Science + magic revisited

Science = applied environmental psychology, evidence based design, functional requirements, also including salutogenic theory
Magic = atmosphere, explained by phenomenology, sensory design,

Intuitive

Instinct, perception, intuition, inherent, visceral, spontaneously conceived without conscious thought

Reason

Calculated, science, objective

More notes on gardening, reuse and...

Pallasmaa also talks about how formal architectural logic is weakened when buildings are reused and renovated. The insertion of new functional/symbolic structures over rides the original architectural logic and opens up new unexpected ranges of experience. "Architectural settings that layer contradictory ingredients project a special sensory richness and empathetic charm." (p37 Architectural Atmospheres...)

He then goes on to say that "Gardening is an art form inherently engaged with time, change, atmosphere, and fragile image."

More rationale for using narratives, thought experiments..

Space & Imagination 

(Juhani Pallasma, Architectural Atmospheres, previously mentioned, pp27-32)

When we read a novel, we are constantly creating the settings and situations in our imagination merely at the suggestion of the author's words. We move effortlessly from one scene to the next as though these settings existed before we sat down to read. We experience these imaginary spaces in full spatiality and atmosphere, not as pictures. Entirely products of our imagination.
What is amazing about this is the completeness of this - as we read a novel, we create cities and landscapes as well as the buildings, the rooms and their ambience all without knowing the details. The totality dominates the detail.

Pallasmaa suggests that we seek historically dense settings because they connect us imaginatively with past life and it makes us feel safe and enriched to be part of that temporal continuum - traces of life support images of safety and continued life.

Experiencing, memorising and imagining spaces engages our imagination. Memories feel similar to actual experience.

..or perhaps peripheral vision...

In the previously quoted book (Architectural Atmospheres), Juhani Pallasmaa discusses the importance of peripheral vision in the perception of atmosphere.

Looking at perspectives in architectural representations leave us as outsiders but multi-perspectival and atmospheric spaces, emulating or using our peripheral vision, enclose us and "...enfolds us in its embrace."

For example, the way that Impressionist, Cubist and Expressionist artists pull us into their spaces.

In contrast, a photograph is a momentary focused fragment in time. The perceptual realm that we sense beyond the our focused vision is as important as the focused image frozen by a camera. Though photographs can be put together in this way, as demonstrated by a favourite of mine, David Hockney..

Pallasmaa argues that perhaps a poverty of peripheral vision is why contemporary spaces often alienate us compared with historical settings. Focused vision makes us just observers, outsiders, while unfocused or peripheral perceptions draw on our other senses to 'fill in the gaps' that we cannot see.

"Peripheral perception is the perceptival mode through which we grasp atmospheres. The importance of the senses...for atmospheric perception arises from their essence as non-directional senses and their embracing character. The role of peripheral and unconscious perception explains why a photographic image is usually an unreliable witness of true architectural quality." (p39)

"The richest experiences happen long before the soul takes notice. And when we being to open our eyes to the visible, we have already been supporters of the invisible for a long time"

- Gabriele d'Annunzio, as quoted in: Bachelard, Gaston. Water and Dreams. An Essay on the Imagination of Matter. Dallas: The Pegasus Foundation. (p16)

This also gave me some ideas for how I should/shouldn't try and represent my final design in the thesis presentation.

The answer is in the air (atmosphere)...

'Rain, Steam, and Speed - The Great Western Railway' (1844) by William Turner, quoted as saying "Atmosphere is my style"

The creation of 'atmosphere' (not in the weather sense) is probably the answer to creating spaces that provide reassurance, and places for mental health patients to restore their mental health.

The following is taken from:  Atmospheres. On the Experience and Politics of Architecture, edited by Christian Borch, 19-41. Basel: Birkhauser, 2014.

What is 'atmosphere'?

"My central argument is that atmospheres are not only numinous, they are also produced by us, and there are professions whose very tasks it is to produce them. As a result, for me the art of stage-setting became the paradigm for the production of atmospheres, an attempt that you can also find in architecture, marketing, and various strategies of design, as well as in the stage-setting of commodities."
- Gernot Bohme (p91)

"I conceive of atmospheres as spaces...with a mood, or emotionally felt spaces. This is an important definition, because it underlines that emotions do not always have to be in your heart or in your soul, something internal. Emotions can be on the outside, they can strike you." - Olafur Eliasson (p96)

Juhani Pallasmaa describes experiential atmosphere as the whole perceptual, sensory and emotive impression of a space or setting. Atmosphere is the unifying character of a room (or place, or landscape or social encounter). It is an experiential property suspended between the object and the subject.

