Subconscious psychological factors can lessen or worsen some symptoms of disease, as our immune system and other bodily functions are effected by our moods and expectations, sometimes with greater effects than you might imagine possible1. 'Psychosomosis' is sometimes used to mean medical symptoms that derive from purely (subconscious) psychological factors; such as ulcers caused by stress2, but in its wider sense it includes positive effects (i.e., meditation) as well negative. The "placebo effect" describes how suggestion and expectation can have positive results, but the "nocebo effect" is when our mental states can create and worsen symptoms needlessly.
Some good practices can increase the health of individuals (and of entire nations). "Therapists of all persuasions agree that reducing anxiety or anger is the best way to alleviate suffering from psychophysiological disorders"3 and good reactions to stress facilitate long-term health4,5. Maintaining strong willpower, a fighting spirit, and a positive attitude towards your own body help against diseases, including cancer6, because our immune system and our body's maintenance are linked to our nervous system7, and can be affected by emotional factors. Many psychosomatic diseases and somatoform disorders can be avoided (and sometimes cured) through education8. The promotion of critical thinking and hysteria-awareness can prevent symptoms appearing in the first place, although there are many forms of biological disease that cannot be meaningfully effected without medical intervention9.
A psychosomatic disease is one in which there are physical symptoms, such as ulcers, caused by a mental process, such as a maladaptive stress response. The following is the definition from the Oxford Companion to the Mind (Gregory 1987), followed by a paragraph on his description of typical psychosomatic diseases:
“Diseases are designated as psychosomatic if two conditions are fulfilled: if (i) the symptoms are accompanied by demonstratable physiological disturbances of function and (ii) the illness as a whole can be interpreted as a manifestation or function of the patient's personality, conflicts, life history, etc. The first condition distinguishes psychosomatic illness from psychoneurosis, particularly conversion hysteria, in which, by definition, the physical symptoms are not accompanied by demonstratable physiological disturbances. [...]
In Human patients [...] there tends to be a remarkable consistency in the psychosomatic disease, which tends to recur in a stereotyped form. The pattern is peculiar to each patient and more or less fixed. It could be argued that a genetic predisposition as, for example, in the asthma-eczema syndrome, to some extent determines the type of psychosomatic disorder that is likely to recur. [...] From time to time there may be a 'syndrome-shift'. Thus a patient who has had several attacks of atopic dermatitis develops bronchial asthma, or perhaps, later in life, rheumatoid arthritis. A sufferer over many years from migraine develops ulcerative colitis, or a patient who has had a recurrent peptic ulcer develops essential hypertension.”
Stan Gooch investigates more extreme cases involving apparently-supernatural phenomenon. His published works explain how in all resolvable cases the causes have been psychological. He describes some typical triggers and typical symptoms:
“Some hysterical sufferers break out in a skin rash or boils whenever (say) they have to visit their mothers, or have asthma attacks when they approach the district where they grew up. Here we can recall the woman whose hip bled every time she saw her handicapped son put on his hip support. A mental problem can in fact be converted into virtually any form of physical symptom or illness - and so can be a very serious position indeed.”
How serious can it get? Studies have found that "giving up" and losing the will to fight are contributing factors to the lethality of cancer (although do not take this to a daft extreme and think that 'willpower' is capable is destroying cancer cells - it can only boost our bodies response). Anecdotal evidence abounds:
“It is a well known fact that many people die simply because they give up and just don't care anymore. This is understandable if the person is very ill, with no apparent chance for recovery. But this often is not the case. Man has become lazy. He has learned to take the easy way out.”
Before we continue, we must make sure that we do not confuse psychosomatic illnesses (such as those mentioned above, that frequently have measurable physical symptoms) with other forms of disease that lack such symptoms.
