Placebo is sometimes called a sugar pill, indicating that it is medically ineffectual, yet a person given such ineffectual treatment will often have an actual improvement in their condition. 

One key thing with the use of placebo, is that it involves deceiving the person receiving it. For example, before many drugs get into the market, they would surely have to be tested against placebo. And people who are being tested, all would think that they are receiving the drug, though some do not know that they are actually taking a placebo, are serving as the “control group”.

So what’s this “non-blind placebo”? In the 1960s, two researchers published an unusual article “Nonblind Placebo Trial: An exploration of neurotic patients.” Non-blind, i.e. the neurotic patients were told that what they were to take are sugar pills, with no active ingredients in it. Fifteen neurotic participants from a psychiatric clinic were selected, and they each read the following script:

“Mr Doe, at the intake conference we discussed your problems and it was decided to consider further the possibility and the need of treatment for you before we make a final recommendation next week. Meanwhile, we have a week between now and our next appointment, and we would like to do something to give you some relief from your symptoms. Many different kinds of tranquilisers and similar pills have been used for condition such as yours, and many of them have helped. Many people with your kind of condition have also been helped by what are sometimes called ‘sugar pills’, and we feel that so-called sugar pill may help you, too. Do you know what a sugar pill is? A sugar pill is a pill with no medicine in it at all. I think this pill will help you as it has helped so many others. Are you willing to try this pill?” (Park & Covi, 1965)

One of the 15 patients refused to take part. Of the remaining 14 patients, 13 showed signs of significant improvement across different measures. The researchers note that the improvement of 41% found here was greater than the improvement found in previous studies of real drugs, using the same measures.

It might sound ludicrous but this is what has been found. (Definitely have to replicate this study when I get the opportunity). What do you think about this research finding?

It’s all about one’s expectation, this is what I think – what you believe and expect is going to happen. You can be given a sugar pill believing that it will do you good and expecting to get better, or you can be given a world most advanced and expensive pill thinking that it is useless and expecting to get worse. So, no matter what kind of treatment you are receiving, be it drug or psychotherapy or hypnotherapy or counselling, have the belief that you will get better, expect that you will get better – these will definitely help! (Self-fulfilling prophecy!)

Sometimes people ask me what I think is the most important “thing” that can help the patient to recover from mental illness. Many would guess it is the patient’s compliance to treatment, support and love from family members, getting help from the right person/place etc. Yes these are all quite important.

But no, I think it’s the patient’s insight to his/her problems, that’s the most important factor.

First you need to be able to recognise that you have a problem. And then you seek help, and then you comply to the treatment, and then maybe your family support you throughout, and then you learn about your illness and how to prevent relapses. Without insight, none of this is possible.

Yes I have mentioned before that for some patients with no insights to their problems, sometimes family members can put medicine into their food/drink. But do you think family member can consistently and successfully put the medicine each and every time? Do you think they can fully recover after a period of time?  Do you think next time they have a relapse the patient can spot the early warning signs themselves? Do you think family members can be there all the time? Do you think about the consequences if and when the patient finds out?

Many people don’t recognise their problem as a problem, and allow it to worsen. It’s a bit like liver cancer, you don’t feel pain, you don’t see any symptoms, by the time it’s discovered, the cancer could have spreaded quite badly. But what we are talking about here is worse than liver cancer, some people with clinical depression don’t recognise it even until the time they jump down from the building and end their lives – they still think it’s their problems that they can’t cope, can’t face and manage adversity in life. They didn’t see that it could be their hormones, their brain circuits, and that maybe they need help (not on adversity in life), on their mood disorder (and perhaps learning some coping skills and become more resilient), and then they can face all the challenges by themselves again.

One’s insight to their problem affects all stages of treatment. Recognising symptoms of hearing voices as mental illness, recognising the need to seek help, recognising the need to be compliant to treatment, recognising how the illness functions, recognising how to prevent relapses, recognising when to see doctor whenever needed.

So sometimes I’ll tell people, it’s good enough that you recognise it as a problem and that you need help. Quite often this is to people with bipolar disorder (don’t recognise the manic phase as problem, as they enjoy it!), morbid jealousy (insist that it’s the partner that’s unfaithful, not their excessive jealousy and suspicion as the problems), schizophrenia (thinking the voices are real, they are not problems to them), depression (genuinely believing that they are useless, they can’t cope, they are stupid etc instead of seeing those as just negative automated thoughts) etc. Don’t worry too much once you have got the insights, there will be people trying to help you along the way. All you need to do first of all, is to reach out, really.