ALERTS AS VOODOO-LIKE NOCEBOS:
The Impact On
By Nicholas Regush
We are still in the
Dark Ages when it comes to understanding the interaction between mind and
body. But we are slowly unraveling some of the mystery. Scientific studies
over the years have provided us with tantalizing clues about the dynamic
nature and complexity of this close relationship. These revelations suggest
that we potentially have enormous positive mental and emotional powers at our
command to enhance our wellbeing. That same core of scientific data suggests
that, on the other hand, we can turn these powers into negative forces
against our very own bodies.
In the flow of daily
life, those mental and emotional powers, both positive and negative, are
mediated by the words, actions and emotions of others: family, friends,
media, politicians, and a wide range of individuals involved in numerous
spheres of cultural, social, economic and political influence.
In times of crisis,
when routines are shattered, dreams erode or collapse, and it becomes more
difficult to set goals, some people will rise to the challenge but many
others will not be capable of doing so. In the wake of the savage terrorist
attacks of September 11, the anthrax scares and the continuing threats of
mayhem, there are signs that more and more people are losing a sense of
control over their lives. In New York City alone, more than one million
people will require some form of mental health counseling, according to an
estimate of the New York State Office of Mental Health.
Many individuals feel
stressed and depressed, cannot sleep, and live with feelings of doom.
In recent weeks, there
have been many concerns raised in the public health field about how a loss of
commitment to a job or goal and feelings of alienation in stressful times can
prove to be so overwhelming that people will become physically ill.
Studies, for example,
show that chronic stress is associated with high circulating levels of
cortisol, one of numerous chemical messengers released by the adrenals.
Cortisol can change both the numbers of immune cells and their function,
leaving an individual more vulnerable to disease. One study showed that wound
healing took 24 per cent longer in highly stressed people who cared for
Alzheimers patients than in people who were not stressed. This suggests that
stress-related changes in immunity may contribute to a health effect.
Lately, there also have
been questions raised about whether the public should be alerted to vague
terrorist threats. It has been suggested that non-specific high alerts made
public by the government only produce greater anxiety and make many
individuals feel even more helpless.
have stated that they believe Americans can "accommodate" the high
alert information. The implication is that most people have sufficient means
to cope effectively with high stress-producing events.
Or are terrorism high
alerts a potentially damaging form of hexing that can have widespread impact
And, if so, are there
ways to protect ourselves against steady waves or sudden bursts of disturbing
and threatening information?
In 1942, an article,
entitled "Voodoo Death" appeared in the American Anthropologist.
In a world now held hostage by terrorism, this scientific classic may help us
to understand how terror can harm, and even kill, a human being. Written by
Walter B. Cannon, a pioneering American physiologist, the article proposed
how a lethal response to fear might be biologically feasible.
Cannon had heard many
stories told by anthropologists about how people in primitive cultures could
be killed after being subjected to a sorcerers spell or hex. This was
sometimes done by "bone pointing." Cannon wrote very vividly about
what occurred after someone discovered he had been hexed by having a finger
or bone pointed at him.
"He stands aghast,
with his eyes staring at the treacherous pointer, with 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."
After eliminating the
possibility that such a victim could have been poisoned or had suffered
physically in some way, Cannon attempted to explain the physiological
processes that led to death, the major psychological requisite being a strong
belief in sorcery and its magical powers.
Because of the fear and
danger that boning triggered, Cannon proposed that the victims body went
through a number of physiological reactions (rise of heart rate, increase in
muscle tension, rise of blood sugar levels, the release of adrenaline and
other hormones) that prepared it to confront an emergency.
When there actually was
no emergency to confront and the threat was prolonged, a state of shock could
result, thereby reducing blood pressure. This could, for example, lead to
Cannon also ventured
that a lack of food and water would make things even worse. Death could come
Some two decades
earlier, Cannon had already shown in experiments that animals suffered
digestive problems when they were restrained and could neither fight nor flee
in the face of danger.
Though one should not
bank on Cannons early efforts as a satisfactory explanation or template of
how terror can be manipulated to cause harm, he did provide insight into a
complex dynamic process, involving culture, psychology and biology. And
scientific interest in phenomena similar to voodoo death is on the rise.
Doctors sometimes tell
their patients that they may only have a few months to live. Is this a modern
form of a sorcerers hex?
The patient (victim)
may feel a lack of control in the presence of a doctor and believe that he is
doomed. Can a biological change occur in the patient following feelings of
This is not farfetched.
Medical conferences are held to explore this type of issue. Although
scientific data are piecemeal, they suggest that expectations of sickness
promote sickness. In one study, women who expected a heart attack were almost
four times more likely to die from a heart condition than women who did not
expect one. In another study, patients who had a shortage of blood flow to
the heart and who suffered from depression had 1.6 times as many so-called
"ischemic" episodes and were 1.5 times as likely to die as a result
of an episode than those heart patients who were not depressed. Other studies
show that blood pressure rises in the doctors office. This has been referred
to as "white-coat hypertension." And other research reveals how a
pessimistic attitude is a risk factor for illness.
