Can someone be magical
The power of evil thoughts
Spring 1938. In the middle of the night, Vance Vanders walks through the small cemetery in his hometown in Alabama. Then he meets the local voodoo priest completely unexpectedly. He waves a bottle with a foul-smelling liquid back and forth in front of Vance Vander's face, murmurs incantations and finally says: "Nothing - absolutely nothing - can save you. Death will soon overtake you." - The curse seems to be working: within a few days, Vance Vander's condition deteriorates dramatically.
"If someone believes they have a serious illness that is killing them, then one has to ask them where the belief actually comes from, what is it that makes the patient believe they have this illness."
In the hospital, the doctor Drayton Doherty cannot find a cause for the severe symptoms - until Vander's wife tells him about the curse. Dr. Doherty goes to his patient's bed and has a nurse bring him a conspicuously large syringe, the contents of which he injects into his patient's arm. Shortly afterwards, he begins to vomit violently. Dr. Doherty about placing a lizard in the vomit: "Just look at Vance. This lizard ate you from the inside. You are cured." And indeed, Vance Vanders fell into a restful sleep. He can leave the hospital just two days later.
"I can well imagine that someone who gets sick under a voodoo will also be cured under a voodoo. In principle, superstition can only be expelled through superstition."
Paul Enck is a psychologist at the University Clinic Tübingen. For many years he has been dealing purely scientifically with phenomena such as the doctor Drayton Doherty experienced with his patient Vance Vanders. Paul Enck would never speak of voodoo. The correct scientific term is nocebo.
The nocebo effect is the bad brother of the placebo effect. Just as belief can heal a sick person, belief in some kind of curse can make a healthy person sick. This not only reveals the true story of Vance Vanders, which was testified by several doctors in 1938. The medic Clifton Meador collected them and other similar cases and published them in a book. As a rule, however, it is not magical rituals that trigger nocebo effects. Most of the time, doctors unintentionally become voodoo priests themselves. Their curses are diagnosis and prognosis.
The first patient who comes to the practice of the renowned cardiologist Bernard Lown asks a surprising question: "Do you remember the significance of today?" The doctor says no, although the patient looks somehow familiar: "Don't you remember? Today it is exactly 20 years since you last saw me." Slowly it dawns on Dr. Lown: Twenty years ago, the patient's father had been treated by him for a heart attack. Even then, the son developed a great fear that one day he would suffer a heart attack himself. Dr. However, Lown was able to confirm that he was completely healthy. Even so, the young man asked for another appointment a month later. "Come back in 20 years," said the doctor. "You said then: in exactly 20 years. And that is today." Dr. Lown is now beginning to understand where the symptoms of severe heart disease that his patient is suffering from actually come from. He cannot find a physical cause.
Doctors are constantly making diagnoses or giving a prognosis about the further course of the disease. Incorrect laboratory values, a mix-up of medical records or simple incompetence - all of this can mean that doctors are wrong with their statements. Cases are known where misdiagnosed patients showed the dramatic symptoms of cancer and were practically dying. Enck:
"What you develop are symptoms, but of course not the disease. Nobody gets cancer because of an incorrect diagnosis of cancer, but they will develop a whole series of symptoms, which they then interpret in connection with the diagnosis."
