The shaman and the spoken placebo
Published on -5/19/2014, 9:15 AM
Gib Valet probably fit into the loose diagnostic category of "delightfully demented."
To strangers, he appeared eccentric or just odd. His friends and relatives were fully aware he was energetically, happily crazy.
Gib was one of those people doctors frequently encounter but less frequently recognize: A guy who needs the doctor's time more than the doctor's medications. Hugs instead of drugs.
Some of his symptoms might've been mitigated a bit by antipsychotic meds, but in return they would inevitably mess him up worse than his disease had.
In his own reality show, Gib seemed pretty happy with the way he was. He could be disappointed or perplexed by the strangeness of the world around him. But he always shrugged off those moments of befuddlement, marshaled his fragmented forces, and resumed his pursuit of life and happiness. He was unaware how lucky he was to have retained his liberty.
Gib was fairly tall, more pudgy than bulky. His broad balding pate topped a round, bejoweled face, upon which was etched a perpetual guileless smile.
When he visited the clinic, sometimes he just needed some personal attention and interaction; people weren't exactly lining up to engage him in small talk. At other times, he felt ill at ease but couldn't say exactly how or why.
We'd chat, and I'd ask him to sit on the exam table for a quick exam. Rarely did anything warrant intervention, but the exam was the intervention.
Any good shaman knows placebos are not limited to sugar pills. A word, a phrase, a gesture, even a sound, can convince a patient that not only are his concerns being respected, but they also have been adequately addressed. Sometimes examinations of healthy people serve just such a placebo function. And, there's nothing wrong with that.
Gib could be vulnerable to exploitation. He was so crazy he trusted people. And seed catalogs.
Each year, eyes wide, he enviously scanned the colorful pictures of beautiful plants he could never grow. He checked off flower, herb and vegetable varieties that impressed him -- and ordered them all.
Some years, that meant seed orders exceeding $400, and back then, that bought a lot of seeds. I don't know if he ever planted any of them.
Predatory relatives and acquaintances also hit him up for "loans" from his disability check, but he managed to get along.
Late one night, I got a call from the ER. Gib had materialized, unhappy though not physically distressed. A brand new delusion had surfaced. Aliens had implanted a device in the back of his head to control his thoughts.
I drove over from home, escorted him from the ER to my more congenial exam room. There was no point in simply asserting his concern was unjustified.
After I conducted a close exam of his head and neck, with appropriate neurological testing, I told him, "I can't find any indication of a skin lesion or scar that would reveal a surgical implantation. We could just follow you and see if anything develops."
This was not sufficiently reassuring, it seemed. I hastily continued, "but we should probably have an X-ray, just this one time, to know how to proceed."
We walked back to the X-ray suite, where I draped him in the heavy lead aprons used to shield against stray rays. I put a film cassette in the vertical holder, positioned him and turned on the machine. As it warmed up, it emitted a series of dramatic clunks, whines and whirs. It did the same as it warmed down -- having released no actual X-rays in between.
This might seem patronizing, and it is. Sometimes docs must act in loco parentis.
Do ends justify means? Is frank deception acceptable if the result is a happier, more functional patient?
Heck, yes. It cost him (and Medicaid) nothing but his time, and no humans were harmed during this production.
I removed the film cassette from the holder and shoved it into a lead-lined wall receptacle opening into the darkroom. The heavy door closed with a deep resonant ka-chunk, echoing the sound of a bank vault or a dungeon door. Very impressive. A placebo sound. High-tech no-tech.
After repeating the process with a second cassette, I seated him in the camera room where he could hear, but not see, the noisy things I did with the processor, opening and closing more heavy doors deep within the darkroom.
When I emerged, I manifest a little perplexity myself. "Gib, it's good news -- I think. I mean, there's no sign of any implanted device, no scar tissue or inflammatory densities, nothing at all even remotely unusual.
"But let's face it, Gib -- it really doesn't matter what an X-ray might or might not show. You are still going to need to be alert -- you own your thoughts, and nobody else has the right to put their thoughts in your mind. You are the one who gets to decide." He nodded vigorously.
"And what we've seen here tonight is that you're very good at deciding what thoughts to think. You had a concern, you took appropriate action, and now you're free of that concern.
"What you need now is a good night's sleep, so you can feel sharp and strong tomorrow."
It seemed to be what he needed. At least, that's what the box in the back of my head said.
Jon Hauxwell, MD, is a retired family physician who grew up in Stockton and now lives outside Hays.