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Energy healing and the placebo effect.An anthropological perspective on theplacebo effectAnn M. Ostenfeld-Rosenthal aa Department of Anthropology and Ethnography, Aarhus University,Moesgaard, 8270 Højbjerg, Denmark

Available online: 31 Jan 2012

To cite this article: Ann M. Ostenfeld-Rosenthal (2012): Energy healing and the placeboeffect. An anthropological perspective on the placebo effect, Anthropology & Medicine,DOI:10.1080/13648470.2011.646943

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Anthropology & Medicine2012, 1–12, iFirst Article

Energy healing and the placebo effect. An anthropological

perspective on the placebo effect

Ann M. Ostenfeld-Rosenthal*

Department of Anthropology and Ethnography, Aarhus University,Moesgaard, 8270 Højbjerg, Denmark

(Received 14 April 2010; final version received 1 June 2011)

The paper deals with a classical anthropological issue, the workingmechanisms of rituals and the relation between healing rituals and theplacebo effect. The point of departure of the paper is MUS (medicallyunexplained symptoms) patients’ experiences of Danish healing rituals. Theaim of the paper is to develop an understanding of how bodily experiencedimages of body and self work to transform the patient during a healingritual. It is argued that a bodily founded symbolic re-editing of body- andself-image is an essential skill in healing rituals. In conclusion, it is arguedthat the placebo is nothing but the effectiveness of bodily experiencedsymbols.

Keywords: healing ritual; placebo; experience; embodiment; medicallyunexplained symptoms

The cure for the headache was a kind of leaf, which required to be accompanied by acharm, and if the person would repeat the charm at the same time as he used the cure, hewould be made whole; but that without the charm the leaf would be of no avail.(Socrates according to Plato. Moerman and Jonas 2002, 471)

Introduction

A research team under the guidance of Ted Kaptchuk, Harvard Medical School,performed a test with placebo acupuncture on 270 persons suffering from chronicpain. Half of the persons were treated, the other half were given placebo: eitherplacebo pills (half) or placebo acupuncture (half). The conclusion was that realacupuncture had the greatest effect, but also that both types of placebo reduced pain.An interesting finding was that placebo acupuncture reduced pain to a greater extentthan placebo pills. The explanation for this difference is that in acupuncture theperformance of the ritual is of great significance with regard to the effect of thetreatment of pain (Kaptchuk et al. 2006). Further, in a study of self-help ritualsinvolving inert substances, Hyland and Whalley (2008) conclude that doing the ritual

*Email: arosenthal@health.sdu.dk

ISSN 1364–8470 print/ISSN 1469–2910 online

� 2012 Taylor & Francis

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rather than believing in the ritual may be an important factor to account for long-

term placebo effects. But why is this so?This paper is based on a study of MUS patients’ (medically unexplained

symptoms) experience of energy healing1 in Denmark. The author has conducted

fieldwork in 2005–2007 in Denmark. Qualitative interviews were conducted by the

author with 24 healers in their clinics and 19 patients in their homes. Five patientshave been observed in healing situations. The author has gone through several

healing rituals with different healers. Five of the 19 informants were paid to receive

healing to rectify a slightly biased group of informants related to gender. The otherswere chosen by the healers. The author has permission to use the material because of

guaranteed anonymity. A recurring theme in the interviews is bodily sensations

during healing, such as for example the experience of a green colour around the heartand a sense of peace. The case was selected because it is representative of a general

pattern of the material.The paper deals with the relation between healing rituals and the placebo effect.

Understanding the effect or the working of rituals is a classical anthropological issue.The question of how a ritual is able to transform a sick person into a healthy person

is thus central to anthropological discussions about healing rituals. But what is it

that makes the ritual work? This is a fundamental question in this paper.The placebo effect has traditionally been viewed as being situated in the

borderland between mind and body, and also between the social and the natural

sciences. As a consequence, the placebo effect has been difficult to understand from a

dualistic perspective. One of the basic capacities of ritual symbols is precisely theirsimultaneous effect on body, mind, and emotions during the performance of the

ritual (Ostenfeld-Rosenthal 2007). Thus, an anthropological understanding of the

placebo effect and the working of rituals may be two sides of the same coin.Medically unexplained symptoms (MUS) are defined as complaints or physical

symptoms for which no adequate physiological basis can be found (Fink, Rosendal,

and Toft 2003). Examples of MUS could be fibromyalgia, chronic fatigue syndrome,

chronic whiplash, and irritable bowel syndrome. Based on MUS patients’ experienceof healing rituals, the aim of this paper is to develop an understanding of how bodily-

experienced symbols or images of body and self work to transform the patient during

a healing ritual; and also to develop an understanding of the process of what so far iscalled a bodily founded symbolic re-editing of body- and self-image – in other words,

to employ an anthropological perspective to expand on an unsolved problem in

studies of symbolic healing: how changes in symbolic processes are translated tochanges at the level of bodily experience or physiology (Hinton, Howes, and

