By Claire Deng
When I see the spots of blood, I think, here we go again, get ready for throbbing pain.
And of course, it comes, expanding like a balloon inside me, the swollen monster I’ve been expecting. But then I pop an Advil. A few minutes after the pill passes through my lips, I can feel the pain losing its jagged edge. I buy a hot drink, lie down, and distract myself with YouTube, and the pain recedes. Fifteen minutes later, I’m perfectly comfortable.
For me, every period is a cycle of expectations: the foreboding of pain, the promise of relief. I expect to feel hurt and then expect to feel better. Would the pain be better if I didn’t dread its arrival? What are the actual health benefits of the hot drink, lying down, or even the Advil? How much of the effect comes from our expectations versus the reality?
This is the power of the placebo effect. The word placebo, meaning “I shall please” in Latin, is in itself an incantation. On the flip side, the term “nocebo,” coined by Walter Kennedy in 1961, fittingly means “I shall harm.” A nocebo gives rise to negative expectations that enhance a negative effect, like believing a flu shot will be painful or that a medication will have severe side effects. If the placebo is the painkiller, the nocebo is the period pain; if the placebo is the charm, then nocebo is the curse.
The spell of the placebo effect goes back centuries. According to the Journal of the Royal Society for Medicine, “placebos” in the 14th century referred to hired professional mourners that stood in for family members at funerals. As a result, the placebo quickly acquired a connotation of falsity and deception—to the extent that a man called Placebo appears in The Canterbury Tales as an evil sycophant, flattering the vanity of his friend. The term placebo only became associated with medicine in the 18th century, when it first appeared in the New Medical Dictionary in 1785 as “a commonplace method or medicine,” or any treatment that had no objective benefits by itself, but somehow made the patient feel better. Since doctors often lied to patients about placebos being real medicine in order to produce the placebo effect, placebos were viewed as sham treatments. Nevertheless, the sham treatments had real effects on people, and by the early 20th century, doctors began accepting the benefits of placebos, though they remained unsure of exactly how they worked.
As attitudes towards the placebo effect evolved in medicine, the placebo effect also found a place in popular culture, becoming a catch-all phrase to describe a more-everyday type of magic. Placebos and nocebos are the agents of the small self-fulfilling prophecies we seem to encounter every day; any time we expect something, we jinx ourselves unknowingly with the placebo effect. We expect to feel more energetic after a drinking cup of coffee, tipsier after taking a shot, or (for me specifically) more calm after savoring a mug of hot chocolate. Extreme nerves before an exam, an interview, or audition can cause us to perform worse than we usually do, and the universal dread of organic chemistry also makes the class feel worse than it should, though I know that’s a controversial argument.
Of course, all of these examples have real, objective effects regardless of our expectations, but our expectations enhance the effects. So why would we want to fool ourselves into thinking that things are better or worse than they really are? Why do we want to experience exaggerated emotional reactions to minor experiences, especially if those emotions are negative? If placebos and nocebos are really shams, why should we keep believing in them?
The answer seems to lie outside the bounds of these logical questions, in the realm of emotions. We need placebos and nocebos because they help us deal with our feelings. It’s our instinct to characterize things as good or bad, to reduce uncertainty, to prepare and exert as much control over our future as possible. And if the placebo/nocebo effect is our coping mechanism, that’s okay. Placebos can also help us feel more in the moment. Some placebos, like being on a sugar high or feeling a heightened caffeine kick, are fun, in the way that fantasizing is fun. Other placebos or nocebos connect us with other people, helping us relate to each other through a common social vibe, whether it’s feeling the buzz at a party or stressing out over a big assignment. Nocebos specifically represent mutual pain and negativity—which seems like a bad thing at first, but can actually help people sympathize with and support each other. Placebos and nocebos represent the shared beliefs and opinions we hold within our communities, and clueing into them can help us adjust to different social situations.
Ultimately, the sham of the placebo effect is the sham of being human. Sure, we may be deluding ourselves a little bit, but those delusions are necessary for us to function in society and enjoy living just a little bit more.
In the end, what matters isn’t actually what’s real, but what’s real for us as individuals. Placebos and nocebos matter because our feelings matter. Our emotional reactions may not always reflect objective reality, but they do reflect our own reality—how each of us sees the world. The magic of placebos and nocebos isn’t that they create effects out of nothing, it’s that they allow our thoughts to play a part in our reality. Our thoughts and feelings are real, despite the lines we draw, and the existence of placebos and nocebos reveal that they are often more real than we can rationalize.
So next month, you better believe that I’ll be dreading my cramps, popping my Advils, and sipping my hot drinks—going through the same-old cycle of nocebo and placebo without a second thought. Will I understand in the moment why I’m doing it? No, but that may be precisely the point.