Justification and changes in symptoms

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PLACEBOS AND THE INTERRELATIONSHIP BETWEEN BELIEFS, BEHAVIOUR AND HEALTH
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COGNITIVE DISSONANCE THEORY
Totman (1976, 1987) placed his cognitive dissonance theory of placebos in the following
context: ‘Why did faith healing last for such a long time?’ and ‘Why are many of the
homeopathic medicines, which have no medically active content, still used?’ He argued
that faith healing has lasted and homeopathic medicines are still used because they
work. In answer to his question why this might be, Totman suggested that the one factor
that all of these medically inert treatments have in common, is that they required an
investment by the individual in terms of money, dedication, pain, time or inconvenience.
He argued that if medically inactive drugs were freely available they would not be
effective and that if an individual lived around the corner to Lourdes then a trip to
Lourdes would have no effect on their health status.
The effect of investment
Totman suggested that this investment results in the individual having to go through two
processes: (1) the individual needs to justify their behaviour; and (2) the individual needs
to see themselves as rational and in control. If these two factors are in line with each
other (e.g. ‘I spent money on a treatment and it worked’), then the individual experiences
low dissonance. If, however, there is a conflict between these two factors (e.g. ‘I spent
money on a treatment and I do not feel any better’), the individual experiences a state of
high dissonance. Totman argued that high justification (it worked) results in low guilt
and low dissonance (e.g. ‘I can justify my behaviour, I am rational and in control’).
However, low justification (e.g. ‘it didn’t work’) results in high guilt and high dissonance
(e.g. I cannot justify my behaviour, I am not rational or in control). How does this relate
to placebo effects and changes in symptoms?
Justification and changes in symptoms
If an individual travels far and pays a lot of money to see a faith healer then they need
to justify this behaviour. Also they need to see themselves as being rational and in
control. If they have put a lot of investment into seeing a faith healer and the faith healer
has no effect on their health status, then they will not be able to see themselves as being
rational and in control, and will therefore be in a state of high dissonance. The best way
to resolve this dissonance according to Totman is for there to be an outcome that enables
the individual to be able to justify their behaviour and to see themselves as rational and
in control. In terms of the faith healer, the best outcome would be an improvement in
health status. This would enable the individual to justify their behaviour and to enable
them to maintain a sense of self as one who is rational and sensible. Totman argued
that when in a state of high dissonance, unconscious regulating mechanisms are
activated, which may cause physical changes that improve the health of the individual,
which enables the individual to justify their behaviour, and this resolves the dissonance.
Totman therefore suggested that for a placebo effect to occur, the individual does not
require an expectation that they will get better, but a need to find justification for their
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