Mind-Body Connection Part 1: The Placebo effect and its evil twin
Feeling better solely due to the psychological effects of taking some medication may be a pleasant thought, but the idea of becoming ill due to the power of suggeston is a little harder to swallow...
This is the first in a series of blogs I'm planning to write relating to the mind-body connection. I hope to highlight just how important our thoughts and beliefs are when it comes to good health and good performance in many activities. The first subject I’ve chosen is one that has continued to surprise me ever since first reading an article about it back in 2009.
The article titled ‘Beware witchdoctors’ by Helen Pilcher was published in the May edition of ‘New Scientist’ magazine of that year. It was about the power of suggestion in relation to our health. At the time it so happened that I’d been learning about the mind-body connection in my Cognitive Hypnotherapy course with the Quest Institute, so the article’s publication was a great coincidence not to mention fascinating.
Most of us have some understanding of what the placebo effect is (the health enhancing effect of simply believing that a given treatment or drug will cure us, even though the treatment or drug is in effect a dummy).
The placebo effect is well documented and though it may not be miraculous it does seem to have measurable and often bizarre effects. It’s mostly observed and documented in medical trials for new drugs, where people in a control group (who’ve been given a placebo rather than the active drug) also seem to get better along with those receiving the active drug. Of course it may be far more common in daily life but as we atribute our improving health to real medication we take when we get ill, it's impossible to tell how much is down to the placebo effect.
However to show the diversity of the effect, in one experiment a team of researchers found that volunteers who thought they’d been drinking Vodka (but was in fact given tonic water and lime) had impaired judgement as if they were drunk. They performed badly in simple tests and their IQ scores actually dropped.
A similar experiment is documented in Professor Richard Wiseman’s book ‘59 Seconds’ where he plies two groups of students with lots of free beer at a student bar, but the twist is that one group is given alcohol free larger. The result is similar to the previous research as the alcohol free students perform badly in simple tests and believe themselves to be drunk.
The evil twin
Few of us on the other hand realise that the placebo effect has an evil twin known as the nocebo, a term coined in the 1960s which means “I will harm”. This is the phenomenon where someone experiences an adverse physiological reaction to what is no more than a psychological prompt (i.e. becoming ill after taking something which they believe to be harmful but is in fact not).
Whereas the potential health gain from a placebo may be limited to the actual physical limits of how well our body can repair itself, the impact of the nocebo can be far-reaching in its potential to harm. In one extreme case from the 1970s, a patient named Sam Shoeman was diagnosed with end-stage liver cancer and given just months to live. As expected Shoeman died in the allotted time, yet the autopsy revealed that the doctor had got it wrong. The tumour was far too small to be the cause of death and it had not spread. So Mr. Shoeman hadn’t died because of the cancer but instead from the belief that he was going to die.
The nocebo has also been known to affect large numbers of people in a closed community (such as a school, industrial site, or a small town). In some cases an innocuous smell or a funny taste in the water have lead to physical symptoms of illness spreading throughout a community in a contagious fashion, only for the cause to be discovered not to be toxic or harmful in any way.
This effect of the nocebo is known as Mass Psychogenic Illness. A quick internet search on cases of mass psychogenic illness shows just how common and well documented it is (see link at bottom).
The key factor in all of this is belief. The more we believe in the potency of a substance or the credibility of the person administering a treatment, the more likely the power of the placebo or nocebo will play its part. Of course practitioners of belief such as evangelist healers or witchdoctors know this very well, so they’ll use things like elaborate ceremonies, uniforms, settings, titles, and group psychology to convince us that what they are administering is potent. Having said that, it is far more likely that in the west, where we may not believe in witchdoctors, that we more willing to accept our fate when it comes from a medical doctor standing in a hospital and wearing a white coat and stethoscope. Of course I’m not suggesting that modern day witchdoctors wear white coats and stethoscopes, but simply to be aware of our own belief system and what this may mean when it comes to our health. Perhaps in major cases a second opinion may be wise!
The placebo and nocebo are both phenomena that are linked to a particular external event, but it does also raise the question ‘if believing in the potency of an external factor has the power to make us better or ill regardless of the actual pharmacological potency, then doesn't it suggest that we should have more control over our health through the power of thought?’
Well it turns out that we do. Lots of scientific research has been done on the power of belief and its ability to heal us. The growing body of evidence and our understanding seems to be growing at quite a rate, and in a way aligning modern medicine with much older holistic views.
At the most basic level there is the very real and proven ability of the mind to make us ill through the negative emotions we feel. In instances where people are going through high levels of stress and anxiety, harmful hormones like adrenalin and cortisol are released by our adrenal glands into the body which then affects our immune system, suppresses our digestive system, the reproduction system, and growth processes (as well as having a negative impact on memory and learning) which ultimately leaves the door open to illnesses. This process, known as the sympathetic system or better known as the fight or flight response, is actually a desirable response in nature as it increases our chances of survival by shutting down the bodily systems which have no immediate use and redirecting the body’s resources to parts that will help us escape or stay to fight. However in the modern world where we’re more likely to be stressed over a report deadline than being chased by a wild animal this automatic response is not of any use to us. Instead it turns out, it's a huge disadvantage and very harmful when we're exposed to it for prelonged periods (More on the fight flight response in a future blog).
So at the very least if we can adopt practices which help us stay relaxed and happy then we’ll be going a long way to maintaining our wellbeing.
Beyond this however, it certainly appears that in cases of the placebo effect, our belief somehow bolsters our immune system. Following on from this, in the next blog I’ll be looking into things that we can do which appear to help maintain health and fight of minor ailments.
Just a final note; it isn’t exactly clear what makes one person more susceptible to the placebo/nocebo effect, but it does seem that it may have something to do with a person’s overall outlook to life, in that optimistic people are more likely to benefit from the placebo effect and pessimistic people more likely to suffer from the nocebo. This of course just another way to state the importance of belief, the only difference is that some people are more likely to believe good news and others bad.
Talk by Helen Pilcher on the nocebo effect
An interesting story of Mass Psychological Illness reported in TIME