The Power of the Nocebo Effect
Nocebo is the evil twin of the placebo effect—and my constant companion. I set out to find out what it is, and how I could learn to harness the more positive effects of medical mind games.
Illustration by Xavier Lalanne-Tauzia
"Help me, I took all my pills.” A 26-year-old man in the emergency room fell to the floor, and an empty prescription bottle dropped from his hands.
Mr. A, as he was referred to in his 2007 case study, was still conscious, but pale-faced, drowsy, and lethargic. He told doctors he had impulsively swallowed 29 capsules after a fight with his girlfriend—the pills were an experimental drug for depression he had been given in a clinical trial.
They were clearly having an effect: Mr. A’s blood pressure dropped abnormally low, and his heart rate was a rapid 110 beats per minute. After four hours on an IV, he showed little improvement.
Then, a doctor who oversaw the clinical trial arrived. He said that Mr. A was part of the placebo group—the patients who are selected at random, and without their knowledge, to receive a pill that did nothing at all. Any symptoms he was having weren’t coming from the pills, but from his mind.
Mr. A “expressed surprise then almost tearful relief.” Within 15 minutes, his blood pressure rose and his heart rate returned to normal. He was fine.
“Mr. A’s hypotension appears to have occurred as a result of the placebo overdose,” the study wrote. Another name for this phenomenon: the nocebo effect. You’ve heard of the placebo effect, from the Latin: I shall be pleasing or acceptable —when a person feels better from a drug or treatment that doesn’t have any pharmacological or physiological properties, whether they’re aware it’s a placebo or not. The nocebo effect is sometimes referred to as placebo’s evil twin; it translates to I shall cause harm or be harmful. It’s when a person experiences negative symptoms from an inert pill or treatment, or even from verbal suggestion or observation. As Mr. A showed us, the nocebo effect can be surprisingly powerful.
I’ve always been enamored with the placebo effect, and gobbled up books and studies that explain how it works. It’s been shown to help people with a wide variety of conditions, like chronic pain, IBS, migraine, and depression. I like how it blurs the line between psychology and biology and reminds us that our brains are our bodies; that medicine doesn’t exist in a vacuum, but in a context of expectation, ritual, and person-to-person interaction.
Yet the placebo effect has somehow felt out of my grasp. I’ve looked on with a twinge of jealousy at people who have miraculous experiences with treatments that are often credited as the placebo effect at work, like Reiki or crystal healing. I’ve watched friends find great relief from things with no active ingredient, and yet even when I’ve tried to open my mind and manifest a cure for minor ailments like stomach pains, dizziness, or anxiety, I never have a similar response.
But the nocebo effect and me? We go way back. I have never “overdosed” on a placebo pill, but I relate to Mr. A. From early childhood, if I heard about someone else feeling sick, I would nearly immediately start to feel the same thing. If my doctor told me about side effects of a medicine, like headaches, stomachaches, even fever, like magic, I would start to experience those symptoms.
If the placebo and nocebo effect are opposite sides of the same coin, how could I be so vulnerable to one and not the other? I would love to harness the power of placebo for myself. If I’m a believer, why has the placebo effect forsaken me? I set out to find out why, and learn more about placebo’s evil twin.
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