A sugar pill for creativity

Following hard on the heels of a post about the possibility of creativity existing in a machine (and how we could tell if it did), today we look at recent research from the Weizmann Institute of Science (of Rehovot, Israel) showing that your creativity can be increased...

... by a placebo.

In a paper released last month, neuroscientists Liron Rozenkrantz, Avraham E. Mayo, Tomer Ilan, Yuval Hart, Lior Noy, and Uri Alon used three standard measures of creativity -- the creative foraging game, alternate uses test, and Torrance test of creative thinking -- to see if subjects' creativity levels improved if they were given a vial of a cinnamon-scented liquid to sniff beforehand.  The interesting thing is that the aromatic chemical in the liquid isn't neuroactive, but some of the test subjects' creativity improved anyhow.

As long as they were told ahead of time that's the effect it would have.

[image courtesy of the Wikimedia Commons]

The authors write:

Creativity is the ability to generate ideas, solutions or insights that are new and potentially useful.  Creativity is often viewed as a trait characteristic of a person; however, creativity can also be viewed as a state, affected by expectation and motivation...  

We find that placebo can enhance the originality aspect of creativity...  What are the psychological mechanisms that allow placebo to increase the originality aspect of creativity?  There are at least two possibilities. The first mechanism is based on extensive research by Amabile and Deci and Ryan, that suggests that creativity is modulated by motivation.  Extrinsic motivators were shown to be mostly detrimental to creativity, whereas intrinsic motivation is conductive to and strongly associated with creative abilities.  A key factor in intrinsic motivation, according to self-determination theory, is the belief in one’s competence.  For example subjects who practiced encouraging statements (related to self-confidence, releasing anxieties etc.) and omitted self-incapacitating statements showed improved creativity scores.  This is in line with the verbal suggestion in our study that the odorant increases creativity, which may have made subjects feel more competent.  Additional components of intrinsic motivation, such as social relatedness, may also have been increased by experimenter effects in the present study, by the experimenter’s perceived interest in the effects of the odorant. 

A second possible psychological mechanism of placebo, as suggested by Weger et al., is to weaken inhibitory mechanisms that normally impair performance.  Creativity was found to increase in several studies that tested conditions with reduced inhibitions, such as alcohol consumption.  Wieth and Zacks showed that creative problem solving was improved when participants were tested during non-optimal times of day, and suggested that this is due to reduced inhibitory control... This effect was suggested to be in line with paradoxical functional facilitation theory, which attributes improved performance of damaged nervous system to release from inhibition. Informal notions in improvisation theatre suggest that the inner critic is a source of inhibition that limits creativity.  The verbal suggestion made in our study that the odorant increases creativity and reduces inhibitions may thus work through a reduced-inhibition mechanism and/or by increasing belief in one’s competence.

So this suggests that there are two outcomes, here:

• Anything that works to increase your confidence in your own creativity will improve your ability.  This undoubtedly varies greatly from person to person, but it does make me wonder if all of the happy-talk "self-affirmation" stuff, which I had previously derided as pop psychology, might not have something to it.
• Ernest Hemingway may have been right when he said, "Write drunk, edit sober."

I can say from my own experience that frustration is the thing that kills my creativity the fastest.  Whether with music or writing (my two main creative outlets), if I start becoming frustrated with my skill, output, or proficiency, all it serves is to get in my way and make things worse.  I used to grit my teeth and try to plow through it, but I learned that this only tightened the downward spiral -- once frustration has set in, every fumbled note, every clumsy sentence, only serves to further shut me down.  The only solution was to leave the instrument or the keyboard behind -- not easy to do for a tightly-wound type-A personality like myself -- and do something completely different, preferably something active like going running.

Afterwards, it was amazing how the cogs had been loosened and the cobwebs blown away.  With writer's block, I often found that it was while I was running that the solution to whatever plot point I was wrestling with suddenly came to me, seemingly out of nowhere.  The research by Rosenkrantz et al. suggests that the loss of inhibition and cessation of negative self-talk from switching gears entirely might have been what shook the ideas free.