Kirmayer 2008; Kirmayer 2004). That is, the paper attempts to provide an

anthropological perspective on the ‘placebo’.The paper begins with a brief introduction to different theoretical perspectives on

the placebo effect. This is followed by a historical context for understanding the

connection between belief, meaning, and the body and the theoretical foundation for

the argument: the working of rituals and the connection to the body. Next, the paperpresents a case followed by a paragraph on the pivotal concept of the paper:

‘the bodily-experienced symbol’. Finally, it is argued that from an

anthropological perspective the placebo effect is the same as the effectiveness ofbodily-experienced symbols. The paper concludes with some reflections on the

concept of healing.

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Perspectives on the placebo

The word placebo is Latin and literally means ‘I shall please’. Over centuries, themeaning of the term has shifted with changing medical paradigms and perceptions,from ‘a commonplace medicine’ in the late eighteenth century to ‘a make-believemedicine’ or ‘inert’, or ‘inactive substance’ during the twentieth century (Jackson1999). In 1955 Henry Beecher published an article entitled ‘The powerful placebo’(Beecher 1955) advocating for further investigation on the placebo effect, and sincethen the placebo has been considered to have clinically important effects. It is nowgenerally accepted, that placebo is ‘a poor word for a good effect’ (Olesen 2007); thatit often appears to be a real and significant agent, which is rewarding to investigateand harness (Guess et al. 2002; Kaptchuk 2002; Moerman and Jonas 2002;Papakostas and Daras 2001; Walach 2003). Thus, at present, the concept of placebois being transformed from a sham in medical practice to a therapeutic ally.

The placebo effect has been investigated from different perspectives, for examplepsycho-neuro-immunology and conditioning (e.g. Ader 1997; Fields and Price 1997).Furthermore, the ritual and symbolic aspects of a treatment are attracting stillgreater attention (Hahn 1997; Helman 2001; Kaptchuk 2002; Kaptchuk et al. 2006;Moerman 2002; Thompson, Ritenbaugh, and Nichter 2009). This paper will explorefurther along these lines.

Because of the many differing, more or less useful connotations of the termplacebo, anthropologist Daniel Moerman has argued that we ought to find a newand more adequate term for the placebo. He suggests the term ‘meaning response’,defined as ‘the physiological or psychological effects of meaning in the treatment ofillness’ (Moerman 2002, 78; Moerman and Jonas 2002). Similarly, medical doctorand anthropologist Cecil Helman defines the placebo as ‘any pill, potion orprocedure’ where belief plays an important part (Helman 2001, 5). As also remarkedby Helman, the meaning/belief perspective implies that the placebo is dependent onthe cultural context in which the treatment takes place. For example, part of theplacebo effect in Western settings is the belief in the effectiveness of pills ordained bymedical doctors.

The meaning/belief definitions are very important contributions to an under-standing of what is at stake in relation to the placebo phenomenon. Still, the natureof the connection between meaning, belief, and physiology is unclear. As mentionedabove, ritual symbols have a unique capacity to influence emotions, thoughts, andthe body simultaneously. Consequently, creating a connection between symbols,thoughts, body, and emotions is a potentially promising approach. It will beattempted to draw these connections in the following discussion.

Bodily experienced meaning and creative rituals

One attempt to understand ‘the effectiveness of symbols’ (Levi-Strauss 1968) inrelation to healing rituals has compared it to Western forms of therapy. The meaningperspective in particular has dominated the discussions and is generally accepted.2

However, a one-sided semiotic perspective detaches the sign from its engagementwith lived life and the body, and is thus only able to provide a partial understandingof what is at stake in healing rituals. Recently, several anthropologists who studyhealing mechanisms have called for more research on patients’ sensory-embodiedexperiences as a supplement to the cognitive, conscious-oriented explanations

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(Csordas 2002; Hinton, Howes, and Kirmayer 2008; Thompson, Ritenbaugh, andNichter 2009). One of the effective strategies of energy healers seems to be afoundation in the body. Therefore ‘bodily-lived-experience’, with its character ofhere-and-now-presence, senses, and emotions, might be a fruitful starting point toexplore the working mechanisms of rituals further.