The_placebo_effect is a positive effect on an illness or medical condition, or on a health-related outcome, that results from suggestion and expectation12. This subtle psychological effect occurs whether or not the underlying treatment actually works and it is strong enough to continually distort medical studies into the effectiveness of health products and can make products seems effective when they are not - it can even do the same for surgical practices.13,14. Such unexpected effects have been studied in greater and greater detail by medical researchers, and it has emerged that placebo effects come in various forms15. The placebo effect is particularly significant in areas such as pain relief and stress, and is therefore best at overcoming aches and pains, headaches, stress-related conditions including recovery from stomach ulcers12 and skin rashes. Most complementary and alternative medicines (CAM) and alternative therapies work through indirect psychological effects, and by the turn of 20th century many New Age related remedies and practices were based on cures by suggestion16. The placebo effect is the reason why these remedies appear to work for so many people, when in reality they don't have any medical effect14,17,18,19,20,21,22,23 and its effects can often support erroneous ideas as to how disease works, and how healing works.
How does it work? (1) There is a link between mood and mental states of mind, and between mood and our immune system, meaning, that our overall impressions of a treatment can affect our outlook, which can boost our immune system7,6,24. (2) When it comes to pain, the prefrontal cortex of the brain can suppress pain messages from the insula25 and other places, meaning that if we prime ourselves to feel less pain (such as when expecting a pill to work) then it really does dull pain. Many experiments have confirmed the ability of people to mentally control pain. (3) Classical conditioning means that many elements of merely receiving a treatment cause our brain to release neurotransmitters and other learned responses in anticipation of feeling better, which improves how we feel13,26. (4) The Hawthorne Effect - people tend to live healthier and perform better simply because they are being studied18,26. (5) Receiving treatment can boost confidence and reduce stress, both of which can improve healing and feelings of wellbeing13,26,4. Finally, (6) It works best when delivered by a confident doctor who also believes the placebo will work27.
For a more comprehensive look at the Placebo Effect, see: The Placebo Effect and the Positive Power of the Mind on Health.
Our expectations about life cause certain experiences, both in how we interpret events, to how we consciously put the world together, and affect our very senses such as sight and hearing. Suggestion and expectation are brothers-in-arms, and many psychosomatic diseases result from our expectations about our own reactions based on what we think is real. It is common that a person dislikes a food, and winds them self up about it to such an extent that consuming the food will make them sick. So far so harmless, but similar effects can be serious. A case from 80 years ago recently appeared in the New Scientist:
“Late one night in a small Alabama cemetery, Vance Vanders [name changed] had a run-in with the local witch doctor [... who] told him he was about to die and that no one could save him. [...] Vanders took to his bed and began to deteriorate. Some weeks later, emaciated and near death, he was admitted to the local hospital, where doctors were unable to find a cause for his symptoms [...]. Only then did his wife tell one of the doctors, Drayton Doherty, of the hex.”
New Scientist (2009)28
The next morning, after much thought, the doctor told the family he had found the witch doctor. He performed another ritual, carefully inspecting his instruments, and administered a drug that made the man sick. He discretely produced a green lizard and pretended it had been secreted by the ill man, " 'Look what has come out of you Vance,' he cried. 'The voodoo curse is lifted.' Vanders did a double take [... and] drifted into a deep sleep. When he woke next day he was alert and ravenous. He quickly regained his strength and was discharged a week later"29.
The cause of the man's illness was his expectation and fear of illness caused by the witch doctor. The clever doctor proscribed an equal but opposite psychological effect. For some time, priests and other representatives of the unknown have been able to change a person's expectations about bodily ills and 'heal' them through suggestion. If the source of the information is given credence, then the effects are pronounced.
These effects can include anticipation of the symptoms of illness.
“Around 60 per cent of patients undergoing chemotherapy start feeling sick before their treatment. "It can happen days before, or on the journey on the way in," says clinical psychologist Guy Montgomery from Mount Sinai School of Medicine in New York. Sometimes the mere thought of treatment or the doctor's voice is enough to make patients feel unwell. This "anticipatory nausea" may be partly due to conditioning - when patients subconsciously link some part of their experience with nausea - and partly due to expectation.[...]”
New Scientist (2009)28
The Researchers asked a group of students to inhale a sample of normal air, which all participants were told contained "a suspected environmental toxin" linked to headache, nausea, itchy skin and drowsiness. Although they were actually inhaling normal air, many of them developed the suggested symptoms. The effect was greater in women who had seen others suffer from the alleged symptoms (one group of subjects saw a woman inhale the air and develop these symptoms). This can serve to make entire nations ill; if (for example) a detergent manufacturer plays up the risk of bacteria, suggestible people will indeed become ill from it. The solution is to remain skeptical about threats and cures promoted by industry.
