|by Charles H. Booras, MD
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
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.
In ancient times, physicians knew that lifting a patients spirits played an important role in relieving pain and curing illness.
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.
The connection between mind and body is very powerful. Our bodies have a miraculous array of systems available to keep us well. I feel we all have the ability to tap into this resource in order to heal ourselves. Making the most of this resource involves a healthy lifestyle, as well as a healthful attitude.
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