The intuitive and emotive capacity to sense the atmosphere of a place before we identify any details or process it intellectually is probably the result of evolutionary biology and neurology. It is suggested that we are genetically and culturally conditioned to seek or avoid certain atmospheres. For example, our universal pleasure in being in the shadow of large trees looking out into a sunlit open field can be explained on the basis of evolutionary programming (Edward Wilson. 'The Right Place' in Biophilia: the Human Bond with Other Species, 103-118. Cambridge: Harvard University Press, 1984). The ability to instantly differentiate a scene of potential danger with one of safety implies obvious evolutionary advantages. The main thing to note is that this is not consciously deduced from details but from the scene as a whole.

Smell is a powerful element of atmosphere. Pallasmaa observes that '...the most persistent memory of any space is often its' smell.' (Eyes of the Skin, p54)

Quasi-objective

Atmosphere is not necessarily a wholly subjective or individual experience. A room may produce a certain feeling which is felt more or less similarly regardless of who experiences it. For example, much religious architecture is based on creating an atmosphere of reverence, reflection, quiet spirituality in all who enter the spaces.As such, it assumes a quasi-objective quality. Entering these spaces influences the basic mood of a person entering them.

Kevin McClouds' Words of Wisdom...

I've always liked Kevin McCloud, even though at times I've been nervous to admit this at university where you'd hear comments like 'Oh have you actually seen any of his buildings? What has he built, it looks like rubbish' etc...as people tend to do with commercially popular people. His documentary on Dharvi was fantastic and brave (for him, I thought, taking him far from his comfort zone it seemed).

I find some of his views and commentaries really useful. There are many things in his 43 Principles of Home that I think are worth pursuing or making sure they are seen in my designs.

Principle 11
Our experience of architecture should improve the closer we get to it. And for that matter the longer we use it.

Principle 14
As good buildings age, the bond with their sites strengthens. A beautiful, interesting or simple ancient building still belongs where it stands, however corrupted that place may have become. Use and adaption of these buildings leave their marks and these, in time, we also see as aspets of he building's integrity
(this one is taken from the philosophy of the Society for Protection of Ancient Buildings, or SPAB)

Principle 15
The strongest visual links with place, the strongest contextual ties, are expressed in the way humans claim territory and populate a place. (eg. the mountain may be big but it's not as important as the enclosed field or whitewashed homestead nearby, likewise a river can be a fabulous visual asset but it functions as context only when used to boat on or cross. Otherwise it's just nature)

Principle 18
New work should express modern needs in a modern language.

Principle 20
Respect the character of old buildings and cherish their idiosyncrasies and imperfections. The character of a place consists of a thousand tiny details which can carelessly be 'improved' with mediocrity.

Principle 23
Finding comfort - the joy of a comfortable chair or door handle - is to be prized above fashion, style and image. Comfort is the most civilising aspect of design or architecture. Seek it out.

Notes from Pezo von Ellrichshausen

An interview with these Chilean architects caught my attention in the similarities between their philosophy and perhaps what mine is/is becoming.

(Interview was in Sensing Spaces. London: Royal Academy of Arts (2014): 112-133)

- emphasis is on the proportions of rooms, their sequence and they way they open
- complexity, integrity, unitary, coherent

"We believe that architecture is a balance between continuity and rupture: for instance, our Poli House and Cien House use ordinary windows, doors and materials but still provide something unexpected. We like the notion of familiar materials within a new spatial logic."

The Dark Horse - metaphors and illness

Of course the narrative for Jubliee was written after watching The Dark Horse...
(Written & Directed by James Napier Robertson, Produced by Tom Hern and Four Knights Film, distributed in NZ by Transmission Films. Released in 2014).

This beautiful and at times hard to watch film is based on the true story of Genesis Potini, trying to find a purpose after being released form a mental institution. He was a gifted chess champion who battled bipolar disease all his life. He died in 2011 leaving behind a legacy of local chess fanatics in Gisborne. The authenticity was reinforced by one of the main characters, Genesis's brother Ariki, played by Wayne Hapi whose real life mirrored the role he played (his first only acting role- see this link).

