Collective fears

Did you catch House last night? It brilliantly illustrated the power of nocebo: if we believe we’ve been exposed to something bad, we can develop the most extraordinary symptoms and convince ourselves we’re sick.

In this episode, House and Cuddy are flying back from conference in Asia when a first-class passenger becomes ill with really ugly symptoms: a rash, barfing, delerium, fever... It looks like he’s dying. A planeload of passengers watch as another passenger gets the same thing. House gathers his “diagnostic team” and instructs one kid to agree with everything he says, a cranky guy to disagree with everything he says and a women to be morally outraged at anything he suggests. And off they go, in typical House style, trying to figure out what’s wrong, while the passengers are growing increasingly scared.

At first, it was suspected to be poisoning from the fish half of everyone had just eaten. Dozens of people scurry off to throw up. Then, Cuddy comes down with it and she hadn’t eaten the fish. She looks like death warmed over. Getting a handle on a common source for the illness is becoming hard with so many different people sick. Is it meningitis? He collects antibiotics from everyone, telling them if they don’t turn over their prescriptions people will be leaving in body bags. He does a spinal tap on the first patient, who really is close to death by now. It comes up clear, but House doesn’t let anyone know that.

House gets on the loud speaker and tells everyone that meningitis is on the plane and that they could get it, too. He says people need to let him know the moment they have any of the symptoms so that they can be treated. He proceeds to describe a list of severe symptoms, including those they’ve all watched hit the first passenger, but adds “shaking of the left hand.” Suddenly, most of the plane is having the symptoms he’s describing, including shaking of the left hand. Now, everyone is sick.

He admits he’s lied in order to show everyone how powerful their minds are and that by simply believing you could be sick you can make yourself sick. The illness is called conversion syndrome, also known as mass hysteria. He says: “It happens in high anxiety situations, mostly to women. I know it sounds sexist, but science says you’re weak and soft. What can I do?”

People are incredulous at first, but to prove it, he shows them that the spinal fluid is clear and that there is no meningitis. Their symptoms abate almost as fast as they appeared. Only the first patient is really sick. For those waiting for the second airing, I won’t spoil the ending and his final diagnosis...

In the news today was another real-life case of mass hysteria. Six hundred school girls at a boarding school in Mexico City were struck by muscle atrophy and nausea. Reporters filmed parents carrying their child to the car, some of the students were unable to stand or walk. Rumors included fears that food or water might be contaminated, which were disproven.

Hundreds of cases of this phenomenon have been reported in the medical literature and throughout history. As explored in a previous post, it occurs when fears and false beliefs about a contaminant, threat, exposure or illness are shared among a group of people causing symptoms to spread among them. Anyone can be taken in and even when we’re told and shown that there is no scientific or biological basis for what we’re experiencing, it’s still hard to believe our minds can be that powerful. The symptoms can be extraordinary and beyond what we might ever imagine the power of suggestion can do to us.

Most cases are not as dramatic as these cases of instant mass hysteria, but the effect is actually quite common and can explain symptoms that range from mild to debilitating. It explains how we can feel ill after eating something we believe bad for us — such as sugar or high fructose corn syrup, an “artificial” chemical or food additive, or a fast food sandwich or packaged food — after being exposed to something we believe dangerous — such as mercury in fillings, electrical power lines, styrofoam coffee cups, “immune system disruptors,” synthetic fabrics to cleaning products — after someone tells us we also have an illness — such as candida albicans, parasites, chronic fatigue syndrome, Lyme disease or pre-hypertension — or after an alternative practitioner has convinced us that our life energies are out of balance or weak.

As we’ve explored here and here, what’s at work is the nocebo effect. It’s the flip side of the placebo effect and works much the same way. We can become convinced that exposure to even a minuscule amount of a contaminant can harm our health, just as a minuscule amount of a healing substance can heal. Alternative practitioners, including clinical ecologists and energy modalities, largely rely on these very real effects. As House showed, when we understand that there is really nothing to fear, our symptoms will go away and we can keep ourselves from being taken in.

