Colour

The patient’s visual impressions of the environment affect his general condition and thus the clinical picture and therapeutic effect. An extensive scientific literature is devoted to the psychology of color and color treatment (see Birren F., 1969). Yellow, for example, causes (Obukhov Ya. L., 1997) both positive (sunlight, gold, honey, amber, topaz) and negative (jaundice, urine, pus) associations. The psychological aspect of yellow includes the recognition that it corresponds to a state of frivolity, frivolity, recklessness, carelessness, that it is the color of unfounded, unverified statements (hence the “yellow press”), and based on psychiatric experience, it is believed that yellow is preferred by patients with schizophrenia (Obukhov Ya. L., 1997). There are reports in the literature about schizophrenia patients preferring other colors (see below). The preference for yellow in the Lusher test, first of all, speaks, according to the interpretation scheme, about the desire for liberation and hope for happiness, about striving for a new, modern, future. If yellow is chosen last, which is interpreted as rejection, the person is disappointed, experiencing emptiness and isolation. There is a connection between such seemingly unrelated phenomena as the choice of car color and the driver’s driving behavior. So, those who prefer a red or black car strive for undivided dominance on the highway. Since the choice of color is a subconscious reflection of the feelings experienced by a person, it is not surprising that owners of silver or blue cars feel great on the road. Drivers of purple or lemon-green cars are more likely to become victims of unbalanced drivers who are annoyed by these two colors, especially during rush hours, like a red bull rag. Owners of pastel-colored cars are many times more likely to become depressed than drivers who prefer bright and eye-catching colors. In addition, color as such directly affects a person. So, yellow, orange and red increase blood pressure, increase pulse and breathing, increase reaction speed, muscle strength, green and blue have the opposite effect (Serov N. V., 1993). Color succeeds in conveying the unconscious, just as a word conveys the conscious. Color can influence the formation of behavior and temperament. Example. An example of this was V. M. Bekhterev’s observation that puppies who grew up in a room with red light grew up mobile, excitable, and active, while puppies of the same litter with the same heredity who grew up in a room with blue or blue light were characterized by slowness, lethargy, and indifference. The soothing and concentration-enhancing effect of matte salad color has long been used in surgery, replacing white coats and underwear in the operating room with light green, painting the walls and ceiling in this color. Has anyone investigated whether there are changes in the emotionality of a person who looks at a tablet of a certain color every time he takes it for many days? Or someone who sees a large color spot for a long time in the form of a multitude of pills in a transparent bottle, from which he takes one or two several times a day to take? There is no exact answer to these questions yet. But it cannot be ruled out that a person’s emotional state is changing, that a new color does not leave him indifferent. When it comes to any color, it is necessary, of course, to indicate exactly which color is meant. Each color, as you know, has many shades. Even the color tables for painters have dozens of variants of the same color. There are big differences within the same color. For example, dark and light green, grass, marsh, etc. Example. Noemi Madejska writes about the same thing using the example of green flowers in her book Painting and Schizophrenia (1976). The author emphasized, criticizing the opinion that patients with schizophrenia prefer green when drawing, that this conclusion is erroneous, since in reality everything is covered by huge individual differences between patients and healthy people in the choice of shades of green, from asparagus greens to spring grass greens. Individual differences in preference for shades of green are as great as the dissimilarity of green in the works of Murillo, Veronese or Dufy. The widely used Max Lusher color test (Lusher M., 1997; Luscher M., 1971,1989) of color preferences has the undoubted advantage that it makes it possible to work with standard colors (the question of the validity of interpretations of the results is left aside here). The researcher knows that the subject prefers or rejects not just green or yellow, but Lusher green (a kind of dark green) or Lusher yellow (“neutral”, not bright). Understanding the information about color contained in the scientific literature is difficult because it is not known which color is being discussed. Therefore, in our experiments (Lapin I. P., Rubitel A.V., 1987; Rubitel A.V. et al., 1987; Lapin I. P., 19906) on the relationship between the coloring of a drug and its expected psychotropic effect, we used standard color cards from the Lusher test set, although our task was not to