Nocebo

Most people are familiar with the concept of a placebo. The word comes from Latin and means “I shall please.” We most frequently hear it used in medical terms. It can be a substance or a treatment that has no known therapeutic value. Common placebos include inert tablets (like sugar pills), and inert injections (like saline).

Sigmund Freud conjectured that since some placebos had a positive effect on what was considered a physical problem, the problem must really be in the mind. In his version of talk therapy providing positive information can improve the perception of well-being.

I have been fascinated with this concept ever since I heard about it in a high school course. But it was only recently that I heard the word nocebo. This is when negative data makes someone feel worse about their own health. Nocebo is Latin for “I shall harm.”

I heard nocebo used in the context of the negative effect that my wearing a fitness tracker on my wrist might have on me. I wear it to track my activities (steps, miles, exercise times). It also monitors my heart rate and my sleep. The device has a positive effect on me when it vibrates to tell me I have hit my steps goal for the day. But what is the effect on me when I spend all day working on the code for a website and discover at dinnertime that I have only taken 1200 steps all day and I have only been active for one of my waking hours? Nocebo effect.

“Placebo” was used in a medicinal context in the late 18th century to describe a “commonplace method or medicine.” In 1811, it was defined as “any medicine adapted more to please than to benefit the patient”.

In the 20th century, studies on the “placebo effect” showed that there could be a positive effect and that it could also have no effect. Inconclusive. However, placebo-controlled studies were used and are still used to evaluate new treatments. Clinical trials control for this effect by including a group of subjects that receives a “sham” treatment. Subjects in such trials don’t know if they received the treatment or a placebo.

I think it is interesting that if a person is given a placebo under one name, and they respond well, they will respond in the same way on a later occasion to that placebo under that name – but not if it is given with another name. Clinical trials are often double-blinded so the researchers also do not know which test subjects are receiving the active or placebo treatment.

I’m no medical authority so I must be careful what I suggest here, but I would think that when someone finds relief from a scientifically questionable treatment (copper bracelets for arthritis, some herbal products, etc.) that relief might be a placebo effect.

What was new to me (and perhaps to you) is the nocebo effect. It seems to apply to more than my fitness watch. What about social media “likes” and reposts and hit counters on your blog or website? They can all have a positive effect on you when you get them, but what about when you don’t get them? I think we might all need to be more conscious of any nocebo effects in out daily lives.