Journalist Erik Vance talks about his first book, Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform and Heal.

Steve Mirsky:              Science Talk will begin after this short message.

Brian:                         Hey, all. I'm hoping you'll join me in a step back into the past, the past where you, pa, ma, grandma, and grandpappy might head down to the local state fair to enter what was once called a Fitter Family's Competition.

Andrea:                       These were not about athletics. They were held in the name of eugenics. Families would happily line up to be judged on their breeding, just like livestock.

Brian:                         My name is Brian.

Andrea:                       And I'm Andrea.

Brian:                         We're from Base Pairs, the official podcast of Cold Spring Harbor Laboratory. There's some huge, new science that's making his unsettling American history an urgent issue.

Andrea:                       More on that later in the episode. Stay tuned.

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Mirsky:                       Welcome to Scientific American Science Talk, posted on November 27, 2017. I'm Steve Mirsky. On this episode:

Erik Vance:                You can't really guess who's hypnotizable or not, but turns out this guy is. So, he goes right under. I mean he was awake. He was conscious. But he couldn't feel the nurses scrubbing out his wounds. Now this is something we need to understand.

Mirsky:                       That's Erik Vance. He's a freelance journalist who describes himself as "a native Bay Area writer replanted in Mexico as a non-native species." He's a frequent contributor to Scientific American. As a resident of Mexico City, was on the scene to cover the September Mexico City earthquake for us. His first book is Suggestable You; The Curious Science of Your Brain's Ability to Deceive, Transform, and Heal. We're talking about things like hypnosis, false memories, and placebos. We were both at a recent conference and discussed the book.

                                    Give us the general outline of what you're dealing with in the book. I do understand that you come – there's a personal aspect to where you come from this subject from.

Vance:                         Absolutely. Well, thanks. I mean I think this is a topic that really resonates with a lot of different people. The book is called Suggestable You. The premise is that we are all suggestable, gullible, malleable creatures. That really underlines who we are. I wanted to write a book that explored all the different ways that what sometimes what we think is true and what we truly believe is true isn't true.

                                    It started really with my childhood as a Christian Scientist. I didn't – Christian Scientist is a religion that – it's faith healing. You don't go to doctors. I didn't go to a doctor till I was 18 years old. I eventually got into science and then after that, science writing. But I maintained this curiosity about the things that I had seen in my faith healing community growing up.

                                    I always wondered what drove the healings that I saw. I think that's important to realize is that whether you're talking about homeopathy or traditional Chinese medicine or faith healing or any of these sort of – the treatments and the alternative medicine that I talk about in the book, these people aren't crazy. They're doing these things because they work. They make your lives better.

Mirsky:                       Or they appear to work.

Vance:                         Certainly, enough to create a burning curiosity in me as to exactly what's going on. That's really what kicked this all off. It turns out there's actually a couple other former Christian Scientists in this field, scientists that are working on this also. They have the same questions I did which is they glimpse some of these things and that you just – you can't help but wonder what's going on. That led me down kind of a rabbit hole that lasted about five years as I saw sort of the connections between all these things.

                                    The connections in my mind is really – it's suggestibility and it's expectation. That's at the heart of my book is your brain is – at its core, it's a prediction machine. This is something that artificial intelligence people have been saying for a long time. Everything it does all day long is creating predictions and to make life easier and to use the past to apply to the present in order to predict what's about to happen.

Mirsky:                       We don't even need the past. I know – maybe I'm hardwired for it or I've – I have not personally experienced falling off a cliff, but I know not to – I know to try not to do it.

Vance:                         Yeah. My one-year-old baby has not gotten that lesson. So, I think that's also an experience kind of thing because he just crawls off whatever he sees. But this is what our brain does. In the process of doing that, it creates – it's an expectation generator. It creates these expectations. What's interesting about them is when your expectation and reality don't match, sometimes the brain will step in and make expectation reality.

                                    The easiest example of this is with pain. One of my first reporting experiences, I got electrocuted in this chair for half an hour or so. Every time I got a green light I got a small shock. Every time I saw a red light I got a large shock and went back and forth. This is a researcher named Luana Colloca, an amazing researcher at Maryland now.