conduct a psychological study “on the Lusher test.” We received a set of original (and not commonly used) cards made in local printing houses with distorted color reproduction directly from Dr. Max Lusher. We have been in scientific correspondence with him for several years. We have repeatedly expressed our gratitude to him for his generous help and valuable up-to-date information on the psychology of color. The methodological basis of the color relationship test (CTO) (Bazhin E. F., Etkind A.M., 1985) is a color-associative experiment based on the assumption that the essential characteristics of nonverbal components of relationships to significant others and to oneself are reflected in color associations. In the CTO, as in our research, an eight-color set of Lusher cards was used. The interpretation of the CTO results is based on two procedures: 1) the comparison of colors associated with certain concepts with their place (rank) in the layout by preference (if colors that occupy the first places in the layout of Lusher’s cards by preference are associated with a certain person or concept, it means that the patient treats this person or concept positively, emotionally accepts him, is satisfied with his attitude towards himself); 2) the emotional and personal significance of each color association. The semantic proximity of the verbal symbols of emotions is reflected in the similarity of their color associations. The subjects were consistently presented with 27 emotional terms representing nine typical emotional states, such as joy, fear, sadness, anger, shame, etc. (each of the states is represented by three terms, the associations with which were summarized during processing). The results of the CTO showed (Bazhin E. F., Etkind A.M., 1985) that, for example, 25% of the blue color choices were for terms denoting a state of sadness, another 25% for a state of interest, and no more than 4% for joy, anger, surprise, etc. In 36%, yellow was associated with surprise and had almost no correlation with sadness and fatigue. Semantically similar emotional terms were often associated with the same color. With the help of a personality differential, factorial estimates of colors were obtained. Their analysis revealed that the color variation in the Evaluation factor is less than in the Strength and Activity factors. The colors represent different combinations of Strength and Activity (red — high Strength and high Activity, black — high Strength and low Activity, yellow — low Strength and high Activity, etc.). The personal characteristics of the colors included in the CTO (and in the Lusher test) are interesting. For example, blue: honest, fair, unflappable, conscientious, kind, calm; purple: unfair, insincere, selfish, independent; green: callous, independent, unflappable. We did not use CTO in our research. However, when interpreting the results of color preference in the Lusher test, we took into account the interpretations of the CTO, which we considered more proven than the postulated (without evidence) interpretations of the Lusher test. The main thing for our research was not which interpretation (although we would not have rejected those that convinced us with evidence), but how stable or unstable the test results were for one person and what this or that single choice or association meant. We do not know whether the results of CT in one person are stable in repeated determinations. If stable, they probably characterize a stable emotional attitude towards someone or something, perhaps even the character or personality structure. If they are not stable (like the Lusher test results), — it’s just an emotional state at the time of testing. It can be assumed that the CTO, the evidence-based interpretation of which, unlike the Lusher test, is known to us, will be more informative in the study of placebo reactivity. Color memorization in patients with depressive states is significantly worse than remembering names or faces (Leo D. et al., 1989). Various colors (8 standard colors of the Lusher kit plus 7 other easily distinguishable colors) were significantly worse remembered by depressed patients than by control individuals. Memorization of names and faces was the same in patients and controls. The patients noted that the differences between the colors had smoothed out, that they saw everything as gray as they saw their mood. Such an association between indifferent colors and color images of one’s painful condition is very eloquent. Indeed, in Russian, the definition of “gray” reflects the bleakness, lifelessness, colorlessness, hopelessness of life. It is also used to characterize other people, their facelessness, colorlessness, mental and spiritual poverty: “gray as a fireman’s pants.” Example. How can I not remember: “He was walking in the midst of the gray (my italics — I. L.) sadness of a cloudy day and looked at the autumn land” — as Sasha Dvanov returned home in the Chevengur Andrey Platonov (Platonov A. Favorites. Minsk, 1989. p. 66). Remove the “gray” from that phrase, and the whole picture will lose its expressiveness and melancholic sound.

