Any sufficiently advanced technology is indistinguishable from magic.—Arthur C. Clarke3
Why, in the most scientifically, economically and socially advanced time in the history of our species, do we seem to be suffering from more depression, anxiety, and psychophysical problems than ever before?
Medicine has defeated most of the infectious diseases that shortened our lives 100 years ago; we are living many more years, with greater access to healthcare. And yet, between 25 per cent and 50 per cent of the problems for which patients now seek help have no evident pathological cause.4
Despite the almost daily promises of medical ‘cures’ and ‘breakthroughs’ in the media, the list of ‘functional’ or ‘somatoform’ disorders is long and seems to be growing. At the moment, it includes chronic medically unexplained pain, irritable bowel syndrome, chronic fatigue syndrome, non-ulcer dyspepsia, headaches, premenstrual syndrome, temporomandibular joint disorder (TMJD), a wide range of autoimmune dysfunctions, and environmental illnesses, such as electromagnetic hypersensitivity, and allergies.
Add to that, the ‘emotional’ disorders, such as depression, anxiety, phobias, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and we can see why the health services are in danger of being overwhelmed, health professionals are becoming frustrated, and patient dissatisfaction is growing.
Lifestyle diseases—sometimes referred to as ‘diseases of civilization’—have taken over from communicable (infectious) diseases as the greatest health risk in the Western world.
These diseases, ranging from asthma and atherosclerosis, through certain forms of cancer, chronic liver, pulmonary and cardiac disease, to osteoporosis, obesity, stroke, and kidney failure, all have a strong behavioral component. In other words, the way many people are living in the ‘civilized’ world is now a major cause of chronic illness and early death.5,6,7
A research paper published by The Lancet points to the fact that diets in many Western countries changed dramatically in the second part of the 20th century, with significant increases in the consumption of meat, dairy products, vegetable oils, fruit juices, and alcohol. At the same time, large reductions in physical activity have been matched by a surge in obesity. An increase in many cancers, including colorectal, breast, prostate, endometrial, and lung, correlates strongly with diets high in animal products, sugar, and fat.
The fact that many people who move from one country to another acquire the cancer rates of the new host country suggests that environmental and behavioral factors are more significant than genetics.8 Furthermore, as increasing numbers of developing countries adopt Western patterns of work, diet and exercise, the incidence of lifestyle diseases is spreading fast.
Smoking, high-calorie fast food, and lack of exercise are expected to cost India an accumulated loss of $236.6-billion within a decade, while the resultant toll of chronic disease—all of long duration and slow progression—will seriously affect people’s earnings.
According to a report jointly prepared by the World Health Organization and the World Economic Forum, income loss to Indians as a result of these diseases, which was already high, at $8.7 billion in 2005, is projected, at the time of writing, to rise to $54 billion in 2015.9
Pakistan faces an accumulated loss of $30.7 billion, with income loss increasing by $5.5 billion to $6.7 billion by 2015, and China, the worst of all countries under review, is expected to suffer an accumulated loss of $557.7 billion. Loss of income will reach $131.8 billion, almost eight times what it was in 2005.
According to the report, 60% of all deaths worldwide in 2005—a total of 35 million—resulted from non-communicable (read, avoidable) diseases and accounted for nearly half the number of premature deaths.
Despite growing insight into the cause (and cost) of the mounting scourge of lifestyle disease, mainstream medicine’s response—to tackle the effect, rather than the cause—is proving singularly ineffective.
However, all this means that many of these diseases and a large percentage of deaths can be avoided by relatively simple changes in lifestyle, including dietary changes; increased exercise; stress management; and early detection of, and response to, fluctuations in health and wellbeing. In fact, an extensive Europe-wide study by Cambridge University researchers clearly shows that comparatively minor lifestyle changes can add a decade or more to the average person’s lifespan.
The study, part of the European Prospective Investigation and Nutrition (EPIC) study, involving more than 500,000 people in 10 European countries, reveals that
A follow-up study at London’s Imperial College has since confirmed that seven relatively simple changes to diet and lifestyle can reduce the risk of dying from any of the major circulatory or respiratory diseases, including stroke and angina, by up to 34%.11
These are:
Further studies confirm that as little as 15 minutes a day spent exercising can significantly reduce the incidence of both cancer and heart disease.12
Physicians are familiar with patients’ resistance to ‘doing the right thing’ (quitting smoking, exercising more, stopping snacking on donuts), however much they are confronted with the challenge to their own mortality. It is therefore understandable that reliance on anti-smoking, fat- and cholesterol-busting drugs, and gastric-band surgery is on the rise, despite the risks and comparative ineffectiveness involved.
