What You Believe Can Kill You
If you believe a pill can help your condition, that pill may help even if it’s a simple sugar pill and not medicine. Such a pill is known as a placebo, and much scientific literature on its effect exists. What’s less studied and largely unknown is its dark flipside, known as the “nocebo.”
Basically, just as our belief that a pill can make us better affects our physical reaction to it, so too does our belief that a pill will result in unpleasant side-effects result in a higher incidence of these additional ailments. In a recent piece for The Atlantic, Alexis Madrigal discusses the terrifying power of belief and its effect on the health and wellness of believers as brilliantly described by Shelley Adler in her new book Sleep Paralysis: Night-mares, Nocebos, and the Mind Body Connection.
One case in support of the nocebo effect in Adler’s book relates to premature death among Chinese Americans: those with strong belief in traditional Chinese culture – if, for example, born in a year linked to poor lung health -- died from lung disease an average of five years before those born some other year who suffered from the same disease. What’s more, people from other cultures born on the same year and suffering from the same disease did not suffer the same fate. The study identified a correlation between how strongly Chinese Americans believed in Chinese astrology and how soon they succumbed to their condition.
Photo by dollen.
More interesting than this example is that of the 117 men who died in their sleep in the late 1970s and early 80s. Only one of these men – a group with a median age of 33 – was ill before death. They were not living in the same area. The only characteristics that they had in common was that they were men, recently arrived Hmong immigrants from Laos, and that they died in their sleep. Unable to figure out what was happening to them, doctors termed the cause of death “Sudden Unexpected Nocturnal Death Syndrome” (SUNDS).
Unifying her interviews within the Hmong and the available scientific literature on the nocebo effect, Shelley Adler, professor in the Department of Family and Community Medicine at the University of California, San Francisco, makes a case for the power of belief. The Hmong, she posits, were killed by their belief in conjunction with sleep paralysis. Sleep paralysis is known to the Hmong as “tsog tsuam” and Adler, who had studied these “nocturnal pressing spirit attacks” within traditional cultural narratives as a graduate student at UCLA, had a hunch that this belief held a key to their untimely death.
The anatomy of sleep paralysis is simple: during the rapid eye movement (REM) phase of sleep, the mind disengages our control over our bodies. To sleep and to dream, we must experience a degree of paralysis. The problem arises when we become conscious during REM. During sleep paralysis, we wake up and we experience our environment, but we are unable to move. The not quite so understood part is one common across many cultures: the feeling of dread, doom and evil that accompanies the paralysis, often along with the perception of a creature or being in the room.
This being is what the Hmong call the tsog tsuam. Culturally, the Hmong must adhere to tradition when worshipping to ensure their ancestors protect them. If rituals are not performed as indicated, if sacrifices are not sufficient, the ancestors will forsake them, enabling evil spirits to harm and even kill them.
Honoring the ancestors is easy enough in a quiet village, but the homes of the Hmong were anything but quiet in the 1970s and 80s. During the Vietnam War, the Hmong rose up against the Laotian government and when the government quashed the revolt, many of them headed to the United States, which had been an ally in their struggle against communism. In the U.S., the Hmong were resettled randomly by the American government across 53 different cities – in short, they were not only in a completely different environment, but they were scattered as well, making it difficult, if not impossible, for them to adhere to the rituals they employed to honor their ancestors or find shamans to help them set things right. As a result, when the tsog tsuam visited, the Hmong victims believed nothing would save them.
According to Adler, it was this powerful belief that killed them:
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, the solitary Hmong man confronted by the numinous terror of the night-mare (and aware of its murderous intent) can die of SUNDS.
Biology, Adler stresses, is local. Things that happen in one place do not necessarily have the same effect as they do when they happen to other people in another place. This difference has everything to do with what the affected people believe. Reflecting on the concept of the nocebo, Alexis Madrigal asks, “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?”
“Be careful what you wish for,” goes the saying. I think we need to be more careful about what we believe.