The Placebo Effect

Until the 1960s, physicians in the United States could legally prescribe “placebo” on a prescription pad and handed to a patient. It was not unethical to do so. Placebo had long been known to be an effective treatment for various medical conditions. For millennia, physicians new that many of their treatments were ineffective and that many conditions could not be treated. Instead of giving treatments that have some pharmacological properties, which meant they would have some side effects and be harmful in some way, it was viewed as more ethical to give an inert pill, a placebo, which would cause no direct pharmacological harm. The view was that the patient might get some psychological benefit from the apparent treatment. The placebo response involves two major aspects: natural history and psychological expectation. Too much attention is given to the latter and not enough to the former. Clinicians see patients improve, as in acute depressive episodes, due to natural history, but they attribute such benefit to the drugs they use, or their psychotherapeutic relationship. Often Nature deserves the credit, and clinicians need to pay more attention to the natural course of psychiatric illnesses.