Monday, September 16, 2013

Thinking while sick

Back when I watched TV, which is many years ago, I would sometimes watch Star Trek. My least favorite character was Mr. Spock. My objection to Spock was that he was extremely foolish in a way that he should have been smart enough to recognize and correct. His foolishness was based in his refusal to admit the importance of understanding emotion and psychology. He would respond to any statement about feelings influencing actions with, "That's illogical," without considering the fact that these statements were also true. Feelings do influence behavior, and to deny that fact, or fail to act on it is illogical.

I was thinking about this last night in the context of the placebo effect. The placebo effect is surprisingly powerful, very easy to demonstrate convincingly, and I've never heard a plausible argument for how the physiology behind it works. There is also good evidence for a negative placebo effect, that believing something will harm you can make it somewhat harmful.

This was on my mind because I have been sick for the last two weeks, with a cold bad enough to keep me from getting much of anything done, and people have started to suggest various home remedies that I am sure don't work. However, because of the placebo effect, I wish I did believe they worked. My inherent skepticism keeps me from gaining the demonstrable benefits of almost any worthless snake-oil. On the other hand my previous experience of frequent and lengthy sickness convinces me that I am likely to stay sick, surely contributing to a negative placebo effect.

It was these thoughts, plus snippets of the Norse myths Iris has been reading to me before bed, that I went to sleep. And what a strange pair of dreams I. First, I dreamed I was in a bar or hall with long wooden tables. Some of my deceased male relatives were there, as were many other people I didn't know. I knew I had only been there long ago, as a child. A man at another table stood, called for attention, and pointed at me. "Look who's come back," he announced mockingly, "Why if it isn't Daniel, the heir to a long proud line of atheists!" I was going to argue, but I woke.

Next, I dreamt that my left thumb-nail had gotten very long and ragged. As I tried to cut it, it started to expanded, unfold and then unroll itself, until it was as big as a post card. It had been tightly folded and wrapped, growing into itself. I cut it off amazed that it could have gotten so big and ingrown without my realizing, and at how compactly wrapped it had been. Looking at my thumb I saw a slot under the skin, maybe a half inch deep just above the nail where the furled and folded nail had rested. Inside the hollow there were areas where minute green plants had started to grow, and areas with many small bloody scabs. I was happy to be able to rinse it clear, and with that I again woke, feeling well rested and fully awake for the first time in weeks.

How do I interpret this? I've decided that simply believing that the placebo effect is helping should be enough to cause the placebo effect to actually help, and that something as simple as a dream of cleansing should be enough to trigger this positive cycle. At present, I am not interested in hearing alternative explanations.


GreenEngineer said...

Hi Dan,

If you haven't done so recently, get your vitamin D levels checked. In the last year, we've had a profound and dramatic demonstration of the difference between a healthy and a low vitamin D. It's apparently a very common and underdiagnosed problem, and it can lead to all kinds of seemingly-unrelated dysfunctions.

Dan Levitis said...

Funny you should ask. I went to the doctor for blood tests to find out why I am always sick, and it turned out my vitamin D was low. Now taking supplements. They don't add D to foods here they way they do there, and I of course failed to notice that.

jte said...

A neighbor has gone deep into the weeds on the topic of vitamin D, and tells me that, contra conventional advice, there is a meaningful advantage in taking D3 in particular over other forms of D. Fyi.

I have often pondered the placebo effect and have my own anecdote that, if you take it to heart, might reduce your reluctance to try out the various snake oils (of which, I make a doozie!).

A number of years ago, I was experiencing rather bad depression, bad enough and long-duration enough to qualify as clinical worth addressing.

A medical person recommended and wrote a prescription for an SSRI anti-depressant. I wondered if I should take it -- after all, in an econometrics class not long before, I had studied a paper that measured the effectiveness of SSRIs (as well as St. John's wort, a commonly used -- and in Europe, prescribed -- herbal antidepressant), and which had found them to be no better than placebos. (We studied the paper as an example of how NOT to write conclusions. In this case, though the data presented within the article showed both SSRIs and St. John's wort to be no better than placebos, the authors in their introduction and conclusion exclusively described the St. John's wort as ineffective, making no mention of the identical finding for SSRIs.)

So there I was, cognizant that randomized, double-blind study of SSRIs had found them to be no better than placebos. This should have induced in me a negative placebo, right? (Assuming I am of the type that is susceptible to the placebo effect. Is everyone supposed to be equally susceptible? Seems unlikely. Some people hypnotize easily, while others do not. Anywho...)

On the principle of "what the hell," I took them anyway. For what it's worth, taking the SSRI correlated very strongly for me with improvement on the depression front. I've taken them off and on for many years now, and both I and someone very dear to me who happens to have what might be termed a sibling relationship to you, both perceive a very clear causative relationship between the drugs and my non-depression. This, by the way after I had earlier tried St. John's wort (prior to reading the research paper in econometrics) without perceiving any effect whatsoever.

One pet theory I have is that SSRIs are, in fact, chemically efficacious against depression, but that their chemical action simultaneously undermines the placebo effect. The result is that -- while a drug that does not affect the placebo effect should statistically result in changes that are equal to the placebo effect PLUS a genuine chemical effect (right?) -- SSRIs give statistical results that equal a genuine chemical effect more-or-less alone, and that that effect, by coincidence, is roughly the same size, statistically, as the placebo effect alone (which ain't shabby at something like 30% for anti-depression interventions).

On that note, I'll mention that one of your favorite sisters got walking pneumonia 5 or 6 years in a row, always around November or December when winter began to really set in. (Your family really is a glutton for respiratory illness.) Then I made a tincture with various "medicinal" mushrooms I collected (defined as such in a book on the topic, some or most of which were specifically designated useful for addressing respiratory illness). When she began to get that tickle in her chest that felt like incipient respiratory illness, she took some of the tincture for a few days and the tickle went away, and no pneumonia occurred. She's done this several times over several years and hasn't gotten any bronchitis or pneumonias of any sort in that time. So if you've got an itch to try out some snake oil, just say the word...