Our contention (and, the reason for writing this book) is that human behavior is more easily, and infinitely more safely, altered by the methods outlined in this book than by drugs, surgery, or well-intentioned advice. Our experience is that people’s capacity to program and re-program their beliefs, behavior, and, by extension, possibly even their biology, is far greater than they are usually given credit for.
However, while most sufferers of chronic dysfunctions accept that some kind of change is necessary for their recovery, few, if any, know specifically how to make that change.
Just as importantly, many physicians are equally mystified as to how effectively to help their patients.
Part of the confusion may be simply explained: the reductionist, molecular, biomedical, cause-and-effect model that proved so spectacularly successful in defeating the microbe is failing to address the more complex psychosocial factors responsible for the current rise in chronic disease and early death.
Cartesian Dualism, the separation of ‘mind’ from body, still affects training and research. Although the hunt for ‘causality’ has shifted from germ to gene, and while the prognosis for a number of fairly rare genetic disorders is improving, no gene is likely to be found for each of the scores of medically unexplained dysfunctions with which practitioners and patients wrestle every day of their lives.
Failure to find the cause (what is ‘the’ cause of depression? what is ‘the’ cause of cancer?) means in practice that the focus of treatment falls on the symptom. Therefore, our dependence on the trillion-dollar pharmaceutical industry is growing, and is matched only by the hopes invested in technological innovation as the rescuer of humanity in what is perceived as an ongoing battle with the ‘disease’ of life.
The implication of all diagnoses of ‘functional’ or ‘somatoform’ disorders may be that they are all, or partly, ‘in the mind’. And ‘mind’ is not widely considered a matter of concern for the average medical professional.
Current treatment guidelines offer two main options: psychotropic (mind-altering) medication, and outsourcing the problem to a ‘talking cure’ professional (where these are available). Either way, the integrity of the patient-as-a-whole is compromised, or, Cartesian Dualism is reinforced.
Pause here and reflect on which cultures, aside from Westerners, subscribe to the ‘all-in-the-mind’ explanation for chronic conditions for which no obvious organic cause can be found. As it happens, there aren’t many. The reason? Possibly because they have no ‘mind’ in which ‘all’ can skulk.
English, as it happens, is one of the few languages that has a word for, and, therefore, a concept of, ‘mind’. Other health systems might speak of problems with your energy meridia; chi; prana; humors; spells and evil spirits. Or, they might point to environmental or dietary deviations from what is required by your innate prakruti, or body-type—but almost never of your mind. Even René Descartes, at whom holists (including ourselves, we must admit) continue to sneer for single-handedly creating the mind-body split, never actually said the ‘mind’, as such, was irrelevant, or even separate from the body. It just didn’t figure in the way of thinking at the time.
In his most famous works, Descartes spoke about amê and corps (and, sometimes, anima). Corps was easy enough to understand, but the translators ran into trouble with the French word, amê. The closest English equivalent to both amê and the Latin anima (which he also sometimes used), is ‘soul’. Just about everyone who believes in the concept of an eternal soul would be happy to declare it separate from the finite physical body, even though Descartes himself regarded it as anchored during life to the pineal gland. But, the damage to the deep complexities of human thought and feeling had been done. Body 1, Mind 0.
What was missed at the time, and continues to be missed, is that ‘mind’ is not, and cannot be, an entity in the same way a body can. Nor are the thoughts and feelings, the experiences by which people ‘know’ they have a mind, discrete objects that can be isolated, identified, and studied in the same way as an organ, a germ or a gene.
All experience is process. People attach meaning to process. Meaning, in turn, affects biology. Therefore, any physical experience we have must affect, and, in turn, be affected by, both the physical and the mental, in an ongoing, dynamic feed-back loop.
To suggest that a problem is ‘all in the mind’ reduces process, and, therefore, lessens the possibility of change. It is as useless and as semantically skewed as to say ‘the light is all in the wire’.
Problems increase when we look at the ‘delivery’ of healthcare, as opposed to its application. For various reasons, some of them political, we have entered a period of cost-effectiveness, ‘quality-adjusted life years’, evidence-based medicine, and increasing bureaucracy.
