Real Change or Placebo Effect?

Let’s say that I’m a school-age child and can’t quite grasp a certain concept—say, multiplication—and to hide my embarrassment and distract everyone from my inability to multiply twelve times twelve, I pull the braids of the girl sitting in front of me. Is that a medical problem? Do I have a mental disorder? Or am I six months away from grasping a concept and in the meantime acting out?

For some reason (and it’s easy to name all the reasons) we have decided as a society that when I pull on Sally’s braids, I have a medical problem called a mental disorder and I should be obliged to take so-called medication to treat my so-called mental disorder. That is where we are today. And it is fascinating that whether or not my behavior actually changes by virtue of the strong chemicals I am forced to ingest, you, whether you are my parent or my teacher, will likely feel relieved that I am “being helped” by taking that “medication.” If asked, you will report that I am much improved.

Furthermore—and rather startlingly—it doesn’t matter if the chemicals I am given are inert and part of a placebo effect experiment. You are still likely to report that I am much improved. My taking something has eased your concerns and you now see me differently, as a better-behaved, compliant boy on meds. The child psychiatrist Scott Shannon is director of the Wholeness Center in Fort Collins, Colorado, a collaborative care and integrative medicine wellness center. He is also the author of two books in the area of the mental health of children, one for professionals called Mental Health for the Whole Child and one for parents called Parenting the Whole Child. In the former he explains:

“One of the most interesting facets of ADHD is the placebo effect. Children with ADHD typically express little placebo effect as they hold little expectation about the intended response. It appears, however, that there is a placebo effect in medicated kids’ parents. A meta-analysis confirms it. Parents and teachers express a placebo effect when children are given stimulants, because the adults hold a clear expectation for the medication’s effects (Waschbusch, Pelham, Waxmonsky, & Johnston, 2009). Parents and teachers evaluate a child more positively if they believe that the child has been medicated. They also tend to attribute positive changes to the medication even when no medications have been given (Waschbusch et al., 2009). This finding diminishes the reliability of parent and teacher reports in evaluating kids for ADHD—the core of the diagnostic process.”

This finding by itself is not enough to permit us to reject the current paradigm of “diagnosing and treating mental disorders.” But it is one of the many findings that, taken together, should alarm us about the current paradigm and cause us to raise our antennae. If a child is taking an inert pill and everyone around him—mental health provider, teacher, and parent—is exclaiming how well he’s doing now, what exactly is going on?

Download this resource: Real Change or Placebo Effect?


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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