Several psychological shades of color

What does the instability of color selection mean? Approximately half of the healthy subjects choose colors significantly unstable, which is already evident when comparing the second choice with the first for each person (Lapin I. P., 19906). The instability of color preference raises the following questions. Which of the choices should the psychological characteristics be interpreted by? If the color preference of each subject is not estimated on an average for the group, as shown by the color distribution curves in a study of students with an interval of two months (Dashkov I. M., Ustinovich E. A., 1980), then it can be seen that it changes within minutes and one hour so significantly and with a change in the composition of pairs that you doubt whether it can characterize stable personality traits. Perhaps the color preference reflects the condition of the subject, which changes rapidly during the course of the study? Leaving aside these questions and suspending doubts, we tried to interpret the results of the examination of several subjects according to standard pairs of colors, strictly following the accepted instructions (Luscher M., 1971), according to the data of the second or third choice, considered by the author to be more valid than the first choice. The interpretations were very different, but they did not contradict each other in the main. We have identified an uneven degree of instability of color preference with frequent and rare repetitions of the choice. But the gist of our conclusion is that one person’s color preference varied significantly on individual days. Therefore, the choice of color cannot be used to assess a person’s personality or character: personality and character do not change from day to day. There was no limit to our surprise why such a find had not been made earlier. Most likely, because they did not repeat the Lusher test several times on different days for the same subject. The instability of color preference was noted among students equally often among placebo-reactors and placebo-non-reactors (Lapin I. P., 19906). The color of the dosage form By color, the patient most often identifies the medicine he receives when, as often happens, he does not know the exact name: “in the morning they give one blue, in the afternoon yellow, before going to bed they add the usual white.” It was noted (Chasar G., 1981) that colored placebo tablets are “more effective” than colorless ones. Most of the colors, including those in which medicines (tablets, pills, capsules, etc.) are colored, evoke associations that have historically developed in society, in art, and in religion. The perception of color, the attitude towards it is individual. And since it’s individual, we can’t help but be interested in color as a phenomenon related to personality, to the attitude to medicine. Color associations can determine the effect on the body of not only drugs, but also placebos. Red, yellow, or brown placebos are more effective than blue or green placebos. It has been suggested that this fact is due to the fact that the first three colors are historically associated with food, foodstuffs. However, the green color is also associated with vegetables and fruits, which affected the greater effectiveness of the green placebo. Perhaps because blue and green are associated with “toxic substances or preparations for external use only” (Shapiro A., 1960). The color of the medicine and the expectation of psychotropic action The green color of the drug in the treatment of panic conditions is more effective than pink (Shapiro A., 1970). Fresh, bright colors enhance the effectiveness of the placebo. The yellow color of the placebo is attributed to the optimal effect in depression. The blue and green color of the medicine is preferable for a calming effect (Janowski K. et al., 1989). The negated placebo colors were combined with the occurrence of negative placebo effects. Certain expectations of the drug’s direction of action are also associated with color (Luscher M., 1984). It is the type of expectation as a psychological parameter of personality that determines the placebo effect (Jensen M. R., Karoly P., 1991; Fillmore M., Vogel-Sprott M., 1992; Kushner M. G., Sher K. J., 1992). When we started an experimental study of the relationship between the color of the drug and the expectation of its psychotropic effect, we faced a fundamental methodological difficulty. We were unable to get tablets (or pills, or capsules) of different colors, but of the same size and shape, from several large pharmacies in the city, so that the tablets being compared differ only in color. We also could not order identical tablets from pharmaceutical factories, differing only in color. That’s why we had to give up the pills. The subjects were presented with 8 standard Lusher kit cards plus the ninth card, which is white, because many pills and pills are white. With this method, we won in the standardness of color and shape (squares of the same size), but lost in the fact that we could not present the original pills to the subjects. A questionnaire was developed listing the nine most likely psychotropic effects, from tonics to sleeping pills. The subject was presented with one Lusher card each and asked to indicate in the questionnaire which of the effects listed in it he expects from a tablet (tablet, capsule) of this color. If there are no expectations, put a dash. If you expect not one, but several effects, please note which ones. The results of a study (Rubitel A.V. et al., 1987) performed on 118 medical students found that the expectation of a calming effect is mainly associated with white, while red, yellow and green (the effect of the latter color turned out to be the most unexpected for us) most often cause the expectation of an exciting, tonic and stimulating effect (differences the frequency differences between these three colors were not statistically significant). Similar results regarding red and yellow were obtained earlier (Jacobs and Nordan, 1979). Purple color most often caused an expectation of mood enhancement, brown — hypnotic effect. The last observation was also unexpected for us. Black color was not associated with any psychotropic effect, but in half of the subjects it was associated with the expectation of a depressing, that is, undesirable and painful effect, which can manifest itself in a high frequency of complaints about the side effect of a black-colored drug. It should be noted that there is a coincidence with the rejection of black in the Lusher test. It is black that firmly occupies the last place when choosing the preferred colors by different groups of subjects. However, there are great differences between different cultures in the preference and rejection of colors. Among the black population of the United States (African Americans), black is not the least preferred color. It is unlikely that this is directly related to skin color. There may be other reasons for choosing a particular color, in particular black. Example. The poet Andrei Voznesensky once drew attention to the fact that in Spanish poetry, more often than in any other, according to his observation, the adjective “black” occurs: a black cloak, a horseman in black, a black night, a black shadow, a black bird, etc. What is the reason for such frequent use of “black”I don’t know the exact words in Spanish poetry. Perhaps the black color of Catholic church robes matters. Has anyone calculated which color — black, white, purple, crimson — prevails in the clothes and interiors of Catholics in Spain? Or at least on canvases of Spanish classical painting? It cannot be ruled out that, for example, in Georgia, where black dominates the everyday clothes of women and, to a lesser extent, men (just recall Pirosmanishvili’s canvases), black does not occupy the last place in the color preference test. Our data on the relationship between the color of the dosage form and the expected effect are generally consistent with the literature data (Buckalew L. W., Coffield K. E., 1982). Is it possible to use in practice knowledge about the relationship between the color of the drug and its expected effect? To achieve maximum effect by combining this expectation with the actual pharmacological effect. Example. In the monograph “Color treatment. Fashion and Harmony” (Serov N. V., 1993) Vincent Van Gogh is quoted as saying: “Color itself expresses something. It should be used.” How to use it in our medicine business? The results of our research, in agreement with the data of other works (see above), gave grounds to propose to the pharmaceutical industry (through a publication in a Chemical and pharmaceutical journal) to produce tablets (pills, capsules) of tranquilizers colored white, antidepressants in purple or lilac, sleeping pills in brown, etc. The proposal was rejected on the “grounds” that “coloring drugs of certain types of action will make it easier for intruders to find them in pharmacies and other places of storage” and “the shortage of dyes does not allow to color dosage forms with a wide range of colors.” How not to remember: “The cannon did not fire for many reasons. Firstly, there were no shells …”. “In theory,” the coloring of drugs not with random colors, but chosen on the basis of scientific facts, seems correct and promising in the light of the above data.