As care becomes increasingly standardized—by the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, and insurance companies in the United States—the personal is giving way to the impersonal, compassion is surrendering to science and practitioners, patients and the economy are all paying the price. Doctors are increasingly required to practice medicine unquestioningly, according to a set of guidelines delivered from sources on high. If they don’t, they can face highly punitive consequences. In our opinion, this is not science; this is theology. Patients’ unhappiness with the care they receive is, in turn, reflected in the growing trend towards litigation.
It should be no surprise, then, that so many physicians retreat behind the barricades of professional detachment, from where they practice an essentially defensive form of medicine that places the effectiveness of the patient’s treatment on the other side of a mountain of bureaucratic obligations, legal concerns, official guidelines, and targets, as well as restrictions on treatment modalities, resources, and time. And no surprise that so many patients are responding negatively towards what they regard as a lack of concern, interest, and sufficient information by emigrating towards ‘alternative’ healthcare, or to the offices of their legal advisors with an intention to sue.
In the first edition of this book, we hinted at the possibility of a crisis engulfing Western medicine. Now, and with no sense of satisfaction, we report our belief that today’s healthcare is already in crisis. An estimated one in 10 patients admitted to hospital in the EU is a victim of medical error. A disproportionately large percentage (a further one in 10) of these accidents results in serious injury or death.13
Figures from elsewhere are even more worrying. According to a report by Dr. Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, medical errors are now the third leading cause of death in the United States, following cancer and heart disease.14
Many researchers believe that the figures for medical errors may be significantly under-reported throughout the world, possibly for fear of litigation.15 Since no effective, mandatory, official system of registration of medical errors, no mandatory root cause analysis, and no systems to prevent the occurrence of medical errors exist in Europe, the figures may be even higher than one in 10. In contrast, motor vehicle accidents have been for decades routinely and systematically registered along with the recording of deaths and injuries.
Various studies blame a number of factors, including work stress in hospitals, limited consultation time, and reduced financial resources. But one of the recurring problems revealed in successive studies is defective communication—between doctors and nurses and their patients, as well as among health professionals themselves. Effective leadership, as well as effective clinical outcomes, is highly dependent on accurate, targeted and mindful communication.
Health professionals, too, are victims of the situation. A large body of evidence shows many doctors suffer high levels of stress as a result of their work, impairing both their health and their ability to provide quality care to their patients. The main sources of work-related stress and burnout among doctors, in both primary and secondary care, have been identified as: workload; the resultant effect on their personal lives; organizational changes; poor management; insufficient resources; constant exposure to the suffering of their patients; medical errors; complaints and litigation.16
We believe both patient and practitioner can benefit from an expanded model of healthcare—the patient by being seen and treated as a ‘whole person’, and the practitioner by having a choice of non-invasive, non-pharmacological tools and principles that, in the consultative partnership, can help to meet that need.
In many ways, this is an idea whose time has come. The Center for Advancement of Health in Washington DC is one of several influential organizations currently lobbying for changes in the approach to healthcare.17 Those organizations, and a growing number of individual campaigners, are broadly in agreement that:
Noble as these sentiments are, it is not enough simply to urge the health professional to begin practicing whole-person healthcare. What exactly is ‘holistic patient management’, and how might it be practically pursued in the context of the medical consultation? Indeed, although we have come to know a lot about disease, what exactly is ‘health’? These are just some of the questions this book seeks to answer.
Our first presupposition is that health is more than an absence of disease. Rather, it exists along an ever-changing continuum between order and chaos. Our body-mind system is in a state of constant, dynamic interaction with both the internal and external environment, which itself is changing rapidly. The degree to which we are able to respond to these changes and can restore body-mind systemic balance (see our thoughts about autonomic coherence on pages 25, 253, 254 and 255) reflects both our current health and our ability to heal.
One purpose of this book is to unravel (as far as is possible at this stage in our knowledge) those elusive qualities that make up a ‘positive relationship’ between doctor and patient—and to share with our colleagues in the healthcare professions some of the principles and techniques that we, and many of the doctors and medical students who have undergone our trainings, have found to help facilitate the healing process.
Neuro-Linguistic Programming, as its name suggests, refers to language (words, as well as other symbol systems, such as physical posture, gestures and related non-verbal forms of communication) as a function of the nervous system and its transformation into ‘subjective experience’.
