The Meaning Effect

Nathan Hill rebrands placebos in his novel “Wellness”

The book I’ve recommended most over the past year is Nathan Hill’s latest novel, Wellness. I don’t like to make general recommendations. I think people are often too quick to recommend a book just because they’ve read it, rather than considering whether the person they’re talking to would actually get something out it. But no matter the conversation, I find myself coming back to this book.

Whenever I mention the title to people, they ask if it’s non-fiction. It sounds like a self-help book. And one of the things I love about this book is that it blurs the line between fact and fiction. Non-fiction authors (think: Malcolm Gladwell, Charles Duhigg, Adam Grant) have gotten increasingly savvy about presenting their arguments in the guise of a story. The natural extension of this trend—the only way for academic arguments to become more storified—is to write a novel that incorporates scientific research. That’s pretty much what Hill has done.

But the book isn’t just about clever presentation of ideas; it’s also a great read. The plot centers on a married couple, Jack and Elizabeth, living in Chicago. Jack is an artist (though he’s not quite achieved the success everyone once believed he would) who now teaches at a local university. Elizabeth is a psychologist. She runs a clinic—called Wellness—which was spun out of a research lab in which she worked. The story charts their relationship from the intense romance of falling in love, when their entire future was ahead of them, to the chronic condition of being middle-aged, trying to keep the flame alive in mature relationship, and having already failed to convert a large portion of one’s potential into actual success.

Throughout the book, the tacit question behind the story is: What does it mean to be well? Whose theory of wellness is the right one? Is ‘more well’ something we can ever really be?

And Hill’s characters really do have theories of wellness (either explicitly rendered or implicitly lived). For example, the treatments offered by Elizabeth’s clinic are based on what she calls the “meaning effect”—a kind of rebranding of the placebo effect. Each character is exploring, in their own way, what story they need to tell to make sense of the life they are living. It’s a book for an age that offers a lot of solutions, without grappling with the deeper questions they’re meant to answer.

[I asked Claude to prompt me with a series of questions about the book. The AI’s questions have been lightly edited; the answers are my own.]

---

From your description, both Jack and Elizabeth are involved in forms of meaning-making - him through art, her through psychology. How do their professional approaches to creating meaning interact or conflict in the story?​​​​​​​​​​​​​​​​

Both Jack and Elizabeth are interested in exploring how far we can stretch storytelling. How much of a good story is reality? And how much of it is just the way you present it?

Elizabeth’s exploration is much more direct, through her clinic. The premise of the clinic is that we’ve been misinterpreting the placebo effect. The way it is normally framed, placebos are meant to show whether the effects of an experimental drug are real, or whether they’re due only to psychological factors. For example, if I’m testing a new pill, I would design a trial where I give half the people the real pill and half the people a fake sugar pill. No one knows who gets the real one versus the fake one (even the experimenter). Often times what happens is that both groups show improvement, simply due to the benefits of the patient’s belief that they are receiving a cutting-edge treatment. The real pill out must outperform the placebo control, otherwise the only effect is due only to the story patients are telling themselves about treatment.

But, according to Elizabeth, that framing misses the point. The point is that patients can tell themselves a story and physically heal themselves as a result. This is the “meaning effect”: it is a treatment that, as Elizabeth explains, is “elicited by a the strong sense of significance and substance surrounding the placebo itself: the context, story, ritual, metaphor, and beliefs associated with the placebo.” The placebo effect is, in other words, “the brain’s response to finding meaning.”

And so Elizabeth’s Wellness clinic is designed around telling the most effective story possible about the meaning of the treatment, while providing patients only with sugar pills. The effect depends on getting the details right—pills of a certain size, weight, and color; adjusting the branding and presentation of the clinic depending on the alleged treatment being offered (e.g., natural vs clinical); and a compelling lie about what biological mechanisms the treatment targets. It is narrative as treatment.