‘Belief kills; belief heals.’ Anthropologists have for a long time held knowledge ofthe effectiveness of symbols, for example in both ‘voodoo’ (nocebo) and shamanisticor faith healing (placebo). It is, thus, common anthropological knowledge, thatsymbols have a real effect on the body, but in line with theoretical orientations of the1970 s the focus has been more or less exclusively on the semiotic and cognitivedimensions of symbolic processes. The problem is, as mentioned, that a one-sidedcognitive or semiotic perspective only gives a partial understanding of the working ofsymbols. That is, leaving out a fundamental element of healing and the placebo – thebody – has prevented the development of a convincing understanding of what is atstake in healing rituals.

In 1983 the anthropologists Hahn and Kleinman took a step towards establishinga connection between symbols and placebo, culture and physiology. They discussedthe interaction between culture and physiology, mediated by the central nervoussystem’s processing of symbolic perceptions in experience. They concluded that

. . .bodies must be understood in the light of the cultural wisdom of societies. (Hahn andKleinman 1983, 16).

The concepts of ‘embodiment’ (Bourdieu 1977) and ‘socio-somatics’ (Kleinmanand Becker 1998) – ‘the fundamental dialectics between the body and the socialworld’ – paved the way for a deeper understanding of the connection between, on theone hand, mind–body and on the other hand culture–society. Consequently, theunderstanding of placebo – as a meaning response – was taken one step further byconnecting it to the body. Continuing these phenomenologically oriented lines ofinvestigation, the paper will expand on the working of bodily experienced symbols inhealing rituals; in other words, on the still unclear connection between symbols,placebo and biology.3

The semiotic perspective on ritual efficacy (and the placebo) has, as already said,been challenged by phenomenology’s emphasis on sensory experience and bodily-lived-meaning. Anthropologist Michael Jackson goes so far as to assert that ‘the‘‘anthropology of the body’’ has been vitiated by a tendency to interpret embodiedexperience in terms of cognitive and linguistic models of meaning’ (Jackson 1983,328). However, as anthropologist William Sax (2010) points out: there is nocontradiction between the semiotic and the instrumental perspective on ritual. Thatleads to a central field concerning healing: the body. The concept of ‘embodiment’ isfounded on the phenomenological assumption that bodily perception is humanbeings’ fundamental approach to the world. ‘Embodiment’ or ‘the socially informedbody’ (Bourdieu 1977) was part of Pierre Bourdieu’s effort to do away with theCartesian dualism. Thus, the socially informed body engages the whole body with allits senses, and consciousness. And it works, not only with the traditional five senses.In addition, the sense of duty, the sense of reason, the sense of the holy, the sense ofhealing, and so on, lies on the backbone (Bourdieu 1977, 124). Bell has developed theconcept of ‘embodiment’ further, exploring the working of rituals from a practice-oriented perspective. She has tried to comprehend how the bodies of participantsbecome restructured during a ritual. An example could be the ritual act of kneeling.

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According to Bell, not only does kneeling communicate subordination to the kneeler,but also, embodying subordination, the act of kneeling creates a subordinate kneelerin and through the ritual act (Bell 1992, 100). Transferred to the domain of healing, itmay be argued that the healing ritual creates a healthy person.4

Understanding patients’ bodily experiencedmeaning and the workingmechanismsof healing rituals has been central for anthropologist Thomas Csordas’s research.Likewise, psychiatrist and anthropologist Laurence Kirmayer has studied the role ofmetaphors in healing mechanisms (Kirmayer 2004). The understanding of body,experience, and meaning in healing rituals in this paper is in line with Csordas,Bourdieu, Bell, andKirmayer: it is intended to complement themeaning perspective bydrawing in the body and bodily experiences and by acknowledging that rituals engagethewhole bodywith all its senses, emotions, and consciousness. It is thus assumed that ahealing ritual has the potential to create a persuasive and transformative image of ahealthy person. And this is because the patient experiences this image or symbol duringthe healing ritual; she is this image, which the ritual postulates. The power of the rituallies, in other words, in what anthropologist Bruce Kapferer refers to as ‘the body asbelief’ (Kapferer 1997), that is to say in the very ritual act.

The transformative capacity and working of healing rituals5 are closely connectedto the fundamental paradox of ritual, its capacity to deal with social and culturalorder and disorder simultaneously (Babcock 1978). This is because from disorderarises its creative and thus transformative power (Ostenfeld-Rosenthal 1999). Ascholar who began to acknowledge the creative potential of ritual was Victor Turner.For example, in his well-known essay ‘Betwixt and between. the liminal period inrites de passage’ he described the liminal phase of ritual as ‘a realm of purepossibility’ (Turner 1967, 95). Turner made a significant contribution to anunderstanding of ritual as a process in opposition to the static Durkheimian viewof ritual inherent in the functionalist tradition and thus for understanding how ritualis able to contribute to a transformation process – a view central for understandingritual efficacy.

