Authors: Benjamin Lorr
My point here is not to
argue one way or another about the usefulness of antidepressants (and there may well be circumstances where they are invaluable). It is to emphasize the enormous positive role the placebo effect can play when we give it room to operate.
In fact, the biggest problem the placebo effect has ever had is its name.
The term comes down to us from Chaucer. Like a liturgical version of those mariachi bands that won’t shut up until they’re paid, medieval “Placebo” singers would march into funerals and bray away, pretending to be mourners in order to get a share of the food and drink. And to this day, the term carries that weight. It is synonymous with “sucker”: sugar pills, saline injections, and kissing a baby’s bruised fingers after they get pinched. A mocking reminder that no matter what our literacy rates are, superstition isn’t dead and the world is still filled with plenty of people who can be convinced into just about anything.
But that’s a problem with the name, not the effect.
The effect is 100 percent real
. And it works on people whether they are Aspergian or avuncular, scientist or clergy. All those depressives weren’t faking their relief. The SSRIs did slash their depression.
It’s just that most of their relief didn’t come from the pill.
In 2005, Dr. Jon-Kar Zubieta examined
the brain scans of men as they underwent a painful injection in their jaw. The screen flared up as the areas of their brains associated with pain response activated. The men were then given a saline placebo and told it might suppress their pain. Results were immediate. Not only did the men self-report feeling their pain lifting, but their brain scans demonstrated a physical response: their bodies began releasing an opioidlike substance associated with painkilling. The saline placebo caused the release of real painkillers in the brain.
To put it another way, belief caused the body to create and release chemicals that stopped the pain.
The effects go far beyond depression
and pain. Over forty-five diseases—from herpes to Parkinson’s to peptic ulcers—have shown clinically significant improvements attributed to a placebo response. Which is not to say the placebo is a panacea. It will not cure cancer. It will not stop a gangrenous infection. But it might alleviate their symptoms as well as any drug.
So think about this again. There is a known, documented, extensively studied effect that involves people’s beliefs mediating positive physical changes on their bodies.
What if it were called the willpower effect? Would we still scorn it?
This is in essence what occurs. Through an act of mind—not related to the physiological efficacy of the substance, therapy, or operation in question—our bodies change. We will efficacy. It is the stuff of miracles, everything a New Age medicine could ever hope for. Even in the briefest survey of the scientific literature we can find evidence for the impossible.
Placebos triggering immune responses
,
lowering heart rates
,
raising energy levels
,
enhancing athletic performance
,
improving sleep
, and
boosting sex drive
.
Sound familiar?
Right now, the placebo is associated with shams because it is dependent
on trickery. It relies on ignorance in the patient, and in most cases diminishes when the subject learns it is not valid. But what if we could train ourselves to turn it on and turn it off? What if we could practice changing our minds? And what if, like almost every other physiological response, with training it could be enhanced?
This, I submit, would be the “yoga effect” as described so many thousands of years ago in the
Katha Upanishad
and developed into a series of physical movements by the Naths in the jungles of India. Yoga is the placebo effect made tangible. It is the steady training of the will to harness the body.
In study after study,
the placebo effect is shown
to grow stronger if the placebo given has side effects or if the doctors in question treat the patients with more “attention and confidence.” Patients see the side effects, feel the doctor’s certainty, and the combined reassurance causes increased efficacy.
And when you compare Bikram Yoga to other exercise regimes or to other yoga lineages, what do you have? Side effects and confidence galore. Rajashree joked at my training that “yoga therapy was medicine without a prescription, healing without a pill.” Which got me thinking, if Bikram Yoga were an FDA-approved medicine, what would go on the warning label?
Bikram Yoga
Side effects may include:
Acne
Weeping
Aches and sores
Sudden weight loss
Occasional puking
Seizure
Hallucination
Irrational bouts of euphoria and/or horniness
Diarrhea
Because what is clear is if you engage in a protracted Bikram Yoga binge, you will experience some very clear, very demonstrable side effects. They will convince you that something profound and active is going on within you.
