Placebo and the Power of Self-Talk – Geoff Mitchell

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Last week I met a woman who presented in an agitated state. Her world was falling apart. Her husband had left some months before, after a long period of poor communication, leaving her with the responsibility of two small children and a full-time job to keep body and soul together. She described her life as a treadmill of working, cooking, looking after the kids, sleeping, repeating – over and over again. The burden was getting her down, and she started getting anxious at her lack of energy and motivation. All she could see were problems and endless drudgery. She was at rock bottom and seemed to have no reserves left.

I had never seen her before. What could I offer? I did what I could; listened, then “mapped” her problems onto three axes – circumstances, personal strengths and weaknesses, and biology (Figure 1).  We discussed that, in order to improve things, we had to deal with each axis individually. What could be done to take the pressure off? Were there any features in her personality that were positives? Could she trade on them?  What were her weaknesses? Could she recognise these and could she forestall them? Was she biologically depressed?

Among other things, I recall talking about the power of words and thoughts.

Self-talk could lift her up or drag her down. There was possibly also some biological depression. She left with a prescription and an appointment for next week.

Next week came, and in walked a different person! She had set herself the goal of painting some feature walls in her house, and had friends over to help, while her ex- took the kids out for a day. She achieved something, and had fun doing it. She had decided her self-talk needed to change. She changed her self-talk at work – out with the negative and in with the positive.  With the changed self-talk, she changed!

What happened there? The antidepressant prescription was almost incidental.  It was the rapport we built, and the conversation we had, that appears to have had such a dramatic effect. My job was to walk alongside her, to build her up, and to change her point of view.

Walking alongside a person gives strength. The journey may be long or short, but is not as fearful when it is shared.  The Bible reminds us:

Two are better than one, because they have a good return for their labor:

If either of them falls down, one can help the other up. But pity anyone who falls, and has no one to help them up.

Also, if two lie down together, they will keep warm. But how can one keep warm alone?

Though one may be overpowered, two can defend themselves. A cord of three strands is not quickly broken.

(Ecc 4:9-12)

As medical and dental professionals, we have the inestimable privilege of walking alongside our patients. If we walk with them, we can build each other up. However, this does not happen to Christians alone – our non-Christian colleagues can also claim this privilege. However, as Christians, we believe and know that God is walking with us, creating the third part of that three-stranded cord. The doctor working with the patient is good, but adding the third strand of God’s presence and guidance is powerful.

Was my consultation a placebo?

A placebo is variously defined as:

  • a medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect,
  • a substance with no therapeutic effect,
  • or a measure designed merely to humour or placate someone.

Was I just humouring her, placating her? Maybe, but I believe it was far more than building positive self-talk. I believe God showed me what that woman needed.

Is my faith in God a placebo? Is God merely a vehicle to improve my self-talk in order to build myself up? I believe God is the creator of all we see, all-powerful and all-wise. He is beyond time, and so sees the beginning and the end of all things. And yet He loves us so much that we become “God’s children…heirs of God and co-heirs with Christ”! (Rom 8:17)   He takes a personal interest in our lives, and cares for us: Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they?” (Matt 6:26). That personal interest culminated in Christ, opening a way to intimacy with Father God through the cross.

To the world, such thoughts are foolish. However, we are told that “the message of the cross is foolishness to the wise, but to those being saved it is the power of God” (1 Cor 1:18).  Such a relationship is more than thoughts. It is real and powerful, and we stake everything on it.

So if my consultation was merely a placebo, then I am all for placebos!

Royal Brisbane and Primary Care Clinical UnitsBIO: Dr Geoffrey Mitchell is Professor of General Practice and Palliative Care at the University of Queensland. His main research interest is in the role of General Practitioners in complex conditions, particularly palliative care, how specialists and GPs can work better together, and in clinical trials.

He is a chief investigator in three nationally-funded centres of research excellence: in primary–secondary care integration, end of life care, and chronic kidney disease.  He is the co-founder and was co-chair of the International Primary Palliative Care Network from 2005 to 2018.

Current and recent research includes improving integration between specialists and primary care, the use of case conferences, the role of general practice at the end of life, and several aspects of the management of chronic kidney disease, including decision making at the end of life and the role of general practice in end of life care.

He is widely published and has a significant research funding track record. He maintains a clinical general practice in Ipswich, Queensland.

 

Figure one.  “Mapping” complex problems – aiding patient understanding and planning management.

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