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Phenomenology: The Nocebo Effect

Paul Kiritsis - Friday, March 28, 2014

It began sometime during the summer of January 1992. I recall I had just returned from a family vacation to Adelaide and Mildura, revelling in the aftermath of much excitement of the trip up north, which had spawned my first experiences of handling live animals at a farm. All nervousness aside, I was even looking forward to my first year of high school. But shortly after we returned, something very bizarre happened.

It came on gradually, perhaps over the course of a week. I woke up one morning feeling somehow not myself. Suddenly, things didn’t feel right within me anymore. There was a wrongness where prior there had been none. Something had changed. I couldn’t put my finger on it; I didn’t know what it was—how could I? I was but a child of twelve years old. The only thing I knew was that I wasn’t as I had been. The thought gnawed away at my heart, physically aching like a headache. It still does. It’s something that’s incredibly difficult to describe without the conventional psychiatric connotations that go with this mode of expression. But make no mistake, there was nothing imagined or emotional about what was happening to me. It was as real and tangible as the air we breathe and the water we drink.

A few weeks later, I was watching the Australian Open tennis with my grandmother. At its conclusion, I started flicking through the channels in the hope that something of interest would be on for late-night viewing. My attention was immediately seized by a horde of individuals huddled together, holding candles. Some of them were being interviewed by a reporter. When I increased the volume, I realized it was a program on people living with HIV, a virus which at that point in time was deemed an undisputed death sentence. It was engaging, so I decided to watch the rest of it.

You might imagine my horror when a young man of about twenty-five began describing what he called a wrongness inside him upon having been diagnosed HIV positive. At that point, I felt the onset of gooseflesh, a lurching stomach, and the blood drain completely from my face. I must have looked like a starved vampire who hasn’t feasted in months. I vividly remember dashing into the bathroom and staring at my reflection in the mirror. Was this what was wrong with me?

Was I HIV positive?

I spent the next few hours crying and wondering what I’d done to deserve a fate like this. Why had God condemned me to an early death at such a young age? It was unfair, unjust. I lay awake that night, and many others, praying to the Virgin Mary, hoping that none of it was true. At one time, I even tried to convince myself that I’d made it all up and that it was nothing more than an illusion—that I’d never seen the show on TV about AIDS.

In hindsight, I’d rate it as the most traumatic moment of my life. Explicit in my recollection of this event is the salvific act of dropping to the ground beside a Byzantine icon of the Virgin and Child, to a most humble position reminiscent of the one a bucolic supplicant might take before royalty. Curled in this position for hours my emotional self would alternate between periods of being immobilized by fear and periods of inner pandemonium where I begged for supernatural intervention and help. The horrific image of damned souls burning in hell for their abhorrent sins, vivid depictions of humans having their flesh roasted and their bits prodded with tridents, forks, and spears by demons, Jesus’s betrayal by Judas Iscariot, indeed everything that was the Biblical embodiment of pain and suffering, I had become in the space of a microsecond. No matter how hard I tried, I just couldn’t extricate myself from this searing space that kept shrinking and shrinking.  

From that moment on, I made every effort to attend Sunday church and put forth my myriad questions to the saints and little baby Jesus. You might ask if I got my answers. To be honest, I’m not really sure. What I can say for certain is that an influx of hope and faith suddenly came from somewhere. Try as I might to shake the idea that I was dying, it became firmly rooted in my unconscious mind, and I spent endless nights cursing my fate, swearing and taking out my frustrations on a punching bag that hung from the roof of my old garage. I never dared to confess any of my secrets to our local priest; I felt that he wouldn’t understand. What was happening to me was beyond comprehension.

In the years that followed, symptoms of constant tiredness and exhaustion manifested. I’m quite certain now that these were psychosomatic. I decided to drown all that had happened in my early teens into a well somewhere deep in the recesses of my unconscious. I then put up a brick wall between myself and HIV—I would have nothing to do with it. I cringed at any mention of the word AIDS.

My thinking became increasingly warped with the passage of time. Seen through the telescope of my own distorted perceptions on my own planet earth, diseases couldn’t hurt me if I didn’t know about them or if my diagnosis remained unconfirmed. The moment a general practitioner confirmed my dormant suspicions with the words “you’re positive,” the illusory protective spell would be broken, and I would die from grief—I was sure of it. Hearsay of terminally ill people living quite normal and healthy lives in ignorant bliss of their ailments upheld my, by then, well-established worldview.

For a while, life seemed to return to normal, and I even found myself attending regular confession at the local Greek Orthodox Church. But years of having kept my darkest fears sealed with a plug of silence deep down in my unconscious hardware finally caught up with me. Just before I turned twenty-one, my physical symptoms worsened to the point where I was left with no choice but to request a full blood examination. You might imagine the pleasant shock when my HIV test came back negative. I remember being somewhat confused. Had I stupidly been living with an irrational fear for all those years without good reason? Was the wrongness that I felt and that which the guy on the AIDS documentary had described just a blind coincidence? If it wasn’t HIV, then what did I have? What else could it have been?

