Placebo Talk

A while back I received an email from a patient, a conventionally trained medical doctor, telling me that he was feeling a lot better and wondering whether it was necessary to take the remedy I had prescribed. It turns out that a sense of well-being — what the patient referred to as ‘OK-ness’ — had come over him in the midst of our consultation and had not dissipated weeks afterward. He also tacked on the following PS: “This whole experience makes me believe that a placebo-controlled homeopathy study is not possible.” This was a significant realization for him because he has an interest in investigating the outcomes of alternative treatments using standard double-blind experimental methods.

It is not unusual to get similar feedback about the effects of a homeopathic consultation. Sometimes people will make intellectual discoveries about themselves, have little epiphanies about how they experience their illness and their lives, or, as in this particular case, just have a shift in the way they feel. In one case, a young woman whose chief complaint was the absence of her menstrual period, began a period two days after the appointment, before she took the remedy.

This phenomena raises some interesting questions. What was the nature of the ‘healing’ that these patients experienced? Could it be deemed a placebo effect? And, along the lines of the patient’s post script, what is the relationship between homeopathy - or any energy based healing system, for that matter - and placebo controlled studies?

When first learning homeopathy, I was taught that there were certain questions one needed to ask about the patient’s complaints and about their general state of health in order to get the appropriate information that would then be analyzed to find the remedy that ‘fit’ that person. It was a pretty straight forward, linear process of data collection and data processing. The only problem was that for many cases — way too many cases — it didn’t really seem to work.

The problem was that homeopathy is not linear in this way at all. What one is really after is not just a collection of data that can be gathered on a questionnaire or through a set battery of questions. In a sense, it is exactly the opposite type of information — if one wants to call it ‘information’ at all — which is most significant for selecting a remedy.

The most appropriate homeopathic remedy is always found by perceiving what is unique about the patient physically, mentally and emotionally. Homeopaths have given this uniqueness many names over the years: “rare, strange and peculiar”, ‘characteristic nature’, ‘individualized constitutional state’, etc. All of these are terms that point to the fact that fundamentally in homeopathy, what is unique is helpful and what is common is not.

Eventually, what I understood was that by asking a standard set of questions I was in effect limiting my perspective on the type of information that would be gathered — and thereby limit my perspective on the nature of the patient. The more directive and well defined the questions, the narrower the scope of my understanding.

So, I learned to do the opposite — to try to elicit information in a non-directive, open ended manner. This was not something that I thought up or invented, but a number of techniques other homeopaths were already exploring, implementing and disseminating. ‘Non-directive’ means to ask for information in a way that the patient takes the lead and the homeopath follows. It is not being totally passive — with each answer, there is a need to prompt the patient to explore and elaborate on the significant aspects of what was just said.

The prompts are straightforward, often repetitive: “Tell me more.” “Describe it further.” “Tell me about the word ‘X’ ”. And the results can be very effective, often startlingly so. Step by step, the patient follows his or her own expressions in a spiral that penetrates through to the core of their state, revealing that characteristic nature needed to select the appropriate remedy.

As an example, I spoke with a patient this morning who was being seen for a respiratory condition. Something showed up on a test, but there were no symptoms - and no diagnosis. “So, what is the worst thing about it?” “It’s a puzzle”. “A puzzle?” “Everything in my life is joined. Things aren’t separate.” “What do you mean?” “Things fit together, they mesh”. “Tell me more.” “Pulled together, whole & comfortable.” “What is together?” “Not fragmented, not crashing around, in place.” “Describe fragmented.” “Fractious, broken up, not smooth, broken.” “Broken?” “Like broken glass, hard edges, like it was thrown on the floor.”

Odd as it may seem, that sensation of things fitting perfectly together versus fragmentation is the characteristic nature of this person — what is called the ‘vital sensation’. The same sensation can be seen in all aspects of life; it is the lens through which life is perceived. Asking for a dream I was told one from the night before about a party, of friends gathering socially - and the feeling was of connecting with everyone, of everyone being together. Asking for a favorite thing to do, I was told of going out at night, lying down and looking at the stars - and the feeling was of complete oneness with the sky and world, of the absolute absence of fragmentation.

A comprehensive homeopathic consultation can last upwards of 2 hours. As the give and take of the conversation hones in on the vital sensation, the patient often will not only intellectually understand what it is, but also can experience it in a very direct, physical level. This phenomenon is quite similar to that of the most fundamental Buddhist meditation technique, in which the meditator is trained to focus on body sensations.

For the homeopath, bringing the conscious mind of the patient to the vital sensation makes it possible to choose the most appropriate remedy. For the patient, like the meditator, it creates a form of experiential awareness beyond the intellect, that resonates energetically throughout the body.

Experiencing the vital sensation directly can elicit strong emotional reactions, positive, negative, or a combination of both. For some it is akin to an act of purification. For others, it can actually be curative to a greater or lesser degree. Whatever the reaction, it is most definitely not a placebo in the common sense of the word and that is why it is correct to question the value of double-blind studies in homeopathy.

The consultation itself has therapeutic value and, as the patient this morning succinctly put it afterward: “I want to let you know that these conversations with you make me goes places I never otherwise go.”