I came across a study that addresses a question you had earlier in the thread regarding why antidepressants were slightly more effective than placebo with severely depressed patients (in some studies).

The authors of this study came to this conclusion:

“Drug-placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.”

Chris

I don’t think the Alzheimer’s example poses any problem for that idea; to the contrary. The initial wound was more on the physical end of the spectrum, and the healing speed was influenced by the mental state.

At every level of the universe, including our bodies, you can draw distinctions that separate things from one another. A full understanding of a system requires understanding both its uniqueness and its interconnectedness.

The fact that elements in a system have specialized function does not detract from their interdependence.

Can you tell me where the mind ends and the body begins, or vice versa? If quantum physics and chaos theory is applied to the study of the body, it quickly becomes clear that the divisions we perceive are not actually divisions at quantum level.

Certainly there are circumstances in which seemingly gross physical forces (I say seemingly because we know that all matter is energy) cause injury and illness, and others where perhaps the cause is more obviously energetic, psychological or emotional.

However, even in the case of a “physical” injury or illness the “mind” is always directly involved in how the body responds. Even to say it this way is wrong, because there is no mind apart from the body or body apart from the mind. No one has been able to isolate them from each other.

Let’s take the example you used above: that someone trips on a stone and scrapes their knee. You claim this is not “psychosomatic”. (I could ask, of course, what was going through the person’s mind and where their attention was when they tripped in the first place – but I’ll let that go for now). You may be right in terms of the initial injury, but the state of the person’s mind and emotions will directly influence how they heal from this injury.

There are many studies which prove this. For example, there’s a study on caregivers of Alzheimer’s patients that shows they heal from wounds about 3 times more slowly than healthy people. Why? Because taking care of someone with Alzheimer’s is incredibly stressful, and this stress weakens their immune system’s capacity to respond to the injury.

There have been many studies showing that medical students are 2-3x more likely to catch a cold in the weeks preceding final exams. In that case, someone might claim the sickness is purely physical since the virus is a pathogen; however, it is known that stress depresses immune activity, and this of course made the med. school students more vulnerable to getting sick.

We can agree to disagree on this, but I just do not see the usefulness (or accuracy) of the term “psychosomatic”. It implies that other illnesses are not related or connected to they psyche, which is just complete B.S.

Not making the distinction between mind and body is like not making the distinction between lung and kidney. Yes, the body is all one interdependent system. But the same can be said about an organ, a cell, a protein, a society, an ecosystem. Each distinction has its own use in the appropriate situation. Using the term “psychosomatic” does not presuppose that the mind is completely separate from the body, only that it has certain unique qualities.

I do know Sarno’s work and I’m aware of the lack of correlation between back pain and structural abnormalities. A similar phenomenon exists in Irritable Bowel Syndrome, of course, and quite a few other chronic pain conditions and “functional illnesses”.

There was a famous “sham surgery” study done by Moseley et al. which showed that arthroscopic knee surgery was no more effective than placebo surgery (a small incision is made but no instruments enter the knee joint)! Now that is a powerful placebo!

To be frank, I think the term “psychosomatic’ is redundant. ALL illnesses are psychosomatic. The idea that our minds and bodies are somehow separate and operating independently is based in 17th century science. As I’m sure you are aware, there is an entirely new discipline called psychoneuroimmunology that studies the complex interrelationships between the brain, nervous system and immune & endocrine systems.

A lot of the research has gone into the stress-disease connection, and more recently, the placebo effect. Both are good examples of the interconnectedness of mind and body. We really need to find a different way of talking about this because our words are inadequate.

It’s interesting to note that in Traditional Chinese Medicine, there is no separate word for “mind” and “body”. They don’t make a clear distinction.