In any case, it's fascinating to find how malleable our minds are, how amenable to suggestion.  It also brings to mind the 2010 study that found that placebos work even when subjects know they're being given a placebo -- and makes me wonder if I should take a good whiff of cinnamon before I next sit down to write.

Your days are numbered

Most people have heard of the placebo effect.  The name comes from the Latin word meaning "I will please," and refers to the phenomenon that people who are given an ineffective medication after being told that it will ameliorate their symptoms often find that the symptoms do, indeed, abate.  The mechanism is still not well elucidated -- it has been suggested that some of the effect might be caused by the brain producing "endogenous opioids" when a placebo is administered, causing decreased sensations of pain, feelings of well-being, and sounder sleep.  But the fact is, we still don't fully understand it.

Less well-known, but equally well-documented, is the nocebo effect.  "Nocebo" means "I will harm" in Latin, and it is more or less the placebo effect turned on its head.  If a person is told that something will cause pain, or bring him/her to harm, it sometimes does -- even if there's no rational reason why it would.  Individuals who believe in voodoo curses, for example, sometimes show actual medically detectable symptoms, even though such curses are merely empty superstition.  Nevertheless, if you believe in them, you might feel their effects.

Naturally, this further bolsters the superstition itself, which ramps up the anxiety and fear, which makes the nocebo more likely to happen the next time, and so round and round it goes.  And this seems to be what is happening right now in Uganda -- a bizarre phenomenon called "numbers disease."

In "numbers disease," an affected individual suddenly notices a raised pattern on his/her skin that looks like a number.  The number that appears, it is said, represents the number of days the person has left.  Once the number shows up, the individual begins to sicken, and when the allotted time is up, the person dies.

[image courtesy of the Wikimedia Commons]

Dr. Thomas Lutalo, of the Ugandan Ministry of Health, says that he is seeing a rapid increase in the incidence of the "disease," and has suggested that much of the hysteria might be due to relatively harmless skin infections like ringworm that worsen because of improper skin care.  Ringworm rashes are often irregular, meaning that if you're looking for a pattern (e.g. a number) you're likely to find one, especially given that any number will do.  Then, the superstition that gave rise to the "disease" lends itself to superstitious "cures" that often make some easily-treatable disease become more serious.

The worst part is that this one-superstition-leads-to-another thing is generating an upswing in the belief in witchcraft, and is giving local religious leaders another tool for converting the fearful.  "Unfortunately, some Pentecostal pastors are already using the fear of the strange disease as a beacon for luring more followers to their worship centres with promises of a 'cure,'" said Dr. Harriet Birabwa, a psychiatrist at a hospital in the city of Butabika.  "It is a myth that needs to be dispelled immediately as very many people are dying because of harboring such baseless beliefs."

Which is all well and good to say, but as we've seen over and over, superstitions are awfully difficult to combat.  In my Critical Thinking class, I ask, "How many are you are superstitious?", and usually about half the class will cheerfully raise their hands -- despite the fact that it's hard to see how self-identifying as "superstitious" could be a good thing.  This generates a discussion about what they're superstitious about and why, and how we come to such conclusions despite there being little evidence for their veracity.  Fortunately, most of the superstitions I hear about in class are minor silliness -- on the level of a lucky keychain, a special pen to take tests with, or making sure that they put their left shoe on first because otherwise it'd be "bad luck."

But the whole superstitious mindset is counterfactual and irrational, and that in and of itself makes it worth fighting.  Why subscribe to a worldview within which sinister forces, over which you have no control, are capriciously doling out good and bad fortune, and for which (more importantly) there is no evidence whatsoever?  As we're seeing in Uganda, superstition is sometimes not as harmless as it seems, and can lead to fear, anxiety, physical harm, and allowing yourself to be manipulated by the unscrupulous.

So call to mind any superstitions you might fall prey to, and think about whether it might not be time to reconsider them.  Maybe it's time that irrationality's days are numbered... not yours.

