ON PSYCHOANALYSIS
401
activities of witch doctors in primitive societies and faith healers in
America today and the efforts of psychoanalyst and patient. The
contents of each of these healing sessions are very similar. Through
the manipulation of physical symbols (such as fetish objects) and
words the patient and the healer interact, both hoping that the
patient will get better. This
is
a situation of persuasion, in which the
healer seeks to persuade the patient primarily through the use of
language or traditional belief that changes in
his
behavior or belief
are both possible and profitable.
In primitive societies the illness of the patient is attributed to
possession by evil spirits, to curses or to violations of taboo. The
function of the healer is to propitiate the evil spirits, lift the curse or
make reparations to the aggrieved gods. Since the healer in this situa–
tion must in all instances be operating on a false theory of disorder,
none of
his
activities (unless he uses folk medicines) can affect the
patient except through the intensity of the belief of the patient and
the credibility of the performance of the healer. I do not mean by
performance that the healer does not believe in what he
is
doing,
but rather that what he is doing has a dramaturgical function for the
sufferer and increases his belief in the capacities of the healer. Unlike
the jazz musician who says, "When you can't make it, fake it," the
healer must attempt to "make it" every time. Given the necessarily
high frequency of failure in primitive medicine, the healer must
select his patients carefully so that the ratio of failures to successes
does not undermine the credibility of his performance either for the
patients or for himself. And patient selection
is
a requisite for the
same reason in modern therapies. The same kind of mutual belief
took place in the exorcism of devils in the Middle Ages, where what
must have been some form of mental illness was viewed as possession,
and the priest played the healer's role. A fascinating chronicle of one
such process is given in Aldous Huxley's
The Devils of Loudun,
in
the Polish film,
Joan of the Angels
and in John Whiting's
The Devils.
Most of the history of medicine in Western countries must be
viewed in this context, for, except for opium and its derivatives
(which are known to physicians as "God's Own Medicine"), very
few drugs with specific effects on bodily processes were known. In
fact, the history of Western medicine has been described as the his–
tory of the placebo effect. A placebo was given to the patient in the