It’s been fourteen years since my emancipation from this night terror and I will openly concede that there’s a part of me, a very vulnerable and sensitive part, that wants to retract all these explicit memories together with their dark emotional inflections, drown them in the deepest geological layers of my unconscious, and emerge with a psyche-soma unencumbered of scratches, dints, and blemishes. But to do so would be an injustice, for I would have rejected the authentic dimensions of metamorphosis and the fertile darkness from which existential encounters with sacred realities spring forth, I would be throwing out the baby with the bathwater.  We need to be dismembered, torn limb from limb by elemental forces acting from without, if we are to individuate in the classical Jungian sense.  The mystery of life is in the darkness and despair, the tears, the enduring hardships, the crises, and the hair-raising descents; we cannot create those meaningful narratives in ambient cosmic fields that will echo along subsequent generations and facilitate spiritual growth and healing if we do not submit to death in the metaphoric sense. The red and white cannot be had without the black.

What astounds me about my own black, save for the obvious fact that it spray painted my rose-tinted glasses over with powerful negative suggestions, is the fact that it did not kill me. We know for instance that when thoughts dictated by poignant negative beliefs are reiterated countless times so that they become part of the psychic unconscious together with its set of underlying limbic mechanisms mediating the endocrine and autonomic nervous systems, the biochemical mechanisms will transmute accordingly to reflect that reality. As a result the individual atrophies and disintegrates both mentally and physically, aligning him or her with a pathological trajectory of chronic illnesses (i.e. depression and hypertension) which may turn lethal if the causative factors and negative conditioning responsible remain unaddressed and unchallenged for indefinite periods. The general rule is that if the mind saunters about irrational fear and fatalism, the genetic codes expressing particular biochemical substrates will alter to reflect that on a physical level. I don’t think the spiritual alchemy which ran as a countermovement to the scientific revolution was wrong in retaining the primordial hermetic doctrine, “As above, so below”, a leitmotif which extends and applies to all facets of the secular world.

Even though the protracted nocebo underpinning my teenage years was involuntary, an imposed contingency rather than a volitional one (at least in my perception), it expedited the same negative programming which might be incurred through the medical diagnosis of a fatal disease coupled with a mutually hope-deflating prognosis. I earnestly believed, in my heart of hearts, that I was going to die. If, then, I had rewired consciousness, mind, inner reality, whatever you wish to call this mystery, in preparation for an early death, why didn’t I wither and die?

From what we know about the nature of the nocebo thus far there are two very feasible possibilities. The first relates to the dichotomy of the human psyche into an omniscient, nonlocal higher Self with access to information telepathically and an inferior ego confined to the space-time continuum and interpersonal sense learning. There may have been communication of authentic and accurate information about the true state of my health across these strata in a way that disrupted the mind-matter chain at one of its junctions, thus allowing the nervous and endocrine systems to function autonomously with little regard for higher directives coming from an emotional self. Put in more modest terms and in the language of the Icarian children, a part of me doubted the objective legitimacy of my own condition. The other prospect has to make do with an intriguing quantum perspective which regards individual minds and their underlying neural mechanisms as subunits of a superconscious correlated nexus able to influence and be influenced by nonlocal thoughts. Negative suggestions encompassed by a shared worldview between patient, doctor, friends, relatives, and the wider scientific community are bound to be much more dynamic in the effect yielded than the patient’s own. If minds are intertwined like a knot in a collective unconscious, then shared attitudes, values, and beliefs, may have a much more seminal role in the fate of biological systems than previously theorized. Perhaps then in my case the complete absence of collective cues in identifying the basis of the problem and responding to it rendered the troublesome nocebo less efficacious. Or it could be something else completely, something as simple as the absence of organic disease in accompaniment with the fact that I didn’t want to die. As we see, sometimes life can be so obstinate in preserving its mysteries.

The raw, colossal power of the nocebo is most evident in the indigenous cultures of the world where social transgressions sometimes result in physical illness or even acute psychogenic death. This is not something hallucinatory by any stretch of the imagination; it is a documented fact recorded by many ethnologists and anthropologists who have spent their entire lives studying indigenous medicine and healing methods. Usually the onset of the illness is sudden and unprecedented. The victim might be perfectly healthy and happy one minute and then suddenly experience a reversal of temperament in which he or she becomes inert, inactive, unresponsive, lethargic, and short-tempered. According to many eyewitness reports made by Westerners, the victim’s whole physiognomy changes so that his or her actions appear disordered and mechanical. Usually there will be a period of distress preceding a sudden lapse into unconsciousness whereby all communication and nourishment is forsaken. Death follows quite swiftly if the victim does not seek a medicine man or physician for the sake of confessing his or her “sin”. What we find amongst indigenous cultures where the belief in confession abounds is that the notion of “sin” or committing a “sin” as understood from a cultural perspective is one and the same with a “breach of taboo”.