The taste of medicine

The medicine is also recognizable by taste. Since childhood, there has been an idea that “medicines are bitter.” This view determines the fact that bitter placebo is more effective than true caffeine (Janowski K. et al., 1989). To control the role of taste, pharmaceutical companies specially produce “active” placebos that completely mimic the taste of the drug under study.

The size of the dosage form

Larger placebo tablets produce a greater placebo effect than smaller tablets (Buckalew L. W., Coffield K. E., 1982). It has been found that very small and very large tablets and capsules make a greater impression on patients than medium-sized dosage forms (Shapiro A., I960). However, it is not uncommon for a patient to be prescribed larger tablets than previously received ones to fear that his condition has worsened if a higher dose is now required for treatment (a larger size is associated with a higher dose). This fear generates pessimism in self-assessment and prognosis. The size of the tablet (tablet, capsule), as well as the volume of the infusion solution, requires a doctor’s comment to the patient. It should be borne in mind that a number of drugs, such as phenibut, aminalon, riboxin, ascorbic acid, are produced in large tablets, as well as other derivatives of natural metabolites, such as piracetam (nootropil), depakin (convulex). This is determined by the fact that one tablet contains a dose of 250 mg (0.25) of the substance. For substances peculiar to the body, and therefore non-toxic, this amount is even less than a single dose, which is why two to three tablets have to be prescribed at one time. If you do not warn the patient that he has not been prescribed a large dose, and do not explain that the drug is close to natural metabolic products such as glucose or ascorbic acid (and therefore it is used in greater quantities than other known drugs), and that a single dose is divided into two or three tablets for ease of administration, he may be afraid of the unusually large size of the pill for him, and the fact that he is prescribed 2-3 tablets at a time, rather than one. It can be explained: if you make small tablets containing 25-50 mg of the drug, you will have to take a single dose of 250 mg each time in 5-10 tablets, which will take more time and will resemble a circus. Additional information to the explanation of the tablet size is that the drug is close in chemical structure to the natural substances of the body, that it is therefore non-toxic, that it belongs to the achievements of modern world science, cannot but contribute to confidence in the drug and its therapeutic effect. It also matters in what dosage form, regardless of the color, the drug is taken (and the placebo). As a sleeping pill, a liquid placebo is more effective than a white placebo tablet, but not superior to a colored tablet (Chasar G., 1981). In descending order of effectiveness, the dosage forms are arranged as follows: injectable drugs, pills, tablets, suppositories. The number of medications is also important. In a special study (Boissel J. P., Millard O., 1996), it was found that reducing the number of doses of the drug improves compliance in general medical practice. For the role of consent, see below.

