mesmer’s patients, some people are more naturally sensitive to placebos than others—in some cases it can be substantial.

  Placebos are even effective for Parkinson’s disease. In one experiment, scientists injected a promising new chemical treatment into the brains of patients with advanced Parkinson’s symptoms. The hope was that doing so would stimulate dopamine production, impoverished levels of which are a root cause of the disease. After the surgeries were performed, the scientists monitored the patients’ symptoms over the next two years. At first glance, the findings were encouraging. Participants who received the injection experienced a significant decline in their symptoms. But there was one problem. Participants in a “sham surgery” group who also had their brains drilled into but didn’t have the injection—a placebo, in this context—experienced the same decline in symptoms. They thought they had received the special treatment, so their brains and bodies responded as if they had. The message from this and many other studies is clear: Our minds are sometimes as powerful as modern medicine.

  But what about chatter? After all, Mesmer also cured patients suffering from “hysteria,” a term that was once used to describe people who experienced difficulty controlling heightened emotions. The placebo of animal magnetism had helped them too. So, do placebos help the inner voice? This was the question that I began discussing one day over coffee with the neuroscientist Tor Wager in 2006, when I was still in graduate school and he was a newly minted assistant professor at Columbia.

  “What if we asked people to inhale a nasal spray filled with saline?” he said. “We’ll tell them it’s a painkiller. I bet that would make them feel better. And we’ll also look at their brains.”

  I won’t say I thought Tor was crazy, but I was skeptical at first. Nonetheless, we soon went ahead with the experiment.

  The result was the study in which we brought the heartbroken of New York City into the lab to study their brains. You’ll recall that we discovered a fascinating overlap between the experience of emotional and physical pain by monitoring participants’ brain activity as they looked at a photo of the person who dumped them. But that was only the first part of the experiment.

  After participants completed that phase of the study, an experimenter in a white lab coat slid them out of the brain scanner and escorted them to a room down the hallway. The experimenter closed the door, then presented half of them with a nasal spray, telling them it contained a harmless saline solution that would improve the clarity of the MRI brain images that we hoped to collect during the next phase of the study. Then participants inhaled the spray twice in each nostril and returned to the scanner for a second round of brain imaging. The other group underwent the exact same procedure with one crucial difference. The experimenter told them that their nasal spray contained an opioid analgesic drug that would temporarily blunt their experience of pain. The salty spray was our placebo.

  Both groups inhaled the same saline solution. But half of them believed that they consumed a substance that would relieve their pain. Now we measured the effect.

  Participants who thought they received a painkiller reported experiencing substantially less distress when they relived their rejection. What’s more, their brain data told a similar story; they displayed significantly less activity in their brain’s social pain circuitry compared with people who knew they had inhaled a saline solution. We discovered that placebos can directly help people with chatter. A spray with nothing chemically meaningful in it could work like a painkiller for the inner voice. It was both strange and exciting: Our minds can cause emotional distress while simultaneously and covertly reducing that distress.

  The findings from our study complemented other work documenting the benefits of placebo for managing a range of conditions in which chatter features prominently, like clinical manifestations of depression and anxiety. And in many cases the benefits aren’t fleeting. For instance, one large analysis of eight studies found that the benefits of consuming a placebo for reducing depressive symptoms endured for several months.

  The wide-ranging effects of placebos raise the question of why they work so miraculously. As it turns out, the explanation i
sn’t miraculous at all. It relates to a necessity our brain generates every waking second of our lives: expectations.

  Great Expectations

  On August 3, 2012, the comedian Tig Notaro took the stage at the club Largo in Los Angeles and performed a set that immediately became legendary. Four days earlier she had learned that she had cancer in both breasts, but this was only the climax of a recent string of misfortunes. She had been severely ill with pneumonia and gone through a horrible breakup, and her mother had died in a fall. None of this was funny in the least, but she grabbed the mic and started talking anyway.

  “Good evening,” Notaro said. “Hello. I have cancer.”

  The crowd laughed expectantly, anticipating a punch line.

  “Hi, how are you? Is everybody having a good time?” she continued. “I have cancer.”

  Some people laughed. Others gasped. The joke was that it wasn’t a joke.

  If part of comedy is about going to uncomfortable places, Notaro did just that. And this was very uncomfortable. But genius that she is, Notaro walked the tightrope between laughing and crying, and got lots of laughs. For instance, she riffed about how her online dating life would change now, infusing it with new urgency. “I have cancer,” she said. “Serious inquiries only.”

  Her set continued in this startling, tragic, brave, and hilarious vein for twenty-nine minutes in all, and eventually vaulted Notaro to a new level of fame and success (and thankfully, she beat her cancer). What I find so illustrative about it is the way it highlights the essential role that expectations play in governing how we function.

  Notaro knew she could make people laugh, even when talking about one of the most somber and chatter-inducing topics imaginable. All she had to do was say the right words in the right order, with the right tone, and with the right pauses. She knew how to do this because of how well honed her expectations were—her expectations about what she could do and what the result would be. If we extend this idea, we begin to realize we all rely on expectations every second of our lives.

  You walk. You move. You speak. Now think for a second about how you are able to engage in these actions. How do you determine where to put your foot when you walk, where to run to catch a ball, or how to project your voice when you’re speaking to a large group? We are able to do these things because we are constantly, both consciously and subconsciously, making predictions about what we expect is going to happen next, and our brain prepares to respond accordingly.

  The brain is a prediction machine that is constantly trying to help us navigate the world. The more we are able to bring our prior experiences to bear on what is required of us, the better we should be at this. And this isn’t just relevant to our behaviors. It generalizes to our internal experiences in our bodies as well, which is where placebos come into play. They are a hack for harnessing the power of expectations to influence our minds and physical health.

