The Placebo Effect

Many people have heard of The Placebo Effect. It is a remarkable medical phenomenon in which a placebo, an inactive substance, can sometimes improve a patient’s condition simply because the person has the expectation that it will be helpful.

Skeptics in many fields cite “The Placebo Effect” to demolish evidence of good and benefit in fields where they have no knowledge or expertise. For example they would say that healing stones have no active properties, so can not possibly work. But empirical evidence is against them; so how do people feel better, or even recover? Well of course “That is the Placebo Effect!” comes back the smug reply.

Why do we need to know about The Placebo Effect?

In coaching, we often use whatever comes to hand to enable our clients to achieve their objectives; Milton Erickson would have called that utilization. By understanding what is happening with the placebo response we can better help the people we work with. What better reason can there be than that?

What the medical experts say

It has been shown in medically supervised tests that placebos have measurable physiological effects. For example, when participants are told they have taken a stimulant, the placebo tends to speed up pulse rate, increase blood pressure, and improve reaction speeds. Placebos have the opposite physiological effects when participants are told they have taken a sleep-producing drug.

Humans have the potential to respond to the suggestion of a healer or coach, or even a caring parent. A patient’s distress may be relieved by something simple like being told “You can feel it getting better”. A familiar example is Band-Aid put on a child. It can make the child feel better by its soothing effect, though there is no medical reason it should do anything.

Many experts question the use of cough medicines because clinical trials have not found that cough medicines are any better than a placebo or dummy treatment. However, there is a massive industry that manufactures, markets and sells cough treatments. Who is right and who is wrong? It depends on your point of view.

How do we use The Placebo Effect

After some careful and protracted analysis, I realized that as coaches, therapists and parents, we use the placebo effect frequently. Sometimes we use it consciously, like the Band-Aid on a child; we do not believe for a moment that there is any magic ingredient in a plaster. At other times without conscious thought, when we give good luck charms as presents.

We use metaphors to elicit desired states in people, and get them to imagine the outcome they want. Sometimes we make those metaphors link to actions or things in the real world, so they have some tangible artifact as their focus. Like my magic stones.

What Magic Stones?

Around my home and office I have a number of magic stones, which I sometimes refer to as healing stones. They are usually river rounded and smooth, and have been collected on my travels round the world, or from the local DIY store. Suitably washed and sterilized, they lie waiting for their moment in someones life.

If someone comes with a particularly intractable problem and needs a shift in focus, I ask them to select one stone out of a choice of three. I then tell them the story of that stone, and weave it into a metaphor, relating to their particular problem. By focusing on the stone, they allow the metaphor to get to work on their unconscious. Finally we layer in some positive emotional states, and anchor them in the feel of their chosen stone.

It works because we have something external to focus on while the metaphor is building in the mind of the subject. Instead of an internal dialogue about how this could not possibly have any positive effect, there is just concentration on the nice smooth stone. We have bypassed the critical faculty which gets in the way of progress.

When they leave, they take the stone with them as a quick and easy way to re-trigger the metaphor and their positive states.

These healing stones have worked for people quitting smoking, overcoming anger and lowering blood pressure. There are another group of magic stones which work for people with performance anxiety, interview nerves and fear of public speaking. Finally there is a special group of stones which help athletes, artist and musicians achieve their full potential.

Of course, we now know that it is the placebo effect at work. There can be no other explanation possible. Or is there?

What If The Placebo Effect is really something else

What if human beings were actually capable of doing and being more than current medical science and physics accept is possible.

Imagine that your vision could be improved by conscious will alone. Imagine that your hearing could be made more sensitive or discerning by your own actions. Imagine that if you took charge of your life that you could control pain, or the way you feel, or physiological factors like blood pressure, heart rate, or weight.

Maybe all that is needed is for someone to give us a sugar pill, or talisman, or magic stone and tell us that we are now healing. Maybe that is all we require to disregard the medical and scientific dogma and rhetoric; that we can only get better by the products of multinational pharmaceutical companies.

Maybe the placebo effect is just a name given to the visible part of the unfathomable depths of human potential.

