The Curious Science Of Your Brain’s Ability To Deceive, Transform, And Heal
Erik Vance – National Geographic
Is this how it works?
“Rarely have we seen someone fail who has thoroughly followed our path…”
Has anyone ever considered raising their hand at this point to say,
“Excuse me… What do you mean by “rarely”? How do you quantify it? Is there a spreadsheet that I can look at? Does a disinterested third party verify your data?”
No? I didn’t think so. I would never dream of doing such a thing. It would upset the old ladies. “How it works” has nothing to do with how it works. “How it works” is a declaration of faith. It is a public expression of belief and says nothing about the horrendous attrition rate typical of AA. Most newcomers attend a few meetings and then disappear back into the haze. Saying that they were not thorough might be convenient but it is not acceptable. In the UK, there is an AA survey every five years that strives to measure attendance levels. I tried mentioning it once and received a volley of assurances that whilst it may well be a good exercise it definitely understates both attendance and retention levels. There was no evidence offered for this, obviously, but the assertion was made with considerable enthusiasm.
For the happy-clappy, true believers in the one and only true way that you must, must, must follow in order to experience lasting sobriety it does seem to work. It does. They may represent a tiny fraction of the alcoholic population but somehow or another, their invisible friend does seem to keep them off the emotion lotion. So what is going on?
A fascinating perspective on how it might work is offered by Erik Vance in his absolutely essential, “Suggestible You – The Curious Science Of Your Brain’s Ability To Deceive, Transform, And Heal.” Mr Vance was brought up in a Christian Science community. As far as I understand it, Christian Science practitioners use faith alone to heal; no doctors, no Xanax, no exceptions. Right. As an adolescent, the young Mr. Vance became interested in rock climbing. One day he finds himself attached to Lost Arrow;
“hanging from a pair of metal rings bolted into a steep, blank wall.”
Vicious bolts of lightning are flashing all around the finger of rock. He tries praying but instead of a heavenly choir what he gets for his efforts is an atheist epiphany. Hanging there, he realises that there is no benign, invisible, interventionist force that will come along with its big hand and put him back on terra firma. The more firma, the less terra. He realises there’s no one there and that he must take responsibility for his own safe descent. Good work, Erik. Following this realisation, Vance looks back on his upbringing, thinks about all of the people he saw being healed through faith, and thinks to himself,
“I wonder how that worked…?”
His book, “Suggestible You” is the product of his search for an explanation.
I spent about a year attending a weekly AA meeting. It was a mainstream meeting with the banners up on the wall, two doses of the Serenity Prayer, and temperatures in the church hall comparable with a Minnesotan winter. The meeting provided me with an excellent opportunity to practice being around people again. I made a lot of progress in one year but the onset of COVID-19 restrictions and the move to online meetings presented an opportunity to reassess what I was doing. I decided to move on. I’ll quickly and very happily add that I’m delighted still to be in touch with a few of them. They are my fellow alcoholics. I couldn’t care less what they believe. I am thrilled to know they are healthy. But in a manner very similar to that of Erik Vance, I did look back and wonder what was going on. If we start from the assumption that there is no invisible friend, then how we can account for AA being effective albeit in a minority of cases? How does it work?
The first section of “Suggestible You” looks at the placebo effect. I thought I understood what this meant: I had no idea. Vance offers a beautifully clear history and explanation of the placebo that reveals its extraordinary significance. His book is easy to read. This is not the equivalent of a free ascent of El Capitan, it’s an afternoon stroll in the park. Great. But what has it got to do with AA? Why would an atheist alcoholic benefit from reading this?
One key point that links AA and the placebo is the absolutely crucial role that storytelling plays in both. For the full power of the placebo to be unleashed you need a compelling story.
I have often wondered how any self-respecting physician could possibly, in good faith, recommend a 12 step program. Well, doctor knows best and doctor most certainly knows about placebo. An American, Henry Beecher was a doctor on the North African and Italian fronts in World War II. He noticed that a wounded man could be brought in with a wound in his back big enough to put your foot in but would only start to wince when given an injection. Dr. Beecher collected data throughout the war:
“In one paper examining 215 patients with “major wounds,” he noted that 40 of the 50 patients with “penetrating wounds of the thorax” declined painkillers.”
Eh? They have a gaping hole in their neck and they refuse morphine? Are you serious? What’s the story?
Dr. Beecher asks us to;
“consider the position of the soldier: his wound suddenly releases him from an exceedingly dangerous environment, one filled with fatigue, discomfort, anxiety, fear and real danger of death, and gives him a ticket to the safety of the hospital. His troubles are over – or he thinks they are.”
Or he thinks they are. The wounded soldier “buys in” to the salvation brought by the wound. For him, it’s a credible story. Jesus H Christ, look at the state of my ass. They’re sending me home this time for sure. Halle-fuckin’-lujah! Beam me up, Scotty. I am OUT of here.” This story of imminent salvation is so credible to the soldier, the buy-in so complete that our serviceman’s placebo can stand smartly to attention and proceed to give his pain a good kicking. In the beginning, was the word. And the word was Bill. Bill looked on the word and saw that it was good.
