Having a seven-year old son means an almost endless series of grazes, knocks and bruises. My go-to response is to kiss it better. Even though he is rapidly shrugging off believing in Santa Claus and the tooth fairy (“it’s a tooth mouse mom, fairies don’t exist”), both he and I happily participate in the illusion of magical mommy kisses. But is it an illusion?
For most of these minor injuries mommy kisses do seem to help. The explanation that makes the most sense to me is what researchers refer to as the meaning effect or meaning response:
“We define the meaning response as the physiologic or psychological effects of meaning in the origins or treatment of illness.” (Moerman and Jonas, 2002)
The idea is that because my son trusts me, and finds meaning in the care I provide to him, his body responds physiologically to the kiss. Or as Eric Mead says “Something fake becomes something real”. Advances in neuroimaging help us to understand the mechanisms for the physiological response (Colagiuri et al., 2015) – assuming you need science to convince you of what has been observable for millennia.
The language around the meaning effect is useful because it allows for a broader range of mechanisms than the placebo effect, which occurs, for example, in the context of pharmaceutical trials where sugar pills have the same effect as the “real” thing. In essence, there is a physiological response in the body as a consequence of the patient believing that the pill will heal them.
But because of this context the placebo effect has taken on negative connotations. It is frequently framed as a nuisance, something that interferes with clinical trials, “an error variance to be minimised” (Walach, 2016). But what this paradigm ignores is the quite astounding capacity human beings have for self-healing. The work around the meaning effect signifies a shift in the way that these physiological responses are understood and characterised. Recognising the power of the meaning effect opens up a wide range of opportunities to improve healthcare outcomes.
The research reveals a startling array of examples of where meaning has an effect. Branded drugs have a more powerful effect than non-branded drugs. Injections have more of an effect than capsules, which have more of an effect than tablets. Blue pills are more effective than white pills. White coats make us feel better. Authoritative instructions make us feel better. Manner and language make a difference. Of course they do! I know I want my doctor to look me in the eye, to remember my name, to be kind and gentle. Diagnosis and prognosis, and the way these are delivered, matter. The time taken with a patient matters.
As Moerman and Jonas (2002) note: “The effects of meaning on health and disease are not restricted to placebos or brand names but permeate life.” Our health and our humanity are deeply connected. From birth to death, our journey is one of pain, of healing, of fearing death, of ageing cells. The care we receive should be just as deeply imbued with humanity. I love the #hellomynameis campaign – an encouragement to healthcare workers to take the time to introduce themselves to patients. Abraham Verghese’s TED talk entitled “A doctor’s touch” is one of my favourites – a reminder of the potential power doctors have at their fingertips. A more local example is the app developed at UCT to help doctors cross language barriers.
My GP spends 45 minutes with me when I go to see her. She takes copious notes and reads back over her notes the night before our consultation. We talk about work, childcare, diet, exercise, my sex life, stress, sleep. These are all pieces of my life that help her understand my health. Granted, the luxury of a long consultation is not available to every practitioner nor is the opportunity to build deep, lasting relationships with their patients. But all practitioners have the ability to choose to do what she does: connecting with me as a person not a series of symptoms; acting as the professional equivalent of a dispenser of mommy kisses.
COLAGIURI, B., SCHENK, L., KESSLER, M., DORSEY, S. & COLLOCA, L. 2015. The placebo effect: from concepts to genes. Neuroscience, 307, 171-190.
MOERMAN, D. E. & JONAS, W. B. 2002. Deconstructing the placebo effect and finding the meaning response. Annals of Internal medicine, 136, 471-476.
WALACH, H. 2016. Reconstructing the Meaning Effect-The Capacity to Self-Heal Emerges From the Placebo Concept. Tidsskrift for Forskning i Sygdom og Samfund, 12.
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