Summary

The placebo effect is a medically demonstrable response by a subject to a suggestion that something is beneficial. The dialogue is between the expert, professional or parent and the subject’s unconscious. The placebo or magic stone is just a way to bypass the troublesome critical faculty. It exists, it works, and it is beneficial. We can ridicule it, ignore it or use it to benefit our clients. It is a matter of personal choice.

Just remember, there are more than a few people in the world who are still carrying a smoothly polished stone in their pocket!

Links about The Placebo Effect

Medical Definition of Placebo effect
Boots WebMD Medical Reference (Cough medicine)

Content updated December 2016, and May 2017.

Every Morning in Africa, a Gazelle Wakes

Remember the old joke about the two explorers on the plain in Africa when they hear the roar of a nearby lion. One explorer quickly starts putting on running shoes, to the amazement of the other. “You must be crazy if you think you can outrun a Lion” says the second explorer. “I don’t need to outrun the lion” responds the first explorer “I just have to run faster than you!”

There is an ancient African proverb. Every morning in Africa, a Gazelle wakes up. It knows it must run faster than the fastest lion or it will be killed. Every morning a Lion wakes up. It knows it must outrun the slowest Gazelle or it will starve to death. It doesn’t matter whether you are a Lion or a Gazelle, when the sun comes up, you’d better be running.

Sometimes when we are faced with change, often perceived as danger threatening, there is a temptation to pull tighter round the metaphorical camp fire circle and wait to see what will happen. This is where comfort and familiarity can be found, and it is easy to associate with other people in the same mindset. There is a facile belief that Lions would not venture into such a safe place.

However if we are in business, this is exactly the wrong thing to do. The initiative rests with with the first one with their running shoes on. When circumstances change in business, when the sun comes up, you’d better be running.

It Could Never Happen Could It?

Once upon a time in a mythical, mystical land, there was an organization that protected the public and did good works to enable people to recover when they lost their way, or fell on hard times, and so become productive members of society. They did their, often thankless, task on the stipend granted by the rulers of the land, largely for the benefit that it brought to society. Nobody in the organization grew rich, but society was a better place.

Because of local and geographical differences, the organization had grown up into local guilds with a strong association with the community. Some guild branches were large, in the cities, and some were very small in rural communities. But regardless of size, they all shared a common aim – to make society a better place.

However, the counters of beans in the royal counting house were bored, and needed something new to focus on. They looked about, and asked if this was the most efficient structure for the benevolent organization. The rulers of the land sought to improve things, consulted their trusted advisers, and decreed that some of the guilds should combine together into larger organizations, in order to make economies of scale.

The affected guilds protested and pointed out that the original arrangements had grown up as a result of local or geographical needs, and would be less efficient. But the will of the rulers was strong, and the amalgamations took place. Cost did indeed rise, but the guilds received no more monies from the counting house, in fact the stipend was reduced. As a result the guilds had to lay off some of the workers, and complete the good works with fewer people, and performance fell.

After much debate, the royal counting house identified that the problem with the amalgamations was that all of the guilds used different signaling and messaging systems, and some of these were incompatible with each other. Of course the different systems had grown up to meet the needs of the original guilds in delivering their good works to the local communities, so suited the way each guild had worked. The advisers to the rulers pointed out that a single system would be much more efficient and so save on the cost of people the guilds needed to deliver the good works.

The guilds protested when they learned of the cost of the new system, however, the rulers knew better, and caused all of the signaling and messaging systems on which the guilds relied to be given to a faceless corporation. Of course the faceless corporation had lawyers and accountants and directors and shareholders, all of whom required payment for their services, so inevitably the costs to the guilds rose. Once again the stipend was reduced by the counters of beans, and sadly the guilds had to lay off more workers, and performance again fell.

The rulers of the land were perplexed by the outcome and sought to identify the reason why the costs had risen, despite the words of the advisers. They concluded that the problem lay with the management of the individual guilds, and so determined that they needed a master guild to oversee them all and show them the way forward. The new master guild employed the very finest analysts and strategist to work on the efficiency problem, and reduce the cost of delivering the good works. They labored together in a magnificent palace near to the rulers of the land so that the rulers could see for themselves the work that was happening.