                                    I got to the point where that red light would go off and I'd be like, "Oh, my god." I mean it was a strong shock. My foot would twitch. On the last round, it felt like maybe the green one had been turned up a tiny bit, it was a harder pinch but not that much. She came in and she said, "Nice job on that last round. We gave you the big one every time."

Mirsky:                       Depending on which color you saw, you felt it differently?

Vance:                         I felt it less and my foot didn't twitch. I mean it wasn't that I was reporting feeling it less. I really felt less pain. It's because I created expectations for what green and red meant. When expectation didn't meet reality, my brain stepped in and released drugs in order to bring down that pain so that it fit with the expected or at least close to what it expected.

                                    That's what's at the heart at a lot of these placebo effects. It's your brain trying to get expectations to meet reality. I think of the brain as sort of a bureaucrat. He's got paperwork to fill out and he doesn't care what happened. He just wants to make sure the paperwork fits.

Mirsky:                       Move down the line.

Vance:                         Exactly.

Mirsky:                       Placebo effect can be so powerful that some patients know that they are being given a – not in a trial, in actual treatments. They know it's not a real drug but it's going to make them feel better anyway.

Vance:                         This is one of the most fascinating parts of the book and there's a lot of fascinating parts in this. It's such a wonderful rabbit hole and I recommend going down it. But there's sort of – the easiest way to describe it is there's two types of placebos that I think we're coming around to. One is a conscious placebo. This is very much based in storytelling and the images that I conjure when I'm telling you about this thing I'm about to do to you. That's a very powerful, important side of things.

                                    But there's also the unconscious placebo. This is often classical conditioning. This is all the times you've taken a pill throughout your life and had them make you feel better. That creates these expectations that you can't stop. So, if I give you a pill and I say, "This is a placebo, there's nothing in this. It is inert." Maybe not you but a substantial number of people will take that pill and feel better because you can't stop that unconscious process. Your body's already going.

                                    That's – there's some really exciting work that's sort of looking at separating the conscious and unconscious placebos and where do they meet and where do they diverge. Karen Jensen's doing that work and it's a really interesting question, because it explains a lot. I mean I had a lot of people who I've talked to say, "Look; I'm not gullible. I don't go in for this kind of stuff, but this supplement really, really works."

                                    It's like, "Well, first of all, yes, you are gullible. I'm gullible. We're all gullible creatures. Second of all, a lot of these things, just because you're rational and you're very skeptical doesn't mean that these things won't work on you, because some of this is unconscious and you can't stop it."

Mirsky:                       Right. To be truly rational, you have to be able to acknowledge and accept that you're going to fall for it because you're wired that way. Like you said, it's almost Pavlovian. Maybe it's completely Pavlovian. I've been taking pills whenever I get a headache for a long, long time. So, if I go through the act of putting the pill in my mouth and swallowing it, even if there's no actual aspirin or ibuprofen in it, just that act might help me get over the headache.

Vance:                         Exactly. This happens to me all the time. I mean having grown up in Christian Science I remember the first time I took Advil. It was like doing the hard drugs. This is like, "Wow, I'm doing – this is medicine."

                                    Since then, I really have sort of an inflated perception of how these things work. But when I got a headache and I'm like, "Oh, my god, I'm in so much pain. I need something." I go into the medicine cabinet. I take out a pill and I get my water and I put it in my mouth and I swallow, I have this, "Oh, thank god."

                                    I don't know if this happens to you. When I ask people in meetings whether or not this happens to them, half people say this happens to them where they, "Oh, thank god." What's interesting about that, I always sort of thought there was a coating on the pill that gave you immediate relief. But no, that pill doesn't kick in for 20 minutes. What you're feeling is a placebo response.

                                    It's important to remember that placebos – yeah, I talk a lot about alternative medicine in the book and faith healing, but it's also on top of active medicines. You have placebos – placebos also are attached to medicines that affect your body and you have the placebo on top of that. That has created a lot of confusion and also a lot of opportunities.

Mirsky:                       Going off on a tangent just a little bit, but I think I'm interested and I think other people might be. Did your family leave Christian Science or did just you leave and what was the precipitating factor?

