The Nocebo Effect: When Thoughts Beget Illness

Alexandra felt well until she heard a terrible verdict from the doctors: “You have only a few months left to live.” The girl began to fade, and as a result she was gone. What was the surprise of the doctors when, after death, the diagnosis, the news of which made the patient refuse to fight for her life, was not confirmed … This is how the effect of the nocebo effect (from the Latin “harmful”) looks like. Of course, such cases ending in death are rare. But the fact that our emotional state directly affects the well-being, today both psychologists and doctors say.

“The development of almost any disease is influenced by the emotional sphere of a person,” says hypnopsychologist Vladimir Kucherenko. – So, for example, the root cause of peptic ulcer is Helicobacter pylori, which 90% of people have. But those who, as a result of emotional experiences in the body, have the conditions for the successful reproduction of bacteria, get sick.

Imaginary sick

“The suspiciousness of some patients itself leads them to a deterioration in well-being,” says neurologist Zinaida Kolesnikova. ‒ Recently, a patient came to me who was just coughing, but she worked herself up so much that she literally believed that she had a fatal illness. The woman went to do expensive tests, and only then believed that she did not have oncology.

Kolesnikova knows from her medical experience that some of us feel worse only after reading the annotation to the drug, which details the side effects. And even if there are no visible manifestations of side effects, after taking medications, it often seems to us that we feel worse.

And those who consider themselves at high risk for a disease are much more likely to get it than those who, being at the same risk, do not know about it.

According to Zinaida Kolesnikova, word of mouth has a nocebo effect. “It is worth a person who is not related to professional medicine to spread a rumor that a certain medicine has a negative effect, as everyone immediately refuses it,” the neurologist notes. ‒ Although they were often treated with it for many years and were satisfied with the result.

Sometimes television plays the role of word of mouth. For example, once on TV they spread information that one French antidepressant was used by drug addicts. Immediately, a wave of refusals began, although the drug had excellent performance and is used by all of Europe.”

The French writer and philosopher of the Renaissance, Michel Montaigne, made famous the saying of the ancient Latins: Fortis imaginatio generat casum – “a strong imagination gives rise to an event.” Montaigne had in mind not diseases, but the materialization of every strong faith. He seemed to be warning: do not waste it on the expectation of trouble.

Everything is material, even anxiety

Placebo and nocebo effects have very real manifestations in the human brain and are explained by material causes. They were identified by Jon-Kar Zubieta¹ from the University of Michigan using positron emission tomography (PET). The scientist demonstrated that the nocebo effect is associated with a decrease in the production of the hormone dopamine, which is involved in the production of opioid peptides that have analgesic properties. This explains why the nocebo exacerbates the pain. At the same time, Fabrizio Benedetti² from the Faculty of Medicine of the University of Turin in Italy found that the pain caused by the nocebo effect can be suppressed with the help of proglumide, a drug that blocks the receptors of a hormone called cholecystokinin (CCK). After all, the expectation of pain causes anxiety, and it activates the CCK receptors, increasing pain.

Nocebo effect in men and women

Who is more susceptible to the nocebo effect – the stronger or the weaker sex? “Anxiety in the form of a nocebo effect is more common in women than in men. But men can also be anxious, and their problem is that they drive their anxiety inside themselves, do not discuss suspicions with the doctor, ”Zinaida Kolesnikova states.

In men, the development of the nocebo effect is more influenced by the expectation of the disease than by life experience and information about the disease. For women, the opposite is true. “Women rely more on past experience, while men are very reluctant to take into account the past when analyzing a specific situation,” says Paul Enck, psychologist at the University Hospital of the University of Tübingen (Germany)³.

contagious psychosis

Perhaps the most striking example of the nocebo effect described in fiction is the reaction of the protagonist of Jerome K. Jerome’s book “Three Men in a Boat Not Counting the Dog” to a medical reference book in the library of the British Museum. “So I conscientiously went through all the letters of the alphabet, and the only disease that I did not find in myself was puerperal fever … I entered this reading room a happy, healthy person. I crawled out of there like a miserable wreck,” the author describes the experience of his hero, a master of negative self-hypnosis.

Unfortunately, in real life, the nocebo effect is not so harmless. Sometimes it takes on the character of a mass psychosis. So, in December 2005, one after another, students of several schools in the Shelkovskiy district of Chechnya began to complain of headaches and suffocation, some were tormented by seizures and muscle spasms. Chemicals capable of causing poisoning with similar symptoms have not been identified. And such outbreaks happened more than once. In Jordan in the 90s, 800 children developed side effects after being vaccinated. At the same time, nothing was found in the vaccine itself that could cause a similar effect.

Hypnosis helps with the nocebo effect. “This is the most powerful method of bringing a person out of a negative psycho-emotional state,” Vladimir Kucherenko believes. – The drugs have a temporary effect, they give you the opportunity to pull yourself together. But then the person returns to the previous state. Hypnosis sessions provide systemic deliverance, since hypnosis affects not only the psyche, but various biochemical processes occurring in the body.

Useful Tips

Love of life. “My advice is to trust less articles in the non-professional press in order to avoid the nocebo effect,” suggests Zinaida Kolesnikova. “Think that a new fine day is coming, you are surrounded by relatives and friends, there is an interesting job, and you will meet friends on the weekend.”

A change in worldview. “A person always has a choice – how to act, what to think and feel. He can “drown” in negative emotions and, as a result of the nocebo effect, be drawn into an illness that he might not have had at all. In this case, it is necessary to radically change the worldview and lifestyle,” says Vladimir Kucherenko.

¹ 20 Symposium on Mechanisms of Placebo/Nocebo Responses, November 2007, Tutzing (Germany).

² «Placebo and nocebo effects», The Point, 2007.

³ «Understanding the Mechanism of Placebo Responses: the Role of Expectation and Conditioning across diseases and treatments», placebo-vw.unito.it