A patient who was diagnosed with end-stage liver cancer in the 1970s died within the timeframe predicted by doctors. Investigation showed that the doctor's prediction was actually wrong - the man was not due to die from the physical effects of the cancer. The patient's expectation led to his demise. The New Scientist article debates the benefits and risks associated with the extensive "side effects" warning of medicines, nothing that:
“Many patients who suffer harmful side effects, for instance, may do so only because they have been told to expect them. [...] The severity of these side effects sometimes matches those associated with real drugs. [... Researchers who ran a study of this found] that if you hear of or observe a possible side effect, you are more likely to develop it yourself.
New Scientist (2009)28
Expectation can have real psychosomatic effects on the body. Take Derek, who was depressed and took all of his anti-depressants as a suicide attempt. He was taken to hospital where he collapsed. His blood pressure floored. He had also been taking part in a trial of a new experimental antidepressant. But a doctor arrived who was involved in the trial and revealed that Derek was in the control group, and that the pills were completely inert - they were placebos, containing no drugs. All of Derek's symptoms were created by expectation that if you take too many pills, you might die. Upon learning the truth Derek was tearily relieved, and his symptoms disappeared within 15 minutes. Anthropologist Robert Hahn of the US Centers for Disease Control and Prevention in Atlanta, Georgia, USA, confirms that "the mere belief that one is susceptible to a heart attack is itself a risk factor. One study found that women who believed they are particularly prone to heart attack are nearly four times as likely to die from coronary conditions as other women with the same risk factors". Derek's belief about his pills, and people's fears about their condition, contributes to their own demise.29
The cure to psychosomatic illness is often correct information delivered by a relevant professional - once the patient learns that there is no poison, disease, or threat, their body stops generating the psychosomatic reaction as their mental state returns to normal. The brain controls all of our immune systems, glands, etc, so that mental states can have pronounced effects on the normal operation of the body. Calm the mind and you can dispel diseases that were caused by the mind.
“In somatoform disorders, the individual complains of bodily symptoms that suggest a physical defect or dysfunction - sometimes rather dramatic in nature - but for which no physiological basis can be found.”
In the The Oxford Companion to the Mind31's definition of psychosomosis, quoted to the right, it mentions "conversion hysteria". This is what some psychologists call "somatoform disorders", where patients complain of physical symptoms, but no physiological problems can be found. In psychosomatic disease, the symptoms include physical components (often visible), whereas in somatoform disorders the physical symptoms are missing. For example, hypochondria, anorexia nervosa and mass hysteria are somatoform disorders, but, asthma attacks brought on by emotional disturbances are psychosomatic (accounting for 37% of cases of asthma)32.
An old case can be seen to sit in a gray area, where it is hard to distinguish between forms of hallucination, and, forms of somatoform disorders:
“A poor lunatic fancied his body increased to such a size, that he dared not attempt to pass through the door of his room. He declared he saw himself that his body was far too large to make it at all possible to go through such an opening. The physician attending him believed that nothing could more effectually cure this error of the imagination, than to show that the thing dreaded could be actually and easily accomplished. He caused the patient to be thrust forcibly through it. The poor fellow, struck with abject horror at the expectant idea, to his mind, of his certain fate, shrieked that he was in agony, that he was being crushed to death, and almost at once expired!”
It would be interesting to note what neurologists such as Oliver Sachs make of such cases.
The nocebo effect (the negative effects of suggestion and expectation) are the opposite of the placebo effect (the positive side of such factors). The former appears when people expect to be ill, and the latter occurs when people expect to get better such as when given medication.
“The nocebo effect can even be catching. Cases where symptoms without an identifiable cause spread through groups of people have been around for centuries, a phenomenon known as mass psychogenic illness.”