Vance:                         So, it's interesting. Christian Science has been – well, they're not allowed to actually take census information for how many people are in the church but there's definitely a sense that Christian Science has been shrinking. I think it's – my family is a pretty good reflection of that. All the kids in my family left Christian Science for a number of reasons. Partly, it's committing.

                                    You have to really be committed to religion in order to not take medicine. It's restricting in a lot of ways. No alcohol and things like that. Once the kids had left, I think my mom sort of was not as drawn to it. It's hard when everyone else is out. My dad still holds the religion. I think he still really loves the teachings.

                                    But they – people, they've had to have surgeries. People get older and they need things taken care of. That has been a challenge. My dad's had a few surgeries and my mom's had some surgeries. It's challenging to weigh these things. This is not just in Christian Science.

                                    This is across a lot of society now. How do you balance these natural treatments with going to the doctor and getting something done? I think it's something a lot of people can understand. Christian Science might be one of the more extreme versions of that.

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Mirsky:                       We'll be right back after this.

Andrea:                       Hi, Brian and Andrea here from Base Pairs, the podcast of Cold Spring Harbor Laboratory. Those Fitter Families competitions we were talking about at the top of the show, they were part of a dark time in America when the public became enamored with the pseudoscience of eugenics.

Brian:                         Now, with new gene editing tools like CRISPR being used on the human genome, we risk repeating history.

Andrea:                       Search for Base Pairs wherever you get your podcast to learn more.

Mirsky:                       Now, more with Erik Vance.

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                                    Let's talk about some of the other things that you discuss in the book, one of which is nocebos as opposed to placebos. So, tell us what nocebos are and what's going on there.

Vance:                         A placebo means, "I shall please," when you expect something good to happen to you and it does. It affects your body in a good way. A nocebo means, "I shall harm." That's when you expect something bad to happen to you and, indeed, it does. They're fascinating. They're very hard to study.

                                    Placebo, in the book, I talk a lot about placebo effects on depressed patients and Parkinson's and these different things and pain. The problem with nocebos is you can't go up to a Parkinson's patient, give them a pill and say, "This is going to make your Parkinson's worse." I mean that would just be terrible. You can't do that with depression. You can't give someone a depression heightening pill.

                                    You can do it with pain. So, when you talk about nocebos, really a lot of the work has been focused on pain, kind of like the light experiment I was telling you about where they go and turn on different lights. Because it's – and people will talk about feeling more pain or feeling less pain and you can condition people to feel more pain even though they're not getting any more shock. That's really where a lot of the research has happened, but it's a fascinating, really – there's a lot in there that I think we're going to be learning about in the next few years.

                                    One of the things I took away from that is nocebos – up until now, I think I can say with some confidence that nocebos are more powerful than placebos. They are easier to create. For a placebo, I have to do that training thing where I condition you. For a nocebo, all I have to say is, "This is really going to hurt. Brace yourself, this is really going to hurt." I can create an enhanced feeling of pain in you because we are wired for fear. We are wired to be cautious. So, that's the one thing.

                                    The other thing is when you – like imagine that experiment I told you where you've got the red and the green and you go back and forth. Then, imagine you mixed it up so they no longer corresponded and you're sort of throwing me for a loop. Well, when you do that, what you see is the placebo effect disappears. But if you have a nocebo effect, that continues much longer because we remember this fear of more pain more than we remember relief from or less pain.

                                    So, these things are very powerful and they're very – you can't – they're very hard to shake. So, the question is, "How does this apply to other elements of our life?" A lot of people have looked at diseases that don't seem to have an obvious mechanism and is there a nocebo content.

Mirsky:                       Fibromyalgia or –

Vance:                         Neuralgia. People talk about being sensitive to electromagnetic fields and – what is it – wind turbine syndrome. The important thing to remember, I think, when we get into that discussion is that these things are real. Nocebos are real. This is not a way of saying that these kinds of diseases aren't real and don't deserve to be taken seriously or, god forbid, don't deserve health care. That's a lesson in the book is just because it's emanating from your brain doesn't make it any less real.

Mirsky:                       Right. The pain is definitely real. The origin of the pain is what we're talking about.