Psychology of drug prices

We are talking about the psychology of price, which is of no small importance, especially in our time, when there are so frequent reminders in the media that “free cheese only happens in a mousetrap,“ “cheap cannot be good in quality,” “a miser pays twice.” The high cost of medicines, including vital ones, is a special topic, no less, but more important for the vast majority of people these days. Needless to say, the psychology of drug prices is a special case of the psychology of any treatment, any type of medical care. Advertising of medicines, like other products, tries to instill in the minds of people who are ignorant or ignorant of pricing and marketing, the idea that a more expensive product is always of better quality and more valuable. And they believe in this, reinforcing this view with the stereotypical statement that cheap means bad. In fact, as you know, two absolutely identical goods can have different costs, determined by the costs of transportation, packaging, advertising, rental of production, warehouse and retail premises, etc., and the product, the cost of which was high, will have a higher price. How can a simple consumer understand the complex relationship between quality and price? It’s easier and easier to believe in the plausible “rule” that “expensive means good.” Examples. The psychology of attitudes towards the price of medicine is similar in many ways among people of different cultures and traditions. It can become one of the determining reasons for not taking medications. At Albert Schweitzer Hospital in Lambarene (Gabon), African patients asked doctors for permission to pay a symbolic amount of money for medicines (everything else: food, care, procedures, operations, etc. — it was free), because, in their opinion, free medicines are not real. Fundamentally, the same thing is observed in developed countries, although there are individual and “class” differences in attitudes towards expensive and cheap medicines. Patients often have a negative attitude towards cheap medicines, believing that a good modern medicine cannot be cheap, and therefore prefer more expensive drugs. Such a preference may well complicate treatment due to the patient’s random choice of a drug that is less shown to him (her). An eloquent example of the psychological assessment of the price of treatment by a doctor who enjoys great recognition among the “new Russians” is contained in an article by journalist Julia Kantor in the St. Petersburg newspaper Nevsky Time dated February 22, 1997. Her interview with a young doctor who “earns thousands of dollars a month” is titled “A doctor for the “new Russians”” and the motto of his life: “To be kind is to be poor.” When asked by a journalist whether this doctor’s qualifications allow him to treat neurosis, obesity, thyroid disease, spinal curvature, and drug addiction, he answers: “Of course, otherwise they wouldn’t have come to me in droves. The main thing is for a person to believe (my italics are I.L.). In this sense, I am not an idealist: I know that if you do not ask some modern businessman for a tidy sum for one treatment session, he will decide that I am a charlatan.” Comments are hardly required here. Of course, in addition to the psychology of price, price itself is of crucial importance. In recent years, as is well known, centralized provision of medicines on preferential terms to the population, especially pensioners, the disabled and the poor, has become a huge social problem. Receiving medicines from pharmacies according to prescriptions for beneficiaries encountered protracted obstacles, which caused a fair protest in the form of pickets, demonstrations, and complaints to all state authorities. The health of thousands of people is at risk. This situation with a shortage of medicines is especially tragic for the elderly, who are constantly in need of vital medicines for the treatment of severe chronic diseases: hypertension, coronary heart disease, atherosclerosis of the brain, diabetes, cancer, etc. The reason for not taking medications, as practice shows, may be the unacceptably high price of the drug. The high cost of the drug becomes an exorbitant burden on the patient’s budget and his family, and he refrains from buying or, at his own choice, replaces the drug with a cheaper one. At the same time, the patient usually does not inform the doctor about the refusal to buy the prescribed medicine, for fear of spoiling the relationship with him (see compliance below), if the refusal is interpreted as ignoring the medical recommendation. It follows that before prescribing a medicine, the doctor needs to know its price, take into account both the patient’s financial capabilities and his likely attitude to a low price. The price, which may be perceived as low by the patient, needs to be commented on with a reference to the mass production that has been established over the years (for example, classic drugs such as aspirin, diazepam, lithium carbonate), a large volume of the company’s products, which reduces the cost of the drug, a proven sales system, etc. Source: Lapin I. P. “Placebo and therapy” Photo: netdna-ssl.com