Before the "pledge marathon" drowned out any chance of decent public radio broadcasting on my drive up to Columbia County, I heard an astonishing bit of news about arthroscopic surgery on knees: basically, it's a useless procedure. A double-blind study over the last ten years has shown that patients who get the surgery do exactly as well as those who get a "fake" surgery (where, I assume, they make little scars and douse it with saline solution). Coming on the heels of the recent revelations about the neck-and-neck efficacy of antidepressants and placebos, it begins to make you wonder exactly which medicines work the way we think they do. It's a bit scary for doctors and patients alike, because any time the placebo effect works, we're tapping into our unconscious abilities to heal ourselves, and there's nothing more unnerving to Westerners than flaky, holistic, touchy-feely solutions when there's so much laser surgery just waiting to be had.
The placebo effect is also hard to harness, as it relies on deception, and there's not one doctor in the world who will risk the malpractice suit of a fake surgery, even if it works. But jesus, does it work - apparently, the subjects of the knee experiment were actually told that many of the surgeries would be fake, and yet the placebo still did as well as the real thing.
This raises some fascinating stuff: first off, it illuminates an incredible lack of unity in our mind-body connection. The placebo effect only works because we want so desperately to be well - yet at the same time, left "unmedicated," our conscious finds a way to keep us sick. I assume our longing for health comes from a survival instinct, but our ability to stay sick is more mysterious. I imagine it's a lack of self-understanding, a belief that we're far removed from the mystical times when we could heal ourselves. But now, give us a sugar pill, call it "Zyxafifor" or something, and we can stave off cancer. Other cultures must find us laughably inept at self-knowledge.
But what is the one thing that unites all of these fabulous placebos together? I'd say it's the hour or so of time spent on the patient the surgery, the physical therapy, just the fucking attention may be all we're really looking for. When a psychopharmacologist prescribes a medication, and a doctor performs a surgery, what they are really saying is "I understand you hurt, and I believe you, and I believe you enough to use my skills to make you better." Since sickness is such a subjective thing (we can never truly express how bad we feel to others), it is only through the active belief of a respected figure that we can actualize our pain, and if Freud is right, that alone can make it go away.
This isn't to say that all drugs are suspect. My sinuses are only unblocked when I spray Afrin into them, and my mom's hip actually does need the oil changed. But I accept that everything I feel from the Celexa may be induced by my own character. I begin to feel anxious, and then I stop, telling myself, "you can't feel anxious you're taking a powerful, expensive drug!" and sure enough, it stops. It could all be a sham, and maybe Sean's knee surgery was also a sham, but this I know to be true: I was miserable, then I took a pill, and now I'm not so miserable. Sometimes the destination is the destination after all.
Posted by at July 12, 2002 8:04 PM