Rituals’ inherent paradox is centred on the fact that while disorder may appearduring the performance of the ritual, the performance attempts to re-establish ameaningful order and, at the same time, to undertake a transformation process.Suffering is one of three fundamental ways in which cultural order can be threatened,as Clifford Geertz said. Sickness and illness challenge the order of our world viewand create problems of meaning (Geertz 1973). The capacity of rituals to create orderand to transform is thus essential to the working of healing rituals.

Case

Emma is one of the patients having her healing paid, and her healing was one of thefive healings observed. She is 50 years old, has not tried energy healing before but isslightly acquainted with the New Age healers’ universe.6 For several years she hassuffered from unexplained pains in her legs and walks with difficulty. The followingis a short description of a healing.

After an initial dialogue with the New Age healer, Carina, about her problems,Emma lies down on the couch. Carina moves quickly to Emma’s legs and says:

Try to sense a red colour moving down through your legs and let red roots grow out ofyour feet deep down into the ground. The red colour will strengthen your legs.

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Meanwhile, she moved her hands from Emma’s hips down her legs. After thehealing, Carina tells Emma that the meaning of the red colour and the root chakra7

is about family, home, and economy. Later in an interview Emma says:

The healer thinks my pains are a result of a lost connection to the earth because ofeconomic uncertainty and my sadness that I cannot support myself. That concern haspulled all the energy from my root chakra, so the important thing is to establish thedesire to walk on earth. That is what she is doing during the healing, and I make asimilar exercise at home . . .During the healing I sensed energy paths opened in my legsand roots growing slowly out of my feet. After the healing I’ve actually got less cold feetand I walk a little more up-right. But the psychological effect is probably the biggest.The healing has released energy. I was about to forget my soul, but I’ve got hold of theold cheerful Emma . . .After a healing, it’s like waking up from a long journey . . . I lookat the world with slightly different eyes, there is a little more light and sunshine. It is as ifsomething has been redeemed.

Bodily experienced symbols

If I could tell you what it meant there would be no point in dancing it. (Isidora Duncanin Bateson 1972, 137)

‘What do you think, your body is trying to tell you?’ is a question a healer willoften ask her clients. In the healers’ universe the body is conceptualized as a subjectwith its own ‘language’, and the patients’ experience of the healing process is deeplyrooted in the body. From the interviews, examples of bodily experienced imagesinclude experiencing your bladder as a juicy grape instead of a dry raisin, repairingyour pelvis with mortar and trowel and reaching down to earth and wanting to walkon this earth by letting roots grow out of your feet and into the ground. Such bodilyexperienced images or symbols are assumed to be one of healing rituals’ effectivedevices. But what is a bodily-experienced symbol?

A bodily experienced symbol can be conceived of as a non-verbal symbol, adevice for communicating phenomenological knowledge and meaning. One way toclarify the concept, then, could be to compare it to verbal symbols: words. Unlikeverbal symbols, which are reflected upon, non-verbal symbols are pre-reflected, likethe bricoleur’s tools: open and multivalent symbols halfway between percept andconcept (Levi-Strauss 1966).

To clarify the distinction further, let us return to Bourdieu and his ideas of bodylanguage (Bourdieu 1977). The concept of ‘embodiment’ implies a bodily ‘getting toknow the world’ and this process, he writes, is more basic than the later reflected,verbally socializing process. Bourdieu’s explanation of the difference between bodylanguage and language may shed further light on ‘bodily-experienced symbols’.The language of the body, he says, is more ambiguous and over-determined thanspoken language. It is broader, vaguer and ‘richer’ than words, which render‘falsifiable’ the language of the body. Body language communicates an experiencethat by its nature cannot be put into words (Bourdieu 1977, 120) such as, forexample, Emma’s experience of energy paths opening in her legs.

The bodily experienced symbol, then, could be conceived of as a pre-reflected,pre-linguistic, over-determined and ‘rich’ bodily-experienced meaning.8 However,words are powerful tools, too.9 Sometimes bodily symbolic experiences emanatefrom the client and sometimes, as is shown in this case, the healer creates a symbolic

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image for the client to experience in her body by means of words. So what about thedifference between non-verbal and verbal symbols?

To answer this question, Turner made a useful distinction: he observed that one ofthe characteristics of dominant symbols, which make them effective, is theirsimultaneous containment of a sensory pole of meaning, which connects to naturaland physiological phenomena, emotions and desires, and an ideological pole ofmeaning, which connects to norms and values. During the performance of theritual ‘an interchange of qualities between its poles of meaning’ takes place (Turner1967, 28).10 Take for example the symbol in energy healing of ‘energy dissolvingblockages in the body’. At the sensory pole it would be (the bodily experience of) awhole person, and at the ideological pole it would be the idea of a person free ofblockages. This idea of a symbol containing a sensory (non-verbal) and an ideological(verbal) pole suggests that it does not have to do with a sharp distinction between non-verbal and verbal symbols but with symbols containing both poles. This paper tries totake Turner’s concept a bit further, suggesting that you may speak of one pole beingmore dominant in the performance of the ritual than the other and that depends on thecontext, e.g. whether the symbol is brought into play on the couch or during a talk withthe healer. When Emma lay on the couch, both poles were operating simultaneously,but in the following dialogue the ideological/verbal pole was dominant.

