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one of the partners conceals important information from the other? If the doctor tells the truth, he destroys the base on which the placebo rests. If he doesn’t tell the truth, he jeopardizes a relationship built on trust.
    This dilemma poses a question involving medical ethics: when is a physician justified in not being completely candid with the patient? In terminal cases, the doctor may think it unwise and even irresponsible to add desolation to pain: and so he skirts around the truth. What about drug addiction? Placebos are now being used by some doctors as a substitute for hard drugs in a systematic attempt to wean their patients away from addiction. In these cases, the patient exhibits the same solution as he does to heroin or cocaine. The body’s raging desire for the drug is appeased—but it doesn’t pay the physiological price of the addictive poisons. Should doctors withhold such treatment because they feel it is a breach of medical ethics not to inform the patient about the true nature of the treatment?
    In an even more fundamental sense, it may be asked whether it is ethical—or, what is more important, wise—for the doctor to nourish the patient’s mystical belief in medication. An increasing number of doctors believe they should not encourage their patients to expect prescriptions, for they know how easy it is to deepen the patient’s psychological and physiological dependence on drugs—or even on placebos, for that matter. Such an approach carries with it the risk that the patient will go across the street to another doctor; but if enough doctors break with ritual in this respect, there is hope that the patient himself will regard the prescription slip in a new light. Dr. Richard C. Cabot once wrote that “the patient has learned to expect a medicine for every symptom. He was not born with that expectation.… It is we physicians who are responsible for perpetuating false ideas about disease and its cure.”
    Another problem in medical ethics arises because many doctors believe not enough is known about the effects of the placebo on the delicate structure and functions of the body’s nervous system. Should the benefits of the placebo be deferred until such time as more answers are obtained?
    Certainly the medical profession is not without precedent in the use of modalities or drugs about which full knowledge is still absent. Electric shock is being used in the treatment of mental disease even though doctors don’t know exactly what happens inside the brain when it is jolted by high voltage. The most widely used drug in the world is aspirin, yet why it reduces inflammation is a mystery.
    True, not everything is known about the placebo. But enough is known to put its continued study high on the medical and human agenda. Knowing more about the gift of life is not merely a way of satisfying random curiosity. In the end, it is what education is all about.
    The most prevalent—and, for all we know, most serious—health problem of our time is stress, which is defined by Hans Selye, dean of the stress concept, as the “rate of wear and tear in the human body.” This definition would thus embrace any demands, whether emotional or physical, beyond the ready capability of any given individual.
    The war against microbes has been largely won, but the struggle for equanimity is being lost. It is not just the congestion outside us—a congestion of people and ideas and issues—but our inner congestion that is hurting us. Our experiences come at us in such profusion and from so many different directions that they are never really sorted out, much less absorbed. The result is clutter and confusion. We gorge the senses and starve the sensitivities.
    â€œYour health is bound to be affected,” Boris Pasternak wrote in Dr. Zhivago , “if, day after day, you say the opposite of what you feel, if you grovel before what you dislike and rejoice at