Put more simply, it focuses on the way we use our five senses to create a ‘map’ of ‘reality’, which we then use to navigate our way through the world. It is a basic premise of NLP that the quality of our maps dictates the quality of our lives. In our opinion, NLP ranks as one of the most significant epistemological developments of our time. It developed—and continues to develop—out of Dr. Richard Bandler’s curiosity about the nature of subjective experience, especially that of individuals whose performance is outstanding in their fields. While most scientific research begins with investigation into how problems and deficiencies develop, Dr. Bandler’s question has always been: how do people achieve excellence?
His first subjects were a group of therapists, unrelated in their approaches, but who were nonetheless achieving results well beyond those of their peers. These included Dr. Milton Erickson, a medical doctor and clinical hypnotist, Virginia Satir, now widely regarded as the founder of family therapy, Gestalt therapist Fritz Perls, and noted body-worker Moshe Feldenkrais. Bandler observed certain commonalities in their work. Interestingly, none of the subjects of his study appeared consciously aware of these patterns, and they had never met each other, and even when they later came together, they were reportedly unimpressed by one another.
Bandler and his colleague, John Grinder, began to experiment. By identifying each sequence of their subjects’ approach, testing it on themselves and other eager volunteers, and refining the processes, they found that the effects could be replicated. Furthermore, these capabilities could easily be taught to others, with similar results.
These experiments led to one of the key presuppositions that have come to underpin NLP: Subjective experience has a structure. Following on from that is the corollary: Change the structure, and the subjective experience will also change.
It was widely believed at that time that, apart from drugs, interpretation and insight were the only means whereby effective emotional and behavioral change could be achieved, and that only with considerable effort and time. But Bandler continued to demonstrate, on a range of patients, including long-stay schizophrenic and psychotic patients, that changing the map could have a dramatic and immediate effect. In the introduction to his first book, The Structure of Magic, published in 1975, he wrote:
The basic principle here is that people end up in pain, not because the world is not rich enough to allow them to satisfy their needs, but because their representation of the world is impoverished.19
Two other key principles emerged from Richard Bandler’s essentially pragmatic approach. The first was that human beings act largely out of various permutations of patterned responses, and, the second, that each person has a signature way of ‘coding’ his experience by the use of his five senses.
Medical NLP—the development and application of the principles and techniques of NLP to the specific needs of health professionals and their patients—is an internationally recognized and licensed model that formally integrates non-invasive, non-pharmacological, and clinically effective approaches with the existing principles and techniques of the consultation process. Training and certification by The Society of Medical NLP is recognized and licensed by Dr. Richard Bandler, the co-creator and developer of NLP, and his Society of NLP. It has also been approved for continuing professional development programs in both the United Kingdom and the Netherlands.
Supported by extensive research and clinical experience, it offers, for the first time, explicit principles and techniques applicable to a wide range of complex, chronic conditions that have symptoms, but no readily identifiable cause. In holding, as a goal, the physical and psychological coherence of the patient, and integrating seamlessly with any aspect of healthcare, it functions as a practical and continually evolving ‘salutogenic’ (health promoting and affirming) model of ‘whole-person’ healing and health in the spirit envisioned and advocated by Aaron Antonovsky.20
One of the central messages of Magic in Practice is that a fundamental component of an effective consultation is an equal and proactive contract between doctor and patient. The relationship functions as a therapeutic agent in itself.
Many practitioners will admit to being mystified by the fact that two patients with apparently identical symptoms will respond entirely differently to the same treatment. And many patients can recall encountering a physician, who, somehow, by some indefinable means unrelated to any specific treatment, just ‘made me feel better’.
Equally, some patients make unexpected, sometimes dramatic, recoveries against all the predictions of current medical knowledge… although these ‘spontaneous remissions’ still tend to be more of an embarrassment to orthodox science. ‘Anecdotal’ is the label usually attached to these events, which, sadly, tends to preclude any closer examination on the part of those people purportedly committed to unbiased scientific investigation.
If pressed, both patient and physician will agree that some factor, other than conventional medical treatment, is responsible for facilitating healing. The doctor may attribute this to the patient’s ‘attitude’, the patient to the doctor’s ‘bedside manner’.
The underlying dynamic undoubtedly depends on effective communication. To focus our students’ attention on the true process and purpose of communication, we draw attention to the origins of the word. It is derived from the Indo-European collective, Ko, meaning ‘share’, and Mei, meaning ‘change’. Communication in Medical NLP, therefore, is a Ko Mei process—a coming together, a sharing, in order to effect change.