How, then, does the bodily experienced symbol or the sensory, non-verbal pole ofthe symbol contribute to a transformation process? In the first place it is assumedthat experience can be transformed because of the symbolic over-determination and‘richness’, i.e. because of ritual disorder, and thus a possibility of creativity; andsecondly because a bodily pre-reflected experience is our primary perception of theworld, and because of the pre-reflected character of the bodily experienced symbol –halfway between percept and concept – perhaps a very fundamental way of affectingthe body beyond consciousness.

A bodily-experienced re-editing

Medical anthropologists have identified the use of narratives as one of the primaryprocesses of re-creating a meaningful order in the disorder that an illness has broughtabout, thereby reconstituting the world and healing the person.11 However, it is theargument of this paper that the performance of ritual and the bringing into play ofbodily experienced symbols or the sensory pole of a symbol is a very importantsupplement to narrative. The meaning of bodily experienced symbols works ‘underthe skin’ precisely because they are experienced and sensed, halfway between perceptand concept, open and ‘endlessly rich’. The very acts of laying on of hands andtransmission of energy, which are the basic techniques in energy healing, constitute inthemselves powerful symbols with a transformative power and bodily effect in sometraditions of Western societies, e.g. among New Age inspired groups.

Arguing in favour of a medical anthropology of sensation, Hinton, Howes, andKirmayer (2008) discuss the same phenomenon. The activation and modulation ofsensations, they argue, have profound effects in relation to meaning and are the keydimensions of healing. Healing often involves making a sensation invoke a script.The term ‘sensation script’ is suggested ‘to emphasize that the sensation schemaactivated [chosen] upon having a sensation will commonly identify specific socialcontexts or scenarios’ (Hinton, Howes, and Kirmayer 2008, 153) – and that promotes

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positive engagement in life process. They describe the process as ‘scripting’ or‘rescripting’ a sensation. The sensation, then, becomes a key aspect of healing:

. . .the induction of a sensation and its association with certain scripts links positivememories, metaphors, and identity imagery to bodily sensations that support the powerand efficacy of the ritual. (Hinton, Howes, and Kirmayer 2008, 153–4)

The idea of rescripting of sensation is similar to the idea of a bodily experiencedsymbolic re-editing of self and self image. Hinton, Howes, and Kirmayer (2008, 154),however, make a useful distinction between: (1) sensation as a key site of embodyingmetaphor; (2) sensation as a key site of memory making; and (3) sensation as a keysite of self-fashioning. These distinctions are valuable because they shed light on thedifferent aspects of the healing process, for example how Emma’s embodied symbolicexperience of roots growing out of her feet and down into the ground contributed toa process of self-fashioning, a regained desire to walk on this earth and ofremembering the old cheerful Emma.

Other informants have given accounts of sensations of lightness, of flow, of‘coming back home to yourself’ or of ‘a sense of being whole’ during the healing. Suchexperiences are believed to constitute the ritual transformation of body and self bymeans of bodily experienced symbols. This is because a bodily-experienced re-editingof body and self - Thompson, Ritenbaugh, and Nichter (2009) describe the process as‘healthful experiences [that can] carve positively embodied pathways to facilitatesubstantive positive health effects’ – is an essential phenomenon in healing rituals.

Recently, Kaptchuk (2002) has argued that the performance of a healing ritualcan be of clinical significance. Similarly, it is likely that in relation to energy healing,and perhaps in relation to healing in general, the performance of ritual is a veryimportant supplement to narrative exactly because the patient experiences and is thesymbolic images that appear spontaneously or are created during the healing.12 AsCsordas expresses it, the imaginal performance may have a healing effect becauseover time the bodily-experienced images are woven together with the patients’ life-world ‘into a single phenomenological fabric’, and this constitutes a transformationof self and self-process (Csordas 1994, 152). When scholars talk about ‘reframing ofexperience’ (Csordas 1994), ‘the performative placebo effect’ (Thompson,Ritenbaugh, and Nichter 2009), or ‘rescripting of sensation’ (Hinton, Howes, andKirmayer 2008), it has to do with a fundamental phenomenon in healing rituals, witha bodily-experienced symbolic re-editing of body- and self image.

