hmmm, its really amazing how placebos work with 90% of the diseases

The efficacy of the Placebo Effect proves that if the mind isn't responsible for 100% of problems, its certainly the lion's share.

In our practice we work with folks with serious Fear of Public Speaking, and in most cases they are able to get over it completely with some simple exercises that rebuild the mind's 'model' of what public speaking is - or will be like.

I have no doubt that some people benefit from the placebo effect, however, the real efficacy of SSRIs in the treatment of social anxiety should not be underscored. I was crippled with social anxiety for the majority fo my life but I refused to believe it was a brain or chemical issue. I finally sought specific drug-free help and partook in numerous courses on overcoming social anxiety, relaxation, and public speaking. Immersing myself in these anxiety provoking situations did not help me in the least. Everytime I freaked out I bereated myself for not having the willpower to overcome such illogical anxiety responses. The truth is most social anxiety patients are not illogical. I knew people weren't judging me when I spoke. I knew most werent even paying attention and I didn't ever percieve any negative feedback. I simply hated being in front of people. I also hated any positive attention. I simply wanted to disappear. It was devastating. I finally agreed to try an SSRI but I did not think for a second that it would work. I thought it really was all placebo effect when people took drugs and blaming my incompetencies on a chemical imbalance a cop out for dealing with the root of the problem ( whatever that may be). To my intense surprise within several weeks of taking Paxil, my world changed completely. I felt calm, I spoke up in class, I even wrote better papers because my thoughts flowed smoothly and intelligently without the fear. I would never have finished grad school, gotten a job, or gone out on dates, had I not taken SSRIs. I continue to take them today in a low dose and there is no doubt in my mind they continue to help me. I am not ashamed that I need help balancing chemicals in my brain that allow me to function the way I want and deserve to function. When people imply I am just tricking myself into believing the medication works or not addressing the "real" problem I become extremely insulted. Anyone who walked a day in my shoes would be a believer in the awsome power of SSRIs. I am no more getting a placebo effect from my pills then a diabetic is getting a placebo effect from thier insulin shots.

That the placebo effect, even tho' it is real, does not mean that a person who benefits from it is somehow "cheating" or that their disorder is less "real" than a person who benefits only from SSRI's or other medications.

It is equally important to be clear that a person who benefits from SSRI's will often be experiencing a genuine pharmacological effect (enhancement of serotonin abundance) whereas other persons treated with SSRI's may be benefiting mostly from placebo.

Here is a hypothetical example; say two groups of social anxiety disorder suffers are tested, one group receives placebo, the other SSRI's. In the placebo group, ~40% of the patients show an improvement in their symptoms (as in the current study). In the SSRI group, it's ~50%. With a relatively small effect such as this, statistical analysis indicates may conclude that there is no significant difference between these two groups. This is the oft-touted claim about SSRI's; that they are statistically no better than placebo. Whilst this may be, and often is, the case, it does NOT mean that SSRI's are bogus, it just means that teasing out their effects is made more complicated by the power of the placebo effect in SOME people.

The placebo effect introduces an extra variable into the system and makes the statistical analysis noisier and thus harder to interpret. If the placebo effect could be eliminated from both groups, such that positive results were obtained in 0% of placebo treated and 10% of SSRI treated patients, then the picture might be much clearer (let me re-emphasise this is a hypothetical example and that testing drug without placebo would require patients to be tested without their knowledge; not allowed and rightly so).

The fact that Seymour Segnit obtains such positive results without SSRI's suggests that many social anxiety disorder sufferers may not need SSRI's. However, this does not mean that it is ALL in the mind. Note the word "most" in the description. Some folks benefit more from SSRI's, Beckys testimony is proof of that.

The tradition of genetic determinism known as the Central Dogma is increasingly challenged through the science of epigenetics and increasing volume of new research. Just this fact throws a monkey wrench in so much other research claiming how genes do this and that, including any assertions about the placebo effect.

For one thing you can remove the nucleus and genes from a living cell and the cell will continue to live for days, weeks or months and perform all of its normal functions during that time. The cell will not be able to reproduce however so it will eventually die. So obviously it did not needs its genes to live normally during that time but it needed them to repair/replace itself.

The new view is that genes are not all active but in most cases actually passive and only activated by cellular signals inside the cell which are in turn triggered by signals outside the cell. In other words our environment and thoughts play an even greater role and gene a lesser role.

This view point doesn't seem to get much press yet
at this time however.

Ultimately it seems to me that we don't really know except in very general terms that there is much more to it than genetic influence.

In other words it may be time to let go the "Central
Dogma" simplistically espoused since the discovery of DNA.