We would like to emphasize, too, that practitioners of NLP and Medical NLP are not de facto ‘therapists’. As Dr. Bandler repeatedly asserts, practitioners don’t strive to ‘cure’ problems, but to help their clients (or patients) re-learn more resourceful physical and/or psychological behaviors that allow them to function more effectively. In Medical Neuro-Linguistic Programming, our cry is: treat the patient, don’t try to cure the disease. Therefore, a knowledge of, or adherence to, a particular school of ‘psychology’ or a specific medical specialization, is not necessary for effective intervention.
What is not in doubt is the fact that the quality of the relationship between practitioner and patient is at least as important as the treatment itself. Historical evidence exists that a number of treatments now discarded as ‘unscientific’ demonstrated a 50–70% cure rate when they were still regarded as mainstream.21 More recent research, specifically in the area of ‘emotional’ disorders (increasingly falling within the provenance of general medicine), suggests that as little as 15% of effectiveness results from the therapeutic procedure alone.22
Physicians who have been in practice for more than a few decades will not be surprised by this. For much of the first part of the 20th century, the relational quality between doctor and patient was emphasized in medical training and explicit in practice, even as science was advancing the knowledge and expertise of the health practitioner. This original commitment to partnering wisdom, human values with technological innovation, and respect for the patient was reflected in the mottos adopted by a number organizations and associations around the world.
In 1952, Britain’s Royal College of General Practitioners adopted the motto Cum Scientia Caritas (Science with Compassionate Care). The Canadian Orthopedic Association’s motto is, Pietate, Arte et Scientia Corrigere (With compassion, skill and knowledge we set right), and the Association of Surgeons of Great Britain and Ireland’s is, Omnes Ab Omnibus Discamus (Let us learn all things from everybody).
We applaud the sentiments, but are unsure, in this age of stringent financial targets and controls and purely ‘evidence-based’ treatment, to what extent they are actually practiced today. Many people, not least patients, hanker after a ‘humanization’ of science—especially medicine.
As a modest contribution to this end, Magic in Practice presents key ‘mainstream’ NLP techniques applied in the specific context of healthcare, as well as new approaches developed in real-world situations out of the principles of observation, information gathering, hypothesis-creation, and some considerable clinical experience.
Although the principles and techniques presented here are not intended to replace medical consultation and appropriate treatment, they will be of interest to doctors in both primary and secondary care, as well as nurses, psychologists, counselors, and therapists—anyone, in fact, interested in developing a more integrative and effective approach to patient care.
Since NLP’s emergence in the mid-1970s, ‘magic’ has been a word often associated with its practice. Where it functions as a ‘meta-psychology’, it focuses on structure and process (how we create and maintain our model of ‘reality’), rather than losing itself in detail and speculation. It demands behavioral flexibility on the part of the practitioner to accommodate the uniqueness of each individual’s patterns, and provides a systematic means of generating techniques specifically tailored to the needs of each patient or client.
The speed with which an elegantly designed and applied intervention can result in change can often challenge and mystify. The mystery is intensified when we consider that the primary tools of these interventions are non-pharmacological, non-invasive, and non-toxic, something that cannot be said for virtually any other current treatment in the field of medical care.
More than 30 years ago, the idea that neurological processes could be impacted and re-routed by non-invasive processes was largely speculative. Richard Bandler was one of the first researchers to apply neural scanning by magnetic resonance imaging (MRI) technology to explore the impact of NLP on brain function. Since then, as we will show in this book, neuroscience and psychology have evolved dramatically, to cast even more light into the ‘black box’ of brain and behavior.
We now know—and ignore at our own peril and that of our patients—that the brain constantly moves in and out of complex, interrelating dynamic equilibria, responding to the context or ‘meaning’ of its experience,23 is actively damaged by ‘negative’ data24 and can even alter its physical architecture.25 It follows then that communication within the practitioner-patient relationship is an important source of data for the meaning-making brain and the body with which it functions as an integrated whole.