  When a doctor tells you that you’ll feel better, this provides you with information you can use to predict how you’re actually going to fare over time, especially if she has fancy medical degrees, wears a white coat, and talks with authority. That’s not a joke. Research shows that features that you might think are peripheral—if a physician wears a lab coat or not, whether she has acronyms attached to her name placards, and even whether the pills you take are referred to as “brand-labeled” or generic—subconsciously strengthen our beliefs.

  Over the course of our lives, we develop automatic beliefs about how certain objects and people influence our health. Like Pavlov’s salivating dogs, we see a pill and we reflexively expect that consuming it will lead us to feel better, often without even knowing what it is or how it works.

  This pathway for expectations, and by extension placebos, is preconscious. It’s not a product of careful thought but rather an automatic, reflexive response. Perhaps unsurprisingly, studies show that rodents and other animals respond to placebos via this same automatic channel. This type of response is adaptive. It provides us with very good guesses about how to react quickly and effectively across a variety of situations. Yet we also evolved an additional pathway in the brain that guides our responses: our conscious thought.

  When my head aches and I take a painkiller, I remind myself that swallowing the pill will make me feel better. This simple awareness provides my brain with something invaluable: It helps silence all the doubts I may have about whether the headache will ever go away. What if nothing will help? I say to myself. This hurts so bad. What can I do? Taking the pill offers me hope that my discomfort is going to diminish and in doing so shifts my internal conversation. Indeed, research indicates that these conscious appraisals draw on the same default system in the brain where our inner voice makes its home.

  In a simpler sense, what’s going on is that I have a belief. This belief shapes my expectations, which in turn makes me feel better. People tell us things that we later tell ourselves, and we also have experiences we extract ideas from, and this process creates an infrastructure of expectation in the brain. What particular beliefs we have depends on the people we know and the things that happen to us. But what’s really going on in the brain that allows this placebo “magic” to happen?

  Because our beliefs pertain to so many different kinds of emotions, physiological responses, and experiences, there is no single neural pathway that creates the placebo effect. For instance, while believing that you’ll feel less pain is linked with lower levels of activation in pain circuitry in the brain and spinal cord, thinking that you’re drinking an expensive wine can increase activation in the brain’s pleasure circuitry. Believing you’re consuming a fatty (versus healthy) milk shake even leads to lower levels of the hunger hormone ghrelin. In effect, once you believe something, your neural machinery brings it to fruition by increasing or decreasing the activation levels of other parts of the brain or body related to the processes you are forming beliefs about.

  Clearly, there are limits to the effects of placebos. You can’t completely believe your way out of any malady. Many medical interventions do provide additional value over and above placebos, and we now know that placebo effects tend to be stronger for psychological outcomes (like chatter) than physical ones. But these caveats notwithstanding, the power of placebos is both profound and undeniable. In fact, mounting evidence indicates that placebos can act as enhancers, supercharging the benefits of certain medicines and treatments.

  The problem, however, is that the back door of placebos is tricky to access. For one to work, we have to be deceived into believing that we’re consuming a substance or engaging in a behavior that has actual healing properties. Outside of research, where people who participate in studies are typically informed about the possibility of receiving a placebo, such lying would be unethical. So we’re left in a bind: We can’t lie to ourselves about the medicine we take, which means that in the case of placebos we have access to a tool we can’t take advantage of.

  Or can we?

  If placebos are fundamentally about changing beliefs, then what if we could identify other ways of altering people’s expectations that don’t involve lying? Information from trusted sources is a potent persuasive device. If I want to convince you of something that you’re skeptical of, facts and science often help. Ted Kaptchuk and his team at Harvard capitalized on this idea in 2010 when they published a study that shattered how the scientific world thought about placebos.

  First, they settled on a common illness that had already been shown to respond well to placebos: irritable bowel syndrome. After Kaptchuk and his colleagues brought participants with IBS into the medical center where they were performing their study, they explained to them what placebos are and how and why they work. In theory, just learning about the placebo pill should have changed the participants’ expectations, which in turn should have spurred their IBS symptoms to wane. And that’s exactly what happened.

  Over th
e course of the twenty-one-day experiment, the participants who were educated about the science behind placebo effects and then informed that they were taking a placebo displayed fewer IBS symptoms and greater relief compared with people who were educated about placebos and didn’t receive any pills. Understanding how a placebo could make their IBS better actually did just that.

  Intrigued by the strange new possibilities of nondeceptive placebos, my lab conducted our own experiment to examine whether Kaptchuk’s findings would generalize beyond problems of the bowels to problems of the mind. We used a similar method and divided participants into two groups, one of which was informed about the science of placebos. In effect, we told them, “If you think a substance will help you, it will.” Then we gave them a placebo—a nasal spray again—and told them again that if they thought it would make them feel better, it would.

  Next, we stirred up their negative emotions by showing them aversive pictures, such as scenes of blood and gore (participants had agreed to view such images in advance). Sure enough, the people in the placebo group experienced less distress. They also displayed less emotional activity in the brain within two seconds of viewing a distressing image.

  Several labs have extended this line of research to other conditions. For example, nondeceptive placebos have been shown to improve allergy symptoms, lower back pain, attention deficit hyperactivity disorder, and depression. We still need to perform more work to understand how powerful and long lasting nondeceptive placebo effects can be. But these discoveries open up a new set of possibilities for how people can cope with physical and emotional pain, and demonstrate how powerfully beliefs affect our inner voice and health. They also reveal something else important—the role culture plays in passing down chatter-fighting practices.