Abstract: Physicians frequently consider the placebo effect in evaluating the efficacy of medical treatments on the human body. It may also be wise to consider the placebo effect and its organizational and psychological analog, the Hawthorne effect, in religious treatments of humans. In suggesting that the placebo effect be considered as a factor in treatments such as LDS Priesthood blessings or declarations of forgiveness or salvation in a variety of faiths, the divine power behind such treatments is not necessarily challenged. The placebo effect, in religious terms, is not a sign of weakness in the patient or a tool for trickery by the therapist, but may be a real expression of the importance of our mental state: when we feel loved and cared for, we are strengthened. There may be a relationship between the placebo effect and both faith and charity that may be helpful to explore and understand. Analysis of changes in performance of a group of people must also be considered in light of the Hawthorne effect. Failure to do so may result in some inherently bad decisions and programs being implemented.
I have long been fascinated with the placebo effect. Though I’ve used it for a variety of lame jokes such as my spoof company, Mega Placebos Plus, the placebo effect itself is a serious matter that physicians, scientists, and others must take into consideration when evaluating the efficacy of any kind of treatment on human beings.
Though some aspects of the placebo effect are controversial (see Carol Hart, “The Mysterious Placebo Effect,” Modern Drug Discovery, 2(4): 30-40 (July/August 1999) and Robert T. Carroll, “The Placebo Effect” in The Skeptics Dictionary (New Jersey: John Wiley & Sons, 2003)), the reality of the placebo effect has been demonstrated in some surprising recent studies, such as the Penn State discovery that cough medicines are no better than non-medicated placebo syrup for children’s coughs (thanks to ScienceBlog.com for the story), or the remarkable finding that 75% or more of the benefit of anti-depressant medications stems from the placebo effect, as reported by Drs. Irving Kirsch and Guy Sapirstein, “Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication, Prevention & Treatment, Vol. 1, June 1998.
What does the placebo effect mean for religion? One of the obvious applications may be Priesthood blessings. Surely a portion of the benefit of these blessings must lie within the scope of the placebo effect, which is not to discount the value and benefit of these blessings at all or the very real miraculous power of God in blessing lives through such means. But in some cases, expressions of love and concern from another, and the belief that treatment is being applied, can provide meaningful aid to the recipient apart from external miraculous actions. I know of many blessings that succeeded far beyond any placebo explanation – genuine divine intervention is the only rational explanation in some cases – but in many cases, it may be that the major benefit provided comes from the love that is expressed by those giving the blessing, who sometimes make genuine sacrifices to be visit the afflicted person and provide the blessing.
If we understand that the placebo effect can play a role in Priesthood blessings, then we may also conclude that the blessing can be more helpful if we take steps to strengthen that effect. For example, most experienced Priesthood holders tend to dress up and put on a tie when they go to give a blessing. Some take extra time for prayer before leaving and may have a prayer first before performing the blessing. These extra steps are often described as ways of showing respect to the Lord in performing Priesthood duties, and I agree. But it also shows the recipient that the Priesthood holders care enough about this act, and about the recipient, to dress up or take other steps. If feeling important and loved contributes to the well-being of the recipient, as I believe it surely must in many cases, then we may wish to take further steps to strengthen our conveyance of love. Follow-up visits and calls, a plate of cookies or a hot meal, a card of sympathy, all these small acts of kindness help convey the love that should already be in our heart, and may help the physical well-being of the recipient.
With a slightly warped perspective, faithful home teaching and visiting teaching could be viewed as providing regularly doses of preventative placebos. Improved physical and mental health may be desirable side effects of our efforts to care for the spiritual well-being of those we serve, thanks to the placebo effect.
It should be no surprise that many aspects of our lives are affected by how we think about ourselves and our situation. Guilt, for example, can be like other forms of psychological stress and can do more than just harm our spirit. The anguish and pain that Alma the younger felt when he confronted the reality of his sins was utterly debilitating (Alma 36), while the joy he experienced when his sins were removed by the power of the Atonement truly empowered him and gave him strength to heal many others for many years. Skeptics will say that guilt is all in our heads and is a sign of mental illness, but I see it as a genuine and often helpful indicator analogous to physical pain that can motivate a person to seek a cure.
Church leaders, parents, spouses, friends and others in the Church (and outside the Church, of course) often have opportunities to those who are dealing with spiritual crises, including guilt and anguish of soul. Drawing a lesson from the reality of the placebo effect, I think we can’t underestimate the importance of simply paying attention to those who suffer. When a sinner humbly goes to meet with a bishop and confess, that person will usually find out that the bishop really cares, that the person is important, and that the bishop or other leaders are willing to spend significant amounts of time listening and trying to help. Even when courts are needed, the result can be a marvelous manifestation of love. My experience in Church leadership positions, beginning as a Stake Clerk many years ago, repeatedly showed me that true charity can be provided in Church courts, even when the sinner is rebellious and excommunication is the outcome. And in many cases, love does much to heal. I think that’s the key lesson from the religious application of the placebo effect. Love heals.
