Synthesis of the definitions proposed by IRICSS on self-healing
Healing definition (Laurence & Malpel, 2023)
Healing refers, in the context of a singular experience of illness, to both a sought-after state, an observed state, a lived experience, a more or less long-term dynamic process aimed at stimulating regeneration and recovery capacities of the body and/or mind, and its physical, mental, psychic, and social consequences. It is located on a continuum that goes from illness to death, through intermediate states related to the evolution of the disease and its management, to sequelae, stabilization at a new health level or return to the initial health level.
Self-healing definition (Laurence & Malpel, 2023)
The notion of self-healing can be considered, to start with a simplification, as the body’s ability to heal on its own. Everyone has been able to experience that, in certain situations, the organism is quite capable of healing on its own; it can for example eliminate infectious agents, mainly thanks to the immune system. It can naturally heal from wounds, notably thanks to the process of cicatrisation. Inflammation, fever, metabolism regulation and the secretion of painkillers are other examples of natural processes of spontaneous healing.
These biological processes, which occur spontaneously and unconsciously when we are affected by a disorder, and which are certainly the physiological component of self-healing, can act in addition to a medical or paramedical action. The care treatment then often acts in a way to help the organism heal. For example, in the case of interventions following a limb fracture, they often involve repositioning the fractured bones in the axis of the limb and immobilizing them with a plaster. But it is indeed the organism itself that will trigger healing and regeneration of bone and other tissues to allow repair. Similarly, some paramedical and herbal treatments, and even some medical treatments, such as cancer immunotherapy, aim to improve the efficiency of the immune system. Medical or paramedical action may therefore consist, at least in some cases, of promoting self-healing processes.
“Self-healing: Set of psychophysiological processes that allow the organism to be put in a favorable disposition for healing, to tend towards a relief from a symptom, an improvement in the state of health, a state of partial or complete recovery, and to prevent the occurrence of new pathologies. These processes can be mobilized by the individual alone or through the intervention of a third party, most often unconsciously, but also in some cases consciously. Various scientific studies suggest the importance of the relationships between, on the one hand, the central nervous system and the autonomic nervous system and, on the other hand, the immune system and other physiological processes, in the mechanisms of self-healing.”
Ainsi la guérison et l’autoguérison ne seraient pas si différentes : en effet la guérison et l’autoguérison seraient en fait strictement équivalentes lorsque le patient ne bénéficie d’aucun traitement curatif qui possède une efficacité propre. Clearly, if the patient heals while he has not received any treatment, we can say that he self-healed. If he has undergone a treatment that we know otherwise does not have its own action, it is also a self-healing. If, on the other hand, the patient has benefited from an effective treatment against his illness, self-healing becomes a component of healing. In the latter case, healing is due to the treatment itself, but also to the mechanisms of self-healing, which are always in action, or even to the combined action of both factors. No need for the patient to be aware of self-healing mechanisms for them to be at work, although through his attitude, lifestyle and certain health practices, he can promote these mechanisms. This proximity of meaning between healing and self-healing is well illustrated by figure 1.
Figure 1: Concept map that allows visualizing the multiple interactions between health, disease and healing/self-healing.
Definition of a self-healing factor (Di Scala, 2023)
Self-healing factors correspond to all forms of objects* and/or situations* leading to homeostatic regulation* of the organism, as part of a benefit-risk balance, presenting symptoms, or diseases without symptoms, resulting from an imbalance. These objects and/or situations could possibly be associated with pleasant primary, social, or background emotions (e.g., joy, happiness, love, recognition, kindness, well-being, or even calm) that can generate feelings in agreement (affective component of these emotions) having an impact on the mind consciously or unconsciously; coupled or not with the favorable expectation of well-being produced. They will trigger a physiological activity leading to a beneficial impact on the body, which can mobilize according to our current knowledge, the activation of the reward system and possibly the opioid system, via the hypothalamus and the autonomic nervous system. This beneficial impact will be defined by a recovery or improvement in the state of health.
*objects: concrete objects (similar to a placebo, for example), abstract objects (music, art, etc.), individuals.
*situations: active or passive situation in the context of interventions, caregiver-patient relationship, physical and sports activities, etc.
*homeostatic: homeostasis is the regulatory process by which the organism maintains the different constants of the internal environment around a beneficial value for the system under consideration.