In other words, symbols have a unique capacity: when brought into play in aritual, they conflate body, experience, emotions, and meaning. Turner claimed thatthe use of a symbol initiates something. And that is, furthermore, why they areeffective in healing rituals: they form the basis of rituals’ bodily-foundedtransformative capacity. They activate a process that heals.

And the placebo?

In conclusion, a reflection on the concept of ‘healing’. What is healing? Does itmerely involve the disappearance of a person’s physical symptoms? Or does healinginclude other dimensions as well? Csordas has a suggestion:

. . . [the object of] healing is not the elimination of a thing (an illness, a problem, asymptom, a disorder) but the transformation of a person, a self that is a bodily being’.(Csordas 2002, 3)

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Or in Kirmayer’s words:

At the heart of any healing practice are metaphorical transformations of the quality ofexperience (from feeling ill to wellness) and the identity of the person (from afflicted tohealed). (Kirmayer 2004, 34)

That is, they conceptualize healing as a process. Equally, when informants speakabout their healing, it is also in terms of process. All of which has contributed to anunderstanding of energy healing – and perhaps healing in general – as a process: aphysical, psychological, social, cultural, and spiritual process; a process embracingall dimensions of human life; a transformation of self and ‘self biography’ (Lindquist1997). As Csordas so gracefully puts it, ‘Healing is like planting a seed’ (Csordas2002, 5). And the person planting the seed is the energy healer. She is a midwife tothis process: a bricoleur working with secondary senses: intuition and association;with open and polysemic symbols halfway between percept and concept; with acertain amount of humaneness and all-explaining total universes (Levi-Strauss 1966).

Returning to the question of the placebo, it is important to stress that the placeboeffect is nothing but ‘the effectiveness of symbols’(Levi-Strauss 1968), but it is crucialto emphasize that it is all about the effectiveness of bodily-experienced meaning, theeffectiveness of bodily-experienced symbols. Furthermore, the healers support thepatients in re-making their unmade life-world – also with narrative – but, in contrastto, for example, therapists, their prime tool is the bodily experienced symbol.

Acknowledgements

The author wishes to thank Aase and Ejnar Danielsen’s Fund and the Danish Centre ofKnowledge and Research in Alternative Medicine for funding this project. In the fieldwork,the author has followed a code of ethics similar to that of the AAA; e.g. openness in relation topurpose, avoidance of harm in relation to safety, ensuring dignity and privacy, a guaranteedanonymity, informed consent, and the possibility to withdraw at any moment during thestudy. Thank you to professor Helle Johannessen, associate professor Bodil Selmer and post.doc. Anita Ulrich for useful comments.

Conflict of interest: none.

Notes

1. The form of healing described in the paper would often be conceptualized as New Agehealing. Although some of the informants would hesitate to conceive of themselves asNew Age healers, the term will be used to characterize beliefs and practices of both healersand patients because of some essential common characteristics, e.g. the central position ofthe individual.

2. See for example Dow (1986), Helman (1994), Kleinman and Sung (1979), Levi-Strauss(1968), McGuire (1988), Moerman (1979, 2002).

3. For similar considerations see also Csordas (1994, 2002); Kirmayer (1993, 2004); Hinton,Howes, and Kirmayer (2008); Thompson, Ritenbaugh, and Nichter (2009).

4. With the concept of ‘ritual virtuality’, anthropologist Bruce Kapferer (1997, 2004) made acontribution to the understanding of the dynamics of ritual. Ritual virtuality is ‘adynamic that allows for all kinds of potentialities of human experience to take shape andform’ (Kapferer 2004, 47) such as for example the experience of a healed person. This isan extended discussion, which lies beyond this paper.

5. Discussing the problems of defining ritual, professor of religious studies, Catherine Bell,proposes the term ‘ritualization’, which focuses on how and why people act to privilegesome activities vis-a-vis others with a point of departure in their different motivations and

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interests (Bell 1992, 74). Using this definition, all forms of healing can be considered asritualizations. As noted by Sax (2010) this notion takes the sensory experience and thebody central to the argument of the paper seriously and will be the implicit approach ofthis paper.

6. For further information on this topic see, for example, Ostenfeld-Rosenthal (2011).7. In the healers’ universe, legs and feet belong to the root chakra.8. Discussing a similar topic – dance and bodily movements – Jackson talks of an experience

of blurred boundaries where the possibility to transform experience is significant (Jackson1983, 338–41).

9. For example Vase et al. (2005) argue that verbal suggestion contributes to expectations ofthe treatment and thus to the placebo effect. See also Brody (2010).

