The human brain has always fascinated me. How person A interprets reality may very well not be the same as how person B does. Why is that the case? And what role do expectations play in the process?
Chris Berdik is a freelance science journalist with something to say about brain-related matters. I recently sat down with him to talk about those subjects and more from his new book, Mind Over Mind: The Surprising Power of Expectations.
What do you mean by expectations?
I mean our mind's habit of jumping to conclusions. It's an admittedly broad definition, that includes our assumptions about medical treatments, the automatic inferences we make about people (including ourselves) based on just a glance, our pre-competition anxiety, the anticipation that alters what we value and filters our sensory experiences.
Often, the quirks of our minds blind us to reality. This book focuses on cases when the dividing line between what's imagined and what's real is more porous and where one could argue that our expectations bend reality.
Why "bend reality"?
The expectations I describe don't become reality, but they can shift it in subtle but very real ways. For instance, placebo morphine causes the brain to release its own painkilling opioids. Believing that you're eating an indulgent, high-calorie food causes a steeper decline in your gut's production of the peptide grehlin (that signals hunger to the brain) than does eating the same food billed as diet or low-calorie. Just looking powerful, by standing expansively for a couple minutes (like Superman) leads to the same hormonal shifts -- an increase in testosterone and a decrease in cortisol -- as does being given actual power, with similar cognitive and behavioral consequences, such as increased risk taking.
Who was Franz Anton Mesmer, and why start the book with his story?
Mesmer was an 18th century healer who cured people of various maladies by supposedly rebalancing an ever-present magnetic force that Mesmer claimed kept the universe and all its creatures in harmony. He was born in Germany, but settled in Paris where he made quite a name for himself (in the truest sense: his technique was known as, "mesmerism"). Eventually, however, the city's medical establishment convinced the king to investigate Mesmer, and the investigators used the first-known placebo-controlled experiments (basically pretending to mesmerize people) to debunk the popular healer and shame him from the city.
I include Mesmer's story for its place in placebo history. But, I also include it, because the king's investigators didn't just render judgment on Mesmer. They wrote up a report that cast a very sinister light on the power of the mind and the "imagination" both in our health and beyond the healing arts. They drew a bright line between what's real and the stuff in our heads, and the purpose of this book is to explore some of the areas where that boundary is not so well-defined.
The placebo effect is an old idea. What don't we know about it?
To most people, placebos mean sugar pills or some other fake treatment that patients are duped into accepting as real medicine. But, recent studies show that these effects are actually everywhere in medical care.
For example, getting a shot of painkiller openly alleviates a lot more pain than the same amount of drug slipped covertly into an IV. Likewise, yellow pills make better antidepressants while dark blue or purple pills are better sleep inducers. We tend to believe that expensive products are higher quality than generic, so "generic" or cut-rate placebos are less effective than branded or full-price placebos for the same ailment.
Plus, something akin to the placebo effect is at work outside of medicine. Take our mind's ability to make us enjoy a wine more just because we think its expensive, or the boost in speed that Olympic class swimmers get when their coaches doctor the stopwatch in training, or the academic advantage students get when they can re-interpret their pre-test jitters as getting psyched up rather than psyched out.
It seems like there's a fine line between taking medical placebos seriously and seeing them as a panacea. How do you navigate that?
Yes, it's easy to get carried away with the idea of expectations influencing reality. For instance, the evidence that positive thinking or a "fighting spirit" can help people with cancer push the disease into remission is slim to none. Yet, it remains a very popular belief, and not long ago, clinicians and social workers who treat people with cancer began to complain about the "tyranny of positive thinking." Put bluntly, patients were asking, if positive thinking can shrink my tumor, then who is to blame if my tumor keeps growing?
Even where medical placebos do work, their effects are conditional and variable. Once you leave behind the facile notion that placebos are all imagination wrapped up in fake medicine, and start talking about the contextual elements of medical care that can impact our bodies, you need to tease apart the factors that may help or hinder placebo effects, while comparing them to patients given no treatment. The study of placebo effects should be just as rigorous as drug research, if not more so.
You cover the role of expectations in everything from wine tasting to education to online digital avatars. What's the main message you hope readers take away from this book?
I think we can be a little less insistent on separating what's imagined from what's real. This book is not about controlling the universe with our thoughts or inviting catastrophe with worry and negativity. Instead, it's about how many things we take for granted as settled, solid and permanent, may partially rest on a foundation of expectations. So, it's worth taking stock of these assumptions and putting some of them to the test by trying out some alternatives.