Scientists are only just beginning to understand how such dramatic nocebo effects come about. What is certain is that there are two basic psychological mechanisms involved: expectation and learning. Enck:
"There is good data showing that within a family the learning of certain ailments is increased or deleted. So, if the mother has irritable bowel syndrome, she is more willing to perceive abdominal pain in the child as serious, and for example the child to say: 'Then you stay at home today and don't go to school', as if the child has ailments that the parents do not know. That means there is a social learning mechanism of the symptoms. "
Pediatricians keep talking about so-called belly families. Studies with identical twins who were adopted by different families after birth have shown that there are no genetic causes behind this. The children were much more likely to develop symptoms from their adoptive parents rather than from their biological parents. The attention and care parents show to a child who appears to be suffering from the same illnesses as themselves acts like a positive reinforcement mechanism. When learning about diseases, the same principles seem to apply as we know them from the behavourists' learning theories. This also applies to classic conditioning. Two stimuli are combined with one another. In Pavlov's dog experiment, for example, the food naturally triggers salivation in the dog. If a bell rings at the same time, after a while the sound of the bell alone can make the saliva flow - even if there is no food at all. In a very similar way, some patients learn to feel sick during chemotherapy. Paul Enck:
"If you have gone through a cycle of chemotherapy and then come to the hospital for the second cycle weeks later and you feel sick long before you get this therapeutic agent, mostly on the way to the hospital, mostly when you are in the room, often then, when the skin is cleansed with the alcohol, vomiting starts. So this is called anticipatory nausea and is certainly a prime example of Pavlovian conditioning. "
Usually negative expectations and learning mechanisms, such as classical conditioning, are involved in the development of a nocebo effect. The chemotherapy patients had the expectation that they would get sick. At the same time, they combined the natural nausea reaction - as with classic conditioning - with a variety of stimuli that are harmless in themselves: the sight of the treatment room or the smell of alcohol.
The two parameters expectation and conditioning can be separated in behavioral experiments. Paul Enck put test subjects on a swivel chair. Turning around makes quite a few people feel sick. The Tübingen psychologist now wanted to know whether this nausea can be aggravated by negative expectations or classic conditioning. To do this, he gave the test subjects a remedy that tasted very strongly of cinnamon, but usually does not cause nausea. Some of the test persons were now told that the nausea on the swivel chair would increase as a result of the drug. In fact, this suggestion made significantly more participants feel bad on the swivel chair. In a second experiment, the test subjects had to repeatedly take the cinnamon-tasting remedy on the swivel chair. However, nothing was said to them. After three weeks, some of them got sick from the cinnamon taste alone - without being turned on the swivel chair. Paul Enck:
"The result is that you can indeed create nocebo effects this way, but that, depending on the gender of the test subjects, it is obviously easier for men if you make a suggestion and for women if you do it conditions. Women can be conditioned, men are suggestible. "
Because his girlfriend has left him, Derek Adams wants to kill himself. He swallows 29 pills of a strong psychotropic drug that he received as a participant in a clinical study. Shortly afterwards he begins to tremble, he breathes heavily, and his blood pressure drops dramatically. In this state, a neighbor finally drives him to the emergency room. Although the doctors there tried everything for over four hours, Derek Adams got worse and worse. The head of the clinical trial is alerted. He can finally give the all-clear: the pills that Derek Adams had swallowed in such a high dose contained nothing but starch and a little lactose. He was part of the placebo group. A quarter of an hour after receiving this news, Adams was able to leave the hospital.
Patients who take part in clinical studies regularly report side effects of drugs - regardless of whether they are in the control group, the so-called placebo group, or actually receiving a real active ingredient. So it is not surprising that a patient who believes they have taken an overdose also suffers from extreme "side effects". At the University of Marburg, the psychologist Yvonne Nestoriuc investigated this phenomenon and analyzed a large number of clinical studies on antidepressants. She was particularly interested in comparing different antidepressants. The so-called selective serotonin reuptake inhibitors are known to cause comparatively few side effects. The tricyclic antidepressants, on the other hand, cause severe side effects.
"We wanted to see whether the side effects differ so clearly in the placebo groups, and that's how it came out. Even surprisingly strong effects, so that the patients who thought they were taking the tricyclic antidepressants three to five times as often Have experienced dry mouth, have experienced weight fluctuations, have reported loss of libido than in the placebo groups believed to have taken the other drug. "
Knowing that tricyclic antidepressants cause severe side effects, the patients in the control group also experienced these side effects. Her negative expectation had triggered a nocebo effect. How strong such effects can be in clinical studies is also shown by the fact that as many participants in the placebo group drop out of the study due to side effects as in the drug group.
