“Very Dramatic”: Healing, Teaching, and the Placebo Effect

Roanne Kantor // Once again, I am in the midst of teaching a medical humanities course to a group primarily composed of pre-med students. Even though it’s quite distant from my original training, I’ve taught this course more than any other since leaving graduate school. Whenever I work with this population, I think of my own erstwhile aspirations to do something practical with my life, something useful, by which I—coming from a family full of doctors, nurses, and other medical professionals—always meant something related to healing. But, as I discovered early on, I lack even the most basic natural talent for medicine or public health. So, here I am, a supremely impractical professor of English. 

When I think about what made my current field a consolation to my dashed hopes in medicine, I have often thought about what healing and teaching might have in common. Usually, I settle on the idea that both are vaguely pro-social, meaning that making people healthier or better educated produces a net good in the world. (It is this shared interest in social good that I explored earlier this summer in the idea of “Fellow Feelings”.) But recent bedtime reading has given me another idea: what if the operational connection between teaching and healing is drama?

This week, The New York Times Magazine ran an article asking, “What if the Placebo Effect Isn’t a Trick?” Beautifully summarizing research from a number of different fields, the article suggests that we have been thinking about the concept of placebo all wrong. Science has used it merely as a comparison set, a baseline from which to prove the efficacy of another intervention. It has therefore ignored the healing potential of the placebo effect itself, and how it might be harnessed within allopathic medicine. The article then goes on to profile a pair of scholars working on the problem at Harvard. One of them, Kathryn Hall, recounts her own experience with a powerful placebo effect from acupuncture. It wasn’t just the little pins that made an impression; rather, the whole set up of the encounter, including the acupuncturist climbing onto the table with her, “was very dramatic.” Hall began to wonder if “maybe the drama itself had something to do with the outcome.” Her research now explores the way that healing is produced not just through pills and injections, incisions and sutures, but through the doctor-patient interaction in its totality. She had transitioned, in a sense, from molecular biology to dramaturgy.

That got me thinking about my own recent interaction with the power of drama.

The location: a three-day Course Development Institute offered by my new university.

The dramatis personae: myself and a new colleague, a theatre director named Michael Rau.

The scene: a peer review of proposed assignments for a new course.

Before embarking on our reviews, we had been duly instructed to make a clear connection between our learning goals and the work at hand. The watchword was transparency: students needed to know at all times the rationale and ultimate purpose of the exercise in order to really “buy in.” Imagine my surprise then, when Michael presented me with the most baffling assignment I had ever seen. Students were tasked with producing a short performance with no prearranged script, but organized around a long list of seemingly random, utterly unrelated but totally mandatory elements like “a passionate kiss” and “an excellent use of depth.”

What, I asked him with some umbrage, is the point of all this? What even qualifies certain uses of depth as “excellent,” while others are only mediocre? Turns out he had an answer for that. Each of these seemingly random elements exemplifies a way that stage direction can create or enhance meaning in a performance. Why not just tell them that, then? Why not say from the beginning that the point of the exercise is to develop a repertoire of staging techniques? Because, Michael explained to me, they learn it differently by muddling through. It’s like a butterfly struggling out of its chrysalis, or a chick from its shell. The struggle itself is pedagogical. They have to go through a process to gain the insight, or they’ll never get it at all.

This I understood. How often, I thought, had I intentionally led my students down one avenue of interpretation, only to stop them short with a question designed to turn everything on its head. How many times had I arranged a discussion so that that it moved slowly but inexorably from light and humorous “rising action” to an intensely serious “climax.” How often have I, too, held back the real purpose of an exercise until halfway through, prompting students to “discover” the point for themselves? I always assumed I knew the purpose of this arrangement: it’s more fun. These forms work for us for the same reason they work in the material we study—they prick and hold our attention, and give, perhaps, a bit more memorable shape to the baggy knowledge we’re trying to convey. But what if drama also works as a placebo in the classroom: an element of learning in itself, in the way that it seems to be an element of healing?

Placebo helps explain, too, my own impact on the classroom. Two years ago, I had the dubious pleasure of running a “natural experiment” when for one semester I taught alternating days at Harvard and Boston University. Teaching the BU students was quite a bit harder. This was not, as I discovered, primarily a difference of innate talent. Yes, Harvard is more elite, but the distinction between student populations in two reasonably competitive private schools is not as stark as either population might wish to believe. I was, moreover, far from the only instructor to have taught at both institutions—in that sense the educational experience was precisely the same.

Instead, the most salient difference between these two groups was their belief in me as their instructor. My BU students thought I was pretty run of the mill—just as they tended to think BU was pretty good, but not great. Their performance in class reflected this somewhat attenuated faith in my ability to make them better writers. My Harvard students, on the other hand, really believed they were getting the best education in the world. They believed, by extension, that I was an exceptional teacher—because what other kind of teacher could have made it to the front of a Harvard classroom? And so they learned. A lot. Their faith in the pill of my presence ensured it.

To me it seems that these insights about placebo follow the the best interdisciplinary research—they cut both ways. There is a lesson for the way that healing might draw on the powers of plot and drama—we call that narrative medicine. But there is a lesson, too, for us on the humanities side. The “emplotment” of our classes, and our own presence at the head of them, are a dynamic part of learning. Our practice requires and engages our students’ faith, not just their rational minds. This effect might be thought of as “false” in that it does not inhere in the content of the course. But it is no mere “trick”—the effect is real, and we would do well to harness it.  

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