New Scientist (2009)28
Psychosomosis, as we have seen, is related to hysteria; which is the paranoid belief that one suffers symptoms when in reality there are none. It should be easy to see that hysterical symptoms result from mental processes. Mass hysteria is especially common amongst schoolchildren. For example, in a school in Shelkovsk, Chechnya "symptoms included convulsions, nausea and breathing difficulties. The illness spread to neighbouring schools. Local doctors suspected mass poisoning, but when a delegation of medics arrived from Moscow, they attributed it to mass hysteria"8. Even when there is no actual virus, poison, or physical cause, children can "pass on" symptoms. Symptoms are real and fall in line with what the patients expect to suffer from. "Mass hysteria, or medically unexplained epidemic illness, has been documented since medieval times. Simon Wessely, a director of the King's Centre for Military Health Research at King's College London, says such outbreaks tend to reflect a society's beliefs". Importantly, Dr Wessely states that the most effective way to stop the epidemic and stop the symptoms is to explain that rumour and suggestion are causing them. [...] Once this has happened, "symptoms vanish within days"8.
What we see here is that, like this page recommends, explaining to people that mental outlook has an effect on physical health can allow people to exercise more control against illness. Schoolchildren's symptoms disappear when it is explained that no poison was found; and, hysterical symptoms disappear when the true causes are empathetically explained by a trusted professional. (Beware that just telling people that the symptoms are their own 'fault' is wrong and does not make things better).
Another example that blurs the boundary between psychosomosis and hysteria is that many aspects of alcoholic drunken behaviour is cultural and caused by social upbringing rather than biology, meaning that the apparent symptoms are brainal rather than purely somatic.
Although there is widespread, there is no health risk from mobile phone radiation34. In experiments investigators have found that some people are sensitive to the idea of radiation from mobile phones use. When scientists scan their brains, they find that pain receptors flare up when the patients are told they are being subjected to the same electromagnetic fields that mobile phones use. Most people, however, are not affected. These electro-sensitives were, however, not actually subjected to any mobile phone radiation (or any other kind). As they lay there, the investigators told the subjects that they were turning on the mobile phone radiation. The patients who thought they were sensitive to it registered pain responses. Those who didn't think they were affected by it felt no pain. This episode was reported in The Economist (2008)35. No subjects were exposed to anything at all, yet, some had psychologically programmed themselves into pain responses through self-identifying as people who were sensitive to mobile phones. This is a mixture between hysteria and psychosomosis.
If people can cause themselves to be sensitive to certain stimuli even when the stimuli isn't real and doesn't really present any risk at all, it can makes things awkward for society as a whole. Protests against mobile phones and calls for regulation, further investigation and tests have cost money, but the cause of the problem is personal paranoia, not radiation. This paranoia translates, as it does in psychosomatics, into measurable symptoms. Quack remedies, supported by opportunistic salespeople, offer products that rely solely on the placebo effect to 'cure' those affected by such psychosomatic illnesses:
“A growing industry of fraud artists is taking advantage of the fact that many of the supposed symptoms of EMF appear to be psychosomatic. They are offering a broad variety of quack remedies that will absorb 'harmful' EMF or otherwise shield the user. These products range from pendants worn around the neck to a patented $727.50 'i-H2O activator' that 'structures all the water you use.'”
This story should be told wide and far because it goes to show what is possible: I bet that self-sensitising in this way is the cause of many minor complaints. We have seen that such psychological effects can go as far to cause ulcers, skin rashes, etc, but it makes sense that lower down on the scale is a whole portion of society afflicted by lesser nuisances that they have convinced themselves into. Education that such psychological clumsiness is possible has helped cure cases of mass hysteria, and general education on psychosomosis would likely help large numbers of people.
Meditation is used by many to achieve a sense of peace, tranquillity and relaxation36. This is done by focusing exclusively on a single mental task, such as repeating a word or phrase (a mantra) or visualizing a fixed image, or paying attention to a very narrow event such as breathing, or conducting repetitive manipulations (e.g. rosary beads) in a mindful manner.37,38 It has been a feature of religious practice since prehistory, and is engaged in extensively by some faiths such as Zen Buddhism39. Some claims made about the power of meditation passes into the territory of the absurd, such as those made in Yoga40 (including yogic levitation)41. Meditation works just as well for the religious as for secular folk42.