Medical professionals have understood for more than a century that many common symptoms can originate from our beliefs. For example, there’s an interesting account from Dr. John N. MacKenzie, M.D., written in 1886. A 32-year old woman believed she was sensitive to numerous environmental contaminants, including the fragrance of roses. She suffered from depression, lethargy, impaired mental ability, irritability, respiratory problems and a long list of things. The doctor got a very realistic-looking artificial rose and carefully cleaned it of any contaminants and at one of her visits when she was feeling well, he held the rose and within minutes of just the sight of the rose, she began itching, her eyes became red and tear, she became congested, hoarse and short of breath. When he revealed to her that the rose was fake, she was amazed but her symptoms went away and within days she was able to enjoy real roses and remain symptom-free.

But sadly, we’re more likely to be surrounded by people and news that reinforce our fears and they can escalate until we’re afraid of everything in our lives. In fact, our brains have the same response whether we’re experiencing a frightening threat first-hand or merely observing others. As a study by New York University researchers just published in the journal Social Cognitive and Affective Neuroscience, found our fears are just as strong when we see vivid images or hear horrible things on the news as if we’d actually experienced them.

Have you ever taken one of those tests to see if you might have a health problem from an environmental exposure, food or toxin that your doctor hasn’t identified? Simply reading the questions, suggests to us all sorts of horrors or possible bad things we might have been exposed to or symptoms we could be experiencing! Our mind begins to run wild with fear and we’re ready to embrace anything to make us feel better. News and the internet, and even college classrooms, are filled with worrisome reports of food, health and environmental dangers that can implant and add to our fears. Take this story that recently appeared in The Varsity, for example, which told college students:

The areas where you live, work, or dissect computers may be harming you. Gas masks aren't necessary, but you may want to pay attention if you feel under the weather when indoors....But have you ever thought to fear the desks and walls of your own office or home? Today, buildings themselves seem to be a serious health issue.

Dr. Lynn Marshall, of the Environmental Health Clinic at the Women's College Hospital, recently gave a presentation on environment-linked conditions that have become increasingly common during the last few decades-"invisible illnesses" whose symptoms often go unseen. She focused on four main chronic conditions: "sick building syndrome," chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity.

These four conditions, which mostly affect middle-aged women, are linked to poor ventilation and exposure to certain chemicals in the environment where people live and work. Common culprits include dustmites, moles that thrive in damp areas, pet dander, pollen, inorganic chemicals (nitrogen dioxide and sulfur dioxide gases), volatile organic compounds like paint thinner and persistent organic pollutants like dioxins.

According to Marshall, the four invisible conditions are closely linked and even have similar symptoms-so similar that sometimes a physician is unable to pinpoint the patient's problem. For instance, the symptoms of sick building syndrome include (but are not limited to) dizziness, headaches, nausea, dry coughs, insomnia, and difficulty concentrating, all of which can be symptoms of the three other conditions, or numerous others.

A few weeks ago, the news reported on a British health spa manager who believes she is sensitive or allergic to “modern life” and develops horrible symptoms when she’s exposed to “electromagnetic fields or ‘smog’ created by computers, microwave ovens, mobile phones and some cars. The walls on her home were installed with special carbon paints and the windows covered with protective film. She and her 45-year-old husband, Tony, sleep under a silver-plated mosquito net to deflect radiowaves.” It has debilitated her life as she says she can’t use phones, microwaves, get into a car or go anyplace where music might be playing and expose her to broadband, or use an old-fashioned television because it "emits gamma rays."

