Is there something that has yet to be better understood that takes place when a patient engages in a course of treatment? According to Milton Cohen, when considering pain there is, “The self-referentiality of living systems (through their qualities of autopoiesis, noncentrality and negentropy) sees pain ‘emerge’ in unpredictable ways that defy any lineal reduction of the lived experience to any particular ‘thing.’

Pain therefore constitutes an aporia, a space and presence that deny us access to its secrets. We suggest a project in which pain may be apprehended in the clinical encounter, through the engagement of two autonomous, self-referential beings in the inter-subjective or so-called third space, from which new therapeutic possibilities can arise.” (Cohen, 2008,pp. 824–834)

What seems to be true in my practice is that if patients are aligned with their choice of treatment, they will engage their mental and emotional energy and commit to its success. Trying to suggest a treatment that is not aligned will not create the same results.

In a recent article, the authors explore the neglected connection between risk benefit assessment and informed consent in which the information communicated to patients can influence treatment benefits and risks. They argue that information disclosure has potentially powerful positive and negative influences on health outcomes. They analyze a study in which they conclude that the “placebo effect” was greater when the patients were positively aligned with the procedure, rather than in the study in which there was uncertainty on whether or not they would get the procedure done. (Franklin et al., 2001)

As has been becoming increasingly clear over the last several posts, the “placebo effect” is a positive health outcome from being empowered and informed. In the next post we’ll look at an example to illustrate the case.