10. As a result, the values or images constructed in the ritual are likely to become the object ofone’s emotions and desires. Expectations and desires are powerful elements of theplacebo. See for example Hyland and Whalley (2008); Fields and Price (1997); Thompson,Ritenbaugh, and Nichter (2009).

11. See, for example, Good (1994); Mattingly (1998).12. In a recent review article on RCT placebo Madsen, Gøtsche, and Hrobjartsson (2009)

conclude, that ‘whether needling at acupuncture points, or at any site, reduces pain,independently of the psychological impact of the treatment ritual, is unclear.’ Perhaps wedo not necessarily have to do with an either/or but a both/and.

References

Ader, Robert. 1997. The role of conditioning in pharmacotherapy. In The placebo effect. An

interdisciplinary exploration, ed. Anne. Harrington, 1–12. London/Cambridge: Harvard

University Press.Babcock, Barbara. 1978. Too many, too few: ritual modes of signification. Semiotica 23: 3–4.

Bateson, Gregory. 1972. Steps to an ecology of mind. A revolutionary approach to man’s

understanding of himself. New York: Ballantine Books.Beecher, Henry. 1955. The powerful placebo. Journal of the American Medical Association 159,

no. 17: 1602–6.Bell, Catherine. 1992. Ritual theory, ritual practice. Oxford: Oxford University Press.Bourdieu, Pierre. 1977. Outline of a theory of practice. Cambridge: Cambridge University

Press.Brody, Howard. 2010. Ritual, medicine, and the placebo response. In The problem of ritual

efficacy, ed. William Sax, Johannes Quack and Jan Weinhold, Oxford: Oxford

University Press.Csordas, Thomas. 1994. The sacred self. A cultural phenomenology of charismatic healing.

Berkeley and Los Angeles: University of California Press.Csordas, Thomas. 2002. Body, meaning, healing. New York: Palgrave Macmillan.Dow, J. 1986. Universal aspects of symbolic healing: A theoretical synthesis. American

Anthropologist. 56–68.Fields, Howard L., and Donold D. Price. 1997. Toward a neurobiology of placebo analgesia.

In The placebo effect. An interdisciplinary exploration, ed. Anne Harrington, 93–116.

London/Cambridge: Harvard University Press.Fink, Per, Marianne Rosendal, and Torsten Toft. 2003. Udredning og behandling af

funktionelle lidelser i almen praksis. (Diagnosing and treatment of functional disorders

in general practice. The TERM model.) Manedsskrift for Praktisk Lægegerning.

Geertz, Clifford. 1973. The interpretation of cultures. New York: Basic Books.Guess Harry, Arthur Kleinman, John W. Kusek, and Linda Engel. 2002. The science of the

placebo. Toward an interdisciplinary agenda. London: BMJ Books.

Good, Byron. 1994. Medicine, rationality, and experience: An anthropological perspective.

Cambridge: Cambridge University Press.

10 A.M. Ostenfeld-Rosenthal

Dow

nloa

ded

by [

Uni

vers

ity o

f G

uelp

h] a

t 11:

00 1

7 M

ay 2

012

Hahn, Robert A. 1997. The nocebo phenomenon: Scope and foundations. In The placebo

effect. An interdisciplinary exploration, ed. Anne. Harrington, 56–76. London/

Cambridge: Harvard University Press.Hahn, Robert, and Arthur Kleinman. 1983. Belief as pathogen, belief as medicine: ‘Voodoo

Death’ and the ‘Placebo Phenomenon’ in anthropological perspective. Medical

Anthropology Quarterly 14, no. 4.Helman, Cecil G. 1994. Culture, health and illness. Oxford: Butterworth-Heinemann.Helman, Cecil G. 2001. Placebos and nocebos: The cultural construction of belief.

In Understanding the placebo effect in complementary medicine, ed. David Peters,

3–16. London: Churchill Livingstone.Hinton, Devon E., David Howes, and Laurence J. Kirmayer. 2008. Toward a medical

anthropology of sensations: Definitions and research agenda. Transcultural Psychiatry

45, no. 2: 142–62.

Hyland, Michael E., and Ben Whalley. 2008. Motivational concordance: An important

mechanism in self-help therapeutic rituals involving inert (placebo) substances. Journal

of Psycosomatic Research 65, no. 5: 405–13.Jackson, Michael. 1983. Knowledge of the body. Man 18, no. 2: 327–45.

Jackson, Stanley. W. 1999. Care of the psyche. A history of psychological healing. New Haven

and London: Yale University Press.

Kapferer, Bruce. 1997. The feast of the sorcerer. Chicago: University of Chicago Press.Kapferer, Bruce. 2004. Ritual dynamics and virtual practice: Beyond representation and

meaning. In Ritual in its own right, ed. Don Handelman and Galina Lindquist, Oxford:

Berghahn Books.