Words can literally affect us for better or worse. It is surprising, then, that so little time and attention are paid to the quality and precision (what NLP calls the ‘elegance’) of the language we use. Substantial research supports the assertion that how a respected health professional says something can directly affect the patient’s physical and psychological wellbeing at least as much as what he says.26
Of course, communication works in different ways. Not only can clinical outcomes be affected for better or worse by the quality of the patient-physician relationship, but, in the event of medical accident, the patient’s decision to litigate has been shown in several studies to be based substantially more on the doctor’s ‘attitude’ and the quality of the relationship between doctor and patient than on the accident itself.27
We believe that at least part of the apparent ‘magic’ of Medical NLP derives not from any mystical properties of the methodology, but from the narrowness of the paradigm it is seeking to expand. To take Arthur C. Clarke’s Third Law further, it is not difficult to demonstrate that virtually any health technology would appear superior to one that regards the individual as merely:
Any change for the better that is unexplained by scientifically approved treatment is often dismissed by the medical establishment as the placebo response. We are not unduly perturbed by this. So prevalent is the response at all levels of research and treatment that we are utterly confident in the declaration that something important is happening that deserves to be recognized and, wherever possible, incorporated into practical healthcare.
Furthermore, we believe that a greater awareness of this apparently inbuilt psychophysiological capability can renew hope for millions of people whose complex chronic conditions remain inadequately addressed by Western scientific knowledge. By this, we are not proposing a reintroduction of dummy pills and sham treatments, but, rather, consideration of the psychological and biochemical substrates that underlie the human body–mind system to self-regulate under certain conditions, the mechanisms of which are just beginning to be understood.
The problem faced by medical orthodoxy, as pointed out by Gershom Zajicek in a seminal paper in the Cancer Journal, is that nothing in pharmacokinetic theory accounts for the placebo effect. Therefore, rather than abandon current belief, the placebo effect is dismissed as random error or noise which should be ignored.28
Regrettably, the word, ‘placebo’ (derived from the medieval prayer, Placebo Domino, ‘I shall please the Lord’) has acquired pejorative overtones, suggesting deception, weakness, and scientific irrelevancy. But this is a semantic rather than a scientifically grounded shift. As we will point out throughout this book, the word for a thing is not the thing itself. We should not confuse naming or defining with understanding or experiencing. We do not make something invalid merely by labeling it as such.
Here’s another way of looking at the placebo effect (our way):
The placebo response doesn’t mean that nothing important has happened; it simply means that something which we haven’t been measuring has happened.
Indeed, so pervasive—and sometimes so dramatic—is the placebo response that some scientists have suggested reclassifying it. Suggestions include ‘the healing response’, ‘remembered wellness’, the ‘human effect’, and the ‘meaning response’, none of which suggests irrelevance or chicanery.
So powerful is the placebo effect that it is routinely employed (and abused) by the pharmaceutical industry. Placebos are routinely used as controls to test new drugs, and, once their purpose has been served, they are discarded.
Or, are they?
After claiming they have successfully eliminated the placebo effect, the pharmaceutical companies go on to market their products in carefully designed sizes, shapes, and colors, all of which are known to increase the placebo effect.29 They know that cheaper generics are less effective than expensive brand names, and that highly advertised brand names perform best of all (and certainly sell billions of pills), especially if advertised by well-known and popular celebrities.
Still, all that shouldn’t matter if the drug performs better than the placebo against which it has been tested, should it?
In theory, no. But, here are three important facts about placebos in research:
In all its forms, the placebo is here to stay. Research into the effect is widespread. Taken together, the studies suggest that the placebo response is a product of a complex interaction of various processes that fall into three main classifications: ‘expectancy’, ‘meaning’, and ‘conditioning’.31
Briefly, this suggests that both practitioner and patient expect a positive outcome, and that the patient is able to understand and attribute meaning to his experience. Conditioning refers to the adoption and perfection of new, health-related behaviors and responses; to the linking of a specific stimulus to a new and healthful response—and, even to the therapeutic effect of receiving advice or medication from a trusted expert.
It would be difficult to study, or even identify, the placebo response, except within the context of relationships—those of the patient and his world-view; the patient and his understanding; and, crucially importantly, the patient and his practitioner.
All treatment outcomes are, in large part, a result of relationships, and relationships are made or broken by communication. We therefore respectfully offer this book for the consideration of all practitioners, regardless of school or specialty, who believe there should be ‘something more’ to healthcare than standardized interpretations and treatments. Conditioning, expectancy, and meaning are all processes that can be modeled, developed, and transmitted through the principles and techniques of Medical NLP.
Whatever we choose to call it, there is a whole vista of healing and health beyond drugs, surgical procedures or psychological counseling. As we will show, there is an increasing body of research that suggests that the success of many currently accepted procedures (up to 75% in one recent review of 19 depression therapy studies32) is unrelated to the physical treatment itself.