The opening scene with the gentle rain falling on Potini reinforces the significance of environment - people with mental illness are often more acutely aware of and effected by details in their surroundings. Subsequent scenes also demonstrate why their family and immediate community is not always the best place for them to go back to. Although in Potini's case, this is where he reuites with his refuge, chess.

His manic mind found a kind of refuge in chess, and it became the thing that grounds his crazy emotional instability. Chess, combined with the sense of purpose, helping others, his sense of self and his own cultural identity ("these chess pieces are warriors"). When Potini finds himself homeless, he curls up on the steps of the Fallen Heroes memorial on Gisborne's Kaiti Hill, an obelisk resembling a giant chess piece.

(The memorial is in honour of Kaiti freezing workers who fought in WWI - erected in 1923 by workers from the Kaiti Freezing Works)

The latter is interesting as this was a place he felt safe, somewhere he could sleep - up high looking out over Gisborne with his back to the giant 'chess piece'. It held some meaning for him. It was a refuge, somewhere he felt safe playing chess, his other 'refuge' with Mana. Away from the gangs and violence of Mana's domestic life.

'The Dark Horse' Similar to 'The Black Dog'? 'Black dog' was the term Winston Churchill used to describe depression

Jubilee's narratives - arrival

Arrival I. Jubilee [acute psychiatric ward, to be treated]

The phoenix palms welcome me back - I've been here so many times. I know the drill, I can be calm now, it's my home. Hoki mai ki te wā kāinga.

The outdoor courtyard is where I go, if they have one. Day or night, sitting outside with my eyes closed hearing only the sounds of bees and cicadas, or crickets, smelling the warm earth of the garden, and feeling the heat of the sun or the fresh night air on my bare skin. I imagine I'm somewhere far away from the hospital with it's glaring walls and shiny floors. I'm back on the land, at the river me and my brother used to play in. I can almost smell the ozone and feel the water rushing around my feet griping the smooth river stones.

I'm led inside where needles prick then sweet pharmaceutical release dampens all those thoughts in my head, the mantras which hold me up and stop the collapse. But I can fall here. It's safe.

Arrival II. Jubilee [kingseat, to live]

I've been here before. The trees, the colours and stern mouth of the building from memories of when I was still just a scared kid. Later the buildings were modern and bland. But I'd always be taken to the side entrance, the one for loonies. This time we keep driving right around to the back, to a different looking entrance but I know it'll be the same inside. They all are. I always eventually end up in a place like this.

They talk to me with dignity and respect here, not like some mental patient. I like that. But I don't need the props, I can walk by myself. They take me upstairs (upstairs?) to my new home - we're up in the sky, I can see so much up here, I'm part of the sky looking down on all those other people. Like Maui. I feel so light up here. The path slopes and is paved with smooth round stones and walking needs my concentration. The sound of rushing water somewhere (where?) - perhaps I'm imagining a river. Cicadas, and pigeons. A new place.

They tell me there's space for my whanau to stay with me sometimes, whenever I want. But not for good, aye, anyhow they wouldn't like staying too long in a loony bin - it's not really though, I guess. Doesn't feel like one up here.

Glancing up the next flight of stairs I catch a glimpse of something and the jittering in my fingers slows. There are 2 people up there sitting in the sun, playing chess...

Atmospheres - Zumthor, Philipe Starck et al.

Time & time again I refer back to my favourite books - including the small beautifully bound rich brown and silver embossed 'Atmospheres' (Peter Zumthor). I love the feel of this book - the weight of it, the texture of the cover and the smell of the paper (you don't get this added pleasure from reading a kindle!).

According to Zumthor, atmosphere is an aesthetic category.

Atmosphere is crafted as an architectural quality that provokes a spontaneous response - whether this is emotional or something more basic, though, I'm not sure. Perhaps atmosphere is something that unlocks memory of another place and time? In any case, I agree with him that it is a quality, an impression, sensed in a fraction of a second, something you're not consciously aware of until you try and analyse it.

Atmosphere requires material presence plus a person experiencing or sensing this presence via sound, light, temperature and spatial recognition resulting from a distinct tension between inside and out.

Reading another book (not so nice to hold and smell but nice enough, nonetheless: Architectural Design: Interior Atmospheres. Julieanna Preston (Ed) Profile no. 103, v78, no. 3 May/June 2008), I was struck by Philippe Starck's treatment of the ceilings in Le Lan restaurant, Beijing.