For the indigenous populations of Uganda, Central Africa, and Polynesia the condition of transgressing is quite heterogeneous in nature and concrete laws or rules are non-existent. Hence a “sin” might be voluntary or involuntary and conscious or non-conscious. Breaking moral codes is also a projection of “sin”, as is protracted labour before childbirth, adultery, drunkenness, theft, verbal offences, and sterility. In developed areas of the world like the United States, Europe, and Australia where the monotheistic religion of Christianity reigns we tend to perceive confession as an act which transpires in complete privacy and under the mediation of a priest. Amongst the aforementioned autochthonous peoples the context is very different; the “sinner” will admit his or her sacrilege or wrongdoing publically before a shaman, medicine man, or healer attempts to purge it from the body through ordinary physiological procedures like forced vomiting, washing, and bleeding. From this inverted perspective the enterprise of “sin” that might be used in a modern sense as a descriptor of dirty laundry becomes a collective concern of the utmost importance. It is also worth mentioning here that a subjectified shame imposed onto an individual acquires a life of its own and becomes as much of a reality to the transgressor as the menacing clouds in the sky or the mantic dreams experienced during sleep. We know that minds are interconnected in a collective unconscious; we know that, under  a collective egregore (thoughtform) may be created by those minds; and further, that that egregore may exert some kind of palpable influence on an individual member of the group. Under such a holistic, quantum configuration it may seem perfectly natural that a “sinner” who has not been expunged of their “sins” will inevitably fall ill and die.   

One such case where the ancestral taboos were transgressed by a young boy was described by missionary Reverend Grebert whilst he was stationed in the former French Congo. According to Grebert the boy was suddenly overcome by paroxysms so violent that they knocked him from his feet and choked him. Distressed onlookers were quick to offer an explanation: “He ate bananas that were cooked in a pot that had been used previously for manioc. Manioc is eki for him; his grandparents told him that if he ever ate any of it–even a tiny bit–he would die.”[1] The obvious explanation here is that the ancestral taboo delineating that eating manioc led to death was so heavily programmed into his unconscious that it manifested or “objectified” itself in the physical convulsions. Grebert explains that an antidote for such a condition existed; that it was readily available in the next village; and that a member of the tribe had dashed on over to collect it. During that time Grebert and some other villagers endeavoured to unobstruct the child’s airway with a rhythmic set of cardiac compressions, all to no avail. The whole enterprise ended rather tragically with the boy dying of asphyxiation before the man could return. There can be no doubt that this situation broadcasts the powers of negative suggestibility when the belief systems to which they are attached are contained within the collective unconscious of a specific culture.

The nocebo also crops up in the magical practices of indigenous peoples from South America, Melanesia, and Australia. In conducting extensive cultural surveys of Aboriginal tribes from central Australia, the Australian anthropologist Herbert Basedow (1881-1933) discovered that magical thinking comprised one of the great ancestral tributaries of traditional Aboriginal life. Working through the mechanism of negative suggestion, sympathetic magic could be used by shamans to wreak havoc in the tribe, generate and cure disease, and even kill someone. The latter was achieved by way of incantations, rituals, and the dreaded “pointing bone”, all of which formed a confluence and projected onto the life force of the intended victim. Baselow’s description of the victim’s disintegration is quite disturbing:

“A man who realizes that he is being “boned” by an enemy is, indeed, a pitiful sight. He stands aghast, his eyes staring at the treacherous pointer, his hands lifted as though to ward off the lethal medium which he imagines is pouring into his body. His cheeks blanch and his eyes become glassy, and the expression on his face becomes horribly distorted, like that of a person stricken with palsy. He attempts to shriek, but usually the sound chokes his throat, and all one might see is froth around his lips. His body begins to tremble and his muscles twitch involuntarily. He sways backwards and falls to the ground, and appears for a short while to be in a swoon; but he soon begins to writhe as if in mortal agony and, covering his face with his hands, begins to moan. After a while, he composes himself somewhat and crawls to his wurley [hut]. From then on, he sickens and frets, refusing to eat and keeping aloof from the daily affairs of the tribe. Unless help is forthcoming in the shape of a counter-charm administered by the Nangarri or medicine man, his death is only a matter of a comparatively short time.”[2] 

As frightening as it is, this is the degree to which pre-programmed collective beliefs can impact our health and future. Whether we choose to brood on negative sentiments like fear, hatred, and anger or allow ourselves to be swept along by the stressful vortices they form isn’t important because the end result will always be the same–susceptibility to ailments of the mind and body, and in the worst case scenarios premature death. What is important is recognition that we do have a choice in whether we play with the nocebo devil or not; we can accept his malevolent advances like meek, submissive, and pessimistic fatalists or we can reject them defiantly and proclaim ourselves sole masters of our destiny. We can let ourselves be washed into a torrent of negativity or we can adopt a positive outlook mediated by optimism and altruistic love and actively pave those meaningful narratives we so desperately crave as immortal protagonists. The choice is nobody else’s; it’s ours.

Hence we must choose our destiny…    

[1] Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York, USA: Basic Books, 1970), pp. 22-23. 

[2] Ibid, pp. 36.

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