Nocebo and why you should know about it
YES, it sounds like placebo. In fact, it is related and only in recent times has it been critically assessed.
from Skepdic.com:
" The placebo effect is the measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered. The placebo effect is not mind over matter; it is not mind-body medicine. 'The placebo effect' has become a catchall term for a positive change in health not attributable to medication or treatment.
A nocebo is something that should be ineffective but which causes symptoms of ill health. A nocebo effect is an ill effect caused by the suggestion or belief that something is harmful. The term 'nocebo' became popular in the 1990s. Prior to that, both pleasant and harmful effects thought to be due to the power of suggestion were usually referred to as being due to the placebo effect. "
(my emphasis)
So, nocebo (latin for "I shall harm") has the capability to create dis-ease, to thwart our natural ability to self correct / heal, and the potential to generally wreak havoc on the human body.
And, where might we find nocebo occurring? A German review study published in 2012 outlines the impact of nocebos in conscious society (1). In one segment of society, it describes the prevalence of nocebo generation arising out of communication by medical personnel to patients. For example in one cited study, the use of words like "STING", "BURN", "HURT", "BAD", "PAIN" when explaining a procedure showed increases in anxiety and heightened perception of pain in patients upon follow through of an injection of a radiographic substance. In another cited study, pregnant woman were prepared for an epidural with either of the following two statements "We are going to give you a local anesthetic that will numb the area so that you will be comfortable during the procedure” or “You are going to feel a big bee sting; this is the worst part of the procedure.” The latter statement produced a significantly greater perception of pain in the individual.
For further understanding, I have compiled some example noceboic statements present in the medical profession today:
- “We’re putting you to sleep now, it’ll soon be all over.” (negative idiom suggestion)
- “That always hurts a lot.” (definitive negative suggestion with magnitude)
- “You must strictly avoid lifting heavy objects—you don’t want to end up paralyzed?!?” (attention to a negative outcome)
- “You have a BULGING disc.” (negative imagery with possible patient catastrophizing)
- “You may feel nauseous.” (attention to a probable negative outcome)
- “Do you feel pain?” (attention to a probable negative outcome)
The unexpected "I shall harm" is becoming clearer. This is certainly not the intention of the medical profession. The awareness of languaging has become prominent in recent times and it is certainly being addressed through normal channels, albeit slowly.
In a published paper back in 2007, Drs. Colloca and Benedetti described the physiologic response to nocebo in contrast to placebo within the context of pain (2).
" By taking the findings on nocebo and those on placebo together, the placebo–nocebo phenomenon represents an example of how positive and negative expectations about pain affect different neurochemical systems, i.e. endogenous opioids, on the one hand, and cholecystokinin, on the other. The balance between these two systems may represent a point of either vulnerability or strength, as they may play a key role both in the course of a painful condition and in the response to a therapy. "
To put that quote in more simpler terms - placebo = pain minimizer, whereas, nocebo = pain magnifier. we can see that there is a measurable physiologic response to our thoughts. Additionally, the complexity of neurochemical interaction is backed up by other research scientists - like Dr. Robert Sapolsky with his research on physiologic stress responses under specific conditions with the baboons he studied in Kenya during the late 20th century. More on this in a future post.
Then there are cultural and societal nocebos. Now don't crucify me because I'm a male pretending to know the female experience! I do think the following observation is relevant. In most every movie depicting child birth, have we not been given the imagery of enduring agony during labor and pain beyond compare during delivery? The mother's sweat soaked body. The anguish in her face. oh... the screams!!! add to this the anecdotal stories from mother to would-be mother and this a great example of a cultural nocebo adding to the probability of said fulfillment. Hopefully, you can see how this is possible... and probable to this biologocal experience.
The negative outcomes from nocebos are endless and in subsequent postings, I will point out where nocebos (and placebos) are relevant to subject at hand. until then...
WHAT TO DO? Use this piece as a jumping off point in finding those professionals you can trust to strive for clean neutral language. Get educated about the mechanisms of pain and relevant medical conditions through substantiated research. Be cognitively aware of what you are being exposed to and consciously disregard the superfluous.