Anyone who takes part in a clinical study is informed very thoroughly by the doctors about possible side effects. As a result, some people have a real expectation that side effects will occur. And of course, participating in a clinical trial also affects how someone deals with the everyday little ailments that plague everyone. Nestoriuc:
"Statistically, according to studies, every patient has an unspecific symptom every third day, for which a measure is taken. So that I have a headache and take an aspirin or a dry area on the skin where I put an ointment on - anyone can do that The only question is, do I attribute this to a new medication I have taken. If I just have it today, I can imagine that the weather has changed and is dealing with it very differently than when I know I started taking a new medication on Monday and that may be a new side effect and I have to worry and go to the doctor and check that, I have to take care of myself - that has a completely different effect on my symptom. "
November 1998, a high school in Tennessee. A teacher notices an unusual smell. "Similar to gasoline" she will report later. She gets a headache, feels sick, has difficulty breathing. She is attacked by dizziness. The school will eventually be evacuated. Within the next week, more than 100 students and school staff will be admitted to the local emergency room. They all complain of symptoms very similar to those of the teacher who first noticed the strange smell. But even the most sophisticated medical tests cannot explain the symptoms. A toxin cannot be detected either in the room air or in the patient's body. A detailed questionnaire finally shows that the sick is very likely to have previously observed the symptoms in another person.
The nocebo effect seems contagious. This was also the result of a study by British scientists at the University of Hull. They asked students to breathe air samples suspected of containing an environmental toxin that could cause headaches, nausea, itching, and drowsiness. While inhaling the samples, half of the study participants observed a woman exhibiting these very symptoms. In fact, this group then complained of the same symptoms more often - even though the air samples naturally did not contain any toxins.
It is not uncommon for the nocebo effect to be used by television, radio, newspaper or the Internet to spread it. Yvonne Nestoriuc's New Zealand colleagues were able to document this in detail in the case of a high blood pressure drug. The well-known active ingredient, which was well tolerated by many patients, had been packaged in a new carrier substance, which gave the tablet a different appearance. At the same time, the pharmaceutical manufacturer had changed the packaging of the high blood pressure drug. Yvonne Nestoriuc:
"There were initial reports from patients that it is much worse tolerated, which were picked up by the press very quickly and this message then spread very quickly and our colleagues in New Zealand then had the opportunity to ask in the various medical practices according to the reports from the patients and that went up to extreme individual reports, all the negative symptoms caused by the new drug. "
Journalists are the voodoo priests of modern media society. Again and again they put a curse on the public - most recently with that of swine flu. Experts do not doubt that the fears fueled in media reports, especially at the beginning of the epidemic, triggered nocebo effects in many people. The swine flu was a real danger. Exactly how the side effects shown in the patient information leaflets can actually occur.
Moneapik was a particularly strong and healthy Inuit who lived in northern Canada at the beginning of this century. It was there that the missionary Julian Bilby met him. He credibly testified how Moneapik was killed by a curse. Obviously the poor man had drawn the medicine man's displeasure. "I order you to die," he said to Moneapik. Thereupon he gave up all his activities, withdrew to his hut and was dead four days later.
A curse or a spell can undoubtedly induce nocebo effects in someone who believes in it. But how real are these effects? Can you actually kill?
1967, Baltimore Municipal Hospital: A young woman, completely distraught, storms into the ambulance and asks for help. The doctors ask how she is and discover that her patient suffers from one thing above all: fear of death. Allegedly, a midwife had already cursed her when she was born and prophesied that she would never live to see her 23rd birthday. Just like two other girls who were all born to different mothers on a Friday the 13th. As the midwife had predicted, these girls had died shortly before their 15th and 21st birthday, respectively. The young woman now feared that the same might happen to her. Although the doctors at the clinic were very skeptical, they took her in for observation. The next morning she was found dead in her hospital bed - with no apparent organic cause of death. Two days later she would have celebrated her 23rd birthday.