As someone who is always complaining about ceilings in healthcare settings (we spend so much time looking at them), this was refreshing but perhaps not what I'll be striving for necessarily...

I love the richness without being stuffy, the baroque theatricality of this compared with more restrained examples of atmosphere such as seen in, for example, Japanese interiors.

Architecture described as being defined by a certain atmosphere celebrates a 'Romantic' sensibility in which emotion and sensory perceptions overshadow the rational and the intellectual (p5, editorial by Helen Castle).

NB. Romanticism was an artistic, literary, and intellectual movement toward the end of the 18th century, at its peak during 1800 to 1850. It was during this time that the term 'atmosphere' expanded from planetary gases to include a 'sense of surrounding influence, mental or moral environment.' It validated intense emotion as an authentic source of aesthetic experience.

Sound - The MIX house -see http://www.joelsandersarchitect.com/

Functionalism revisited - notes from Lang & Moleski

(notes from Functionalism Revisited, written by Jon Lang & Walter Moleski, Ashgate Publishing, Farnham: 2010)

From the Chapter 'Experiencing Architecture' (pp 39-62)

Although the basic nature of our perceptual systems is generally universal, what we pay attention to in our environment differs, shaped by cultural and personality-bound differences which in turn shapes our motivations.

When we design buildings we focus on the visual world, its appearance, because that is what we simulate or model in our drawings. We speculate on what people will do in the building and on what it will smell, feel and sound like to them. Our understanding is biased by our own knowledge and also by how we value certain aspects of it.

p50

It is easy to fall into the trap of thinking that the configuration - the milieu - of the built world determines our social behaviour and aesthetic experiences. However, what we create is a potential environment for human activity patterns and aesthetic experiences. The effective environment consists of what people pay attention to and use. We look for 'affordances' that will enable us to fulfill our needs. (The 'affordances' of a space/surface/texture etc are simply what these things makes available for us to use or interpret)

Healing Places - notes from Gesler

(notes from Healing Places by Wilbert M. Gesler Rowman & Littlefield Publishers, Inc. Lanham, USA: 2003)

pp5-6
Meaning is achieved through the experiences people have in places, such as a sense of identity, security or of belonging.An important component of mental illness is a feeling of homelessness or rootlessness, of no place to call home. Psychiatric patients benefit from a sense of home or attachment to certain places
The humanist geographer Yi-Fu Tuan has another perspective on a sense of place when he talk about 2 elements that enhance our experience of a place - public symbols and fields of care.
Public symbols = what strike us first about a place, the visual impression, eg. the imposing structure of a hospital facade (or Kingseat), public monuments which make us feel proud of a place - however, they can also be negative (eg. Kingseat).
Fields of care = more subtle and represent a longer lasting attachment to a place. They are the nonvisual elements of a place and include the networks of interpersonal concern. It does not make an immediate impact and is only felt after longer experience of a place. Healing places are considered fields of care eg. the sound of the ocean at a beach retreat, the therapeutic touch of a nurse, the caring voice of a therapist.
pp 7-16
Gesler defines 4 environments to be important in the definition of a healing place: natural, built, symbolic, social.
Natural = related to the biophilia hypothesis (as humans evolved from nature the acquired an affinity for nature and therefore feel comforted by it); a belief in nature as the healer; beauty, aesthetic pleasure from the surroundings; remoteness, immersion in nature; working in gardens is considered therapeutic; research to back the positive effects of views of nature through hosptial windows and the healing process (Ulrich)
Built = (basically all the aspects covered by evidence-based design) can provide a sense of trust and security; affects the senses; symbolic power of designs;
Symbolic = eg. water symbolises purity, washing out of sin and disease; high tech equipment in hospitals can represent the power of medicine, trust (but perhaps also fear); this category also includes rituals, and even the way a doctor may use a simple, ritual phrase such as 'you're going to be all right'. Many healing ceremonies have ritual language. This also includes associated myths about a certain place.
Social = the interactions with people who play various roles in the healing process eg. the therapists. The idea that good social relationships are essential to providing healing environments was at the core of the 'therapeutic community or mileu therapy'

Ebenezer Howards' Garden City

Ebenezer Howard's plans for his ideal new town, the Garden City, included insane asylums around the more rural outskirts of the city centre. His goal was to recapture the 'wholesomeness' of pre-industrial life by designing an ideal town housing around 30,000 people with principles of quiet, healthful air, greenery and fresh produce. Farms around the outside would provide food for the town and any industry was placed on the outer ring of the plan.

