Deepak Chopra: “I Will Not Be Pleased” – Your Health and the Nocebo Effect

For decades the placebo effect has existed basically as a nuisance, so far as the medical profession is concerned.   Some people benefit from being given a sugar pill instead of an actual drug. This remarkable result cannot be marketed, however. It doesn’t fall within the ethics of medicine to prescribe fake drugs. Therefore, a doctor in practice, whose training has drummed into him that “real” medicine means drugs and surgery, will shrug off the placebo effect as psychosomatic, or “it’s all in your head.”

This attitude shuts down a fascinating possibility, that a patient’s expectations plays a major role in being well or getting sick.

The placebo effect is real medicine, because it triggers the body’s healing system. One could argue that this is the best medicine, in fact, since:  a) drugs do not trigger the healing system and b) the placebo effect has no side effects. Staying well means that the body is taking care of itself — and you — through a feedback loop of chemical messages. Circulating throughout the bloodstream, lymphatic system, and central nervous system, chemical messages are crucial to the healing system, because they keep every cell in communication with every other.

Like it or not, every thought, decision, and action influences this feedback loop. The “or not” is important. Unwittingly, we damage the body’s natural state of health with negative input.  The fact that this input comes from the brain means that thoughts, moods, and expectations, however intangible, get translated into chemical messages just as surely as molecules of aspirin or glucose.  You and I bear the responsibility of sending positive messages to our cells as opposed to negative ones.

This is prelude to an overview of the nocebo effect that recently appeared in the New York Times.  The placebo effect, which is based on a person’s positive expectation, has been widely studied. Its opposite, the nocebo effect, has not. But clearly a negative expectation can be powerful. Subjects who volunteer for drug trials sometimes drop out, for example, because the side effects of the new drug are too severe. This is true even when the side effects are being induced by a sugar pill and not a real drug. To quote from the Times article:

“We found that 11 percent of people in fibromyalgia drug trials who were taking fake medication dropped out of the studies because of side effects like dizziness or nausea.”

“…the discontinuation rates because of side effects in placebo groups in migraine or tension drug trials were as much as 5 percent.”

If these percentages seem rather low, consider the following remarkable finding: A study on lactose intolerance took a group of subjects who complained of intestinal problems caused by lactose, the sugar found in milk. Some of these people had been diagnosed with lactose intolerance; others only suspected that they had it. When asked to take lactose by the experimenters, “44 percent of people with known lactose intolerance and 26 percent of those without lactose intolerance complained of gastrointestinal symptoms” – and yet all had actually been given glucose, which doesn’t do harm to the intestines.

The two authors of the Times article, Paul Enck and Winfried Haeuser, are German professors of psychology and psychosomatic medicine respectively, and their overview covered 31 studies in the nocebo effect. The most telling case they refer to was a patient who took 26 placebo antidepressants in a suicide attempt and had his blood pressure fall “perilously” low, as would happen overdosing on real antidepressants. What makes this case so telling is that it demonstrates that the body can turn any mental intention into its chemical correlation.

The key to the placebo effect is that the patient expects a good outcome, while in the nocebo effect the expectation is of a bad outcome: I will be pleased versus I will not be pleased. Set aside the medical implications. We make judgments about all of our experiences every day, expecting them to turn out well or badly. Does this point to a holistic placebo versus nocebo effect?  We’ll explore that possibility in the next post.

To be continued…

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photo by: heipei


  1. I love reading your work Deepak and you’ve been an inspirational teacher to me. Having said that, this is yet another example of something I hadn’t thought of. Further proof of how powerful our thoughts are in manfesting our physical reality.

    This also reminds me of a larger problem we face as a society and that’s our addiction to attachment and outcome/expectation. We end every day feeling lost and asking ourselves what our purpose (intention) is yet our daily actions speak not to our intention/meaning in life but to our attachments and expectations.

    Perhaps if stopped our pursuit for meaning that does not exist in attachment or outcome we’ll begin to find it. Afterall, our intention/meaning in life is only realized when the opposite of our daily actions exist. That is, “allowing” ourselves to surrender to uncertainty and letting our intention guide us. Releasing our attachment to the outcome and letting purpose drive us will utlimately give us what we want. It’s unfortunate more of us don’t know that.

    Thank you.

  2. As an acupuncturist interested in scientific research, I’ve been reading a lot about the placebo effect lately. It’s disappointing that many studies on acupuncture find that the traditional points produce no better effect than credible placebo acupuncture on non-traditional points (even if the placebo does not involve inserting needles). I’m wrestling with this in terms of ethics, informed consent, and patient autonomy.

    It seems like a contradiction when you say that the placebo effect has no negative side effects then mention the nocebo effect, which is just that. From what I’ve read, the placebo effect mostly works on subjective symptoms such as pain and nausea. It doesn’t actually heal diseases (Ted Kaptchuck showed this in a study on asthma where the placebos led to reports of improvement, but not real improvement on lung capacity).

    Many patients of alternative/natural medicine have developed such a fear/hatred of mainstream medicine that they give themselves nocebo effects when they take prescription medications. I’ve seen naturopaths and acupuncturists who reinforce the belief that prescription drugs are “toxic” and give horrible side effects. If side effect warnings were required for alternative medicines, more people would experience them.

    This is somewhat of a paradox, but mainly shows the need to design good studies which take placebo and nocebo effects into account so we can discover what truly works.