October 25, 2012

JUST BECAUSE IT'S ALL IN YOUR HEAD DOESN'T MAKE IT ANY LESS REAL:

Deadly Dancing: Could a Nocebo Effect Explain Medieval Europe's Dancing Plagues? [Excerpt] : Science journalist Chris Berdik describes the sometimes dangerous power of expectations (Chris Berdik, 10/19/12, Scientific American)

Mass psychogenic illnesses [MPI] are fueled by stress and flow from expectations. According to John Waller, author of A Time to Dance, a Time to Die (2008), there were at least ten dancing outbreaks in towns along the Rhine and Mosel rivers, and most of them followed periods of tremendous hardship, such as the waves of crop-killing weather and famine that preceded the 1518 epidemic in Strasbourg.

A hungry and fearful populace was primed for a freak-out, but the loss of control that followed was scripted by cultural expectations. The region's pious citizens knew well the story of Saint Vitus, and some of the first of these dancing plagues began on or near June 15, Saint Vitus' Day.

Today's versions of MPI follow more modern expectations --including fears of environmental toxins and terrorist attacks. In November 1998, for example, a teacher in a Tennessee high school came down with a headache, nausea, and shortness of breath after complaining of a "gasoline-like" smell. Soon her students began to feel sick, too. Eventually more than a hundred staff and students were taken to the emergency room. The school was evacuated and closed for two days while extensive tests were done to locate the source of toxicity. Nothing was ever found. Sometime later, questionnaires revealed that people who reported symptoms were more likely to have known or seen somebody else get sick.

Certainly, MPI should be a designation of last resort. In addition to the risk of neglecting a dangerous toxin or infection, there's the unfortunate implication that those with symptoms are either lemmings or liars. In 2011, more than a dozen teenagers, mostly girls, in Le Roy, a town outside Rochester, New York, were hit with a mysterious outbreak of uncontrollable facial tics and muscle spasms. Investigations by public health authorities found no evidence of environmental or infectious causes, leading many to suspect MPI. That suspicion didn't sit well with many of the girls and their families. They took it as a suggestion that they were faking, that there was no pill they could take to get better, and there was no one to blame but themselves. It's the same stigma that's followed placebos for centuries, of course, only applied to the nocebo in this case. If the mind causes it, then it can't be real.

As we've seen, however, the brain has many ways to make good on our expectations, both good and bad. In response to a clinician's promise, the brain releases painkillers as strong as morphine. Anxiety short-circuits anticipation and the athlete's worst fears come true. The embodied expectations of looking powerful can send our hormones racing. As Ader's saccharin-slurping rats demonstrated, the immune system can be ratcheted up and down without a word being said.

We saw in Chapters 6 and 8 how readily we take cues for our own behavior from watching others. Why couldn't placebo and nocebo effects spread socially, too?

Posted by at October 25, 2012 5:15 AM
  

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