(ref: Gilbert Lupfer, Jurgen Paul, Paul Sigel authors of the chapter 'Ebenezer Howard (1850-1928) To-morrow: a Peaceful Path to Real Refor. In Architectural Theory. From Renaissance to the Present. Volume 2. Taschen: Koln 20122) p668-672

Amber's narratives - Arrival

Arrival I. Amber [acute psychiatric ward, to be treated]

Arrival was fast, sharp and noisy with people yelling and everything zigzagging in my head. A dull throb in my wrists. I didn’t see the building so I can’t say it made an impression at all from the outside. I can just imagine what it looked like though – a big efficient building, busy with vents and fans, trying to be friendly, making a real effort. Just like the huge welcoming committee; I was the centre of attention but now they'll be fussing over someone else. I was Amber-How-Are-You-Feeling but now I'm that patient in room 46.

Moving quickly through uncomfortably bright corridors with banging doors, feet first, horizontal. The ceilings are so unsettling, you’d think they’d give you something soothing to look at, flat on your back feeling so out of control as you’re being whisked away to stitch up your wrists. Instead there are just strange flickering lights, sensors sensing unknown things, cameras (trying to be discrete), grids, strange vents....all flying past in a blur...

Shiny anonymous easy to clean walls and floors with a faint whiff of...nothing...or at least nothing I can recognise, perhaps it’s cleaning product. I think so. Maybe dead flowers from someone’s room, smells a bit like Gran's room.

This place is a hospital. I would recognise it anywhere. Just like the movies, or Shortland Street, or visits to Gran when she was dying.

Glimpses of trees through the windows, everything through glass. Look but don’t touch. Everyone can see me and there’s nowhere to hide, not even the bathroom. No rails to hang things (or yourself). No space that feels like mine, every room looks the same, I panic when I can’t find my room. Things are fuzzy in this too bright room with no rails or sharp things, no smells, no mess, nothing.

Arrival II. Amber [kingseat, to live]

Driving slowly up the driveway with that view!. It let all those fireflies loose in my stomach, sending sparks all the way out to my fingertips, leaving smoking tendrils of nausea. A ghost of a building with it’s white sun scorched walls. The glow of the setting sun silhouetting strangely irregular folding shapes where the roof line should be, almost like a blanket had settled there.

This is not a building trying to be friendly, but suggesting authority and paternalism. A second glance, however, suggests there is more to it and that perhaps there is something hidden, something unexpected inside.

The tall sentries lining the driveway are making sure we don’t turn back. I’m afraid to turn around and look behind us in case I'll see the huge palm fronds knitting together preventing any change of mind. My left heel is nervously tapping on the car floor.

The driveway sweeps us around the bare field giving up it's green scent of freshly cut grass undercut with faint traces of petrol and manuka smoke. Wafting in uninvited, interrupting my anxiety with memories of home on a Saturday afternoon. Dad mowing the lawn, later the fire lit inside.

We slowly drive right past the heavy ominous Entrance Door with its gaping mouth, surprising me. The fireflies slowly settle and my fingertips and lips stop tingling. The further we drive away from that Entrance Door and around behind the building, the safer I feel until the car finally stops at another. I feel cheated. This is the Same Door!

I’m ushered quietly towards this Door, under the heavy eaves, gravity pulling at my legs. The solid steps, dark chill porch, then that Door - heavy with solid wood slightly rough in places but smoothly worn by a thousand hands near the brass handle. Thick ancient glass panels ominously distort the view beyond like some bad movie scene.

My minder coaxes me through the dark entrance, that Door, and then gestures upwards. My feet seem to have a life of their own, heading up the dark stairs despite me. Glancing down at those traitorous feet, the intricate detailing on the tiles makes me wonder who thought it was worth using such beautiful tiles on us, the no hopers. What a surprise.

Another world is slowly revealed as the stairs take us up and break through the roof. Above the building, in the late afternoon sky, on the roof with those strange shapes.

