"Nocebos" and WebMD disease

by Rob Horning

26 November 2008


One of my hypotheses is that consumer behavior is anchored in the placebo effect, and advertising serves the vital function of supplying the mind with material to work with, just enough to make belief plausible enough to achieve desirable effects. We just have to grant ads the authority we give to actual experts, like doctors. It seems as though we do this readily, without much profound consideration of what should constitute actual expertise. (I’m supposed to buy a certain kind of tea because Dodgers manager Joe Torre drinks it.) We are basically culpable in our being seduced by ads; we’re not somehow tricked into belief against our will. It’s beneficial to believe, because it promises us placebo magic. Skepticism can turn out to be a costly failure of imagination, especially when we just need to imagine we can feel better to actually achieve it.

Consumerism supplies imaginary solutions to problems that marketing has convinced us to reconceptualize as purchasing decisions. Making the choice to buy masks whatever underlying problem spurred the “retail therapy” in the first place. Whether or not the good has any actual demonstrable effect on anything—whether or not we even use it—is beside the point. An example: I downloaded a bunch of Genesis albums the other day, but I can assure you that I will never listen to most of them. But there was still something satisfying about filling a hole in my music collection, even if that hole wasn’t actually a problem. It wasn’t like I was suffering for want of hearing Trespass. But acquiring things is a simple way of making myself feel like I have taken some sort of action. Marketing, I guess, functions by making sure I am always aware of that sweet simplicity.

Anyway, I’ve seen a few articles lately that explore the dark side of the placebo effect, where the benefits of belief turn into liabilities. Last week, the WSJ reported on “nocebos”:

Research has shown that expecting to feel ill can bring illness on in some instances, particularly when stress is involved. The technical term is the “nocebo effect,” and it’s placebo’s evil twin. “It’s not a psychiatric disorder—it’s the way the mind works,” says Arthur Barsky, director of Psychiatric Research at Brigham and Women’s Hospital in Boston.
Nocebos can even be fatal. In one classic example, women in the multi-decade Framingham Heart study who thought they were at risk for heart attacks were 3.7 times as likely to die of coronary conditions as women who didn’t have such fears—regardless of whether they smoked or had other risk factors.
Research deliberately causing nocebos has been limited (after all, it’s kind of cruel). But in one 1960s test, when hospital patients were given sugar water and told it would make them vomit, 80% of them did.

This is a scary look at what the socially distributed notion of authority can accomplish. Even internal movements of our consciousness, which seem to be generated from within, are apparently easily shaped, once we commit ourselves to participation and belief. Back up would-be authority figures with institutional heft, and they can basically create your reality, down to the level of nausea you feel.

Doctors may unwittingly foster placebo or nocebo effects by how enthusiastically or warily they discuss medication. “Physician communication with patients is the closest thing to magic. It gets communicated in incredibly subtle ways—a flash in the eye, a smile, a spring in the step,” says Daniel Moerman, an emeritus professor of anthropology at the University of Michigan-Dearborn.

The authority figure—the social relation—is what counts. Often, apparently, the medicine is just the trace of that.

I’m tempted to get sidetracked into a consideration of whether such induced feelings are “authentic” or not, though I suppose death is about as authentic an effect as can be achieved. But it’s probably irrelevant to the degree that all “symptoms” are in some way “induced” by something. If we attempt to ignore or downplay the “induced” aspects of consciousness, what would be left to be real? The article makes clear how when you ask someone for symptoms, they generally will supply them.

“People’s expectations play a very important role in how they react to all medications,” says Richard Kradin, a physician and psychoanalyst at Massachusetts General Hospital in Boston, and author of “The Placebo Response and the Power of Unconscious Healing.” He notes that about 25% of patients who get completely inert placebos in clinical trials complain of side effects—typically headaches, drowsiness and dizziness.

If the stage is set for us to be self-aware in that way, our minds will make something happen. This has led me to be against biofeedback. The more I know about what is happening with my body, the more I think is wrong with me and the worse I feel. Is there a way to have no expectations at all? Is there a way to achieve total health ignorance? Would preventive care prevent me from feeling good?

The NYT followed with this article on research Microsoft carried out that suggests, to the surprise of absolutely no one, “that self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them.”

Such findings evoke the debate about whether the internet can create and propagate new mental illnesses by making the very concepts behind them more prevalent and accessible. (This Atlantic story, which I am always looking for excuses to link to, explores that question.)

//Mixed media

'Steep' Loves Its Mountains

// Moving Pixels

"SSX wanted you to fight its mountains, Steep wants you to love its mountains.

READ the article