Meditation can influence our physical bodies in areas where symptoms are typically known to be susceptible to psychosomatic factors (placebo effects and nocebo effects) with some evidence it helps with diseases associated with blood pressure and heart disease43 but also cancer (according to one study)43. The experience of pain is readily influenced by our mental states and meditation is often cited as a positive method of pain control; in some cases it has had a radical effect44. A medical analysis of 47 trials on mental health found that meditation helps with anxiety, depression and pain, and helps a bit with overall quality of life36. But the evidence is that meditation is not better than behavioural therapies (such as exercising more) in combatting mental ills36.
For more, see: "Meditation" by Vexen Crabtree (2018).
“Touching the skin with a pencil may cause blisters if the participant has been told it is red hot.”
Under hypnosis, people can hallucinate incredibly real (-seeming) events in their minds, making themselves think they are flying, that they are talking to people who are not really there, etc. Also, latent talents and confidence can be brought out: when there are no social consequences the self is more capable of a broader range of actions.
Suggestible subjects can develop serious and real physical symptoms and injuries on command, some of them quite spectacular and unbelievable, such as blisters, seizures, open wounds and stigmata. Cures for existing diseases can be brought about through the same method, even for diseases, as we shall see below, that do not otherwise respond to medical treatment.
In a seemingly impossible and complex case of reverse psychosomosis, a boy who was born with a progressive skin disease was healed through suggestion whilst hypnotized. Mental processes of the brain, in their complex interactions with the body, are responsible for the biochemical changes that would have been required to cure the disease. Some primitive part of the brain must have been responsible, since birth, for causing the disease and the suggestion for it to stop allowed a normal epidermis to grow.
“Probably the most daunting and famous case of hypnosis on record concerns a boy aged sixteen who suffered from a congenital, progressive, structured disease of the skin, present from birth. The condition, ichthyosiform erythrodermia complex, is resistant to all forms of treatment. In it, a thick, black, horny layer covers most or all of the body, and this layer itself is covered with further warty excrescences. The skin, if such we can call it, is as hard as a fingernail. Any bending or flexing of any part of the body causes painful cracks, which ooze bloodstained serum. The condition also gives rise to an objectionable smell that others find intolerable.
On 10 February 1951, in the Queen Elizabeth Hospital, the boy concerned was hypnotized and told that his left arm would clear of the disease. Five days later the horny layer softened, broke and fell off, to reveal normal new skin beneath. In later hypnotic sessions the remainder of the body was successfully treated. The whole case was observed throughout by specialists and reported in full in the British Medical Journal46.”
“A physician who appeared in a British television documentary series on hypnosis narrated the following story. He was treating a boy who was suffering from the so-called 'total allergy syndrome'. These individuals have been described as being 'allergic to the twentieth century'. They have to be cared for in a sterilized, sealed environment, and supplied with filtered air and special foods. The doctor was attempting to increase the boy's resistance by the use of hypnosis. At one point he began telling the boy that he (the boy) was having a picnic on a mountainside, but as the doctor described the imaginary scene, the youngster began to go into spasm. [...] The horrified physician realized that his patient was undergoing terminal spasm [and] summoned a helicopter, which swooped down and carried the boy up into the pure stratosphere above the earth. As the doctor quickly described these imaginary events, the boy's spasm subsided and he began breathing again.”
Hypnosis changes the relationship between our conscious and subconscious selves, and therefore allows different factors to affect our nervous system than when in a normal mental state. This allows the possibility of changing psychosomatic diseases through suggestion, where (of course) those diseases are within biochemical reach of the body's biochemistry. In other words, it can be effective if the cure can result from changing the levels of produced biochemicals under the nervous system's control.
Hypnotized and entranced subjects can develop spontaneous (but not random) wounds, such as patients who are touched with a (room temperature) pen that they are told is red hot, and develop real blisters as a result of the imagined heat. Wounds like these are frequently associated with powerful memories; one subject would develop weals and blisters around his wrists similar to wounds he received 10 years earlier when tied up. A 37 year old female patient described her father's childhood beatings, and while doing so "bleeding whip marks appeared on her legs, buttocks, shoulders and hands. These were witnessed, photographed and reported by physicians, and had moreover to be dressed and treated [...]. Two further cases of this same phenomenon are also reported by Dr Moody"48.
