Personal interest declaration: as founder editor of New Psychiatry, I hired Colin Brewer after reading an outspoken letter of his in The Guardian. This was no one-off. As a columnist Brewer was so controversial that our publisher quickly wanted rid of him for fear of libel. I insisted otherwise — successfully — which did wonders for the letters’ pages.
He was an elegant and witty writer. The God Effect shows that, more than 50 years later, he remains so.
Brewer was also a controversial psychiatrist: the first doctor in Britain to withdraw heroin addicts humanely under sedation or anaesthesia and the first to use heroin-blocking naltrexone implants to prevent relapse. He also set up the first British hair-testing service for drug detection. After working in the NHS and academia, he directed London’s Stapleford addiction treatment centre for nearly 20 years.
His pioneering techniques became the focus in 2006 of what the BMJ called the ‘longest and most complicated’ case in GMC history. He and two colleagues were found guilty of irresponsible prescribing after a 114 day hearing and scrutiny of more than 1500 prescriptions. Brewer insists that the case was ‘widely regarded’ as reflecting ‘establishment’ addiction policies rather than the specific cases in question.
The GMC hearing and The God Effect are linked. Brewer started the book during ‘several extremely stressful years’ while he and colleagues were awaiting the hearing.
The preface: says: “It is very common for physicians to feel suicidal in this situation and an alarming number do take their own lives. I came very close to doing so… Thinking that if I did go the whole way, I should leave some sort of personal and professional memoir, I started writing and it turned out to be quite therapeutic.”
The book is the first about common factors between medicine and religion. It argues that just as placebos can make patients feel better by virtue of their belief in the doctor and his or her remedies, belief in the power of priests, shamans, rabbis and other religious practitioners can make people feel subjectively better.
Brewer probably supports the Kingsley Amis’ school of writing. The Lucky Jim author reportedly said: “If you can’t annoy somebody, there is little point in writing.”
Brewer may annoy King Charles, royal patron of The Faculty of Homeopathy, for calling him ‘a walking placebo’. Research, says, Brewer, shows that any homeopathic benefits are restricted to the placebo effect. It is ironic, he adds, that The King and other royals who support complementary medicine ‘seem to be unaware of the power of the placebo effect ‘since they are, in a sense, its walking incarnation’.
He asks: “What else is the placebo effect, except respect, suggestibility, image tradition, expectation and good publicity. What else is the monarchy?”
Similarly, the drama and ritual of church services attract both congregations and officiating priests
Brewer also attacks Sigmund Freud — as self-deluding, grandiose, dogmatic and utterly convinced of the brilliance and correctness of his ideas. There is no evidence, Brewer writes, that Freud seriously considered the possible placebo effects of just listening and talking to patients.
Critics will say that may psychiatrists who despise Freud have accepted many of his ideas, For example, the concept of the unconscious mind — the idea that much anxiety, depression and guilt derives from conflicting drives below the level of consciousness.
Brewer accuses the Roman Catholic church of promoting bogus miracle cures and running a vast ‘Vatican saint factory’ on the back of the placebo effect — the basis of faith.
This enables popes to create new saints with little or no external scrutiny, he says. The canonisation of saints requires them to perform miracles, nearly always of a therapeutic nature, and often involving cancer. But Brewer believes that so called miracle cancer cures owe more to spontaneous remission than to divine intervention.
He says: “We can have little faith in supposedly miracle cancer cures that were proclaimed before the 19th century, when microscopic examination of diseased human tissue began to make histological diagnosis increasingly reliable.
“Many other incapacitating or potentially lethal conditions could not be accurately diagnosed until the following century and misdiagnosis must have been common, but even when diagnosis became a more precise science, I suspect that the show had to go on and the miracles had to keep on coming.
“How else could the Vatican explain to the faithful that God had stoped performing the medical miracles?”
Within two decades, John-Paul 11, who died in 2005, presided over the canonisation or beatification of nearly 1500 people. Brewer writes: “This massive expansion of the Vatican’s saint-factory has created more saints than the entire total since Pope Urban V111 started the formal process in the 1620s.”
This is a comprehensive book although I would liked to have more on the possible comeback of the placebo. Resulting in more advances in medical science in the last 75 years than in the previous 2000, the therapeutic revolution seemed set in the 1970s to exorcise the prescribing of placebos such as inactive creams, salt water injections and inert pills. Witch doctor care had no place in the temple of scientific medicine and and was incompatible with transparency. Placebos were increasingly regarded as unethical.
But human nature may be and almost certainly is as susceptible as ever to the power of suggestion, the basis of placebo power. Brewer reports that placebos may make a come-back thanks to researchers studying long neglected evidence that patients may respond positively to placebos even when they are told that they contain no active ingredients. The concept of the doctor as a therapeutic instrument in his own right may live on after all, perhaps alongside generative AI.