I’m going to be posting on something related in the near future, back pain. I believe garden-variety back pain (and most other chronic pain) is psychosomatic. This is based on my reading as well as personal experience. Actually, I bet you’d get a kick out of this. Mainstream back pain treatments, including surgery, are miserable failures. The only thing that really works is heavy-duty pain killers! Furthermore, there seems to be no correlation between vertebral/disc abnormalities and pain. It’s anatomically impossible for garden-variety back pain to result from spinal nerve impingement. Are you familiar with the work of Dr. John Sarno?

“Thus there seems to be little support for the suggestion that recent failure to find marked differences between antidepressants and placebo is due to recruitment of patients with mild depression that is less responsive to antidepressants.”

I’ve already quoted the rest of their remarks about this in my previous reply above. What it could mean is that there may be some difference in response in relation to severity within a given study population, but not when taken overall. Since almost all of the studies Kirsch reviewed were done on patients that were severely depressed, it follows that ADs are not more effective than placebos in severely depressed populations.

Perhaps I’ll contact Moncrieff or Kirsch and see if they can shed some light on that question.

The placebo effect is evidence of the body’s powerful capacity for self-healing. I will be writing more about this as it has been a subject of intense interest for me for some time now, and I’ve done a lot of research on it. I think Kirsch’s numbers on the effectiveness on pain management are low. Recent studies I’ve looked at have put the placebo effect at closer to 70-75% for pain management. Many researchers believe that between 40-60% of ALL medication effects are due to placebo.

Unfortunately, there has been little discussion about how to utilize this effect in clinical practice because the pharmaceutical companies can’t see any way to make money off of it. They just want it to go away. All of their research efforts around the placebo effect have been centered on how to identify the type of patient that is likely to respond to placebos so they can eliminate them from their studies and thus give their drugs a better chance of being approved.

You are right: placebo is powerful. But it is powerful because the innate healing mechanisms of our body are so much more sophisticated than even the most advanced medical treatments available today. The potential exists for the placebo effect to become MORE powerful if people come to understand that their own belief and attitude towards life is perhaps the single greatest contributing factor to their health – or illness.

Of course this is both empowering and scary, because with that realization the responsibility for our own wellness shifts from doctors and the medical care system to ourselves.

Witch-doctors are powerful healers! In fact, I believe that the most skilled healers in any modality are those that can elicit the most powerful placebo response. And how can that possibly be considered inferior as a method to the practice of prescribing dangerous drugs with unknown effects or performing invasive, life-threatening surgery?

I’m not saying there’s anything wrong with drugs and surgery when necessary, but I am saying that these methods are not nearly as sophisticated and desirable as utilizing the body’s natural healing mechanisms. Drugs and surgery should be a last resort, not the first step.

Drug–placebo differences increased as a function of initial severity, rising from virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression, reaching conventional criteria for clinical significance only for patients at the upper end of the very severely depressed category.

I thought this was pretty neat from the discussion:

The response to placebo in these trials was exceptionally large, duplicating more than 80% of the improvement observed in the drug groups. In contrast, the effect of placebo on pain is estimated to be about 50% of the response to pain medication [24–26].

Placebo effect is a powerful thing! I wonder how much of medicine is just witch-doctoring, and if its efficacy will change if people lose faith in it.

Also, another recent meta-analysis found no relation between severity and antidepressant effect, and a meta-analysis of older studies showed that differences between antidepressants and placebo were smaller and less significant in inpatient trials (where people tend to be more severely depressed) than outpatient trials. The NICE meta-analysis failed to find a consistent gradient of effect from “moderate” (HAM-D score 14-18) through “severe” (19-22) to “very severe” depression (>23). In fact, the middle group, which would generally be referred to as “moderately depressed”, tended to show larger effects than either of the other two – but numbers of studies were small.

As Moncrieff states in a 2006 paper (“Efficacy of Antidepressants in Adults”, in BMJ) “The possibility that patients in the mid-range of severity show a greater antidepressant response, as suggested by the NICE data, would not be expected from a simple biological effect. It may indicate that this group is more susceptible to some methodological artifact such as infringement of the double blind.”

Thanks again for your participation, Stephan. I’m enjoying the dialogue!

Chris