We’ve all met the person who, as one malaise follows another, declares, ‘If it’s not one thing with me, it’s something else!’
But have we ever wondered why this might be so? Is it just bad luck that this poor individual appears to be a constant repository of illness? Or is there something else lurking in the shadows? And is it lurking in me as well?
Many of us are aware of the placebo effect. We are unknowingly given a dummy pill, with no restorative power in itself – but told it will help us. And, as many tests have shown, it often does. We feel a whole lot better. The mind tells us we’re being healed, and the body responds.
But while the placebo effect is well known, the nocebo effect is perhaps less so; and the clue is in the name. The word ‘placebo’ is from the Latin, ‘I shall please’. But the word ‘nocebo’ is from the Latin, ‘I shall harm’. And this is what it does.
In research circles, the nocebo effect is well documented. Unlike the placebo, which improves health, the nocebo, using the mind, takes it away. We are told, for instance, that a pill we take, or a vaccination we receive, may have side effects – and what often occurs? We have side effects, even though the pill was a dummy. As Helen Pincher tells us in her book ‘This book may cause side effects’, ‘This effect has been seen millions of times in hundreds of thousands of clinical trials where it appears in the “control group” of people who take placebo treatments.’
When people are led to expect symptoms, even though the pill is neutral, expected symptoms often occur, ‘including headaches, dizziness, fatigue, seizures, allergic reactions and constricted airways.’
It has also been tested with food allergies. When people who think they are gluten-intolerant are fed gluten-free bread, but told it contains the offending ingredient, some still develop abdominal pain and bloating. Not all, but some.
The Nocebo effect is startling. The neural prediction is that I’m going to be unwell in one way or another, and low and behold, I am. I was speaking with someone recently diagnosed with atrial fibrillation. This was news to her, and what happened? She immediately felt irregular heart rhythms at play. She had never felt these before. This isn’t to say that it’s a false diagnosis. It’s simply noting that from never having noticed her heart activity, she suddenly mirrored the diagnosis, as soon as it was given. And interestingly, she found her heart more settled after hearing of the nocebo effect. Her mind was calmed, and her body followed.
These stories remind us of the close link between the mind and the body. It is a silent tsunami rolling through our health services. When we cannot see a real doctor, we visit Doctor Google to consider treatment available and discover the accompanying side-effects. We imagine this information gives us control. But for many, as the mind gets to work, it just brings harm.
Pilcher says this was at play with the first Covid jab, ‘where it has been shown that more than two-thirds of the common side-effects experienced by people were caused not by the vaccine, but by the nocebo effect.’ When we have negative expectations about medicines, we make them less likely to work and more likely to produce side-effects.
This isn’t to say that symptoms are imagined. They are experienced as real. It’s merely asking what put them there, the medicine or the mind? Sometimes it will be the medicine, this is for sure, but the mind also appears a significant player, as clinical trials reveal. The mind tells the body and the body makes it so. It’s the Nocebo effect. When people are led to expect symptoms, very often symptoms ensue.
I often suggest exercise for individuals; especially when they are getting caught up in destructive thought patterns. Exercise is free and effective. But there’s a problem: ‘Yes, I used to do more,’ they might say, ‘but I’m too tired when I get back from the office. I don’t have the energy.’ This, of course, is a lie. Their mind may be tired; but we can be sure their body isn’t. Their body is aching to be stretched. But the mind has told the body it’s tired, and so the body is too tired for exercise. If you expect to be tired, even though you aren’t, you will be tired. The mind wins; the body loses.
The Nocebo effect is a significant issue for doctors. One GP who I spoke to was in despair: ‘There are patients who are self-fulfilling prophecies. I dread seeing them. I see them all the time. They complain about their physical ills, demanding all treatments available, and nothing is enough, of course. But they never think to link these ills to their anxious catastrophising, to their own perceptions. And I have no medicine for those.’
Nothing in life is lasting, and this includes our health. As Samuel Beckett reminds the human race, we ‘give birth astride of a grave, the light gleams an instant, then it’s night once more.’ Nothing reverses this general direction of travel. There are some health shifts visible in our twenties, with more noticeable decline in our thirties, with regard to metabolism, muscle mass and capacity for cellular repair. Decline continues in our forties and fifties, with major changes in our sixties and seventies. Genetics, environmental factors and lifestyle are all factors in the unique story of our body. But is the mind a less famous contributor to our health narrative?
The nocebo effect is the conscious or subconscious anticipation of a harmful future event; when the future doesn’t exist. Only the present exists. When Jesus said ‘Take no thought for tomorrow,’ he wasn’t suggesting a chaotic or careless absence of planning. But inviting us to inhabit the present, where the nocebo effect has no power to organise harm.
Simon Parke is a therapist and author www.simonparke.com