The analysts and strategist sent out books of rules to which every guild must adhere, and demanded that carrier pigeons be dispatched every month with details of how the guilds were implementing the new strategies. Unfortunately all this regulation increased the cost to the guilds delivering the good works, and the guilds protested, but to no avail.

Since the analysts and strategist in their magnificent palace cost a lot to maintain, the counters of beans in the royal counting house were appalled at the escalating bill for delivering the good works, and lamented the fall in performance. They demanded that something be done to rectify the situation immediately, and proposed that groups of guilds be formed together, based on regional and geographical location. Each guild region would have an overseer who would commission the good works, and withhold payment from any guild that fell short of performance targets. Once again the guilds protested that it was becoming impossible to deliver the good works with all the rules and layers of bureaucracy, but the rulers of the land acted on the words of the advisers of the counters of beans, and appointed the overseers.

In order to ensure that they understood all of the challenges faced by the guilds in doing the good works, the overseers requested that their guilds dispatched carrier pigeons to the regional palace every week. The overseers each kept a staff of administrators and under-managers to process the returns, and ensure that no guild unfairly had their stipend withheld. However the regional palaces, overseers, administrators and under-managers all increased the cost to the royal counting house.

As the information demands of the master guild had not reduced since the implementation of the overseer, soon the guilds were swamped with carrier pigeons for each of the different bodies. Each guild had to divert essential resources from delivering good works into maintaining and dispatching the pigeons, and each had a sizable loft and systems for ensuring efficient dispatch of the messages. Unfortunately the overheads of feeding and housing all the pigeons was costing the guilds dearly, and to make matters worse, performance was still falling.

More and more initiatives were proposed and implemented by the rulers, all without success.

  • The maintenance and cleaning of the pigeon lofts across the land was granted to another faceless corporation, but performance fell and costs increased.
  • Standards were documented by the scribes and applied to every guild across the land, but still costs increased.
  • A proposal was circulated that all the pigeon lofts were to be amalgamated into a single super loft, implemented by one of the faceless corporations, even though the guilds protested that pigeon technology was outdated. The proposal went ahead, but the idea fell down as each guild still needed it’s own loft, and of course costs spiraled.

The counters of beans were in despair, and the rulers of the land squirmed uncomfortably. Something had to change!

At last, the rulers of the land ordered an investigation into the situation, and demanded a solution to the problem of the rising cost of performing the good works. The sun rose and set many times while the seers and advisers proposed and counter-proposed, argued and debated. The only thing that hadn’t been changed was the guilds themselves. They must be the cause of the problem, but how could the good works be delivered without the guilds? The only solution would be to outsource all the good works to one of the many faceless corporations which showed such expertise in delivering magnificent contracts!

Just then, one of the advisers pointed out that the faceless corporations were there to make a profit, so no-one would bid for the contract because of all the bureaucracy, standards, constraints, rules and regulations. On this there was general agreement, so the rulers of the land made a series of proclamations

  • They disbanded the regional overseers
  • They relaxed the rules which prevented the people delivering the good works from using their judgement
  • They removed the requirement for the faceless corporation to dispatch all the pigeons
  • They removed any regulation or standard which would increase the cost for the faceless organization, and so dissuade them from taking the contract
  • They wrapped the contract in all sorts of sweeteners and incentives,

Most importantly, they made it difficult for the guilds to operate on a commercial basis by insisting that they continue to use the obsolete messaging system, dependent on the pigeon lofts.

The night that the magnificent contract was awarded to the faceless corporation, the counting house resounded to joyous singing. The rulers of the land were relieved that they had divested themselves of the problem of delivering the good works to the diverse people in the cities, towns and hamlets. They grasped and shook the hands of the lawyers and and advisers, who had worked so hard to make it all possible. Merriment was unrestrained, until at last everyone retired to sleep, happy and exhausted.

The next morning, all the representatives of the the faceless corporations, who had been acting as advisers to the rulers of the land, slipped silently back to their employers, their work complete. Let the carnage begin.

This is just a metaphor, a story. There are no people, genders, institutions or organizations identified here. Any conclusions you may draw are your own. It is not real, and it could not happen.

Or could it?

A Motivated Person Digs a Hole

I am often asked about the nature of motivation, and whether it is an internal or external phenomenon. In other words is motivate something you do to someone else, or is it something you do by yourself. The answer, of course, is that it depends!