Figure 1: Explanatory diagram proposing the definitions of a self-healing factor/self-prevention factor/harmful factor/risk factor
Definition of a well-being factor (Di Scala & Gueyffier, 2025)
This analysis leads us to propose the distinction between a well-being factor, which can improve the positive emotional perception of the individual, and a self-healing factor. The improvement of positive emotional perception, consequent to a factor of well-being, seems to be a necessary parameter, but not sufficient to trigger a self-healing mechanism. We can therefore propose that a factor of well-being participates in the establishment of a favorable emotional environment, necessary for self-healing.
We might wonder if a factor of well-being could not have an influence on the evolution of the disease in the long term, for example, which could thus lead to a self-healing of symptoms over delayed times and/or perhaps not measurable in the methodology employed. This could question us more broadly about the status of a well-being factor: is a well-being factor, or can it be, or become, a self-healing factor? Could we then rather speak of a co-factor, or an indirect self-healing factor?
Conceptual analysis of the notion of placebo, placebo effect, specific effect and therapeutic (Boussageon, Gueyffier, Moreau, Serrau & Ferchakhi, 2023)
The concepts of therapeutic, placebo, and placebo effect are polysemic and confusing. We propose a lighting and try to define these concepts as well as possible. This highlights the crucial role of evaluating the causal effect of treatments by the triple-blind randomized placebo clinical trial (controlling for the risk of false positives), which is the only study that can ensure causality and specificity, and thus to define what a therapeutic is. In the end, whether with a real drug (proven effective) or with a placebo, it is indeed the organism/person (living) that reacts to its intake. In the case of the drug, this reaction is both related to the pharmacological molecule and to the "signal" that constitutes this taking of medication; a signal that only makes sense for the person and the organism in a given cultural context. This clarification allows the treatment and healing factors that are usually poorly taken into account to be reintegrated into treating medicine, because they are often only considered to be effective through their "placebo effect". From a pragmatic point of view, these therapeutics or self-healing factors are useful for care, even if their effectiveness is linked to an optimized placebo effect. It is therefore a question of studying them for themselves.
The definition of what counts as a therapeutic intervention allows one to sort through all factors purported to be effective, particularly self-healing factors and the placebo effect. A placebo may have no effect. It is therefore important to be aware of situations in which a factor (placebo or not) has been shown to have a positive influence on health.
A survey work with a panel of 29 experts using a questionnaire from a literature review on the empirical data of the placebo/nocebo effect allowed obtaining an expert consensus and recommendations on the subject:
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Consider the placebo effect as a full-fledged treatment by optimizing it to improve clinical outcomes and informing its interest with the patient;
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Take into account the history and experience of the disease, its context of severity, the ethical, cultural and genetic dimension of the person;
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Prevent the nocebo effect by informing of its existence to minimize its effects. The way to address risks and adverse effects matters, by reassuring about their impact and avoiding a dramatizing attitude towards negative effects;
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Take into account the patient’s information needs and enter into a deliberative process of shared medical decision (DMP), informed consent, and therapeutic education;
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Develop an empathetic, warm therapeutic relationship that gives confidence while avoiding falling into premature or unrealistic reassurances;
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Develop studies on how to optimize the placebo effect and minimize the nocebo effect.
Self-healing and therapeutic relationship of patient-centered approach (Moreau, Di Scala & Boussageon, 2025)
A synthesis of the literature has shown that the positive therapeutic relationship is a factor promoting self-healing insofar as it mobilizes expectations, hope, feelings-emotions and positive representations. All this will act on the autonomic nervous system (ANS) and neuroendocrine and thus promote homeostasis (see definition of self-healing factor above). We find in the positive caregiver-patient relationship a situation of interaction that is associated with emotions and feelings produced by the patient, consciously or not. The expectation and hope for well-being or a perspective of better being in the context of exchanges between caregiver and patient, also participate. The experimental data from the literature identified show the improvement of health status within the framework of a caregiver-patient relationship beneficial for the patient. Patient representations also play a role in the implementation of this improvement in health. This parameter also meets the definition of self-healing factors. Indeed, if the psychological part has a capital importance in the emotional appreciation of a situation, social representations also participate through convictions, beliefs, values that they convey, associated with the social and cultural practices of the person. It is customary to think that the non-specific placebo effect and the specific effect of a therapeutic device add up according to an additive model. This patient-professional relational interaction found in self-healing suggests that the two effects are interacting.