I’ve heard from a variety of people that confessing sins to a bishop was a critical step for them in overcoming sin, and that they came away stronger for the experience. Not to downplay the power of the Lord’s organization in blessing our lives, I would like to know what portion of the benefit of confession comes from placebo-like benefits?
We can extend this idea by drawing upon the finding that side effects can play a critical role in medical placebos. The study that found 75% or more of the benefit of anti-depressant medications stems from the placebo effect also raised the possibility that the remaining 25% of the benefit also might come from the placebo effect, due to side effects. When patients were on placebos and did not experience adverse side effects, they suspected they were receiving placebos and this probably did not get the full placebo benefit. When painful side effects are present, they are more likely to think the treatment is effective. Perhaps this explains some of the religious appeal (?) of flagellism. In terms of LDS confession by someone with serious sins, the painful consequences imposed by a bishop such as temporary probation, restrictions on membership privileges, or even a disciplinary council (as loving as they can be) may have the benefit of adding a “painful side effect” to the treatment to help the person feel that there is an actual treatment being applied that should help.
I absolutely believe in the divine power of the Atonement, the miracle of divine forgiveness, and the divinity of the Priesthood – but there may be some aspects of the human administrative actions at the Church level that also aid and strengthen the penitent person through means that may be partially interpreted in light of the placebo effect. This is not to say that sinners will get the same benefit by confessing to roommate or imposing self-discipline. The Priesthood is real, and God has revealed the proper channels for us to deal with serious sin. The issue I raise is whether internal mental processes akin to the mechanisms behind the placebo effect might contribute to the benefits that one can experience when going through formal repentance processes in the Church. I suspect the answer is yes.
The Hawthorne Effect
Having discussed the placebo effect on individuals, let’s turn our attention to a related phenomenon for groups or organizations, the Hawthorne effect. According to this effect, the productivity of people improves when attention is paid to them and they believe that the efforts of management or others are designed to help them. The Hawthorne effect is commonly expressed as the tendency for performance to improve when people know that the performance is being measured, though measurement alone won’t improve performance unless efforts are taken to make the people being studied feel important. The mere act of selecting someone for training or for participation in a pilot program can make them feel important and put forth more effort, regardless of how helpful the training or pilot program is.
A common expression of the Hawthorne effect is the tendency of a change implemented in an organization to lead to temporary benefits, regardless of the inherent value of the change. This helps explain some of the popular anecdotal evidence for improved learning when some education “reforms” are implemented, even when long-term studies show that some of these reforms do not help or even hurt (for example, I have argued that block scheduling in secondary education is an example of such an adverse fad). Thus, almost any change might lead to a temporary gain in some measures of performance, as long as participants are told that it’s helpful and attention is paid to their performance (e.g., they know that their performance is being measured more closely than before).
If you’d like to try the Hawthorne effect yourself, tell a class of students about the “Wisconsin Education Miracle” and inform them that by wearing cheesehead hats in class for a week, they may be able to remember science and history better than before. Give them each a cheesehead class, measure their performance, and bingo – I’ll bet they all feel like they learned more during cheesehead week. You might even have grateful parents gush about your brilliant teaching techniques. With luck, cheesehead education will become part of the “No Student Left Behind” program, and I’ll be able to quit my day job and cash in as the nation’s leading cheesehead hat consultant for K-12 and beyond.
The difficulties raised by the Hawthorne effect for organizations is treated briefly by Richard Farson in his fabulous little book, Management of the Absurd: Paradoxes in Leadership (New York: Simon and Schuster, 1996). Chapter 22, “Everything We Try Works, and Nothing Works,” deals with the paradox of even deleterious changes seemingly bringing good results. It leads to a lot of bad programs being implemented by managers who mistook the boost from the Hawthorne effect as a validation of their program or their leadership style or a consultant’s quackery. Farson concludes (p. 121) that “Lasting [positive] change comes only from adoption of sound management principles that are practices on a continuing basis. There are no quick fixes.”
I think the Hawthorne effect may come into play in a church when there is a change in leadership, programs, policies, or other factors. Implement some new way of promoting home teaching, let the leaders and the members know that it is being tracked, and it just might increase. At local levels, I’ve sometimes seen some questionable decisions made or arguably suboptimal programs implemented on the basis of a boost in measured performance from a pilot study. I’ve also wondered about the emphasis on numbers that we sometimes see: if home teaching statistics are given great importance by leaders, and people know that their performance is being measured, we might see the numbers jump, without a corresponding actual improvement in Christlike service. But I would agree that for the most part, higher statistics ought to mean that more people are being visited and more good is being done, so I don’t want to criticize the value of the statistics, and recognize that they are helpful indicators, as long as they are not means unto themselves.
Bottom line (sorry I rambled so much on this post!): the placebo effect in its various forms is a real effect with applications to our religious lives and ministry to others. Understanding its impact may help us to better understand the importance of charity in helping to strengthen the physical, mental, and spiritual facets of other human beings. Understanding its organizational sister, the Hawthorne effect, may also be helpful, especially for Church leaders.
And hey, if you’re like me, you’ll want to enjoy the benefits of placebos in your own life by taking daily placebo supplements. I make mine from chocolate, when available.