by Charles H. Booras, MD Revised 7/27/97

According to Dr. Herbert Benson, president of the Mind & Body Medical Institute at Harvard Medical School, the placebo (a dummy drug or treatment that has a positive effect simply because the patient believes in it) has its counterpart in the nocebo. In a clinical setting, this is the negative influence of a patient's fear, anxiety, and hopelessness, usually interacting with what is perceived as a physician's doubts or indifference. Negative expectations can work against you, however, even when no physician is involved at all.

Nocebo's can work in several ways. First, there's the more generalized form, in which a person who is depressed and pessimistic may be more susceptible to various illnesses and is less able to recover once ill. There is a large body of evidence showing that depression, hostility, anger, and pessimism can indeed have adverse health effects over the years. Second, there is the more specific kind of nocebo. It's been shown, for example, that women with breast cancer who have a fighting spirit may survive longer than those who feel hopeless. Other studies have found that chronic fear of heart attack can bring on chest pain even when no signs of heart disease can be detected. Recently a study in Circulation found that depression, as measured in almost 1,000 Danish subjects with coronary artery disease, predicted their death, especially among women.

Modern medicine, with it's army of specialists and it's reliance on testing, drugs, and technology, may need to pause and hearken back to those earlier times. A doctor's positive attitude is no substitute for knowledge, but "lifting the spirits" should always be included as a medical goal. The role of emotion in sickness and in health remains, to a large extent, a mystery. Optimistic, sweet-tempered people do fall ill and die; and the angry and pessimistic have been known to live long and healthy lives.

Nevertheless, keep these suggestions in mind.

Try to choose a doctor with a positive and open attitude. One who will take the time to talk with you, answer your questions, and respond sympathetically to your concerns. Form a partnership with your healthcare provider and make decisions together. A physician-patient rapport is therapeutic. If this healing connection is missing, then you are both better off by severing the relationship.

Try to learn better attitudes. Admittedly, it is difficult to turn pessimism into optimism. Personality traits are notoriously hard to alter. Consider some form of counseling or joining a support group. If you are depressed, remember that depression can usually be treated successfully. Get help. Chronic depression is not something you have to live with.

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