I have a humourous anecdote to relate about my own experience with the “nocebo effect”. Nocebo effect is, as you may be aware, the opposite of the placebo effect, although both belong to what we might call “the magical mode” of consciousness and are very much involved in the “intentionality” of consciousness.
As most of you already know, I was rushed to hospital in February 2015 as a result of sudden kidney failure, where I spent twelve days undergoing treatment and surgeries of various kinds, diagnosed with the hopeful sounding name “End Stage Renal Disease” (ESRD) or “Stage 5” (there’s no stage 6). The cause of the kidney failure was, apparently, a congenital deformity of the ureters. In normal people, they are straight. Mine are for some unknown reason cork-screwed. The result of this twisting of the ureters was a steady build-up of damaging back-pressure on the kidneys. Nothing to be done for it except manage the problem through diet and regular monitoring of kidney function. But, since my discharge, my remaining kidney function has remained stable. I have about 15% function — sufficient to keep me off dialysis.
I was discharged with an expensive list of medications to ingest daily, actually mostly dietary supplements or “blockers” designed to bind my three devils — sodium, potassium, and phosphorous — the three minerals that proper kidney function is designed to regulate but which can become toxic to the body when not properly regulated. But in addition to the blockers I was also prescribed a blood-pressure regulator, since high blood pressure is also damaging to kidneys. It’s a very expensive drug. Over the course of the last year, though, I’ve been allowed to drop many of the medications I was originally prescribed, except for the blood-pressure regulator. It puzzled me, actually, because I’ve never had really high blood pressure.
My nephrologist, who I usually see once a month, is always pleased with my blood pressure. “You’re very calm!” he once remarked. Which is true, but I wondered also whether he was factoring in the medication that had been prescribed. I suppose he expected me in my condition to be otherwise than calm. Am I supposed to worry and fidget?
In any case, I dutifully took my very expensive blood-pressure pill that cost me 100.00 a month regardless, until I had a very large Jeep repair to do and was suddenly short of ready cash to renew my prescription. So, I let it slide for ten days. And during those ten days nothing at all changed in my blood pressure, which I monitor myself twice a day and record on a chart. And I began to question whether this medication wasn’t actually a placebo. Had I paid out 1500.00 over the course of the year for what was only a placebo?
When I brought it to my nurse’s and nephrologist’s attention, during one of my regular checkups, they both expressed surprise that there had been no change in my blood pressure after dropping the medication. I suggested that I would like to drop the medication entirely, and monitor my blood pressure to see the results. They agreed, and lo and behold, the most unusual thing happened. My blood pressure actually dropped even further than “normal” into the “excellent” range.
So now we’re really baffled. Dropping the blood-pressure medication not only did not result in the “logical” consequence of higher blood pressure, the blood pressure actually improved even more than the earlier results when I dropped it for that ten days.
So, I came to the conclusion that it was “nocebo effect” — and not even placebo. The cost of the drug was a petty irritant of mine. Even the thought of the drug was an irritant. Somehow, the fact of taking the blood pressure suppressant seemed to be enough to raise my blood pressure slightly. When I made the decision to drop it definitively, my blood pressure fell even lower than its “normal” range. Ironically, the blood-pressure pill had the perverse effect of raising my blood pressure rather than lowering it. So, I concluded that this expensive medication actually only relied on the placebo effect for its reputation. In my case, it worked just the opposite. It had convinced me that I had modestly high blood pressure which it could control, and which the measurement results seemed to prove. But in fact, the drug — a Bayer product — itself created the effect, and when I made the decision to drop the irritant of having to take the drug at all, my blood pressure actually fell from “good” to “excellent”.
There may well be people who benefit from the bloody blood-pressure drug, but I suspect it’s because it invokes the placebo effect, much as many headache remedies do, and not because of some inherent chemical property of the pill itself. It relies on the patient’s own “marshalling of intent”, as we might call it, for its effectiveness. But it seems to have had the opposite result for me.
The “nocebo effect” has been particularly noted in doctors’ waiting rooms. Here’s how it plays out in the case of blood pressure. You’re in the waiting room or in hospital. These are relatively stressful situations for most people, so your blood pressure rises. Suddenly, you are diagnosed with high blood pressure, which may actually only be the result of your own negative perception of your situation. So, the doctor prescribes a blood-pressure meliorative. It may only be a placebo, and the doctor may not even be aware that it’s a placebo. But subsequently, it lowers the blood pressure. It seems to work. But what has only changed is your perception of the situation. You’re self-image, now, is suddenly of someone with high blood pressure requiring medication. It becomes a tautology, or what is called “a positive feedback loop”.
It’s a good example, to a certain extent, of the role of “intentionality” — and of the principle “you create the reality you know”, both individually and collectively. And this is why I take such an interest in propaganda and branding, which works pretty much on the same principles as those which bring about the placebo and nocebo effects — the marshalling and manipulation of intentionality.