Vance:                         It gets down to like, "How do you attack these things? How do you –" if someone has fibromyalgia, they can't leave their home and their life is – I've talked to a lot of people who are struggling with this. It is a serious disease. But we're talking about where does it begin and how can you start to address it. These are the questions that get really interesting, very tricky.

                                    The other direction I go is talking about superstition and even curses. I get cursed by a witch doctor at one point just to see how it affects my expectation. These things can have powerful effects on your body. I mean there's a lot of anecdotal evidence that people can die believing that they've somehow been cursed or that they've somehow been – that there's this extreme nocebo that's hanging over them. This is – it's fascinating and it's kind of fun in the book, but these can also be very serious issues and they can cause mass hysteria and all kinds of things.

Mirsky:                       Let's talk about hypnosis a little bit. People are fascinated by that, and you talk about that in the book.

Vance:                         Mm-hmm. I think hypnosis is one of the most crapped on, fascinating fields in the history of science. I have never seen something so interesting and with so much potential be so denigrated by scientists. It's fascinating. I trace it in the book all the way back to Mesmer and Mesmer is sort of is at the heart of a lot of this stuff, both placebos and hypnosis. For a while, in the 1800s, it was really a very serious – it was kind of all of psychology. It was a very big, important thing that people took very seriously. I don't know. Have you ever read the book Dracula?

Mirsky:                       No. The Bram Stoker original? No.

Vance:                         Yeah, the original. Well, maybe if people have seen the movie, they might know that in the Bram Stoker original, which came out in the late 1800s it was actually the heroes who used hypnosis in order to find the vampire. By the time Dracula came out on the silver screen, it was the vampire who used hypnosis to lure in his victims. That time period, sort of that early part of the century was really where hypnosis took a turn for the worst. It was things like Trilby and all these different very high-profile sort of lousy press that hypnosis got. It was also several very highly respected psychologists sort of turned away from it. It really just took a turn for the worse and never recovered.

                                    One of things that was a part of this was people became convinced that you could sexually assault women using it and that you could get people to rob banks. There was this one guy, a very high-profile case at the time where this guy was hypnotized and then robbed a bank. It was like you can hypnotize people to rob banks. It's out of control.

Mirsky:                       Let me guess. He had been a bank robber.

Vance:                         He was a professional bank robber, yes. No one mentioned it. It was a great defense to say, "Hey, I got hypnotized," without mentioning, "Hey, I've also robbed ten other banks." So, but this captured the imagination of the world. Suddenly, hypnosis became this dangerous thing. It never really recovered from that.

                                    But there are a few scientists working today who see this incredible value that's in there and, despite all of the snickers, they're willing to look at this. One of these guys, David Patterson, at University of Washington, he had this case where he was working a burn unit, a burn – in a hospital. He had this patient who he had these full-body burns. The way it's been described to me, there is no pain that is worse than a full-body burn. I mean I've had women who have had children say, "Childbirth is nothing compared to the kind of pain that you get with these large burns." It's insane.

                                    He was really struggling. David asked him, "Can I try to hypnotize you?" He says, "You can try but I can't be hypnotized." He said, "Okay, I want you to relax." He says, "No, I'm not going to relax." He says, "Okay, I want you to get tense." He says, "No, I'm going to get relax." So, he finally gets this guy to relax.

                                    Turns out this guy just happens to be highly hypnotizable. This is no – you can't really guess who's hypnotizable or not, but turns out this guy is. So, he goes right under. They were able to remove all of his bandages and scrub out all of his wounds. This guy, he wasn't asleep.

                                    He wasn't – I mean he was awake. He was conscious. But he couldn't feel the nurses scrubbing out his wounds. Now this is something we need to understand. This is not something you toss out and just say, "Oh, well the brain's crazy." This could be a tremendous asset for something.

                                    So, people like David Patterson and a few others have doggedly sort of tried to understand hypnosis and tried to see how it can be used in our lives and how it's functioning. In the book, I talk a lot about sort of this process. I often think of placebo as sort of a suggestion for the future. It's a suggestion about, "If you take this, this thing will happen to you."

                                    If that's true, hypnosis is kind of a suggestion for the present. It's – you're walking through a field and the pain just evaporates off your body. It's not the same mechanism. There's a lot of things that are different between the two things but there is that thematic connection.