One strong implication
from this body of research is that stress, fear, and pessimism may exacerbate
existing medical problems, particularly in those people who already have weak
or damaged immune systems.
As in primitive
cultures, modern ones also are driven by beliefs, attitudes and expectations.
Some medical researchers believe that negative expectations may contribute to
a lot of pathology.
Such a negative belief
system is sometimes termed a "nocebo," which comes from the latin,
nocere (I will harm). Some like to refer to the nocebo as the placebos evil
twin. Placebo (I will please) is a term often used to characterize some
positive attitude in the form of words, or a sugar pill, that can lead to a
positive response in a patient.
Herbert Benson of
Harvard Medical School says both the placebo and nocebo appear to work via
the "mind-body connection." For example, in the case of a nocebo,
it may mean the chemicals that fear produces stimulate the brain, and, in
turn, this action could affect the heart, leading to ventricular fibrillation
or uncontrolled fluttering, and possibly death. There is strong evidence that
the brain can activate the release of stress hormones. The hypothalamus sends
electrical and chemical signals to the pituitary gland. Then the pituitary
sends the hormone ACTH to the adrenals where, as previously mentioned, the chemical
messengers are released, including cortisol.
While the exact
mechanism of how this would work still remains unclear long after Walter B.
Cannon took a crack at explaining the phenomenon of voodoo death, the field
of "psychoneuroimmunology," as it is often called, is definitely on
the upswing. According to Robert Ader, professor of psychosocial medicine at
the University of Rochester who coined the term in 1975, there are likely
many medical phenomena for which the exact mechanisms remain undefined. Ader
is convinced that there are enough data to show that psychosocial factors can
influence a persons vulnerability to disease.
More research is
obviously needed in this cutting edge field of inquiry to determine how
factors such as stress and fear change immunity, but the strong clues
stemming from this growing body of work suggest that negative beliefs and
expectations built on pessimism and terror could affect the health of some
individuals and perhaps many in times of crisis.
who issue vague terrorism high alerts at a time when the United States is
already on an "indefinite" high state of alert, may well be playing
with fire. The threat is announced, fear and anxiety spread in a population
that is already highly vulnerable to bad news and then the threat of major
catastrophe doesnt occur within the announced time frame. And the cycle is
repeated. One would have to assume that many people treat these high alerts
seriously and become stressed and fearful as they follow news events very
This process, while by
no means identical to Cannons characterization of the steps required for a
voodoo death, has some striking similarities, particularly in the terrorized
state of mind that is achieved by the "hex." What we dont really
understand yet in sufficiently detailed scientific terms is how this
psychological process turns on biology, even to the point of affecting
longevity. But because we dont understand the process, this is no reason to
assume that some elements of what Cannon described in his voodoo death
article do not apply to modern times.
Is there a method to
fight off a hex that could damage health? Certainly not a scientifically
proven one. But again, there are some clues that emerge from the scientific
literature. First, ones beliefs appear to be important in the mix. Strong
belief in the governments hands-on knowledge of emerging threats, however
vaguely publicized, may set the stage for a high degree of fear in some
people. A more critical, yet still attentive attitude, might lessen the
build-up of terror and its potential medical consequences.
Psychologists have long
argued that ways of coping with stress effectively include maintaining a
commitment to ones goals and life principles. This may be more difficult to
achieve in times of crisis, but a strong effort to do so may prove invaluable
in fighting off a general atmosphere of fear and helplessness. In short, it
adds up to facing the challenge, becoming more engaged in life, rather than
watching cable news all day long, and feeling more in control.
A helpful mantra here
may be: The present is the point of power.
Benson, H, "The
Nocebo Effect: History and Physiology," Preventive Medicine, Vol.
Cannon, Walter B.,
"Voodoo Death," American Anthropologist, Vol. 33, 1942.
Pathogenesis of Coronary Artery Disease. McGraw-Hill, New York, 1969
Glaser, R. et. al.,
"Stress-Related Immune Suppression: Health Implications," Brain,
Behavior and Immunity, Vol. 1, 1987
"Personality and Resistance to Illness," American Journal of
Community Psychology, Vol. 7, 1979
Meador, C.K. "Hex
Death: Voodoo Magic or Persuasion?" Southern Medical Journal, Vol. 85,
Snyder, B.K. et. al.,
"Stress and Psychological Factors: Effects on Primary Cellular Immune
Response," Journal of Behavioral Medicine," Vol. 16, 1993
"Nocebos Contribute to a Host of Ills," Journal of the American
Medical Association, Vol. 275, 1996
Wole, E.L., et. al., Walter B. Cannon: Science and Society, Harvard
University Press, 2000
All rights reserved
Site Philosophy |
Columnists | Special Features | Health | Science | Environment |
| Media | Arts | RFW Store | Free Newsletter | Links | Home | E-mail |