AA practice is characterised by storytelling. In the beginning, was the word. And the word was Bill. Bill looked on the word and saw that it was good. In Glasgow, spiritual home of alcoholism, AA people use the phrase, “doing a table.” This means appearing as a speaker at the meeting. Someone introduces the speaker, the speaker then gives a sort of condensed history of his drinking:
“Our stories disclose in a general way what we used to be like, what happened, and what we are like now.”
The supposed benefit for others is that they can identify with aspects of the account presented and this identification does what? I guess there is an element of reinforcement here – it works for that guy, his experience was a bit like mine, maybe it’ll work for me too. “Doing a table” also seems to be a way of policing conformity. A bit like reading out “How it works”, speaking in this context is a public opportunity to demonstrate adherence to the quasi-Christian notions within AA: the rock bottom and the redemption and all that good stuff. But before we get to the content it is worth pausing to look at the basic structure. What we have here, ladies and gentlemen is a story-teller and an audience. Was she any good, doing that table? Was she authentic or, possibly, was she convincing? Did you buy any of that? Were you persuaded? Did you find that credible?
I have not read the Big Book. I did try to read it on a number of occasions but I have always recoiled in horror. From memory, I believe it is a collection of first-person accounts of drinking. It is a book of stories. I want to say, “a bit like Bukowski” and, on a certain level, it kind of is.
In the germ-ridden, god-infested rehab centre where I wound up in 2019, the genius in charge of my so-called therapy told me a story. His name was No-way Jose. He described how his higher power came to his rescue one night. Jose, having enjoyed one or two small sherries, was zooming along a dark road on his motorbike in the Superman position – legs stretched out behind him. Suddenly – yikes! – there were two vehicles in front of him with only the tiniest, teeniest gap between them. Fortunately, his higher power, being eternally wakeful, looked down, saw the danger, and… and… tell us, please! And at the last minute old HP looked down and guided that motorcycle through the gap. Phew! No-way Jose found a way and, hey, he lived to ride another day! Exciting stuff.
I said, no way, Jose. What you have described is an experiment in road safety. There’s no need to go bothering god. I suggest you define the variables required to repeat the experiment. Please recreate those conditions and test your hypothesis. I didn’t find the story convincing. For him, it was. Good luck to him. I hope he’s sober. He was convinced by his story. His story was important to him. It had the dog-eared feel of an account that had been handled so often that the original experience had become somewhat obscure. Nonetheless, in the context of “Suggestible You,” his story was good enough for him. It was not good enough for me.
My favourite kind of AA story is what I call, “Granny from beyond the grave.” You must have heard a variation of it. My fellow alcoholic has just ordered a pizza. The pizza guy turns up. Damn. Not enough cash. By chance – or was it? – by chance, my fellow alcoholic sticks her hand down the back of the couch. Whoah! A crumpled banknote. Just enough for the pizza. At that moment – sniff, she dabs away a tiny, silent tear, and remembers granny, she remembers good old gran and how she would always slip her a little money now and then and – sniff, another tear, tinier and even more silent – and at that moment she knew, she just knew,
“That was gran. I’m telling you… I could… feel her… That was gran saying, ‘everything’s all right’…”
There you go, o ye of little faith. What more evidence do you need? From beyond the grave, dead granny has been working on origami, calculus, and aerodynamics. Using these post-mortem skills, granny, god bless her, has devised a manner of folding a banknote such that it can be propelled through the space-time continuum in order to lodge itself down the back of the couch just in time for the pizza guy turning up. Coincidence? Given that she can do all that if she wanted to reassure her grandchild, couldn’t she just send a text? Death doesn’t stop her from learning origami but we are asked to believe that granny doesn’t have basic Microsoft Office products on her heavenly desktop? Really?
It doesn’t matter whether the dead granny has Outlook. What matters is that the alcoholic grandchild can buy into the story she tells herself. And that’s what matters to me. What I’ve learned from Erik Vance is that the nature of the story that I’m telling myself matters. The language matters. The thinking matters.
In these days of relentless partisan division, I hesitate to blast away at easy targets. Making fun of AA, whilst enjoyable, is no job for a grown man. Anyway, what if they can’t help it? Vance goes into this in considerable detail but let’s just suppose that like Elvis, the King of Rock ’n’ Roll, our friends in traditional AA just can’t help believin’? What if they are wired up in some neuro-illogical manner such that they are inherently susceptible to the god talk and it’s the god-talk that does it for them? If that’s the case, and I strongly suspect it is, then it doesn’t really matter how it works. What matters is that they’re sober. It most certainly does not matter if they can not grasp that I am wired differently. Health is the priority. I want only the best for those excellent people I met at my local meeting. Their service ethos is remarkable. There is much to be commended.
The story of the distinguished doctor, Henry Beecher, is merely one of many absolutely fascinating aspects of this book. I have barely grazed the surface here. Vance has no need to make a compelling case for the placebo. It is all there in the medical literature. Following the terrible Thalidomide affair, the FDA brought in new tests to make sure that the damn drug does what it’s supposed to do and is more effective than a sugar pill administered by a convincing doctor. Part of the reason why we are waiting for a COVID-19 vaccine is because the potential vaccines have to beat the placebo. This is a serious business. As you know, alcoholism is a serious business. Alcoholism is no trivial matter. Understanding placebo and suggestion, as presented with such clarity by Erik Vance, might just be of some assistance.