Unpacking the Placebo Response: Insights from Ethnographic Studies of Healing

Abstract

This paper selectively reviews cross-cultural studies of healing to identify parallels with the process of responding to placebos in biomedical contexts. Placebo responses involve positive therapeutic effects of symbolic stimuli that may be mediated by changes in cognition and attention as well as psychophysiological mechanisms. Ethnographic studies of healing point to additional social and cultural processes that may mediate and modulate placebo responding, including: (i) the cognitive and social grounding of believed-in-efficacy and expectations; (ii) interpersonal processes of narrating and re-negotiating symptom and illness experience; and (iii) the embedding of healing in cultural ontologies, values and social institutions that define positive health outcomes and that govern the esthetics and rhetorical power of healing interventions. Research on the social-contextual basis of placebo responding can contribute to an integrative theory of healing. Because placebo responding is part of any therapeutic intervention, there is no theoretical or practical justification for the deceptive use of placebos. Strengthening the components of placebo responding inherent in clinical effectiveness will insure maximum benefit for patients and maintain the credibility and fidelity of medical practitioners and institutions.