We have seen that this clinical method aims to promote the collaborative encounter between two fields of expertise, the experiential one of the patient with the biomedical one of the health professional in a global biopsychosocial approach to find a common ground to solve the situation-problem-disease-health within the framework of a relationship and therapeutic alliance. Each of the protagonists has their own perspective. The TRUE perspective of the patient covers their lived experience of their situation-problem -disease-health that they are the only one to know, to feel emotionally and that it is important to listen actively. He will be able to address his representations, opinions, ideas, beliefs about this situation-problem-disease-health and its expectations, hopes, needs, demands. He will be able to tell us what is important for him, his life values, the meaning he gives to this situation-problem-disease-health. Through his narration, he will talk about his state of mind which gives us an idea of his personality. This allows adapting the contextual factors of the help, support relationship and the indispensable therapeutic alliance. For its part, the perspective of the physician covers the exercise of his medical competence through his clinical reasoning, his knowledge of specific treatments validated if possible by current scientific data, his knowledge of the patient’s TRUE perspective in a biopsychosocial approach that takes into account the context of care. An empathic communication of active listening with positive reinforcement and reassurance will fuel the trust necessary for the therapeutic alliance, a condition of an appropriate therapeutic relationship. The reflexivity and self-awareness of the professional promotes the management of its counter-transfer generated by its therapeutic relationship with the patient and, on the other hand, the therapeutic alliance. It allows one to be realistic about their limits and time management. The objective of the professional is to establish a cooperative, deliberative relationship to find common ground on understanding the situation-problem-disease-health and finding solutions for a shared decision process. This clinical approach promotes self-realization, authorization to act and patient empowerment. It allows to influence changes in behavior through suggestions favorable to self-healing in an ethical framework. It maximizes the non-specific placebo effect by associating them with the specific effects of the therapeutics validated by the EBM (figure 2).
Level of evidence to support reflection on self-healing mechanisms (Gueyffier & Boussageon, 2023)
We propose a new level of evidence scale for the evaluation of therapeutics, drug and non-drug, as well as an individualization approach to the results of therapeutic trials and a framework for the evaluation of self-healing factors. The two main innovations of the level of proof scale concern on one hand the situation of the meta-analysis tool, which does not modify the level of proof by not providing a demonstration of effect per se, but constitutes a parallel approach to synthesis. On the other hand, we specifically consider the tests conducted in double-blind, which only allow to dissociate the therapeutic effect from the impact of bias and the placebo effect. We recommend the greatest transparency when a therapeutic effect is suggested by open-label trials, so that the therapist does not deliver truncated information, but clearly specifies that the demonstrated effect includes the placebo effect and the potential impact of other biases, these being able to take a preponderant part in it. The effectiveness of placebo, open-label therapies should allow the therapist to reveal the limitations of this open-label assessment without fear of loss in efficacy.
The evaluation of mechanisms involved in self-healing processes will require specific and precise experimental designs to enable therapists and patients to use the most comprehensive range of health improvement tools.
Work plan for this new level of evidence scale
This proposal, resulting from reflections on self-healing, is a starting point. Its consideration and deployment will require its analysis and validation by a dedicated group, bringing together expertise and multiple perspectives (methodologists of clinical research on the drug or non-drug interventions, sociologists, patient association, philosophers, epistemologists, decision specialists, regulators, etc.). This new scale was designed to support reflection on self-healing mechanisms, guide the implementation of experiments that can identify the mechanisms at work, but also test interventions targeting these mechanisms.
References cited (see the publications tab):
Laurence D. & Malpel S. (2023) Définir la guérison et l’autoguérison, HEGEL, (4), 311-324.
Di Scala E. (2023) Proposition de définition d’un facteur d’autoguérison, HEGEL, (4), 335-346.
Di Scala E. & Gueyffier F. (2025) Les représentations émotionnelles de patients atteints de cancer : l’influence de vêtements adaptés lors des soins de chimiothérapie, Santé Publique, (1), 37, 197-207.
Boussageon R., Gueyffier F., Moreau A., Serrau V. & Ferchakhi W. (2023) Qu’est-ce qu’une thérapeutique – Analyse conceptuelle de la notion de placebo, d’effet placebo, d’effet spécifique et de thérapeutique, HEGEL, (4), 325-334.
Gueyffier F. & Boussageon R. (2023) Fondamentaux de l’évaluation des thérapeutiques, médicamenteuses et non médicamenteuses – un cadre pour l’évaluation des processus d’autoguérison, HEGEL, (4), 347-358.
Moreau A., Di Scala E. & Boussageon R. (2025) Autoguérison et relation thérapeutique d’approche centrée patient, HGEL, (1), 1-10.