This would also explain why people in the West, especially the most ardent supporters, become so obsessed with the authenticity and ritual of yoga. The five thousand years of silent open-eyed meditation, chanting, hand gestures, urine drinking, and rigid Sanskrit pronunciations enhance the placebo effect. They enhance our confidence.
This is not to say that the forces behind the placebo effect are responsible for all the benefits of yoga. It is to point out that there is an amazing ability in every human to connect beliefs and thoughts to the physical body on a very deep and nonintuitive level, which yoga draws out. People learn to control their heartbeat. People learn to release endogenous opiates to control their pain sensations.
Processes we think of as
automatic can be brought under something like conscious control.
Ancient yogis realized this and spent years studying it. They discovered this effect and instead of deciding it was sugar pills for suckers decided it was a sign that our minds and bodies were unified. They decided most of us lived in a world of delusion they called
maya,
where we believed these units to be separate. But they also believed that separation was fundamentally artificial and that through yoga we could overcome it.
It can be no accident that the first and most important of the
tapas
was breath control. Respiration is a boundary—at various times during our lives, it is both a reflex action and under conscious control: autonomic and voluntary. Perhaps as focus recedes deep into the brain during breathing exercises we can locate the area of the brain that mediates this control. It is the basis for all yoga practice. The first place to practice manipulating the master switch that all the great yogis—the Tonys, the Eskas, the Courtneys—eventually learn to throw: integrating the voluntary and involuntary, material and immaterial, the union of an individual body with the world surrounding it.
We Are Yogi
Reading about the placebo effect felt like a coming-out party. Janis’s “We are yogi” became a private decree. A cross between a physiological extension of Hamlet’s “nothing either good or bad, but thinking makes it so” and
Ernest Shackleton’s declamation that
he had “pierced the veneer of outside things” as he navigated into Antarctica. It is
Jack LaLanne swimming from Alcatraz in
the 60-degree San Francisco harbor, arms handcuffed behind him with his legs tied via tow rope to a ten-thousand-pound boat. Or Denis willing himself to walk again after his motorcycle accident. It is not a lifestyle or a routine. It is not dependent on heat or a particular series so much as it is an ability to tap into an understanding about human performance. It is every freakish human accomplishment that stuns us into believing some people are really and truly different—walking, breathing superhumans. And then it is listening to those superhumans describe their accomplishments and choosing to suspend disbelief for a second and accepting what they say when they invariably describe it as Luke did of his methadone detox: “The first thing to remember whenever you see someone do the incredible—and this includes incredible suffering—is they have been working at it for a very, very long time and they started from a place very, very close to you.”
It is also, I think, to swear vigilance to the other side of the coin: the critical memory that no matter what heights of accomplishment you ascend, you are precisely not a freakish superhuman, that your normality is what made it all possible, that you are equipped with a body capable of failure and brain driven toward hubris and mistake. That true balance means exactly 50 percent of the time, less is more. That we all have a fulcrum point in our lives we need to identify and study. Negotiating that line is the true edge. The men and women who go over it are lost to us. They may burn bright for a moment, they may amass riches and attract our envies, but theirs is the brightness of the supernova, the flaring right before the collapse, and their trajectory is written as sure as any star into the cold self-absorbed energy of a black hole.