Whether we call it the placebo response, the human effect or the healing response, it is both ‘real’ and a valuable component of good medicine. Dr. W. Grant Thompson, a noted consultant on clinical trials and author of The Placebo Effect and Health, observes that, whatever the view, the placebo effect is a reality and modern medicine can benefit from understanding it. Wise doctors, he adds, know that it is a factor in every treatment and an essential part of their daily work.33
We do not claim to have definitive answers; we certainly have many questions still unanswered that continue to spark our curiosity. But, even at this stage, we can point to a substantial body of theory and research currently excluded from ‘evidence-based’ medical decision-making. It is also interesting to note how much of this now supports the observation and reasoning that prompted Richard Bandler and his colleagues to develop NLP more than 30 years ago.
We also present explicit principles and techniques that we and our Medical NLP-trained colleagues have found useful in our practices, together with anecdotes and case studies —some of them new for this edition of Magic in Practice—to illustrate their practical application. Certain details, of course, have been changed to maintain confidentiality.
We encourage you to develop curiosity and behavioral flexibility, to explore these principles for yourself, and to reclaim the status of the practitioner as co-creator of his patients’ health by actively enhancing and administering what Michael Balint referred to as the most powerful of all drugs—the practitioner himself.34
Or, as a senior consultant remarked at the end of one of our trainings, ‘If all this is the placebo effect, I want to be the best placebo I possibly can.’
3. Clarke A (1961) Clarke’s third law. In Profiles of the Future. London: Weidenfeld & Nicolson.
4. Olde Hartman TC, Lucassen PL, van de Lisdonk EH et al (2004) Chronic functional somatic symptoms: a single syndrome? British Journal of General Practice 54: 922–7.
5. Vaillant GE, Mukamal K. Successful Aging. Am J Psychiatry (2001) Jun 1; 158(6): 839-847.
6. Fraser GE, Shavlik DJ (2001) Ten Years of Life: Is It a Matter of Choice? Arch Intern Med. 161: 1645-1652.
7. Steyn K; Fourie J; Bradshaw D (1992) The impact of chronic diseases of lifestyle and their major risk factors on mortality in South Africa. S Afr Med J, Oct, 82: 4, 227-31.
8. Key TJ, Allen NE, Spencer EA (2002) The effect of diet on risk of cancer. Lancet. Sept 14; 360 (9336): 861-8.
9. http://articles.timesofindia.indiatimes.com/2008-05-20/india/27759260_1_
lifestyle-diseases-couch-potato-cost.
10. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection - http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=567660.
11. A-C Vergnaud et al. Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study, Am J Clin Nutr May 2013. First published April 3, 2013.
12. Chi Pang Wen, et al (2011) Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study, The Lancet, Early Online Publication, 16 August—http://www.thelancet.com/journals/lancet/
article/PIIS0140-6736%2811%2960749-6/abstract
13. NPSA report: Building a memory: preventing harm, reducing risks & improving patient safety, London July (2005) p53.
14. The Journal of the American Medical Association (JAMA) (2000) Vol 284, No 4, July 26, 2000
15. Bismark M, Paterson R No Fault Compensation in New Zealand: Harmonizing Injury Compensation, Provider Accountability & Patient Safety. Health (Milwood) 200; 25: 278-83.
16. BMA Health Policy and Economic Research Unit (2000) Work-related Stress Among Senior Doctors: Review of Research. London: BMA Health Policy and Economic Research Unit.
17. See www.cfah.org.
18. Adapted from Bakal D (1999) Minding the Body. New York: Guildford Press.
19. Bandler R, Grinder J (1975) The Structure of Magic. Palo Alto, CA: Science and Behavior Books.
20. Antonovsky A (1979) Health, Stress and Coping. San Francisco: Jossey-Bass.
21. Dixon M, Sweeney K (2000) The Human Effect in Medicine. Oxfordshire: Radcliffe Medical Press.
22. Lambert MJ (1992) Psychotherapy outcome research: implications for integrative and eclectic therapists. In Norcoss C, Goldfriend M (eds) Handbook of Psychotherapy Integration, Ch. 3. New York: Basic Books.
23. Scott KJA (1995) Dynamic Patterns—the Self-Organization of Brain and Behavior. Cambridge, MA: MIT Press.
24. Lipton B (2005) The Biology of Belief. California: Elite Books.
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