Hardly any other organ is as sensitive to panic and fear as the human heart. During important football broadcasts, the heart attack rate regularly skyrockets. If a lost soccer game is life-threatening for someone with a weakened heart, how great is the danger of a curse? Provided, of course, that the person believes in the curse. It is the associated fear that is ultimately fatal.
Fears, negative expectations and learning mechanisms - they are ultimately behind the nocebo effect and influence a large number of processes in the body. This is also shown by an experiment by neurologist Ulrike Bingel. At the University Medical Center Hamburg-Eppendorf, she triggered a pain stimulus in test subjects with the help of a hot plate on the hand. In the MRI scanner, she followed the reactions in the brain. During the entire experiment, the study participants received the highly potent pain reliever remifentanyl. Bingel:
"We gave the drug in three conditions. In one case, the test subjects didn't even know at the moment that they were receiving it. So we secretly smuggled the drug into the test subjects. In the next condition, they had a positive expectation of therapy because they knew they were going to get the drug now.And in the third condition, the subjects expected that we would stop the drug now and that this could lead to an increase in pain sensation. In fact, however, we have not stopped the drug in the condition now. "
The test subjects therefore always received a constant amount of painkillers in all trials. The only thing that varied was the expectations of the study participants. And that obviously had a massive impact on how strong the pain caused by the hot plate was perceived. Bingel:
"The fact is that with a positive expectation you could almost double the pain relieving effect, and with a negative expectation the pain relieving effect was almost completely destroyed. This means that the test subjects had a potentially very effective drug in their body, but still got no pain relief felt because they expected the pain to increase. "
In doing so, Ulrike Bingel not only relied on the statements of her test subjects: in the magnetic resonance tomograph she could see that the areas responsible for the pain were actually active. The stronger the pain according to the test subjects, the stronger this activation was. That could mean nothing else than that the person in the magnetic resonance tomograph actually felt this pain. This perception of pain is probably modulated by an area in the front part of the cerebral cortex, where the expectation arises. The study by the Hamburg neurologist shows one thing very clearly: the symptoms that arise with a nocebo effect are not imaginary but highly real.
For Ulrike Bingel, her results only allow one conclusion:
"I believe that in the future we will have to pay much more attention to this interaction between the effect of the drug and the effect of expectation."
The expectations that are so important for the nocebo effect arise in the brain and the perception of pain is essentially a process that takes place in the brain. Does the nocebo effect only change how a person feels his body via the brain? What symptoms is he experiencing? Or can it also impair other - consciously uncontrollable - bodily functions? One thing is certain: Nocebo effects can be seen in almost all organs and parts of the body. How they influence the immune system, the psychologist Manfred Schedlowski examined at the University Hospital Essen:
"In these studies, test subjects drink a greenish liquid and take a drug at the same time, that is cyclosporine A, and this drug suppresses the immune system. Well, if we combine this two or better four times, that is, this green liquid together with the drug and then wait about a week, we order the test subjects back into the laboratory. And this time the test subjects get a placebo, really a dummy drug, and drink this green liquid again and then we see a suppression of the immune system in the form that was previously caused by the drug. So a conditioned immunosuppression. "
Manfred Schedlowski was able to see in the patients' blood that the completely harmless green liquid can also block the immune system on its own: the number of T lymphocytes had declined, the effect of the nocebo effect was just as strong as that of the drug cyclosporine. Even consciously uncontrollable body functions can be conditioned - because the brain also reaches the immune system via nerve tracts and hormones. The Essen researcher was able to understand this with experiments on rats. Schedlowski:
"We know that the way from the brain runs via the splenic nerves, i.e. via the direct innervation of the spleen, because if we cut through these nerves, we also stop this conditioning effect."
