The Nocebo Effect
The nocebo effect is the evil twin of the placebo effect. Just as positive expectations of a drug or traditional remedy can trigger the body’s natural healing response, negative expectations can exacerbate a condition, or cause illness where previously there was none. The nocebo effect is extremely powerful, yet doctors are often unaware of the effect a negative diagnosis can have on a patient’s health. A commitment to honesty – telling the patient the worst-case scenario – can be extremely dangerous because the power of suggestion often causes us to simulate symptoms – and the underlying causes – that may previously not have been there at all. Worrying something is wrong with us can actually cause us to develop the ailment we fear.
Keith Petrie at Auckland University has studied how switching to generics from branded medication causes patients to report worsening of conditions …even though chemically they are just the same. When people believe they are on generics they report more side effects and the drug is less effective.
Research by Irene Tracy at John Radcliffe Hospital in Oxford, UK, has demonstrated that the nocebo effect can be even more powerful than the placebo effect, and yet scant attention has been paid to it until now. Volunteers were connected to an infusion pump and were exposed to heat. They were asked to rate the pain as it increased from one to ten. They were then administered a pain killer but were not told the infusion had begun. The pain rating dropped but only slightly – for example, from ten to eight. The researchers then took their blood pressure and announced the infusion would now begin, saying a ‘strong analgesic’ would be administered to help them cope with the pain. The volunteers then rated the pain at a five. The key here was the positive expectation. However, then they were told the infusion was stopping – even though this was not the case – and the pain rating increased even further than at the start – to a nine. This demonstrated the nocebo effect was so powerful it actually overrode a powerful analgesic compound. If the nocebo effect can wipe out the effect of a powerful drug, we can only imagine how strong it can be when there is no drug, and only negative expectations, such as a doctor listing possible symptoms, side effects or the worst-case scenario of a cancer diagnosis.
The brain has the capacity to control pain using opioids, since there are circumstances where pain does not serve us, but the nocebo effect appears to switch this off. It is thought this occurs via a neurotransmitter called CCK which is activated by anticipatory anxiety.
If very real symptoms can be neutralised simply through suggestion, the question is whether the visible signs of ageing can also be switched off if we ignore the social cues that reaching certain key ages expose us to. An example of the mind-blowing power of suggestion is the bizarre case of Audrey Chabot, a French woman who suffered from borderline personality disorder. After giving birth in the toilet and telling her malignantly narcissistic mother, who had not noticed her pregnancy, that she “didn’t want it”, her mother smothered the new-born and hid the body. Both were imprisoned for infanticide after her father took his daughter to hospital due to her haemorrhaging. Some years after her release, Chabot’s new partner discovered two frozen new-borns in the freezer. Audrey Chabot had done the same again – twice. The incredible thing about this story is that nobody, not her family, nor those around her nor even her partner noticed she had been pregnant. A video of Chabot working in the bar in summer clothes where she was a waitress a few days before giving birth shows no sign at all of a pregnancy. Her refusal of motherhood was so strong that her body obeyed her mind.
The expert psychologist said during her trial, “Her body showed no sign, and nor did she. It was not the usual type of pregnancy denial. She lived exactly as though she was not pregnant, as if she did not want to know, terrified of becoming the cold, selfish monster she had for a mother. It was more a refusal of pregnancy, which prevents the woman’s body from developing normally. The foetus lies along the spine and the abdomen does not expand. This can change in a matter of hours if the pregnancy is suddenly revealed or accepted.”
This story demonstrates the incredible power of mind over body, and raises serious questions for the medical profession. Should doctors practise “authorised deception”, and rather than acting on the principle of informed consent while listing effects such as headache, fatigue, dizziness and “how long you’ve got”, give only the best-case scenario, emphasizing instead the body’s amazing ability to self-heal?
Ill health is not inevitable as we age. Some might also ask, is death?
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