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A Pharmacology of Words

This chapter proposes that placebos are best understood as a metaphor in which words (and doctors) are drugs and can thereby alleviate symptoms and promote healing. Placebos may be chemically inert, yet they possess clinical potency. Various explanations for the placebo effect have been proposed, including conditioning, expectancy, meaning response, and ritual, and the relevant causal neural mechanisms are reviewed. The chapter examines the paradox of the widespread use of placebos and the mistrust they often elicit, while reviewing the importance of the patient’s and physician’s belief in the impact of words and ritual. The various types are noted, including hidden or covert placebos, open-label placebos, and socially transmitted placebos. The chapter emphasizes the importance of context and the clinical relationship in the benefits provided by this long-underappreciated clinical phenomenon.