Placebo effect and psychotherapy, thirty years ago

It seems I’m thirty years late. A blog reader read the placebo series of a few weeks ago and sent me to a 1979 article on culture and the placebo effect in psychotherapy in which ethnobotanist Daniel E. Moerman makes the helpful distinction between specific and general medical treatment (Anthropology of Symbolic Healing. Current Anthropology, Vol. 20, No. 1) and speculates on how the difference might be relevant to psychotherapy. “Specific” medical treatment is healing which is specific to the disorder/disease, and “general” medical treatment is that healing is not. Given that general medical treatment (which might include bedside manner as well as any medicine-related placebo effects) accounts for a sizable proportion of the variance in improvement, clearly it is worthy of more study than it usually gets. Moerman suggests that it is general medical treatment which is also at work in many “traditional” medical practices, and in turn that most of psychotherapy works on this principle.

Like most writing in anthropology, Moerman’s is better than the stuff we get in psychology (at least these days):

Psychotherapy, like Protestantism, can be viewed as a highly vigorous sectarian movement. While insiders loudly proclaim the merits of their own and protest the failings of other theoretical persuasions (or liturgies), outside observers detect few substantive differences.

I’ve always told students that if you observed a patient with a cognitive behavioral therapist and then observed the same patient with a psychoanalyst, you’d probably see a lot of the same things happen even though the therapists would talk about the sessions using very different language. I’m not so sure about the same experiment with Lutherans and Baptists.

Here’s another gem:

It is an anthropological commonplace that shamanism, not prostitution, is the first profession.

So I’m thirty years late, but that’s really nothing when you consider the history of making people better.

Moerman’s article is followed by a series of commentaries from different academic types, providing a wonderful exchange of ideas and substantial criticism (the take-home: Moerman’s a better anthropologist than medical scholar). I love this proto-blog format, and I’m not sure why it’s not done more often (American Psychologist does a version of this for some articles, but I don’t see many other journals publishing rigorous critique and response). Anyone know of scholarly blogs in psychology?

Moerman also published a 2002 book on this topic: Meaning, Medicine, and the Placebo Effect. Here’s a review.


2 Responses to “Placebo effect and psychotherapy, thirty years ago”

  1. 1 james w herrick February 20, 2012 at 12:40 pm

    I still like Herrick’s “Placebos, psychosomatic & psychogenic illnesses and psychotherapy: Their theorized cross-cultural development” which appeared in The Psychological Record in 1978. It’s amazing how this article is never cited — even by those who are fully aware of its existence.

    • 2 andyrasmussen February 22, 2012 at 1:17 pm

      Thanks much for your comment! Placebos will continue to fascinate, and likely continue to inspire new “reinventions of the wheel,” I expect. –AR

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