Anti-Pathy

"Then, when the rhetorician is more persuasive than the physician, the ignorant is more persuasive with the ignorant than he who has knowledge? - is not that the inference?"
-- Socrates, Gorgias

Placebos are disturbing things. Last night I was reading about them over pizza and beer. They work incredibly well. A huge stack of surveys documents the fact that physicians regularly prescribe placebos for their patients, and that they work just fine. Pharmacists get sucked into the game too, since a prescription that plainly calls for something inert traps them in the middle: they probably can't substitute their pharmaceutical expertise for the doctor's broader medical expertise -- they can't diagnose, in other words -- but they're the ones on the cutting edge of the deceit: they hand the customer a bottle of things that are represented as medicine but in fact have no bioactive ingredient.

The crazy thing is, study after study shows that placebos work. If patients expect that what's in the bottle will ease their pain or other symptoms, then very often those symptoms vanish. And the converse is also true: chemicals that should interact with bodily processes in a defined way are completely ineffective if accompanied by a suggestion or distraction that convinces the patient that the drug won't work properly.

The rub is, even if it works, it's entirely deceitful. Even if the results are better than than what the actual drug would produce, does that justify lying to the patient? Even if you can demonstrate that an actual drug is only effective so long as you enlist the mind, the imagination, the expectations of the patient, you can't escape from the fact that the doctor is fully aware of the fraudulent nature of the transaction. It may work, but effectiveness is not honesty. Isn't that, at the very least, troubling?

I got to thinking about that this morning, because I'm teaching rhetoric in the spring, and throughout the history of human civilization, we've had a love-hate relationship with rhetoric. Socrates couldn't stand the study of it; said it was an inferior art, concerned only with appearances and flattery, and that instead we should concern ourselves with truth, as discovered through dialectic. And he reminds me of a patient saying "Never mind the placebos. I want a real, entirely bioactive drug." It's certainly to be expected that Socrates prefers truth to rhetoric, but it's also far from clear that this insistence gets him where he wants to go.

My take on absolute truth: yes, it exists, but it exists as the sole and exclusive property of God. Its essence is congruence with His thoughts, His pronouncements, His judgments. The quality "true" can be defined as "what God thinks." And I think He speaks to us in true statements. But those concessions land a long way from stipulating that we can understand those truths, act on them, or transmit them to anyone else without distorting them. (Look here and here and here.) Furthermore, plenty of folks have had the truth revealed to them, and have fled from it. As with medicine, sometimes the ways people reshape themselves, the damage they inflict on themselves, puts them beyond the help of the medicine, but a placebo can be the lever to the fulcrum of their expectations, and can dislodge what ails them.

From research, we know that placebos work because people are swayed by the trappings of a medical setting: lab coats, medical equipment, gleaming institutional hallways, etc. They're also emotionally invested: they're in pain, frightened for their lives. And finally, it's well-documented in medical literature that experimental treatments can produce a placebo effect because patients feel a bond with their doctor and want to please her or him. And I'm sure you see this coming: Aristotle categorized rhetorical appeals as logos (the objective, institutional proof that anyone should accept as authoritative), pathos (proof based on emotion), and ethos (proof based on the character or identity of the person doing the persuading). I don't think that's a coincidence.

And then there are the dynamics of resistance and addiction. Antibiotics become less effective as people keep taking them, because the pathogens they target evolve countermeasures that enable them to survive the chemical attack. Pain killers become less effective because the body's chemistry changes, and people develop a physical addiction, a tolerance, to the drug's effects. In the same way, critical, life-changing truths can hit us incredibly hard on the first hearing, but lose their potency and become mundane upon repeated hearings. And far too often, truth is outflanked and contained by clever counter-maneuvering; sometimes by an outside party who is both clever and dishonest, but just as often through our own rationalizing.

In short, I think we romanticize medicine, and I think we romanticize truth. In both cases, I think we mistake our cloud of perceptions for objective features of reality, and we think the milieu in which we move is far more clear-cut and stable than it really is. Healing is in God's hands, just like truth, and I think we concoct ersatz stand-ins for His power because we cannot stand to wait for His time, to face fully our dependence on Him. We swallow medicine so we can pretend that we've taken control of our illness. We pronounce statements true or false so we can feel the Godly authority of policing the quality of knowledge, of sorting fact and error into their categories, even though those pursuits fly in the face of everything we know about our human limitations.

So it's not a question of whether placebos are better or worse than medicine. I think there's not a difference. God heals, and every healing happens by His permission. The same is true of rhetoric and the truth. Rhetoricians have worked through the years to establish the claim that all communication, all human pronouncements are rhetorical, and I've always shook my head impatiently because I thought that diluted the concept out of existence. But now I think they're probably right. It is all rhetorical, simply because truth is a quality that does not, and cannot, come from us. It's all just placebos.