Читать книгу Placebo: Mind over Matter in Modern Medicine - Dylan Evans - Страница 25

If placebos worked for every kind of mental disorder, their power would not be limited to anxiety and depression, but would extend even to the most severe psychoses, including schizophrenia. Is there any evidence that placebos can affect such extreme mental conditions?

In the 1950s, many psychiatrists were unwilling to accept the idea that placebos could alleviate depression, let alone schizophrenia. One German psychiatrist, however, decided to test the idea. Heinz Lehmann picked three of the most mute and deteriorated schizophrenics on one of the back wards at Verdun hospital. He told the patients and their nurses that they were going to try out a new experimental hormone, which was, in fact, just a placebo. The injection site was painted with a disinfectant that left a prominent red stain, and the patients were injected twice a week for two weeks. By the third week, two of the three had broken their silence, and were talking quite sensibly.²²

This study is, as far as I can tell, the only evidence that schizophrenia might be placebo-responsive, and it is not particularly strong evidence at that. For a start, there was no control group, the sample size was tiny – only three patients – and we do not know how long the improvement lasted. We cannot even be sure that the three patients were all really suffering from schizophrenia. Back in the 1950s, diagnostic standards were extremely variable, and the diagnosis of schizophrenia in particular was often used as a catch-all category to deal with any kind of patient whose prognosis was not good. Many people with learning disabilities, personality disorders or even simply unconventional behaviour were tagged as schizophrenics and confined to locked wards throughout Europe and America, where they eventually became so institutionalised that their behaviour mimicked the very diagnosis they had been given. They became mute and withdrawn, just as those suffering from the catatonic form of schizophrenia were supposed to. A vicious circle would establish itself, in which the condition of the patients and the pessimistic views of the nursing staff regarding their recovery became mutually reinforcing. It is not hard to see how, given a change in the views of the nursing staff, this circle could be broken. Perhaps this is what occurred with Lehmann’s patients. If so, it is not really a case of placebos curing schizophrenia.

In the absence of more conclusive evidence, then, it would be premature to pronounce any verdict on whether or not placebos can affect severe psychotic illnesses such as schizophrenia. For the time being, all we can say is that less serious mental conditions such as anxiety disorders and most types of depression do appear to be placebo-responsive. When it comes to schizophrenia, the jury is still out.