Jack’s interest in storytelling is more abstract. He’s a photographer. But his photographs are of… well, he doesn’t actually take photographs. Rather, he creates abstract images by manipulating the photographic development process. It’s an artistic counterpoint to Elizabeth’s take on the placebo effect. Jack’s thesis is less compelling than Elizabeth’s, since no one buys his art. But we ultimately learn—no spoilers here—that this practice is meaningful to himself personally, for reasons having to do with his sister.​​​​​​​​​​​​​​​​

Would you say the novel takes a position on whether Elizabeth's more calculated, outcome-oriented approach to meaning-making is more or less "valid" than Jack's more personal, intrinsic one? Or does it maintain an ambiguity about this tension?​​​​​​​​​​​​​​​​

One of the things that I love about Hill’s book is that it doesn’t offer easy answers. Everyone’s argument is presented as the strongest version of itself. No one is caricatured. Everyone is very clearly right—in certain ways and at certain times. Everyone is also very clearly wrong. No one has the answers in full.

This is one of my favorite effects in literary fiction: we get to see the same event viewed from the perspective of multiple characters. Often what happens is that the first time around we’re sympathetic to the character whose point of view we’ve had privileged access to. We wonder why the other character is so staunchly committed to being a bastard. Then we see the event from the other character’s perspective. We see why they are the way they are—what it is in their past they’re reacting against that makes their actions seem like a legitimate, even necessary, way of operating in the world. We see that it’s not that they are a bastard in some intrinsic sense, but that the situation has conspired to give them no way out.

Hill’s novel does this really well. And it’s especially important when it comes to the section on Jack and Elizabeth’s relationship in middle age. It’s obviously screwed up. It’s obviously suboptimal. What can they do to get themselves out of the predicament? So often, in non-fiction, we’re sold the idea that quality decision-making can get us out of whatever life situations we don’t want to be in. But with Jack and Elizabeth, we see there is no easy way out, at least not something simple. They’re not missing something. Getting separate bedrooms isn’t going to fix things. Trying to reignite the passion of their youth won’t make them young again. They’re in a genuinely difficult situation. And the fact is, individual decision-making is not a strong enough force to affect the tsunami wall of reality.

To me, this is one of the great psychological facts which can be revealed only in literature, not experiments. In experimental psychology, the force of human-decision making is all powerful. There’s no history to contend with, no weight of meaning of an action taken. There’s only the four white walls of the sterile lab. In narratives, as in real life, our decisions are a thin strand in a vast web of more significant forces.

Let’s connect this back to Elizabeth's work at the Wellness clinic. While she's professionally invested in the idea that the right story can heal, her own life seems to resist such neat narrative solutions. This seems to create an ironic tension in the book - between her professional theory about the power of meaning-making and her personal experience of meaning's limits. How do you see that playing out in the novel’s plot?

One of Hill’s major themes in Wellness is the precarity of the story. It’s fair to say in the book that no one is actually “well.” But some people think they are.

For example, Elizabeth gets invited to join a discussion group, led by the queen mom of her neighborhood. This mom, Brandie, is able to draw on a seemingly infinite reserve of energy; she bakes the best cookies and can instantaneously get Elizabeth’s kid to stop crying, even when Elizabeth can’t. Elizabeth admires Brandie and seeks her validation. So when Brandie invites her to the discussion group, Elizabeth wants to make a good impression. What she finds is that the group is dedicated to unrelenting positivity. As Brandie explains it: “If you want your life to change, you have to believe it will change, you have to envision the change, and then it will change. Speak of things as if they’re true, and they will become true.”

One of the guys in the group claims that after joining, he and his wife got back together. Elizabeth asks him when she moved back in. The guy clarifies that his wife is still technically—he says it with air quotes—“living with Chad.” But, according to Brandie, if he just believes in the story hard enough, reality will come to reflect it.

Hill’s point is that this kind of naive positivity is obviously stupid.

Brandie’s discussion group is a kind of foil to Elizabeth’s clinic. Hill uses it to convey that relying on stories alone isn’t enough. It’s insufficient as a life strategy to just tell a story about how you want things to be then cross your fingers that reality will conform to it. The hard thing, though, is that Brandie seems to be getting results in areas where Elizabeth is not. This makes the novel’s central question more nuanced: Just how much do you have to affect reality to make your story work?