This may sound like an isolated case, but state disability rosters are filled with people unable to work because of chemical sensitivity, “sick building syndrome” and chronic fatigue for which medical experts have determined there is no causative agent. These poor people are really suffering and are very difficult for doctors to treat. But countless experts and well-conducted investigations (such as the scientific expert analyses conducted by the American Medical Association, the California Medical Board and the American Academy of Allergy, Asthma and Immunology already discussed here) have found no support for the explanations made by proponents for the vast array of symptoms experienced by most of these patients.

Environmental illnesses, just like the safety of our foods, have been studied for decades. A clinical review of 50 cases published in the Archives of Internal Medicine found only a few people actually had a disease, but that most symptoms were subjective without supporting physical findings. No food or chemical sensitivities or immune system abnormalities were found. The author concluded that clinical ecology theories are not supported as an explanation for these psychosomatic illnesses.

Donald W. Black, M.D., and colleagues at the University of Iowa College of Medicine in Iowa City, have been conducting research on people claiming to be suffering from multiple chemical sensitivity and other environmental illnesses. As they’ve followed these patients for years, they’ve found most have become strongly attached to their diagnoses and are following the special restrictive or organic diets and lifestyle modifications prescribed by clinical ecologists. These patients try to eliminate chemicals and contaminants from their environments and foods that they’ve come to believe are unhealthy. They are also pursuing a range of alternative modalities because they’ve become distrustful of traditional medicine. Among those they’ve studied, their symptoms have continued for a decade, as long as they continue to believe in their diagnoses and are under the care of clinical ecologists.

Of those suffering symptoms, Black’s research found that about 83% met criteria for various mental health disorders and they need the care of mental health professionals. Dr. Black concluded in an issue of Regulatory Toxicology and Pharmacology:

Research has shown that individuals receiving a diagnosis of environmental illness frequently have common psychiatric or medical disorders, which are usually unrecognized and untreated. Thus, the clinical ecologists are misinterpreting common signs and symptoms of illness and failing to prescribe appropriate and proven therapies. The advice and recommendations of a clinical ecologist can lead to iatrogenic social and occupational disability.

This is why many in the medical community believe it’s unethical to promote or use alternative modalities that lack a scientifically plausible rationale or to reinforce unsubstantiated fears. Instead, these sufferers need our help understanding that their diagnoses are labels, not actual diseases, and that stress and fears can often lead to symptoms. As doctors Ronald E. Gots, M.D., Ph.D., and Stephen Barrett, M.D., wrote in Chemical Sensitivity:

Clinical ecology patients run the risks of misdiagnosis, mistreatment, financial exploitation, and/or delay of proper medical and psychiatric care. In addition, insurance companies, employers, educational facilities, homeowners, and other taxpayers, and ultimately all citizens are being burdened by dubious claims for disability and damages.

If you know someone suffering from an environmental illness, you know how heartbreaking it is to watch and how hard it can be to help them. Doctors Gots and Barrett advise families and friends to realize the symptoms are the result of stress and not get taken in by them, too, or be led to financial ruin. They suggest helping loved ones get away from clinical ecologists and to a good medical doctor and mental health practitioner. They advise educators not to make accommodations for children whose parents believe them to have multiple chemical sensitivities because it reinforces false messages to children about their health. The potential for harm to children (and adults) convinced that chemicals or bad foods can make them behave a certain way or get sick, “undermines their self esteem by implanting notions that they are unhealthy and fragile,” isolates them from others, and prevents them from receiving appropriate medical care. They advise insurance companies to not subsidize unsound diagnostic and treatment methods. They advise legislators to stop funding research or practices with hypotheses that are not plausible, testable or likely to produce information that is medically helpful. They advise the media to stop glorifying these sufferers, repeating unsound conjectures and fears, or encouraging readers to see clinical ecologists. Doing so, they said, has “great potential for harm.” They concluded: “Public information should be based on established fact, not speculation.”

As House dramatized, our minds are powerful things. We can use them to become incapacitated and surrounded by negativity and fears about life or we can learn, grow and realize how good things really are.

© 2007 Sandy Szwarc