The comforting scents of cut grass and fireplace smoke return, this time gladly received and welcomed – the smoke is stronger and mixed with the heady scent of Hoya – with an involuntary sniff I’m transported back in time again to my Gran's patio where Hoya clung to the warm brick walls, releasing it’s scent in the late afternoon sun. Anxiety is replaced with comfort and a sense of home, the scents of home.

There’s a garden in this roof! I was expecting white sterile, easy to clean plasticky walls and floors squeaking against my sneakers. The faint whiff of disinfectant perhaps, not the smell of fresh leaves and warm tiles as I’m shown to my room.

Abe's narratives - arrival

Arrival I. Abe [acute psychiatric ward, to be treated]

Arrival was blurred and in slow motion but at the same time I couldn’t sit still. Hard edges and sterile cramped corridors. What are all those sensors and cameras for? Who is watching me? I can’t really remember my first impression of the hospital as everything that day was too mixed up with too many other thoughts crowding in.

But I do remember the chapel. The only place I could be still and feel quiet without the drugs. We were all still and quiet – like one entity, felt a bit weird but I remember a strange kind of comfort knowing the wards were on the other side of the door. I can hear my own breath. The top of the pew in front of me has a sheen to it, polished by a thousand glancing hands. The chapel had that smell of old churches, even though it wasn’t that old. That incense-wax-rubbed wood-old hymn book kind of smell. I think of my mum & dad, dragging me along to church as a kid. Sitting for hours on those hard seats staring at the back of the seat, memorising all the lines in the wood or the creases in Doug’s suit jacket in front of me.

Outside the chapel, the hospital was cold and white with anonymous corridors not giving away any evidence of previous use – scrubbed out beyond trace. But the chapel was warm and proudly displayed it’s history of use in the cracked leather cushions with the impressions of a hundred bums, the wooden pew top rubbed smooth from arms and elbows bent to contemplate, pray, cry.

The chapel is the only place I felt at home. The rest of the hospital is just too frantic and bright with sterile clean newness - if I hadn't had drugs, it would have been too much.

Arrival II. Abe [kingseat, to live]

We drove up that crazy entrance drive with the Pheonix palms towering over us like some kind of alien welcoming committee. Living pylons – like those ones along the desert road. I used to imagine they were walking when we weren’t looking. Even in the dark I could see the palms and imagined what might be lurking up high in their fronds, watching us drive in.

The building was familiar, I felt that I knew it - like the others I’d been sent to years ago. The shivers up my back had nothing to do with fictional ghosts and graves but my own real ghosts of memories I’d rather forget. Damn. I thought it would be different. Even in the dark with friendly warm yellow lights in the windows, beckoning and promising a welcome. I could make out the old familiar outlines though the lights on the roof promised something different, they highlighted something unexpected which captured my thoughts and pulled them away from the past.

Instead of entering in the front, we kept driving around the back where the lights were far more welcoming that I was expecting from a service entrance - it certainly didn't have the look of a service entrance. I could smell dinner cooking, roast beef maybe, like Sunday lunch after church with my mum in the kitchen fussing over the gravy. My dog under the table sneaking the bits I didn't like, doused in gravy. My dog...we're allowed pets here which is the only reason I wanted to come in the end. If I hadn’t been able to bring Obi...

I’m ushered quietly out of the car with Obi sniffing and straining to catch the aroma of roast beef (now we're closer I think maybe it’s lamb). Imagine that, cooking roast lamb for us (my minder tells me that's my dinner cooking) The this-is-no-service-entrance is warmly lit, guiding our steps up towards the door with the same feel as those wooden pews. That same smell.

The walk up the steps into the night air and stars is magical. With only the sounds of our breath and Obi’s whining to be let free. Crickets and moreporks have replaced the constant staccato of car tires, helicopters overhead, sirens in the distance. My thoughts have room to organise themselves here, like the chapel.

Placebos & Mental Illness

According to Dylan Evans (Placebo. The Belief Effect. 2003), there are no well controlled clinical trials which demonstrate that patients with anxiety and depression do better when given a placebo compared with no treatment.  However, there are other kinds of evidence while do provide a basis for suspecting that placebos can reduce anxiety and depression. Results from a study* of patients with anxiety and phobias who were all given the same dose of an anxiolytic drug but in tablets of different colours showed that there were significant differences in the responses of patients according to the colour of the tablets (green were the most effective in reducing anxiety while red ones were the least effective). A large meta analysis of studies of antidepressants also suggests a placebo effect in depression.** When patients were able to guess which group they were in (active treatment or placebo), the differences between the active treatment group and the placebo group increased which suggests that belief is playing some role in the efficacy of the antidepressant medication. In other words, the placebo effect does seem to work for depression.