Stigmata is where the wounds of Jesus Christ spontaneously appear on the hands and feet. Similar processes must be at work in stigmata as during the injuries that can manifest under hypnotism and trance. It may be that some still believe that an actual, real, supernatural Christ causes these (they normally afflict saints and devout Christians) but there is clearly room for these wounds to be entirely psychosomatic and self-generated. Despite this, some Christians and paranormalists still claim that stigmata are the result of spiritual contact with Christ.
“However, the argument for the wounds of the stigmatic (the spear wound in the side, the marks of the thorns on the head, the nail marks in feet and hands, and so on) having been produced by contact with the actual spirit of Christ collapses completely on examination. For example, the stigmatics regularly produced (and produce to this day) nail wounds in the palms of their hands - as shown in many paintings and carvings of the crucified Christ - whereas in fact the real historical Christ, like all crucified victims of those days, was nailed to the cross through the wrists. More telling still is the finding that the particular marks (size, shape, position) on some stigmatics are identical with those on the particular crucifix or painting before which the stigmatic habitually worships. Here we seem to identify the exact source of inspiration which the unconscious mind has employed.”
“When in 1894 Dr Imbert-Gourbeyre produced his scholarly but gullible book La Stigmatisation, he discovered 321 stigmatics since the time of St Francis of Assisi produced the first stigmata. Of these, only 41 were men and 280 were women. [...] Even ardent champions of stigmatics, like Dr Imbert-Goubeyre or Fr Thurston SJ do not deny that many stigmatics have had a history of emotional disturbance before they received the stigmata. Just as the anorexic has to have a certain type of personality, the stigmatic has to be deeply suggestible, as was the contemporary stigmatic, Cloretta Robertson, who had the stigmata [since the age of 10] until recently when she was 'cured' by hypnosis.”
The separation of diseases into 'mental' and 'physical' is essentially arbitrary as psychological factors have a basis in neurology. Therefore psychological and psychosomatic disorders are physical, biological, and in this reductionist sense it makes no sense to call any phenomenon 'mental' or psyche-logical. To call something 'psychosomatic' when 'somatic' means bodily, and 'psyche' means psychological, may seem to be contradictory. However, the words used to describe the mind have a use because they determine the physical location of the causes of illness (the brain and the nervous system). This aids understanding, for to call all disease somatic would be to lose this major practical classification.
Free will and Causation: Is it true to say that, with psychosomatic disorders, the mind exercises 'free will' in 'choosing' illness? I think not. Although the cause of psychosomatic illness is psychological, the cause of the psychosomatic illness is itself the behaviour of the neurones of the brain and therefore psychosomosis is ultimately regulated by the laws of chemistry and physics, just like other biological and conscious systems. As a result, we find that the existence of psychosomosis (whether in curing or in causing illness) merely proves that the mind, the brain and the body all have a single, physical nature, and not two separate natures (body and soul).
"How We Know What Isn't So: The Fallibility of Human Reason in Everyday Life" by Thomas Gilovich (1991)9
Despite the studies above that detail the pervasive and powerful effects that psychology can have on disease, we must heed certain common-sense warnings. Studies that have shown psychosomatic illness to be hindered by the mind have only been consistent in a few types of disease, and the wise philosopher Thomas Gilovich warns us that the most extreme predictions of any theory have tended to be untrue9. For example in a compendium of skeptical essays, Paul R. Grob lectures that many illnesses that are said to be due to stress actually have other causes - although in the case of asthma he admits that stressful events cause attacks51. Some powerful pain relief drugs such as morphine have effects which far outstrip the possibilities of the placebo effect52. So although there are sometimes quite extreme bodily effects resulting from the mind's neurology, the reality is often more subdued than the extremes of theoretical possibility. Willpower cannot perform magic, and can only affect disease where such disease is affected by our nervous system's control of our body.