Placebo, Nocebo, And The Power Of Suggestion

A placebo is more than just a potentless pill. It’s a powerful form of suggestion that shows that mind over matter may actually matter more than you think.

Then, there’s the nocebo: the placebo’s evil twin, through which a person actually manifests illness rather than healing, all due essentially to word choice, observation, expectation and belief.

In the world of healthcare, these concepts are of utmost significance. Doctors and other medical professionals must take extreme care in their choice of words, as they may be of similar import as actual treatment.

But even in our everyday lives, the power of suggestion is at constant play, sometimes tricking our bodies into reacting certain ways.

Placebos and nocebos: how they work

The science of belief is mysterious even to experts. What we know is this: if a person is made aware of benefits or consequences of something, even if they are utterly made up, the person may report or even manifest certain results, whether they are good or bad.

Doctors have been using placebos for centuries as treatments meant “more to please than benefit” the patient. The positive effects of placebos have been demonstrated time and time again. But patients also sometimes report negative side effects of placebos: this is called the nocebo effect.

There are several theories used to explain why:

  • The subject-expectancy effect theorizes that when people know what a medicine is supposed to do, they’re body unconsciously changes its reaction to bring about that result.
  • The classic conditioning theory posits that people are conditioned, not unlike Pavlov’s dog, to experience relief along with medication.

How, though? Studies point to the expectation of relief actually causing the brain to activate its natural relief system. Others suggest certain gene variants may make people more subject to the placebo effect than others.

In healthcare

Placebos are used in clinical drug trials commonly, and work on a varying percentage of patients; the effect itself has even been shown to alter brain chemistry.

But beyond pills — over which the ethical debate over deceit remains strong — there is a lot of evidence to show that, in healthcare, the attitude and manner of doctors impacts patients greatly as a type of placebo.

For example, one study found that depressed patients taking placebos administered by an empathetic doctor showed more improvement than patients taking active drugs from one that showed little interest.

But on the negative end, certain words, phrases, and warnings can trigger negative health issues in patients. In an example provided by the BBC,  words like “bad news” and phrasing that emphasizes side effects disproportionately can aggravate patient wellbeing.

In the media

It’s not just healthcare professionals responsible for triggering psychological (and sometimes physiological) responses through suggestion alone. The media has been known to fan the flame, too, typically by spreading irrational fear and overblown facts quickly.

That’s right: click-bait could actually make you sick.

For example, Canadians experienced illnesses attributed to “wind turbine syndrome” only after (misleading) media reports of it. People have reported feeling sick after vaccinations, or aversion to electromagnetic waves for similar reasons.

Recent hype around the Ebola virus also yielded mass hysteria in America accompanied by over 5,000 false reports. However, it’s unclear if any of these people may have willed themselves sick.

In everyday life

Anyone can invoke a placebo or nocebo effect just by talking, or giving off social cues and implications that could alter someone else’s behavior.

For example:

  • If someone near you yawns, you may yawn too, but not because it’s actually contagious
  • If someone mentions fleas or bedbugs, you may start itching
  • If someone suggests your food is tainted, it may make you feel sick
  • If a place or thing is rumored to be cursed, it could make you ill
  • If a place or thing is rumored to be lucky, you may experience relief
  • If you think a drink will loosen you up, it probably will regardless of content

Then, there’s also emotional contagion — the unconscious adoption of feelings based on the expressions and cues of those around you, both in real life and on social media. In this case, just the observation of certain feelings can spread like wildfire.

Controlling the effects

From placebo pills, to hyped up health scares, to alternative medicine and good luck charms, it’s clear that the remarkable effects of placebo and nocebo are triggered by two main factors: expectation and belief.

Many wrote off such effects as being “all in your head,” but recent efforts are being made not to discount them. The mind-body connection is as such that psychology and physical wellness are very much linked, and no types of healing (or harm) should be disregarded.

Here’s where analysts recommend moving forward:

Healthcare: Doctors should choose words carefully, and be careful not to overemphasize negative effects. They may also want to work such verbal healing tactics into their treatment plants to help lower patients’ dosages.

The media: Responsible reporting, as opposed to fear-mongering, could prevent psychological ill-effects and hysteria among readers. On clicks and shares? Maybe not so much.

And as for you? It’s clear that expecting and believing in good outcomes can indeed beget good outcomes, but be wary of those willing to exploit you for it — and reserve even more skepticism for that which could potentially harm you.

But most importantly, manage your expectations, and understand that they alone are extremely powerful in high dosage.

We measure success by the understanding we deliver. If you could express it as a percentage, how much fresh understanding did we provide?

Jennifer Markert