*Schapira, K., H.A. McClelland et al. (1970). Study on the effects of tablet colour in the treatment of anxiety states. British Medical Journal 2:446-449
**Kirsch, I. and G. Sapristein (1998). Listening to Prozac but hearing placebo: a meta-analysis of antidepressant medication. Prevention and Treatment 1, Article 0002a. http://journals.apa.org/prevention/volume 1/pre0010002a.html

The Placebo & The Belief Effect (why positive affirmations are rubbish)

Notes from "Placebo. The Belief Effect" Dylan Evans. Harper Collins Publishers, London. 2003.

There are so many sources of variation in people's responses to placebo, many of which are related to how the recipient processes the information about what is being administered to them and their own levels of skepticism or belief.
If the placebo effect is really 'just' the belief effect, then the magnitude of response should depend on the person's strength of belief in the treatment being administered or experienced. The number of variables that can influence the strength of an individual's belief is virtually unlimited, which leads us to the conclusion that when it comes to placebo responses, only the most vague generalisations can be applied with any certainty...
(p92)

This is further complicated by the fact that people do not always really know what they believe. Just because you want to believe something does not necessarily mean that you do, in the same way that you can say you changed your mind about something but this does by no means guarantee that you have.

There are basically 3 main ways in which we acquire new beliefs:

1. accepting on trust what someone else says, someone who we think is an authority on the matter (for example a trusted doctor or therapist)
2. learning from our own personal experience (I did this before and it worked)
3. logic - to help us figure our previously unrealised consequences or inconsistencies of our old beliefs which cause us to reject them

None of the above are really voluntary - despite convincing illusions to the contrary, we never just decide to change our minds, it changes itself as a result of one or more of the above. Willpower alone does not do it, nor do 'positive affirmations' on their own...but give someone a placebo and you may very well succeed in causing them to acquire the belief needed to boost the immune system which is why placebos are so intimately tied up with the belief effect. Giving a placebo just happens to be a good way of inducing beliefs necessary to trigger various immune mechanisms or neurological responses. Placebos do this via the first and second routes described above.
(p94)

Placebos - so how do they work?

Notes from "Placebo. The Belief Effect" Dylan Evans. Harper Collins Publishers, London. 2003.

While there is no scientific consensus on what actually causes the placebo effect, it is accepted that it begins with some neural response. Placebo effects are associated with a local release of endorphins in the body but its not clear how or where in the brain this release is triggered.
Evans proposes that the secret ingredient in the placebo response is belief and from the research I've done this seems to be a good explanation - one that is suitably vague and mysterious but believable and something we can all relate to. We take our beliefs very seriously.

Hope, expectation & the placebo

Hope has been attributed as the primary mechanism of change in traditional healing, and in psychotherapy.

Hope can be defined as the desire and expectation that the future will be better than the present.

Expectation may also play a role in the 'Hawthorne Effect' - this is the clinical improvements seen in patients simply due to the fact that they are being observed.  A patient who knows that they are being studied may expect a better therapeutic outcome because of the many examinations, the special attention and the trust in the new therapy under investigation.

Expectation of a future positive outcome may reduce anxiety and/or activate the neuronal networks of reward mechanisms (the reverse can be true). When given a placebo, if you expect a distressing symptom to  subside soon then you become less anxious (eg. as soon as I take pain relief medication for a headache I start to become less concerned about it even though I know it won't take effect for a while).

Placebo - 'to please'

Early Christian communities of monks would begin a particular prayer session after a member had died with a reading of the ninth verse of Psalm 116 which in Latin is "Placebo Domino n Rione viroum", roughly translated this means 'I shall be pleasing the Lord in the land of the living'. So placebo in this context was usually translated as 'I shall please'.

In medieval English, the word took on the meaning of a flatterer, sycophant or parasite - someone out to please others with artifice rather than substance.

Then in the early nineteenth century, this meaning of the word started to be used by physicians. A medical dictionary published in 1811 defined a placebo as

"an epithet given to any medicine adapted more to please than benefit the patient".

[From reading Daniel Moerman's "Meaning, Medicine and the 'Placebo Effect'"]