An enactive account of placebo effects.

Summary

Placebos are typically seen as ineffective treatments lacking a known mechanism for their effects, yet they can produce substantial therapeutic outcomes. This paper argues that an enactive conception of cognition—where an organism’s bodily processes, intentional attitudes, and environmental meanings co-emerge as a dynamic system—makes placebo effects intelligible. The puzzle of how beliefs about a treatment can trigger appropriate bodily changes is resolved by viewing mind, body, and world as interconnected rather than separate.

Study at a glance

Abstract

Placebos are commonly defined as ineffective treatments. They are treatments that lack a known mechanism linking their properties to the properties of the condition on which treatment aims to intervene. Given this, the fact that placebos can have substantial therapeutic effects looks puzzling. The puzzle, we argue, arises from the relationship placebos present between culturally meaningful entities (such as treatments or therapies), our intentional relationship to the environment (such as implicit or explicit beliefs about a treatment's healing powers) and bodily effects (placebo responses). How can a mere attitude toward a treatment result in appropriate bodily changes? We argue that an 'enactive' conception of cognition accommodates and renders intelligible the phenomenon of placebo effects. Enactivism depicts an organism's adaptive bodily processes, its intentional directedness, and the meaningful properties of its environment as co-emergent aspects of a single dynamic system. In doing so it provides an account of the interrelations between mind, body and world that demystifies placebo effects.

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