Getting to the point

There is one alternative medicine modality that I've always been hesitant to criticize.  That hesitancy has come from the fact that it is widespread, so widespread that I know a dozen people who have used it and reported positive results.  Even though I could see no biologically sound reason why it would work the way its practitioners claimed, it's always seemed to me to fall into that gray area of "things that may work for some as-yet unknown reason."

That modality is acupuncture.  I get asked about it regularly, both in my Biology classes and in my Critical Thinking classes, and I've usually shrugged, and said, "Well, I don't believe in prana and chakras and the rest of it, but could acupuncture be triggering some positive response, in some way we have yet to elucidate?  Sure.  People used medicinal plants long before they understood pharmacology, and the fact that they attributed the plants' success at treating disease to good magic or benevolent spirits doesn't mean that the plants didn't work.  It could be the same here."

Well, I can't make that claim any more.

Just last week, David Colquhoun (University College of London) and Steven Novella (Yale School of Medicine) published a paper in Anesthesia & Analgesia (available here) that evaluates the results of every controlled study of acupuncture in the past ten years, and reaches the following conclusion:

The outcome of this research, we propose, is that the benefits of acupuncture, if any, are too small and too transient to be of any clinical significance.  It seems that acupuncture is little or no more than a theatrical placebo... 

The best controlled studies show a clear pattern – with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are what define "acupuncture" the only sensible conclusion is that acupuncture does not work. Everything else is the expected noise of clinical trials, and this noise seems particularly high with acupuncture research. The most parsimonious conclusion is that with acupuncture there is no signal, only noise.

The interests of medicine would be best-served if we emulated the Chinese Emperor Dao Guang and issued an edict stating that acupuncture and moxibustion should no longer be used in clinical practice. 

I have to admit that when I read this paper, my first reaction was to wince.  Part of me, I suppose, really wanted acupuncture to work -- even if we had no idea how it worked, the idea that you could alleviate pain (or anxiety, or insomnia, or depression) simply by sticking someone with little needles seemed preferable to telling people that they simply had to live with chronic conditions if standard medical treatment failed.  But one of the harsher sides of the rationalist view is that you go wherever the evidence drives you, even if you don't want to.  And after reading the paper by Colquhoun and Novella, and taking a look at their sources, I am brought to the inescapable conclusion that they are correct.

It's frequently that way, though, isn't it?  I think most of us, even the most hard-nosed skeptics in the world, would be delighted if some of the wild things the woo-woos claim turned out to be true.  Being a biologist, I would be thrilled if there were surviving proto-hominids like Sasquatch or surviving dinosaurs like Nessie, Champ, Mokele-Mbembe, Kelpies, and the Bunyip.  A convincing demonstration of intelligent alien life would be about the coolest thing I can imagine.  Even the existence of an afterlife is something I'd be mighty happy about (as long as it wasn't the being-tortured-by-Satan-for-all-eternity variety).

But, as my grandma used to say, "Wishin' don't make it so."  And it appears that in the case of acupuncture, the Colquhoun/Novella study conclusively demonstrates that there's nothing much there besides the placebo effect -- sorry though I am to have to say so.

Of course, that doesn't mean that acupuncturists are going to go out of business any time soon.  There are still a lot of true believers out there, and they can pull in clients from odd sources, sometimes.  Just last week, the veterinarians at a Tel Aviv zoo decided to call in acupuncturists because their attempts to treat a chronic ear infection in one of the zoo animals had failed.  The patient?

A fourteen-year-old Sumatran tiger.

Now that's some conviction in your beliefs.  You think acupuncture works?  Here, go stick some needles in this live tiger.

Be that as it may, apparently they anesthetized the tiger beforehand (smart move), and the acupuncturists all survived unscathed.  No word yet on whether Kitty's ears have stopped hurting.  My guess, given the Colquhoun/Novella study, is no, since the placebo effect doesn't work too well on cats.

Although to be fair, judging by my success rate at giving pills to my own cats, traditional veterinary medicine generates its own, unique set of problems as well.