The biopsychosocial medicine placebo toolbox will be published 2019

NB a draft – confidential until 2019! Also, careful, my dyslexia can construe problems!  

The structure below follows my plan from my dissertation 1986 ( where the English translation of the manual Medbestämmande i Livet, MBiL, the “COOL; Chef of one´s own life” was never published (but used e.g. at the University of Seville 1988, a series of lectures). But will be now I hope.
The structure 1986 – which I follow now also – was;

  1. Personality                                          The personality spectacles
  2. Biological systems                             The diet/breathing/movement/sleeping  Screwdrivers
  3. Psychological systems                       The iron-bar lever
  4. Social systems                                     The social movement networker
  5. Socio-cultural systems                      The cultural shaper
  6. And lastly a special approach to motivation; “How do I get started to do what I actually want to do” – a practical guide.      The lets do it-road

1.The personality model IRO/V is modified into

(a)    Internal and external locus of processing (not just control)

(b)    Rational (new brain*) and emotional (old brain*) locus of processing

(c)     Where the above complex interplays are not either well understand where we try to evaluate (in spite of huge problems with psychpsychological measure- and readable outcome measures below) in terms of the assumed net effect of positive, neutral or negative outcome from phasic towards basic levels.

Comments to the above: The complexity of biopsychosocial toolbox interventions (learning, tailoring and coaching) will be addressed in an appendix trying to give ideas where most is really not understood, but still urgent needs to be used at individual adjusted level – using the manual “patient as an educated, (a reasonable) competent resource and coworker in her/his own rehab”.

That is, an ideographical level which (as I see it) is not yet substantially addressed, possible dependent on it is (by some regarded) impossible complexity at all levels, especially organizational and political (and its consequences for its practical realizations) lack of systems integrating to be added to the scientific and clinical shortcomings, largely not only dependent on we are not working in an exact science but also personal prestige (as well as profits) related fighting about what paradigm is what counts! Where the biopsychosocial systems integrating paradigm (probably formally proposed first by George Engel, 1977) still has substantially not yet get started.

A further note is on placebo as a precognitive, not preferably conscious, spatial information processing in terms of “believe”, a complex concept to defined in rational terms while its is mostly assumed to be a irrational, emotional, Limbic information processing which integrating with human brain interactions can be to some very limited extent can be “seen” in dream processes where verbal and spatial related processing are mixed often in a surrealistic way. So, from this discussed perspective it is not easy to address placebo processes from only just an rational approach.

This opens the door for hypnosis like approaches, where in our “iron-bar lever” tool (part of it!) we use, a somewhat new kind of hypnosis definition and its practical personalized applications where psychological knowledge from different subfields are trying to be integrated based also on George Kelly´s personal construct theory (1955) as well as traditional hypnosis technology.

The believe construct (will be included into Kelly´s axiomatic model) processing can content

  1. Also traditional pharmacological thinking but then at best with some part/element of a natural diet, e.g. curcumin will cure me (not our suggestion but as an example),
  2. That what every personal significant (we are not yet in the knowledge position to rationally measure/understand .. just assume spatially/”picture”/image ..probably while we still do not scientifically rational work with this medical challenge) “thing/person/…
  3. Summarizing, placebo as a spatial, not preferably conscious, irrational, Limbic information processing can during yet understood (many more or less well articulated ideas/hypothesis exists since long .. where this one developed during last 25 years) circumstances can emerge a placebo effect (if slow we will probably not even think about the concept placebo, but call it spontaneous recovery, a word on something we also assume), that dependent variable where we now try to understand some of the independent variable (IDV), that is what is activating a process that result in a placebo effect! This IDV can be anything, a thing, a spirit, a “usual” person, .. magic thinking if you will!

Here comes hypnosis into the picture – training to integrated rational-verbal and irrational-spatial target marked (by the individual during the training) processes where also state-dependent learning (processing, operational conditioning) also is integrated (more details below), The idea is to use this complex (to understand and learn), but easy to practically do actually strategy as a part of self-regulation (over time integrated with other tools).

This hypnosis strategy prototype has been tested now for almost a year now and will be published in 2019. The main problem is dependent (outcome) measures of curse. As regard cellular dysfunctions, e.g. in terms of cancer behaviors, as dynamic behaviors (NB behaviors) where the mitochondria physiology is a critical part of the dysfunctional process, the search for useful outcome measures is, and probably will be for a long time, critical problem. As we say in integrating psychophysiology ( “see what you do and do what you see” is not around the corner.

So – rational clinical science has to deal with non-rational processes to be able to increase understanding perhaps the most important, non pharmacological personalized intervention approach waiting to be explored, more and more understood and put into biopsychosocial medicine practice – an all winner project we are at present very far from. Therefore, we need to challenge creatively to basic paradigm in western medicine!

-> Critical constructive suggestions is appreciated at intervention and dynamic outcome measurement levels as well as methodology (where IBED is the best I have come up with so far, Individual Biological Evidenced based Documentations, possible in IPBM but not yet in placebo research at individuals clinical levels!

2. Biological systems

More is to come …