The Human Truth Foundation

Psychosomosis - the Placebo and Nocebo Effects
Curing and Causing Disease with the Mind

By Vexen Crabtree 2008

#health #placebo_effect #psychology #self_development

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 (e.g., 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.

1. Psychological Diseases and the Body

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:

Book CoverDiseases 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.

"The Oxford Companion to the Mind" by Richard L. Gregory (1987)2

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.

"The Origins of Psychic Phenomena: Poltergeists, Incubi, Succubi, and the Unconscious Mind" by Stan Gooch (2007) [Book Review]10

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.

"The Satanic Bible"
Anton LaVey (1969)11

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.

2. The Placebo Effect and the Positive Effects of Mental Attitudes

#alternative_medicine #expectation #hawthorne_effect #health #immune_system #medicine #new_age #placebo_effect #psychoimmunology #psychology #quackery #self_development #stress

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 more, see:

3. The Nocebo Effect: Negative Psychological Effects of the Mind on the Body

#mental_health #Placebo_Effect #psychology

Nocebo Effects are negative effects borne from purely psychological factors, causing symptoms where there need be none. It's the negative form of Psychosomosis (the Placebo Effect being the positive form). Nocebo is normally used when a particular perceived threat vector causes distress in a person, which can then cause some kinds of symptoms whether or not the perception of the threat was rational or not. Linked terms such as psychoneurosis, conversion hysteria and somatoform disorders all describe the destructive effect that the mind can have on the body.28,29

Only some physiological symptoms can be made worse by mental states, or induced purely them. They include nausea, headaches, dizziness, skin rashes, breathing difficulties, stomach ulcers, eating disorders and changes in heart rate. Psychoneurosis accounts for 37% of cases of asthma30. Modern fears of things like mobile phone signals are psychosomatic, and in history, so are curses31. Belief can be passed on, in worst-case scenarios becoming psychogenic mass hysteria8.

'Cures' for the nocebo effects are often imagined to be calm reassurance and the presentation of medical facts by someone the sufferer trusts, but, the best long-term preventative measures are a good education, stability at home and general improvements in mental health. Unfortunately these fixes are difficult to attain once things are amiss, but without them it is uncommon that the mere presentation of facts will placate nocebo effects; a variety of social and psychological changes must first occur and the precise combination required is wildly different between individuals.

For more, see:

4. Meditation

#health #mental_health #psychology

Meditation is used by many to achieve a sense of peace, tranquillity and relaxation32. 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.33,34 It has been a feature of religious practice since prehistory, and is engaged in extensively by some faiths such as Zen Buddhism35. Some claims made about the power of meditation passes into the territory of the absurd, such as those made in Yoga36 (including yogic levitation)37. Meditation works just as well for the religious as for secular folk38.

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 disease39 but also cancer (according to one study)39. 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 effect40. 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 life32. But the evidence is that meditation is not better than behavioural therapies (such as exercising more) in combatting mental ills32.

For more, see:

5. Hypnosis

Touching the skin with a pencil may cause blisters if the participant has been told it is red hot.

"Psychology: The Science of Mind and Behaviour" by Richard Gross (1996)41

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, some of them quite spectacular and unbelievable, such as blisters, seizures and stigmata. Cures for existing diseases can be brought about through the same method, even for some kinds of 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 Journal42.

"The Origins of Psychic Phenomena: Poltergeists, Incubi, Succubi, and the Unconscious Mind" by Stan Gooch (2007) [Book Review]43

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.

"The Origins of Psychic Phenomena: Poltergeists, Incubi, Succubi, and the Unconscious Mind" by Stan Gooch (2007) [Book Review]43

But a word of warning. There are many who have vested interests in expanding the possibilities of hypnosis, and the field of demonstration and study is frought by smoke and mirrors.

Books written by professional magicians and showmen explain that they use shills planted in the audience, the power of suggestion, and even the willingness of the victim to play along with the ruse. [...] Hypnosis can accentuate certain aspects of consciousness and help retrieve certain memories, but it cannot make you squawk like a chicken without your permission.

"The Future of the Mind" by Michio Kaku (2014)44

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 reach. 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.

6. Stigmata

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"45.

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.

"The Origins of Psychic Phenomena: Poltergeists, Incubi, Succubi, and the Unconscious Mind" by Stan Gooch (2007) [Book Review]46

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 Gospel According to Woman: Christianity's Creation of the Sex War in the West" by Karen Armstrong (1986)47

7. Philosophical Issues

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).

8. The Limits of Psychosomosis

Book CoverOther investigators argue that while mental states might exert some influence on the initiation of disease, they are likely to be powerless to affect advanced organic pathology.

"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 attacks48. Some powerful pain relief drugs such as morphine have effects which far outstrip the possibilities of the placebo effect49 and will always be more effective than any psychosomosis. 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.