Norman Plotkin

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Placebo ~ Nocebo and the Role of Expectation

Expectation plays a huge role in healing. If you are given the expectation of no hope this will become your reality. In the lead up to my cancer diagnosis my doctors, perhaps tacitly addressing expectation, wouldn’t tell me I had cancer until I scheduled the surgery for its removal and they needed informed consent. I would have liked to have had a frank conversation with a physician earlier in the process about the possibility. In either case, expectation is an important element. So, let’s take a look at what is behind expectation in the healing process.

The placebo effect is well known and acknowledged by Western medicine. You know, fake treatments such as sugar pills, saline injections, and similar techniques. These techniques are routinely used in clinical trials as a control against which drugs, treatments, or surgeries are measured in order to determine if they are truly effective. In a landmark 1955 study by Dr. Henry Beecher featured in the Journal of the American Medical Association and titled The Powerful Placebo, about a third of people who were given inert ingredients like salt water or sugar, for example, were not only cured in their minds, but also showed measurable physiological recovery.

In modern, evidence-based medicine, any drug, treatment, or surgery must do better than the placebo in trials in order to be deemed effective. So, the power of the placebo effect is not only acknowledged by evidenced-based medicine, it is used as a baseline determinant for what is considered an effective therapy. But it poses a practical problem for a doctor in modern practice, who, as Dr. Deepak Chopra has noted, considers the placebo effect a nuisance because their medical training has preconditioned them to consider real medicine as drugs and surgery, and their medical ethics preclude prescribing fake drugs.

But people like Dr. Chopra and others argue that the placebo effect is real medicine because it triggers the body’s healing mechanism, and it does so, free from side effects. Every thought, decision, and action influences a chemical feedback loop within the body. For these reasons, it is critical to be aware of your self-talk and your thoughts because, as the placebo effect makes very clear, expectation plays an incredibly important role in your healing and recovery.

Conversely, just as you can positively influence your healing, you damage your body's natural state of health or worsen your disease condition with negative thoughts. The fact that this input comes from the brain means that thoughts, moods, and expectations, incorporeal and detached as they may seem, get translated into chemical messages just as surely as chemical therapies like drugs. You must be deliberate in your thinking, because it is your responsibility and in your self-interest to send positive messages to your cells as opposed to negative ones.

  Expectancy plays a tremendous role in your day-to-day health, but it is especially powerful when you are sick and/or in a diseased state. It has been scientifically proven that focusing your attention on illness will make you sick. Ask any medical student if, after accumulating substantial knowledge about what can go wrong with the body and the endless ways in which the physical body can break down, they didn’t at least once begin to experience physical symptoms. A 1966 study in the Journal of Medical Education titled Medical Students’ Disease: Hypochondriasis in Medical Education found that 79 percent of students reported developing symptoms.

This phenomenon has been referred to as the nocebo effect. Where the placebo effect reinforces the power of nurturing, hope, positive thinking, and expectation, the nocebo effect points to the power of negative thinking and how it can cause one to experience physical symptoms. In either case, we see the power of expectation, state of mind, and the foundation for the mind-body connection.

What are your expectations and how are they affecting your body and your health?

Norman Plotkin