White blood cells - including T lymphocytes - are increased in the spleen. The brain can disrupt the function of the spleen directly via the splenic nerve. In addition, the cells of the immune system contain binding sites for messenger substances released by the nervous system. So the mind triumphs over the body and uses the body's own biochemistry for this. Schedlowski:
"We see the limits insofar as we can only let the mind dominate those bodily processes where the communication channels, the biochemical communication channels also exist. And only then does it seem to work well."
In the case of allergies, for example, the mechanism works: if someone who is allergic to roses starts to sneeze at the sight of a picture of a rose.
"The learning effect here is that the eye identifies this rose image and this association is made in the brain and then, within the framework of this learning process, this allergic reaction actually takes place as a conditioned, learned reaction."
Learning processes and negative expectations do not even allow an allergy to develop. But they modulate the severity of many pre-existing diseases.
Ms. S. has suffered from cardiac valve insufficiency since childhood rheumatic illness. The leaflet valve located on the right between the atrium and the ventricle is scarred and its function is impaired. This repeatedly requires shorter hospital stays. However, Ms. S.'s heart disease is not life-threatening. Even as an elderly lady, she still does her job as a librarian. To her doctor, Dr. Levine she has an intimate relationship. When she is in the hospital again, Levine has little time on rounds. He introduces the patient to the other doctors with the words: "Here is a case of TS". Then it goes on. Ms. S.'s condition, however, deteriorates dramatically. A young assistant doctor tries to find out what's behind this and asks Ms. S: "Doctor Levine said that I have TS." "Yes, of course you have TS." Then the old lady begins to cry softly to herself, as if the young doctor had pronounced her death sentence. "What do you think TS means?" "Terminal situation". In fact, however, Dr. Levine with TS only uses the Latin name for Ms. S.'s disease: tricuspid valve stenosis. Despite the assurances of the young assistant doctor, Ms. S. sticks to her convictions and dies that same evening.
There is a cure for the power of bad thoughts: and these are good thoughts. They can heal - or at least promote the healing process. A number of studies have shown, for example, that nothing has more influence on the course of a heart disease than the patient's expectation. It was crucial for their recovery that they themselves were convinced that they would be able to return to work soon. How severe the arterial occlusion was, whether an operation went without complications - none of this had nearly as much influence on the course of the disease as the patient's expectations. In some cancer wards, psychotherapists and doctors work specifically to arouse positive expectations in the sick. Elsewhere, on the other hand, there is little time for this. Ulrike Bingel:
"So far it has been the case that practitioners earn little money from talking to patients, but they earn their money by doing examinations, doing another examination, referring them, but sitting down with a patient and talking about it for a quarter of an hour Talking about the clinical picture or the therapy is very poorly remunerated in Germany and that is perhaps one of the reasons why it has so far not been used across the board and consciously. "
Unfortunately, doctors are much more active than gloomy prophets, mumbling dark spells in Latin - and only making their patients sicker. In doing so, they could practice white magic and become healing gurus. Globally recognized cardiologist Bernard Lown believes the ability to make patients optimistic is far more important than any medical device. "The lost art of healing" is the title of his book. In it he also describes how he managed to give the old and seriously ill Tony ten years of life. The story began when Dr. Lown proposed to his patient that he marry his young mistress, who cared for him with devotion.
"Well then, Doctor, I'm ready to make an agreement. Lisa is keen to get married, and if you give me a written guarantee that I'll live another five years, I'll be ready to follow your suggestion." Dr. Lown does not shy away from drafting such a document, although the situation is actually hopeless. In fact, Tony recovers, marries beautiful Lisa and reappears in the practice five years later after the "contract" has expired. "Doctor, the five years are up, I need a new contract." Again, Dr. Lown a document confirming that Tony can live another five years. When these five years are up, Tony knows that no document in the world can save him anymore. He dies two years later.
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