Mirsky:                       I've been – I've seen a lot of medical situations. I've watched surgeries. I've watched them take blood out of my arm. It doesn't bother me at all. I was visiting a friend in a burn ward and I almost passed out. I had to go outside and sit and get fresh air for a while before I could come back in and sit with him and talk to him, as he blithely talked about what was going on with him and the grafts that he would be getting. I was looking at his exposed skin and it's incredibly intense.

Vance:                         We think about morphine is something that you can just give and it will fix everything, but not everyone actually responds the same to morphine. A lot of these patients, you give them the maximum amount of morphine and they're just – it just doesn't make it any better. This is what's at the heart of the need to understand hypnosis is we need to get away especially with these kind of cases from just dumping morphine. It doesn't work for everybody.

Mirsky:                       Yeah. So, let's also talk about the false memories that you talk about in your book.

Vance:                         So, if placebos are a suggestion for the future and hypnosis is a suggestion for the present, then I see false memories as a suggestion for the past. This is a way and it's a – this is where I kind of took some liberties and I took a little chance for the book because this isn't necessarily connected in the same way that some of the other elements are. But thematically, it feels very much the same. A lot of the scientists who study placebos, privately afterwards, would tell me, "Look, I've been fascinated with false memories. I'm wondering if there's some sort of connection there."

                                    Like I said, we are fallible, malleable creatures and a lot of it has to do with these promises of the future. Well, false memories, you're changing what has already happened. It turns out that false memories - and this has been written about a lot. It's tremendously easy to take something that you believe is true and tweak it. Because when you're remembering something, you're not actually remembering the thing. You're remembering the last time you remembered it.

                                    Some of our best memories tend to be things you haven't thought of in a long time. I have a vivid memory of – well I start the book off with a healing that I had in Christian Science as a young baby. I have a vivid memory of what that night was like when I was sort of passing away and I had this very dramatic healing. I obviously don't remember the real thing.

                                    First of all, I remember seeing myself there, which isn't necessarily an indication that it isn't a true memory. But I remember seeing myself. Second of all, the wallpaper's wrong. All the furniture's wrong. Let's be honest, I was a baby. There's no way I remember this stuff. But it's – I could easily – I could tell you all the details in that room.

                                    This is the way memory is. Memory fills in blanks and you can use that. I talk a lot about Elizabeth Loftus, who's a scientist who has really pioneered this field. She's sort of been able to input all these memories, my favorite of which is during this sort of memory war. She did a study that she was able to convince people that they met Bugs Bunny at Disneyworld and these rich memories of meeting Bugs Bunny, shaking his hand, giving him a lollypop, or whatever you have.

                                    Well, Bugs Bunny is not at Disneyworld. He's Warner Brothers, two different companies. He can't be there. That was sort of her way of saying these really are fake memories. They just can't be real.

                                    It does though – in the book, I profile some people, a woman who had some terrible – well, had a memory come to her through hypnosis that a terrible, terrible injustice had been done to her when she was much younger. Then she lived with that. Then she realized later on that it was actually a false memory. So, she didn't have the memory and then she did have the memory and then she realized it was a false memory. So, it's a very confusing thing to try and grapple with.

                                    It can – people are in prison right now because of false memories. There are people who are suffering who've been estranged from their families. It comes down to hypnosis a little bit. Hypnosis is a wonderful tool and it's important for pain relief and a lot of things, but it's not a tool for accessing memories. You really want to keep those things separate.

Mirsky:                       Am I right in remembering that there have been studies where researchers have been able to implant the equivalent of a false memory into mice?

Vance:                         Yes. Yeah, that was – there's a really great study looking at – and some of the neurobiologists involved in that and being able to implant memories. One of the goals in some of this research is trying to separate false memories from real memories. This is some –

Mirsky:                       Or from regular conditioning.

Vance:                         Right. Then also can we remove memories? Is there a way to – this might be one of the positive sides. I mean can we use the study of false memories to affect PTSD, for example. That was sort of – it's a very early experiment out of Harvard, I think, and it's – but that's where it's getting at. Can we – maybe not erase memories but maybe take away some of their emotional power, destructive power.

