Music and Intention: Placebo, Nocebo and the Mind’s Power in Health & Disease

I have been thinking for some time about the impact of music therapy in the traumatic experience of people who are hospitalized. Whether a diagnosis is chronic, and treatment is on-going, such as chemotherapy (Cancer) or blood transfusion (HIV), or a diagnosis is more sudden, or acute such as a gun shot wound, animal attack or heart failure; the mind and body, and in particular one's belief about treatment, including the episode and the doctor's, nurse's, therapist's, words about treatment have an apparent influence on treatment outcomes.

Today I am writing about placebo and nocebo, both understood to create 'effects' in the medical experience. Placebo is the measurable, observable, or "felt improvement" in health behavior that is thought to occur outside of one's admistered routine medical treatment. Placebo is Latin for "I shall please"-and in the pharmacological realm, implies that an inert substance such as starch or saline has the capability to produce an effect similar to a pharmacologically induced active substance/pill.

The placebo effect has been studied and is most often written about as a psychological phenomena. University of Connecticut, psychologists Irving Kirsch and Guy Sapirstein wrote about Prozac's effects as the result of a placebo when they analyzed 19 clinical trials of antidepressants and concluded that the expectation of improvement, rather than adjustments in brain chemistry, accounted for 75 percent of the drugs' effectiveness (Kirsch,1998). "The critical factor," according to Kirsch, "is our beliefs about what's going to happen to us. You don't have to rely on drugs to see profound transformation." Sapirstein analyzed 39 studies, from the 70's-nineties and found that depressed patients were treated pharmacologically, psychotherapeutically, or with a combination of both drugs and verbal psychotherapy. He found that 50 percent of the drug effect was due to the placebo response.

Nocebo is Latin for "I will harm." This term coined by Walter Kennedy, in 1961, is the antecedent of the term "placebo." If placebo is the drug that induces a desirable consequence as a direct result of that subject's beliefs and expectations, the term "nocebo" instills an unpredictable unintentional injurious response with unpleasant results that are pharmacologically-generated and have predictably injurious outcomes resulting from its administration. W.R.Houston was among the first of doctors to pose that harmful "placebo" procedures, as distinct from the other, harmless sort of "placebo" procedures a doctor might apply has "usefulness... in direct proportion to the faith that the doctor had and the faith that he was able to inspire in his patients".

It is interesting to think of treatment affects as being will-ful and faith-related. One of my favorite doctors, Herbert Benson said: "Surgeons are wary of people who are convinced that they will die," There are examples of studies done on people undergoing surgery who wanted to die to re-contact a loved one. Close to 100 percent of people under those circumstances die."Martina Amanzio et al. (2001) demonstrated that "at least part of the physiological basis for the placebo effect is opioid in nature" (Bausell 2007: 160). Chemical substances such as endorphins, catecholamines, cortisol, and adrenaline can be activated with positive belief and thought processing.

Daniel Levitan's "This is Your Brain on Music" and Oliver Sack's "Musicophelia" address in a variety of ways that the power of music can instill and effect a person's thoughts and wishes which may in turn directly alter biochemical factors of the brain. Music is a sensory experience which can alter neurochemical system affects and this includes the hormonal and immune systems.

Music therapy builds resiliency by generating a person's incentive and belief which may empower their physical well-being and enhance the recovery process from illness to wellness. I wonder why people are so surprised when they are told that the "effective drug" they are using is a placebo. Hearing that their problem may be "in their mind" implies that there is in reality nothing wrong with them. There is a great deal of research which has reported objective improvements in health-related outcomes which are the result of placebos.

I am awaiting the day when we use our psychological impetus more consciously to create a desired effect. Music making builds the means for incentive. In consciously visualizing, singing, or playing about our desired outcomes, we create the field for change to occur. In music we can address the physical, emotional and cognitive in a single experience. I am hopeful that the experience of making music can enhance the brain's ability to alter the body. This is occurring in ways we have only just begun to understand.