Pain, Prophecy and Placebo


How the Way You Think Can Change the Way You Feel

Ever heard of a self-fulfilling prophecy? We’re not talking here about the idea that if you want a Ferrari you can just believe one is on its way and have it turn up! Rather, we mean the kind of self-fulfilling prophecy that impacts on your health…

In its simplest form, a self-fulfilling prophecy has a clear and demonstrable sequence that starts with your thoughts, beliefs or feelings: the things we think, feel and believe influence our attitude. Our attitude influences our actions. Our actions influence or dictate the possible outcomes

An Example…
Let’s give a really common, everyday example of this… Nothing to do with health yet, just a clear example. Imagine you’re hurrying to catch a bus. You see it whizzing by the top of the road, and you realise it’s early. You might think… “It’s early! I can’t catch that…” Believing that might determine your attitude: “No point running – I’m going to be late!” This determines your actions… You continue walking!

Walking results in your seeing, from a short distance, the bus pull out and drive off without you. You missed it! All of which reinforces your original belief, and influences your future thinking: you wouldn’t catch the bus – and yes: you are going to be late!

Change the Thought. Change the Outcome.
What if, though, you had in your mind an ever-so-slightly different picture in the first place? So… You’re hurrying to catch a bus! It whizzes by: you realise it’s early. You might think…

“It’s early! But I might still be able to catch it…” Believing that might determine your attitude: “I’ll have to run, though!” This determines your actions… You run!

This COULD result in your catching the bus – in which case, you were right! It confirms your belief that you might, indeed, have caught it if you ran… And you would only have run if you held the belief that there was a chance of catching it in the first place. It’s your thinking that shapes the reality in this situation.

Given the mundanity of the example we’re giving, you can probably see how common self-fulfilling prophecies are. You might also appreciate why they often underpin acts such as goal setting and visualisation exercises… You can consciously decide to believe in and pursue a belief and have it affect or dictate an outcome. When it comes to your health, though, the phenomenon can be a LOT more subtle…

The Placebo Effect
Maybe you’ve heard of this? It’s best known, perhaps, in the context of an unsuspecting patient being given a sugar pill instead of a real drug to treat their condition. While the sugar pill shouldn’t affect the condition in any way, that often proves not to be the case.

Indeed, a great many studies show that about a third of patients who don’t know that they’re being given a placebo treatment often begin to feel better despite not having any medicine at all. Even more bizarrely, when some patients are told they may also experience specific side effects of the medication, they do! This is a form of self-fulfilling prophecy, but one that predominantly happens in the unconscious mind. You expect to feel better or worse for having taken what you believe is a drug… And so you do!

Red Pill. Blue Pill.
Research shows that – in relation to causing a placebo effect – injections are better than capsules, and that capsules are better than pills… Big pills are better than small pills, and that four pills are better than two pills! Red pills make better placebos than blue unless you want the placebo to have a calming effect, in which case it should be blue!

What’s more, external factors outside the medication itself may also influence the placebo. For example, some tests show that an authoritative doctor, the surrounding environment, the way you’re spoken to, the amount of time you’re given and other factors can also have a profound effect on the perception of impact and subsequent recovery.

The Nocebo Effect
This is the exact opposite effect: believing something negative or deleterious is going to happen only to influence your body in that way. When you tell yourself something is GOING to hurt, for example, your brain effectively puts your central nervous system on red alert…

So the receptors in the body part you’re worrying about instruct your muscles to be more protective. Then, when you go to make the movement, it actually can be more painful. In other words, just thinking something is going to hurt means you automatically increase the chances that it WILL hurt. Isn’t that extraordinary?

BUT… How does all this help?
If people could bottle the placebo effect and sell it, pharmaceutical companies would be all over it! Oddly, though, the biggest problem with self-fulfilling prophecies and placebo seems to be that people say of them something to the effect, “Yes, but this is stuff that’s just in your head! I need real help…”

Sadly, this completely misses the point, which is this: many people can be made to feel less pain, to feel happier and to be more relaxed just because external factors convince them it’s going to happen. What would the implications be for you if your attitude, as entering a treatment, were optimistic?

Where Does it HURT?
No small part of the problem in western medicine seems to be that many health professionals continually direct attention only to what’s wrong. It’s all too common for a doctor to ask, “What’s making you depressed?” before prescribing pills without learning about the days on which a patient feels optimistic and upbeat… “Where does it hurt?” is certainly a question that needs asking – but we also need to focus attention on where doesn’t hurt!

Given this AND what we know about a person’s Basic Needs – you can read about them here – might part of the problem now be that the quality of attention from health professionals is often so low? Take a patient with poor sleep, few friends and a recent bereavement, for example… They might need only to understand – from a friendly, sympathetic doctor – how the cycle of depression actually works in order to change their thoughts, take up Pilates, say, and avoid the very spiral they found themselves entering…

Understanding how the mind and body deal with suggestion and expectation could very well be the difference that makes the difference in the lives of millions… No matter from where that expectation comes! In the next issue of Bob’s Bones we’ll look at the Cycle of Depression which involves some of the most pernicious self-fulfilling prophecies of all.

Back in Shape cannot accept responsibility for the consequences of any action or inaction based on its Info Sheets. If you have any doubts or concerns over medical and health issues, our best advice is always to pop in to see us, visit your GP or call NHS Direct on 111 to discuss your health.