Some people are entirely internally motivated, and need no other impetus to get them going. They are often known as self-starters, and will stand out as having get-up-and-go or some other phrase which indicates internal energy. They are also often can-do people who need little convincing about the merits of a project before they are contributing ideas of their own. If you give a self motivated person a spade and tell them where you need a hole, you had better tell them how deep you want it, or you may find you need to back-fill later!

On the other hand some people seem to be externally motivated, and may appear at first glance to need considerable external management in order to get them going. That does not mean that they are lazy, or in some way less than the self-starter, it is just that they will need a better business case in order to start work. They will also probably need more information about the size of the hole needed so that they can deliver what is required. This is really less about motivation and more about understanding the task in hand.

In practice, people are combination of types, and the ratio may even vary from hour to hour depending on their interest in the subject. Many people will recognize an individual who is keen to get out and polish the car on a Sunday, but less motivated to polish the ornaments on the mantle. Some may even recognize themselves!

To some managers, motivation is something you do to others in order to climb the ladder of success. It almost goes without saying that there is an assumption that the recipient requires the motivation, otherwise why would you even bother to do it. If you can motivate someone, then of course you should. Well no, perhaps not. What is the effect of applying your own model of motivation on an already internally motivation person? What is the cost of providing motivation, in the form of supervision, is that necessary, required, or possibly even counter productive?

A Motivated Person Digs a Hole
A story I sometimes tell, concerns a motivated person who digs holes for a living. As a self-starter, they enjoy digging holes, and work to their maximum sustainable capacity and can do no more. Their unit of productivity in this ideal scenario is one, that is, one person digs one hole in one unit of time, for the purpose of this story a working day. To further simplify things our digger is paid $1.00 per day, which makes the unit cost of a hole $1.00. If you need the motivated person to dig ten holes, you know it will take ten days, and cost you $10.00

Anyway, on a project that needs one hundred holes, the project manager wants the job done more quickly than one person can manage. The motivated digger brings along nine motivated friends, who manage to dig the first ten holes in one day. This costs the project $10.00. However, the project manager thinks it could be done better.

On the next day the project manager promotes the motivated digger to supervisor, with a promise of a bonus for increased productivity, and sets the party to work. The motivated digger uses all their skills, but the day’s output is only nine holes. The project manager demotes the previously motivated digger without paying the bonus, and promotes one of the other diggers. The project manager is not happy that the unit cost per hole has risen to $1.11.

The next day the previously motivated digger sets to work with the eight motivated diggers and newly promoted supervisor. To be honest the heart of the previously motivated digger really is not on the job. As a result the previously motivated digger only produces 90% of their usual day’s total, and the group’s collective output falls to 8.9 holes. The project manager is incensed because the unit cost per hole has risen to $1.12 and he reduces the new supervisor back to digger.

The third day the project manager appoints an external supervisor at a daily rate of $1.10, and sets the party to work. However, with two demotivated diggers, despite the supervisor’s best effort, the total output is only 9.8 holes. Although better productivity than the previous day, the unit costs have risen to $1.26, and the project manager is incandescent.

As a last resort, the project manager instructs the supervisor to personally motivate every digger for the next day’s work. Despite reservations, the external supervisor personally motivates every digger, and spends the whole day visiting each digger and exhorting them to greater effort, but with mixed results. Half of the diggers seemed to be motivated, and responded well to the additional exhortations, and gave 100% for the whole day. Half of the diggers were self-starters who resented the additional pressure and interruption from the supervisor, so only produced 90% of their usual day’s total. Despite the addition motivation, there were only nine and a half holes in total for the day. The unit costs are still too high at $1.17, so next day the project manager fired the external supervisor.

Now in despair, the project manager sat down and began to doubt that the project could ever be completed on time and within budget. Just at that moment a wise old sage happened along the road and asked the project manager what had happened. After a few moments of explanation, the wise old sage nodded and asked the project manager for permission to fix the problem, which the project manager quickly gave.

