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The Nocebo Effect : Be Careful What You Believe

“Nocebo – (Latin for “I shall harm”) is an inert substance or form of therapy that creates harmful effects in a patient. The nocebo effect is the adverse reaction experienced by a patient who receives such a therapy. Conversely, a placebo is an inert substance or form of therapy that creates a beneficial response in a patient. The phenomenon by which a placebo creates a beneficial response is called the placebo effect. In contrast to the placebo effect, the nocebo effect is relatively obscure.” – Wikepedia

Virtually everyone is aware of what is sometimes called the power of suggestion. If you’veIllness ever been to a magic show, thought you had scabies, or got freaked out by some show about snakes on Animal Planet, you know how it works. You are exposed to, or told something, that you begin to believe relates to you. That scratching that you see somebody else engage in triggers something in you and you respond in kind, literally feeling their pain, at least until you realize that it’s not really happening to you. Anyone who has ever taken Psychology 101 is aware of the placebo effect and the positive benefit that comes from the power of belief. (See also: http://mindbodycoach.org/really-power-placebo/ ) What most people are not aware of is the nocebo effect, the negative impact from negative beliefs, expectations, and previous negative experiences. Unfortunately, the nocebo effect is even more powerful and prevalent than the placebo.

As a practicing psychotherapist and coach for the past 20 years, I am acutely aware of the power that the nocebo has on people’s lives. People carry negative beliefs and expectations well into their senior years that impact their lives in negative ways, impose limitations on quality of life, and even lead to early or possibly sudden death. Consider the following : Eighteenth Century Viennese neurologist and university teacher, Erich Menninger von Lerchenthal, described how students at his medical school picked on a much-disliked assistant. Planning to teach him a lesson, they sprung upon him before announcing that he was about to be decapitated. Blindfolding him, they bowed his head onto the chopping block. One student swung and ax into a chunk of wood, while another dropped a wet cloth on his neck. Convinced it was the kiss of a steel blade, the poor man “died on the spot”.

The power of the nocebo as a cause of sudden death is well documented. In many cultures, the curse of a witch doctor or shaman has led to the demise of believers. In the modern era, people frequently get sick from the flu, viruses, and exposure to elements that are both real and imagined. In fact, with many minor illnesses it is really difficult for science to know what the actual cause is – an exposure to a germ or virus, the power of the nocebo, or some combination of the two. Research on the power of the nocebo is very hard to quantify-how it happens, who is more susceptible, or how frequently such events occur, but most of us have been exposed to this either through our own beliefs or those of people that we know. In this day and age the Internet is full of warnings, anecdotal tales of medical catastrophes, strange occurrences, and a host of ideas that can wreak havoc on the imagination of someone prone to the power of the nocebo.

We’ve all heard stories of someone who at an advanced age literally chose the way that they would die. My paternal grandmother, a 5 foot tall bundle of Italian energy, passed away in her sleep at age 84, exactly as she had predicted for the previous 10 years. As her mind began to deteriorate, she would occasionally experience brief waves of depression and wish that she would go to bed that night and not wake up. She passed away peacefully in her sleep early one Sunday morning, literally choosing the way that she wanted to exit this life. Coincidence or choice? Really doesn’t matter because my grandmother had the luxury of choosing the way that she wanted to depart this earth. If your family is similar to mine, I’m sure there is some similar story in your family tree as well.

The power of the nocebo also influences beliefs about our capabilities, likability, skills, and ability to learn new tasks. For whatever reason some people are impacted more by negative messages in childhood than others. These messages come from parents, teachers, clergy, friends, and classmates where, for whatever reason, something that is said to us or happens to us sticks with us for a lifetime. I had a counseling client years ago who was in his early 40s and never had a meaningful relationship as an adult because of a traumatic breakup when he was in the eighth grade. A girl broke up with him rather publicly at an eighth grade dance. His behavior through his high school years and beyond reinforced this belief-that he was undesirable, ugly, and incapable of having a meaningful relationship. One of the great things about life is that age is a great equalizer. The “beautiful people” of our high school years eventually look like those who were labeled as physically ugly or undesirable. Any high school reunion beyond the 30 year mark proves this. People still carry these negative beliefs about themselves that are formed in adolescent and early teen years, one of the more interesting and detrimental aspects of the nocebo.

“The man who thinks he can, and the man who thinks he can’t, are both right.”-Henry Ford

As a former athletic coach and official I’ve seen this hundreds of times. Athletics tends to Sumobe a great laboratory for beliefs and the power of both the placebo and nocebo. Athletics are filled with thousands upon thousands of examples of athletes who either exceeded their physical ability through hard work combined with a powerful belief system or athletes who squandered a lot of God-given talent because they were “head cases,” unable to harness their ability. Those that succeed are able to put setbacks in perspective and assess their situations realistically, those who can’t fall back upon their negative belief systems. If you’re a sports fan, I’m sure you can think of hundreds of examples that illustrate this. For every Larry Bird and Carl Yastremski there is a Todd Marinovich and a Johnny Manziel.

We tend to believe our own thoughts. We are not always fully aware of where these thoughts come from. It’s not important to know where the thoughts are coming from as much as it is to be aware of the impact that our thoughts, self talk, and beliefs about ourselves have upon our current behaviors. We tend to believe our thinking and it becomes our “truth” even if it is not literally true. In therapy and coaching you can often see how people’s behavior reinforces their beliefs and how a person’s actions, or lack of, really make the faulty beliefs come true. Clients frequently respond to failure with logic such as, “See, I told you I couldn’t do it!”

Take a careful look at how you are influenced by the power of the placebo, but more importantly, the nocebo. Before you fall victim to the latest medical scare, before you fail at some task, or hesitate to take some chance, ask yourself: what am I thinking right now, where is this thought coming from, and is there some action that I could take that would give me a better outcome? You may be surprised at the answer. We all just may lead richer lives if we become aware of the role that negative belief systems and the nocebo affect play in shaping our reality.

“I discovered that everything you do is in response to a request or a suggestion made to rockyyou by some other party either inside you or outside. Some of these suggestions are good and praiseworthy and some of them are undoubtedly delightful. But the majority of them are definitely bad and are pretty considerable sins as sins go.” – Flann O’Brien, The Third Policeman

John

P. S. If you found this article helpful, you may benefit from some personalized mindbody coaching. Contact me at http://mindbodycoach.org/contact-us/ if interested in online mindbody coaching. Please check out my Products page through the link at the top of this post.. Follow me on Facebook, Twitter, YouTube, and social media. Email me with questions at john@mindbodycoach.org

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