Daily Archives: September 3, 2011

nocebo

You probably know what a placebo is: an inert medication, a “sugar pill”; they’re used in clinical trials to give a basis of comparison with the medicine being studied (the patients don’t know if they’re getting the drug or the placebo, and in the best studies the researchers don’t, either, until after).

A common idea people have is that a placebo is something that simply doesn’t and can’t produce effects, and any perceived effect is all in your head. This is not actually true: the placebo effect is quite real – given the right stimulus, the mind actually can cause real improvements in symptoms, and not just self-reported improvements. The placebo effect typically wears off over time, but, then again, so do a lot of drugs. And of course in order for a drug to be considered effective, it has to produce significantly more benefit than a placebo would. (There’s a nice article on the power of the mind in healing in the August 27, 2011 issue of New Scientist, complete with references to several studies published in journals.)

Now, how about something that, instead of stimulating your mind to help heal you, instead stimulates your mind to help hurt you? That would be no placebo! Instead of the great “yes” of healing it would give the great “no” of decline. What would we call it? Hmmm… how about nocebo?

Does that look like a really stupid English-Latin amalgam, a portmanteau of no and placebo? Do you want to say, “No, that’s out of place”? Well, guess what: just as placebo is Latin for “I will please”, nocebo is Latin for “I will harm”. The noc root shows up in words such as innocent, innocuous, and (mutated) noxious.

But who would create such a thing? And who would take a pill that they are told would harm them? It seems senseless, and yet many people swallow bitter pills every day – figuratively speaking. Nocebo usually shows up followed by effect, for the point, in the main, is that negative expectations tend to produce negative results. A therapy is more likely to fail, or to have weaker effect, if the patient expects it to fail.

Oh, and there are those drug trials – it is not only a drug’s positive effects that are measured against placebo; it is also its adverse effects, commonly called “side effects.” Placebos also produce side effects, just as drugs do (and of course people sometimes ascribe unrelated sensations to treatments too). And if a given side effect is produced no more often by a drug than by a placebo, it can be assumed not actually to be caused by the drug’s active ingredient.

Now, this word nocebo – does it seem especially nocent, nocuous, noxious? It begins with no, and that is indeed a strong effect, as it is such a foundational word. I am put in mind of NoHo, a New York neighbourhood north of Houston street (SoHo is south of Houston): it gains for a me a sense of negativity and inferiority from that No, though of course the reality of the neighbourhood does weigh against that.

But aside from that, the word nocebo has a certain sweetness – it is not itself such a bitter pill. It has that lovely sequence of rings, five in various transformations o c e (bent in) b (with a line) o – it just cries out for modernist typography. Its beginning may make French speakers think of noce (wedding); the bo may bring out beau, or a bow, or a guy named Bo. The /o – i – o/ of the vowels brings forth Romeo, rodeo, Oreo, do-si-do, and perhaps torpedo. It also sounds like it should be the name of a city – it has tastes, perhaps, of Nogales and Toledo, among others (there is a Nødebo in Denmark, but the pronunciation of that is somewhat different).

But of course that’s how it tastes to me. You may get something quite different from it – one person’s food is another’s poison, and, yes, one person’s placebo may be another’s nocebo.

alethic

You have reached the river, the lethal river, the river Lethe. All that you have been is behind you, all your memories, the house you have constructed of yourself; ahead is the eternal sunshine of the spotless mind: oblivion. Metempsychosis requires not merely mental lethargy but deletion of the cargo. Be reassured: the erasure is of the chalk, not the board. But you have no choice: you must drink the cup in order to persist; were you not to, you would become nothing but memories.

But what is the real ethic of this? Who is the true you? Is your self the graffiti on your wall, or is it the wall? Are you being turned on the lathe of time in your formation, or are you the hands and instruments that carve? Are the memories mere illusions, a narrative of distraction from being? Or are they the only truth? Are there two mutually exclusive truths? Is a person who has forgotten who they were the same person?

We know, at least, what the ancient Greeks thought: truth and forgetfulness are opposites, just as sleep and intelligence are. “Intelligent” in Greek, after all, is εξυπνος exupnos, “unasleep”. And α a “not” plus λήθη léthé “forgetfulness” gives us ἀλήθεια alétheia, “truth”. And is death forgetfulness? No, lethal comes from Latin lethum “death” and is unrelated. It is rebirth, not death, that requires forgetting.

From alétheia we get (aside from the female name Alethea) our word alethic, a lithe word with its liquid and soft fricative, a word not necessarily for thelemites but one for philosophers and linguists. It refers not to ethical considerations but to questions of truth.

And yet what is truth? How well do your memories truly serve you? You close your eyes only for a moment and the moment’s gone. If someone says you did such-and-such or saw so-and-so last week, past a certain point of specificity you may only say that it probably happened or probably didn’t, or that it must have or couldn’t have. So, too, in reference to things that have not happened, you may talk about whether they could have or could not have; and in reference to determinations of present reality not known from experience, you may talk of what must be the case and what can’t be the case.

All of this is in some sense alethic, but just as we have two parallel universes for the truth of who you are, so too do we have two parallel universes for alethic. You see, in linguistics, the alethic modality is when you make a statement of logical necessity, possibility, or impossibility in relation to the world you are in: “Because every moment of being is an unrepeatable combination of circumstances and time, and change is unceasing, the person you were at time x cannot be the person you will be at time x+y.” “As you may not remain in the past, and as the present instantly becomes the past, you have no choice but to proceed into the future, to be what you were not before.” This is what we know is; by contrast, when you talk of things the way you know they are not or have not been, that is certainly not alethic; it is subjunctive, it is counterfactual.

But in modal logic, the subjunctive mode, the counterfactual mode, is what is called the alethic mode. It is the question not of how things are – they are as they are – but of how things could be, or would have to be, or could not be, if they were otherwise than what they are: “If you could stop becoming, you would never be anything other than what you have been.” “Were you not to drink the cup, you would become nothing but memories.”

So you are at the river, the river Lethe, one of the rivers of Hades, and you have no choice – do you? All your dreams pass before your eyes, a curiosity. Could you make a lithe, graceful, athletic leap, and like Thalia write your own comedy or idyll? Oh, no, your idyll is only an empty idol, an idle fantasy. The truth is what must be, and the truth is that, from where you are now, you must have been what you were, but you must become something you never have been before. You bend to drink from the stream… and then you realize that you are, and always have been, nothing other than a wave in the stream, and your bending is no more than you, the wave, subsiding again, the same water but no more wave, nothing lost but nothing there. The world of the surface versus the world of the substance: parallel universes, Lethe and aletheia. And which is true?