Part of Hill’s broader thesis is that we go to great pains to exist in the tiny sliver of reality in which our story actually works. This is something that our decisions can really affect (of course, until something big and unexpected happens—which is always possible). Towards the end of the book, one of the characters has an extended discourse about the Leaning Tower of Pisa. In trying to tell a story about our lives, we’re like the tourists trying to take pictures where it looks like they’re holding the tower up with their hand. It only works from one specific angle. From every other point of view you see how ridiculous it really is.​​​​​​​​​​​​​​​​

The contrast between Brandie's group and Elizabeth's clinic seems particularly telling. Both are selling stories, but Elizabeth seems to understand that you need more sophisticated machinery around the story - the right pill size, the clinical aesthetic, the scientific-sounding explanations. It's not enough to just declare "speak it into existence" like Brandie's group. You need to create the conditions that make the story plausible.

One of Hill's insights seems to be that modern wellness culture often tries to skip straight to the "meaning effect" without doing the hard work of building the contextual framework that makes meaning possible. We want the benefits of a good story without investing in making it believable. What do you make of that?

It’s definitely the case that some characters’ strategies for storytelling are more effective than others. There are better and worse ways of doing it. But no one in the novel is so good at storytelling that it ameliorates the actual problems of their life. The only person who is that good at storytelling is Brandie. She’s evidently a great mom. But she’s also a fool. And eventually we learn that perhaps she’s not as great as Elizabeth first thought. I’ll let you read the book and make the judgment for yourself. Hill’s main point, I think, is that the right contextual framework can make a stronger or flimsier foundation for meaning. On the whole, it’s better to have a strong one than a flimsy one.

But Hill makes it clear that a strong contextual framework for one’s story is not an unmitigated good. For example, a strong foundation for meaning doesn’t yield Brandie’s kind of unrelenting positivity. It yields self-doubt, skepticism, and an insistence on digging into life’s toughest parts. So in this sense a “good story” doesn’t just yield benefits. It also forces the characters to confront a lot of negativity—both in their present lives and the route that got them there.

Ultimately, for Hill, a story isn’t just measured in terms of its believability, but also in terms of what he seems to think of as humanity. Holding one’s beliefs lightly and compassionately: this is clearly important to Hill. Part of the deconstruction of the Brandie illusion is how she has a death grip on her beliefs and is unwilling to give them up even in the face of overwhelming contradictory evidence. Elizabeth’s academic mentor has a great line about how if you want the god to really laugh you, then by all means—responding to Elizabeth’s insistent labelling of her and Jack’s fancy new apartment—call it your “forever home.”

But I think the line that captures it best is this: “that between ourselves and the world are a million stories, and if we don’t know which among them are true, we might as well try out those that are most humane, most generous, most beautiful, most loving.”​​​​​​​​​​​​​​​​

There's something deeply human about both wanting to believe in permanence and knowing better - and perhaps wisdom lies not in resolving that tension but in holding it with grace. Would you say the novel suggests that true "wellness" might have more to do with how we hold our stories than with what those stories actually are?​​​​​​​​​​​​​​​​

Elizabeth’s clinic does not “solve” the problem of being well. In the exposition on the theory behind the “meaning effect, Elizabeth makes it very clear that placebos are most effective on chronic illness. They usually can’t help with acute problems, like a broken arm, but often can help with longer-term issues like inexplicable back pain, “ambiguous inflammation, endless emotional anguish, spiritual hopelessness” or (possibly) being middle-aged. So there’s a distinction between what meaning can do for you in life’s long-term versus the short-term.

At any given moment, in a specific time-slice of your life overall, meaning can’t solve your problems. It can’t actually make a difficult situation easier or a sharp pain feel better. But over the broader course of living, it can help you make sense of things. It can give you a frame for explaining the past, using it to organize the present and orient yourself toward the future. In that past, you may have made bad decisions. You can’t do anything about that now. But you are still on the hook to make good decision in the present.

The reason why the effectiveness of a story is important is that it is answers the individual question of what constitutes a good outcome. As Elizabeth explains, the basis of her clinic’s interventions was that patients “created a story that explained themselves to themselves, and then they believed their made-up story was the actual objective truth.”

The reason why the humanity of a story is important is because it acknowledges the Pisa problem. Just because the story you’re telling works for you doesn’t mean it also works for everyone around you. It doesn’t guarantee that you’re making the world a better place. You aren’t actually holding up the tower. In the end, you have to remember a story isn’t reality. It is just a story.​​​​​​​​​​​​​​​​