Mirsky:                       Potential.

Vance:                         The other thing that ties in at least my experience in some of the rest of the book is false memories don't have to be completely false. They can also be sort of exaggerated. In my community growing up, people would often talk about these instantaneous healings. They had this revelation and the pain just disappeared. Oftentimes, in my experience, it's usually not instantaneous. It's sort of a process. But when you remember it, you remember it as instantaneous.

                                    You remember it as being this like – because we like to create narratives that make sense and are more dramatic. This is throughout false memories. We see that they lean towards more dramatic. "I tried this pill and immediately I felt better." What that does, in addition to making you buy the pill again, it also creates more expectation for the future. So, the next time you will take it, you will be – you are primed to have even more healing. So, there are some interesting connections with other chapters in the book.

                                    I mean belief and expectation, I talk a lot about placebos but we're really talking about expectation and we're talking about this sort of prediction machine of your brain. It affects so many different parts of our lives. So, the last couple chapters, I do talk about sex. I talk about lifestyle. I talk about food. All of these things, athletics, all of these things are also affected by these beliefs.

                                    My favorite thing is when Viagra was first being tested. Of course, I talk a lot about stuff that does not beat the placebo. This is very fascinating. Well, of course, Viagra did beat the placebo. It's an effective drug. You look at the rates would be like 40 percent with Viagra and then 25 or 30 percent with the placebo. It's like, "Okay, well, it works."

                                    But what you never think about is, "Who are those 25, 30 percent people?" Some of these people have like serious diseases that make it impossible for them to get an erection. Yet, when you actually break down the placebo, there were people. It wasn't just the lighter cases. There were also some very serious cases who were able to have sex again because they've been given a placebo pill.

                                    While they weren't – it wasn't as effective as a Viagra, you do have to wonder what's happening with some of those people. This pops up in a lot of different ways. If you give someone an MIT pen, they tend to do better on tests than if you give them a regular pen. There's a lot of different –

Mirsky:                       You mean like a Harvard pen.

Vance:                         Right. [Laughter] Yeah, Harvard pens don't help at all.

Mirsky:                       Or a regular pen. I love the _____.

Vance:                         So, there's all these different ways of suggestion and your brain is constantly looking to see what's going on and how it should be responding to what's about to happen. There's all these ways that you can sort of tweak it. There's famous wine studies. They call them marketing placebos where you taste a wine that's more expensive and it tastes better.

                                    We often laugh at people like that like, "Oh, look how silly they are," but there's a distinct possibility that it actually does taste better, that the price of the wine actually affects the way you experience the flavor. That's something to be taken seriously, I think. I mean this is not nothing.

Mirsky:                       So, when you're selling something, you might want to sell it for $15.00 rather than $10.00 because the user may have a more positive experience having purchased it at $15.00 rather than $10.00?

Vance:                         That is completely reasonable. I think we're not – I'm very curious to see where this research goes, but everyone always talks about Coke and Pepsi. Pepsi regularly wins taste tests when they're blind. Coke regularly wins taste tests when they're not blind. It's silly for us to think that it's – that we're just – that the people are lying or saying what they want to expect. It's possible that Coke really does taste better when you know what it is.

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Mirsky:                       I'll be back in a moment.

Brian:                         Hey, all. Brian here from Cold Spring Harbor Laboratory.

Andrea:                       I'm Andrea. Base Pairs is the podcast about the power of genetic information. With that power comes responsibility.

Brian:                         In our newest episode, we speak with experts like Jennifer Doudna, co-creator of the revolutionary gene editing tool –

Andrea:                       - to find out how to avoid the unscientific traps that gave rise to the American eugenics movement.

Brian:                         Find us on Apple podcasts, Stitcher, Sound Cloud, Google Play, and wherever else you get your podcasts.

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Mirsky:                       That's it for this episode. Get your science news at our website, www.ScientificAmerican.com where you can read neuroscientist Doug Field's article on the search for understanding why electroconvulsive therapy, more commonly known as shock therapy, can actually work. Follow us on Twitter where you'll get a tweet whenever a new item hits the website. Our Twitter name is @sciam. For Scientific American Science Talk, I'm Steve Mirsky. Thanks for clicking on us.

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