Inspiration and Skepticism

skepticismA very dear and cherished friend is visiting us. She has inspired this post.

Every time we are fortunate enough to visit with her I have an opportunity to wrestle with the dichotomy of faith and inspiration, as opposed to science and skeptical inquiry, that is at the heart of Western medicine.

Carey has vigorously embraced healing and faith. And her enthusiasm for mysticism always calls out my skeptical side. Which leads to many enjoyable debates.

One of the key principles of the clinic where I work is something called evidence based medicine. I summarize that idea this way –

“We try to do the things that we know work before we do things where we don’t know whether they work or not.”

This is a nice summary that sounds reasonable… But one of the things that we know works is faith and inspiration.

Believing in your doctor, or healer, and being offered treatments that fit your view of what is wrong with you have very powerful beneficial effects.

Recently there has been a lot of controversy about whether or not antidepressants work. A series of articles, often written by psychologists, suggest that the effects of these medications are relatively insignificant.

There are two problem with this conclusion. The first is that it seems to fly in the face off robust clinical experience that these medications can be incredibly effective. The second is that it leaves us with relatively few options to help people with serious depression.

The literature on the effectiveness of psychotherapy for patients with more severe depression is even weaker than the literature on medications.

Here’s my quick summary of what all of this means. There are 3 types of medication effects –

  1. beneficial pharmacological effects
  2. harmful pharmacological effects
  3. and faith and hope (also called the placebo effect).

For many treatments, including antidepressants, the benefits of faith and hope are about equal to the pharmacological effects. However, because some people get worse (negative pharmacological effects) the net pharmacological effect is a lot smaller than the placebo effect.

In short term trials, where you combine negative and positive effects into a net pharmacological effect, it is often hard to show that the overall benefit is statistically significant (couldn’t have just happened by chance) when compared with placebo.

In long term use in clinical practice those people who get worse don’t keep taking the medications and so the net effect shifts more strongly to positive.

The point I wanted to make was not so much about antidepressants as about the magnitude of the effect of faith and hope. It is large.

This means that doctors who are better at conveying optimism about treatment are likely to get quite a bit better results.

My dilemma, then, is that my skeptical scientific mind knows that being too skeptical is not good for the people who come to me for help.

So I am always trying to look at things from two perspectives – a skeptical one which tries to avoid exposing people to treatments that turn out to actually have negative effects, and a hopeful side that seeks to inspire in people a sense of optimism that is such an important part of the work of a healer, of whatever tradition.