Mind Over Mind: Consequences of Expectations

Mind Over Mind: Consequences of Expectations

Placebo & Nocebo: You Are What You Think

If any pill has been shown undeniably to work in clinical trials, it is the sugar pill. The placebo effect is the benefit one gets from taking a fake pill or other treatment. Although the mechanism behind them is still largely a scientific mystery, the effectiveness of placebo treatments has been known for a long time. The foundation for the placebo effect is believed to rest on the holy trinity of belief, expectation, and hope.

Science has shown how a placebo can be an effective treatment for a wide range of symptoms and disorders. In fact, much to the dismay of pharmaceutical drug manufacturers, placebos often work as well as some of the most commonly prescribed Rx drugs on the market. The placebo can relieve depression as much as Prozac, relieve discomfort as effectively as acupuncture, and reduce as much disability and back pain as a widely used spinal surgery. These facts are frequently used to denounce the effectiveness of these popular drugs. However, instead of focusing on the lack of effectiveness of the drugs in comparison to Tic Tacs disguised as medicine, perhaps it would be wiser to highlight the seemingly endless capabilities of the human mind.

Is Ignorance Bliss?

People sometimes say that telling someone with depression that their drugs fail to work better than placebos is cruel because they would have to face the realization that the healing was all in their minds. The truth is, there is nothing cruel about that realization. In fact, maybe it should be a cause for celebration. You are telling them that they no longer need to rely on drugs. That their individual minds were strong enough to heal their illness. And that they saw the proof with their own eyes. This can not be a bad thing. It should raise belief, expectation and hope in their innate ability to combat ills.

While the placebo effect refers to health benefits produced by a treatment that should have no effect, patients experiencing the nocebo effect experience the opposite. They presume the worst, health-wise, and that’s just what they get. A nocebo response occurs when the suggestion of a negative effect of an intervention leads to an actual negative outcome. It describes any case where putting someone in a negative frame of mind has an adverse effect on their health or well-being.

Some people claim to feel worse after taking the inert chemicals. They complain of headaches, fatigue, insomnia, stomach aches, nausea, dizziness, weakness, and other symptoms: side effects they claim weren’t there, pre-placebo. These ailments are not only real, but can be disabling, and about a quarter of those taking placebos report them. Clinical-trial participants have reported a wide variety of nocebo-fueled medical complaints. These nocebo complaints aren’t random; they tend to be specific to the type of drug that patients believe they may be taking.

Furthermore, responses to drugs has increased during clinical trials over the past few years. It is speculated that drug advertising, which exploded after 1997, when the Food and Drug Administration began allowing direct-to-consumer ads, has led us to expect more from drugs. Those expectations, in turn, have made us feel better just for popping a pill. Placebo responses can also occur simply when you book appointments with doctors or psychotherapists.

Nocebo effects can be distressing and costly. Patients who blame their symptoms on the pill they’re taking may give up too soon on a potentially beneficial treatment. They can also waste time and money by returning to the doctor to have the medication changed, or to seek treatment for their nocebo symptoms. Basically, a patient who expects to suffer painful symptoms is more likely to. They’re convinced that something is going to go wrong, and it’s a self-fulfilling prophecy.

Ending Life with Your Mind

Many of us have heard the anecdotal stories of people dying from being cursed by a witch or a voodoo doctor. There are numerous documented instances from many parts of the globe of people dying after being cursed. However, with no medical records and no autopsy results, there’s no way to be sure exactly how these people met their end. You might think this sort of thing is increasingly rare, and limited to remote tribes. But it is not.

For example, Sam Shoeman was diagnosed with end-stage liver cancer in the 1970s and given just months to live. Shoeman indeed died in the predicted time frame. However the autopsy revealed that his doctors were wrong. The tumor was small and had not spread. He didn’t die from cancer, but from believing he was dying from cancer. If everyone treats you as if you are dying, you buy into it. Everything in your whole life becomes about dying. In Shoeman’s case it seems as though the doctors’ prognosis had been a death curse.

“Surgeons are wary of people who are convinced that they will die,” said Herbert Benson, a Harvard professor and the president Mind/Body Medical Institute in Boston. “There are examples of studies done on people undergoing surgery who almost want to die to re-contact a loved one. Close to 100 percent of people under those circumstances die.”

Adversity Provides Opportunity for Growth

Despite the anecdotal reports and a few modest clinical studies, research on the phenomenon has not been sufficient, mostly for ethical reasons: Doctors should not induce illness in patients who are not sick. Changing ethical standards have made it difficult to repeat some of the classic nocebo experiments. But resistance to in-depth study of the nocebo effect rests on more than ethical reservations. Belief does not have a strong place in the anatomy-centered world of modern medicine. The fact is that the placebo and nocebo phenomena essentially are too conceptually difficult to understand in our current medical system. Health is thought to be a biological phenomenon. Psychosomatic elements are hard to deal with.

Bad news promotes bad physiology. It is possible that one can persuade people that they’re going to die and have it happen. There is nothing mystical about it. We are just uncomfortable with the idea that words or symbolic actions can cause death because it challenges our biomolecular model of the world. In a nutshell, we fear what we do not understand. But we must overcome this paralyzing fear. Mysteries and the new ideas are opportunities for growth.

Science and Spirituality

Science is gradually wearing away at the wall between mind and body. With the aid of high-tech imaging devices, neurologists are getting better at taking pictures of the brain in action. In one blinded study last year, researchers found that patients with Parkinson’s disease given a placebo released a brain chemical called dopamine, just as the brain exposed to an active drug would do. That flood of brain chemicals, it appears, has everything to do with what the mind expects. Even the mere color of a pill can induce the nocebo or placebo effect.

Psychologists have cautioned that public health and nutrition information, or simply reading about scary diseases, triggers the nocebo effect. The growing trend to issue precautionary advice concerning health risks, even when there is no evidence for any credible risk to people’s health, can also feed the nocebo effect. Fears are not benign and the nocebo effect can have real and harmful effects and there are growing examples in the medical literature.

Research shows that about three-quarters of patients and healthcare workers are unacquainted with the nocebo effect. We offer this advice to doctors and nurses: take pains to identify any chronic symptoms that patients may suffer from before beginning a course of treatment, and discuss the nocebo phenomenon with them. Admittedly, it’s possible that some doctors will just switch the patient to another medication. But they then risk seeing the same pattern of side effects repeat itself. In the long run, they’ll save time by having these conversations.

Until then, it is important for us to understand the placebo and nocebo effect for what it is. It is a demonstration of the power of our expectations, and evidence of how positive and negative energy can affect our well-being. It is not something to be feared. Instead, we should embrace the healing potential of our minds and use it to our advantage. Now that we know how beneficial positive thoughts can be and how destructive negative thoughts can be, we should all aim to think positively even when feeling down. For there is evidence that healthy thinking can produce a health body. The ultimate cause of the placebo and nocebo effect is not neurochemistry but belief.

Ted Kaptchuk, a placebo expert at Harvard Medical School said, “We still don’t completely understand how it works.” But Kaptchuk says it’s possible to maximize placebo benefits and overcome nocebo problems simply by being aware of them. Simply put:

Mind over Mind


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