Kaptchuk, Ted. 2002. The placebo effect in alternative medicine: Can the performance of a

healing ritual have clinical significance? Annals of Internal Medicine 136: 817–25.

Kaptchuk, Ted, William B. Stason, Roger B. Davis, Anna T.R. Legedza, Rosa N. Schnyer,

Catherine E. Kerr, David A. Stone, Bong Hyun Nam, Irving Kirsch, and Rose H.

Goldman. 2006. Sham device v inert pill: randomised controlled trial of two placebo

treatments. British Medical Journal 332: 391–7.Kirmayer, Laurence. 1993. Healing and the invention of metaphor: The effectiveness of

symbols revisited. Culture, Medicine and Psychiatry 17: 161–95.Kirmayer, Laurence. 2004. The cultural diversity of healing: Meaning, metaphor and

mechanism. British Medical Bulletin 69: 33–48.Kleinman, Arthur, and L.H. Sung. 1979. Why do indigenous practitioners successfully heal?

Social Science and Medicine 13b: 7–26.Kleinman, Arthur., and A. Becker. 1998. ‘Sociosomatics’: The contributions of anthropology

to sociosomatic medicine. Psycosomatic Medicine 60: 389–93.Levi Strauss, Claude. 1966. The savage mind. London: Weidenfeld and Nicolson.Levi Strauss, Claude. 1968. The effectiveness of symbols. Structural anthropology. New York:

Allen Lane, Penguin Press.Lindquist, Galina. 1997. Shamanic performances on the urban scene. Stockholm: Stockholm

University Press.Madsen, Matias V., Peter C. Gøtsche, and Asbjørn Hrobjartsson. 2009. Acupuncture

treatment for pain. British Medical Journal 338: a3115.Mattingly, Cheryl. 1998. Healing dramas and clinical plots. The narrative structure of

experience. Cambridge: Cambridge University Press.McGuire, Meredith. 1988. Ritual healing in suburban America. New Brunswick: Rutgers

University Press.Moerman, Daniel. 1979. Anthropology of symbolic healing. Current Anthropology 20, no. 1:

59–80.Moerman, Daniel. 2002. Meaning, medicine and the ‘placebo effect’. Cambridge: Cambridge

University Press.

Anthropology & Medicine 11

Dow

nloa

ded

by [

Uni

vers

ity o

f G

uelp

h] a

t 11:

00 1

7 M

ay 2

012

Moerman, Daniel, and Wayne B. Jonas. 2002. Deconstructingthe placebo effect and findingthe meaning response. Annals of Internal Medicine 136, no. 6: 471–6.

Olesen, Frede. 2007. Placebo. Et darligt ord for en god effekt? (Placebo. A poor word for agood effect?) Manedsskrift for Praktisk Lægegerning 4: 445–54.

Ostenfeld-Rosenthal, Ann. 1999. Poiesis and politics in an Andalusian Marian cult. Ananthropological analysis of ritual, identity and regionalism in a Spain in transition.Aarhus University, Unpublished PhD dissertation (in Danish).

Ostenfeld-Rosenthal, Ann. 2007. Symbolsk healing ‘embodied’. Krop, mening og spiritualitet idanske helbredelsesritualer. Tidsskrift for Forskning i sygdom og Samfund 6: 129–50.

Ostenfeld-Rosenthal, Ann. 2011. Re-enchanted bodies: The significance of the spiritual

dimension in Danish healing rituals. In Body and soul: on Corporeality in contemporaryreligiosity, ed. Ruy Blanes and Anna Fedele. Berghahn Books.

Papakostas, Yiannis G., and Michael D. Daras. 2001. Placebos, placebo effect, and the

response to the healing situation: the evolution of a concept. Epilepsia 42, no. 12:1614–25.

Sax, William. 2010. Ritual and the problem of efficacy. In The problem of ritual efficacy, ed.William Sax, Johannes Quack and Jan Weinhold, Oxford: Oxford University Press.

Thompson, Jennifer Jo, Cheryl Ritenbaugh, and Mark Nichter. 2009. Reconsidering theplacebo response from a broad anthropological perspective. Culture, Medicine andPsychiatry 33, no. 1: 112–52.

Turner, Victor. 1967. The forest of symbols. New York: Cornell University Press.Vase, Lene, M.E., Robinson, G.N. Verne, and D.D. Price. 2005. Increased placebo analgesia

over time in irritable bowel syndrome (IBS) patients is associated with desire and

expectation but not endogenous opioid mechanisms. Pain 115, no. 3: 338–47.Walach, Harald. 2003. Placebo and placebo effects – a concise review. Focus on Alternative and

Complementary Therapies 8, no. 2: 178–87.

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