demands reflection on one’s own attitudes as well as an appreciation of the
nature of the main ceremonies (step 1).
It is certainly as well to remember that conventional medicine has long
looked upon magical practices as lacking credibility, certainly since the
seventeenth to eighteenth centuries when supernatural practices were
increasingly expunged from regular treatments. In fact, this trend joined the
growing scepticism, on the part of many practitioners, of the value of
numerous herbal treatments including those used by aboriginal peoples. For
instance, in 1897 James Mooney indicated that only 25% of an admittedly
small group of Cherokee plants were used correctly (see Hamel and
Chiltosky,^18 page 6).
Step 1 (preparation): the placebo effect
Before noting some features of healing ceremonies (the sweat lodge as an
example) that can be useful for a practitioner in discussions with patients, it
is helpful to reflect on a reason commonly heard today for paying little
attention to aboriginal treatments, namely that any benefit is ‘merely a
placebo effect’. Such a dismissal – it also applies to a wide range of other
‘unproven’ traditional and CAM treatments – invariably overlooks the
negative feelings towards a placebo action that became widespread only
after the 1950s when placebo controls became a key part of RCTs. With this
new role, physicians began to feel that it was unethical to prescribe a
placebo consciously – as had previously been fairly common (the proverbial
‘bottle of coloured water’, although attacked at times) – either as ‘fake’
treatment or as one unsupported by clinical trial data.^31 This view was
bolstered by a new emphasis on the autonomy of patients, such that any
deception in information (meaning failure to give full disclosure) became
unacceptable. It is noteworthy that the change in attitudes from before the
1950s seemingly occurred without general discussion on the potential to
diminish placebo effects that benefited patients.
Having said this, it is as well to appreciate that, since writing this, some
change in attitudes might be under way. At least a British Medical Journal
editorial (3 May 2008) strongly hinted that the placebo effect may be one of
the most ‘added value’ tools in the medical bag.^32 Certainly some practi-
tioners, in remembering that placebo effects are virtually universal in any
therapeutic intervention, challenge any quick dismissal of an unconventional
therapy – at least a dismissal without careful assessment merely because it
has no modern supporting epidemiological or clinical trial data. This applies
to healing ceremonies although they are often acknowledged to have poten-
tial psychological effects for some participants, perhaps associated with the
power of the ritual (see below). Moreover, many facets of healing ceremonies
resonate with those viewed as essential for effective therapeutic relationships:
56 |Traditional medicine