There is a component of all interventions which has remained somewhat obscured in the wings. From acupuncture through drug treatment to surgical intervention the manifestations of the placebo effect loom large. It is estimated that the placebo contribution to the success of a multitude of healthcare interventions is of the order of 40 – 50%.
The history of the placebo effect goes back a long way in our neuro-biological heritage. There was a time in our evolutionary narrative that we as a species needed to evolve the mind state required for the nurturing of helpless, dependent offspring. Incorporated in that mind state were required the elements of empathy, trust, belief and awe. In time, this mind state was to take shape and become associated with a region of our frontal lobes – the cingulate gyrus. The chemistry mediating this function was oxytocin – the nurturing hormone produced by the posterior pituitary gland. Thence was the time ripe to be fruitful and multiply.
Oxytocin plays a major part in initiating and maintaining uterine contractions, lactation and breastfeeding. It is also responsible for sustaining the appropriate mind state for nurture. However the association of the mind state is not confined to the nurture role alone. Empathy, trust, belief and awe give rise to the secretion of oxytocin in non-pregnant females and males (non-pregnant!). Oxytocin in turn stimulates the cingulate gyrus which generates the said mind states. The secretion of oxytocin also results from the act of breastfeeding, eating, digestion and defecation. Additionally, sexual activity and massage also stimulate the secretion of oxytocin. Finally it has been shown that the bonding of individuals to each other or within a group gives rise to increased oxytocin production.
In addition to its nurture mediation function, oxytocin increases dopamine production giving rise to heightened gratification and enhanced engagement with the pre-frontal cortex. This latter action stimulates reasoning and reflection – which probably explains why we become so reflective while at stool! Oxytocin has also been shown to diminish amygdala function and its associated fear, anxiety, panic and rage. Finally, oxytocin has been shown to diminish the levels of inflammatory mediators and degrees of inflammation. Interestingly, in the realm of sexual activity, it has been demonstrated that there are two types of sexual engagement – dopamine-based and oxytocin-based. The dopamine-based engagement seeks primarily personal gratification. Oxytocin-based engagement seeks both personal gratification as well as the gratification experienced by the partner as a result of a sensitive, empathic and trusting bond. With the additional dopamine stimulation by oxytocin, the level of gratification is elevated. The reward gratification of this interaction exists independent of orgasm as a result of the intensity of the sensitive empathic bonding as opposed to the pure dopamine gratification which is centred upon orgasm. I would suggest that this knowledge existed in antiquity hence ancient literature such as the Kama Sutra may have evolved from the understanding of the great benefits of prolonging sexual engagement, incorporating empathic and sensitive bonding in a space of trust. But I digress ...
Getting back to the placebo effect, it becomes clear that if one develops a mind state emphasizing belief and trust relating to a specific intervention, increased oxytocin will be secreted. We know that oxytocin will additionally create that “feel good” state related to the increased production of dopamine and resulting gratification. Adding to the “feel good” state is the physiological suppression of amygdala-based fear and anxiety as well as the suppression of inflammation. And there you have it ... the placebo effect. That which you believe in will work for you. Conversely that which you don’t believe in won’t work for you. Hence the power of belief – arguably the most determining of human emotions. It is this emotion that also fuels and escalates the hype in a collective of bonded individuals that share a common belief.
In conclusion it has been shown that excessive amygdala-based fear, chronic inflammation and its consequences as well as states of immune-suppression may all reflect degrees of nurture deprivation. It is these very conditions that are suppressed by oxytocin. Since empathy, trust, belief and awe inherently mediate the secretion of oxytocin, we arrive at the profound realization that the emotions incorporated in our neuro-biological birthright are the very antidotes to the ills inherited from nurture deprivation.
References
https://pubmed.ncbi.nlm.nih.gov/20228171/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6632777/
https://pubmed.ncbi.nlm.nih.gov/18940936/
https://pubmed.ncbi.nlm.nih.gov/18498743/
Copyright reserved - Ian Weinberg 2022 This discussion is based on the Triangles Model and its applications (TMA). For those seeking a deeper dive into this fascinating world, I invite you to peruse the online courses available at www.neuronostic.com – Online Mentoring Courses for the lay public and the Online Accreditation Course for professionals.