September 16, 2011

IT'S ALL IN YOUR HEAD:

The Dark Side of the Placebo Effect: When Intense Belief Kills (Alexis Madrigal, Sep 14 2011, The Atlantic)

They died in their sleep one by one, thousands of miles from home. Their median age was 33. All but one -- 116 of the 117 -- were healthy men. Immigrants from southeast Asia, you could count the time most had spent on American soil in just months. At the peak of the deaths in the early 1980s, the death rate from this mysterious problem among the Hmong ethnic group was equivalent to the top five natural causes of death for other American men in their age group.

Something was killing Hmong men in their sleep, and no one could figure out what it was. There was no obvious cause of death. None of them had been sick, physically. The men weren't clustered all that tightly, geographically speaking. They were united by dislocation from Laos and a shared culture, but little else. Even House would have been stumped.

Doctors gave the problem a name, the kind that reeks of defeat, a dragon label on the edge of the known medical world: Sudden Unexpected Nocturnal Death Syndrome. SUNDS. It didn't do much in terms of diagnosis or treatment, but it was easier to track the periodic conferences dedicated to understanding the problem.

Twenty-five years later, Shelley Adler's new book pieces together what happened, drawing on interviews with the Hmong population and analyzing the extant scientific literature. Sleep Paralysis: Night-mares, Nocebos, and the Mind Body Connection is a mind-bending exploration of how what you believe interacts with how your body works. [...]

Drawing on all this evidence, Adler makes the provocative claim that the Laotian immigrants of the 1980s were in some sense killed by their powerful cultural belief in night spirits. It was not a simple process.

"It is my contention that in the context of severe and ongoing stress related to cultural disruption and national resettlement (exacerbated by intense feelings of powerlessness about existence in the United States), and from the perspective of a belief system in which evil spirits have the power to kill men who do not fulfill their religious obligations," Adler writes, "the solitary Hmong man confronted by the numinous terror of the night-mare (and aware of its murderous intent) can die of SUNDS."

Her argument amounts to a stirring and chilling case for the power of the nocebo, the flipside to the placebo effect. While placebo studies have grown in importance, the nocebo effect has not been studied well in scientific literature, in part because of the ethical issues involved in deliberately doing something that might harm people. Limited studies suggest that it is real and it is powerful. For example, doctors have found that patients made to feel anxious need larger amounts of opiates after surgery than other people. They've found that pretending to expose people who say they are sensitive to electromagnetic radiation to cell phone signals can give them debilitating headaches. Even patients' level of side effects from arthritis medication seem determined by those patients' beliefs about those medicines. Logically speaking, if the evidence shows the upside of belief, why wouldn't we believe in the downside, too? And why wouldn't we believe that the intensity of the downside would vary with the intensity of the belief, even if those beliefs were about something unscientific, like spirits or astrology?




Posted by at September 16, 2011 7:15 AM
  

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