I continue to practice every day, growing stronger Tony Sanchez–style, in the cold of my apartment, in a small space between a couch and a bookshelf. I still sneak off to the hot room every once in a while because I love it. And when I’m there, I do it all just as Bikram would want and burn myself to the ground. Janis has opened his first studio in Latvia. He calls me out of the blue one day to tell me his son was drafted by a pro-hockey team and offers to fly me to Riga to teach with him. Joseph, survivor of a childhood heart attack, wins the international competition in 2011. It is his beautiful asana I am watching offstage in the prologue, his spine in a perfect O. Luke is living in small house on the coast of Auckland with his girlfriend, surfing at sunrise, keeping warm with donated lumber in the evening. Courtney Mace is still my favorite yogi of all time. She recently adopted a three-legged dog named Mona. Sol is still jogging. Still training for successively longer races. He recently tore something ugly in his knee. After the MRI, he decided to rehab it in the hot room. So after an extended hiatus, he’s back to bending again. Esak remains out. He tells me Jedi Fight Club will endure. He tells me he loves Bikram and can’t understand what has happened. He tells me, just like competition, just like pain, Bikram exiling him is a part of him, that he doesn’t blame anyone, that it’s his work. He laughs and tells me he’s excited. It’s all yoga, after all. Now there’s just more to do.
A book like this is a record of a moment. Everyone involved in this project was constantly thinking and refining their ideas, and I take it for granted that none of the representations in here can define the breadth of who they are or the depth of what they stand for. My own ideas about yoga have changed tremendously over the course of just the editing period; in fact, when I look back, the only constant in writing this book has been the generosity and kindness of the people I encountered. Accordingly, a few overdue thanks:
Thank you to the teachers who shared their wisdom and time: Tony Sanchez, Lucas M., Sarah Baughn, L-Like Linda, Esak Garcia, Mary Jarvis, Bonnie Jones Reynolds, Jimmy Barkan, Joseph Encinia, Chad Clark, Jeff Renfro, Eleanor Payson, Dr. Brian Nelson, Dr. Susan Yeargin, and Dr. Santiago Lorenzo.
Thank you to the teachers who shared their kindness and support: Hector, Janis, Jenny, Cristin, Shaina, Vinny, Denis, Fiona, Afton, Brett, Lauran, Chaukei, Karla, Lisa, David, Jessica, Johanna, Anna, Angie, Mike, Monica, Hilde, Ainsley from BYHQ, Yanus from Austin, Susan, Nikki, Roseann from Roseann Wang Photography, Gil from SandowPlus, and Sandy Wong-Sanchez from Baja, CA.
Thank you to the teachers who don’t want to be named due to the nature of this investigation and their privacy.
Thank you to the teachers whom I just can’t thank enough for everything they have done for me: Aiko Nakasone, Troy Meyers, and Courtney Mace. You three defined everything positive about my yoga experience. Everyone should be lucky enough to walk into a studio and find such knowledgeable teachers.
Thank you to Bikram in the cosmic sense of making this all possible.
Thank you to my editor Yaniv Soha, who is graced with almost supernatural levels of patience. To my agent Mike Harriot, who was graced with the persistence to continue reading the query letter for this book even though it was addressed to someone else.
To the whole JJ8 crew. To Ash and Sol. To Mu-shu and Wonton. To Raju and Athas for keeping me drunk. To Dave, Christy, Matt BL, Jon, Joe, Josh, Katie, David A. and David M. To Nad. To secret editor Rachel McKeen. To secret photographer Kenan Halabi. To Josh, Stephen, Scott, Mike, and Matt for making group roadside puking the most enjoyable thing in the world.
Thank you to the staff at the Hudson Diner where I wrote this whole damned thing. To Ramón, Sandra, and Gabi for keeping my coffee warm. To El Patron, Rajiv Choudhury, behind the register. To my little green booth of an office.
To Bushwick Outreach Center. To Bushwick Community High School. For never letting me forget that there is real work to be done in this world with real people. And that, however enjoyable, dithering in a yoga class isn’t doing anything to impact them. To Mike Rothman at Eskolta for tolerating me showing up at meetings sweaty and stretched out.
To Victoria, who puts up with me, and put up with this book. And who in the putting up, made us both better (me and the book that is). Who knows that I love her madly even though I show it in really weird ways.
To my sister Sarah, ’cause she’s the best.
To my Mom and Dad most of all. You’ve always had my back, and I’ve always known it. And that has meant the world.
A Short Note on Folk Singing and the Space Between Solutions