Picking up a spade from the nearby pile of tools, the wise old sage handed it to the project manager, with the instruction to begin digging in the nearest hole, and whatever the temptation, not to stop digging until the project was complete. Bemused, the project manager wanted to question the instruction, but because of the reputation of the wise old sage, reluctantly complied. The wise old sage whispered something while passing the diggers who had been gathered awaiting instructions, and then wandered off down the road. Even more bewildered, the project manager watched as the diggers started work unsupervised.

Unused to the hard physical work, the project manager struggled with the spade, which seemed to have a mind of its own. Occasionally the project manager noticed that one or other of the diggers seemed to be watching, but remembering the words of the sage, made no comment. At the end of the day the project manager had only completed half of the first hole, however the ten other diggers had completed a hole each, so the day’s total was 10.5 holes.

The next day the project manager set to work with the spade and completed the hole started the sixth day, and then got started on the next one. The project manager again noticed that one or other of the diggers seemed to be leaning briefly on the spade, watching, but as they mostly seemed to be digging, let it pass without comment. By the end of the day, the ten other diggers had again each completed a hole, the day’s total was 10.6 holes.

The next day, the eighth, the project manager almost completed the hole started the previous day, and the diggers had again each completed a hole, despite the occasional glances, so the day’s total was 10.8 holes.

The ninth day, the project manager completed 90% of a hole, and the diggers had again each completed a hole, so the day’s total was 10.9 holes.

On the tenth day, the project manager dug a complete hole as did the diggers, so the day’s total was eleven. Amazed the project manager checked, and all the holes for the project had been completed. The project was finished on time, so the manager thanked the diggers profusely, paid them what was due and waved them goodbye.

As the diggers went on their way, the project manager noticed the wise old sage coming back up the road. Greeting the sage warmly the project manager asked for an explanation of what had happened to motivate the diggers to work unsupervised.

The sage replied that there are three things to know about motivation:

  1. You can’t motivate people, they have to motivate and empower themselves.
  2. Enthusiasm is contagious. If you’re enthusiastic about the job you are doing, it’s much easier for others to be, too. Different people are motivated by different things, but leading by example usually works well, as it shows how keen you are to get the job done.
  3. People are more inspired by your vision than by you telling them what to do

The project manager was starting to understand what had happened, and how the job had been finished in spite if the earlier interference, rather than because of it. As the wise old sage started to walk away, the project manager asked what had been said to the other diggers in passing to keep them working so well.

“Simple!” replied the sage, “I told them that you were so keen to finish the hundred holes that you might do yourself a mischief, so I asked them to keep an eye on you!”

Scurvy Elephants and Childhood Misconceptions

I am a great fan of Dr Wayne Dyer, the respected American self-help advocate, author, and lecturer, and once had the great privilege to listen to him speak at a luau next to his home in Maui, Hawaii. He is a master of recounting anecdotes from his family life, and uses his own experiences as a example. One of my favorite anecdotes from Wayne Dyer concerns his revelations about scurvy elephants, and goes something like this:

Wayne Dyer came home from school one day and asked his mum, “What’s a scurvy elephant?”. She told him she’d never heard of one and asked where he’d heard it. “From my teacher; he said I was a scurvy elephant.” Bewildered, his mother called the teacher and asked what he had meant. The teacher responded, “As usual Wayne got it wrong. I didn’t say he was a scurvy elephant; I said he was a disturbing element!”

I love this story because it reminds me of my childhood and the mistakes I used to make. How many times did I mishear something and jumped to a wrong conclusion. Sometimes I have constructed whole alternative explanations for things and incorporated them into my reality, only to learn much later that I have got it wrong, and the misconception has collapsed. It is part of growing up and reevaluating what is happening around you. You learn from your mistakes and grow as a person. However, I wonder how many other things I have misheard or misunderstood and built into a false reality, but not yet learned the error of my ways.

It also resonates with me as I have been called a Scurvy Elephant (and worse) many times because I haven’t always fitted in to other people’s model of the world. Who is to say who’s view is right and who’s is wrong? Sometimes you just have to have your own opinion and do what you know is right. Wayne Dyer is proud to be a Scurvy Elephant and I am pleased to join him.

If you are not yet sure if you are a Scurvy Elephant and want to find out more, why not click here to visit Dr Wayne Dyer’s website