I don’t identify with the term ‘pessimism’. I see myself as ‘rationally realistic’. My husband, an ‘eternal optimist’, would probably disagree.
I’ve written before about the version of pessimism that I carry through life (which can be summarized as ‘hope for the best / plan for the worst’). The prior post I wrote included a link to an Alec Benjamin video for his song “I’m not a cynic” in which he addresses the age-old cliche of whether a glass is half empty or half full. He sings that it’s not cynicism to acknowledge that sometimes, your glass just has no water in it.
I agree.
BUT
I also recognize the incredible power of positivity and know that sayings such as “the difference between success and failure is attitude” often ring absolutely true… even when you’re sick and tired of being sick and tired.
It’s why ‘The Placebo Effect‘ works. Ever popped a tablet in your mouth and sighed with relief? It hasn’t even made it out of your mouth and already you feel better. That’s not the medicine working, it’s the belief you have that the medicine WILL work.
The opposite of a placebo is an ‘anti-placebo’ / ‘inverse-placebo’ – or The Nocebo Effect.
Instead of believing that treatment options will work, you suspect they won’t… or worse still, you believe they will make you sicker… and your negative anticipation can actually make you feel sicker.
Wikipedia notes that the THOUGHTS you have suggesting you will be harmed (medically or otherwise) are enough to trigger actual FEELINGS of being unwell, such as; nausea, itching, depression, sleep problems, loss of appetite…
The term was apparently coined by Walter Kennedy in 1961 from the Latin nocēbō which means “I shall harm” (as opposed to the Latin placēbō; “I shall please”).
Examples of the nocebo effect that float around online don’t just relate to medicine. They include hearing someone say, “it’s cold outside” and feeling cold regardless of the actual temperature, or telling yourself, “I can’t sleep if I drink coffee after 3pm” and then staying awake after drinking decaf.
Examples I could give from personal experience, include the queasy feelings I get in anticipation of getting on a boat, and the pain that I feel from my migraine-preventative Botox injections; there’s 31 of them, and they are not comfortable, but I suspect that my fear of needles makes them even more unpleasant. That said, I believe the Botox is helping me, so it’s not really the nocebo effect at play. In regards to the boat, on the other hand, I do feel like life lived off solid ground is detrimental and I might be harmed, so it’s a no-sea-bo for me!
One of the research problems with studying the nocebo effect is how to conduct tests ethically. Imagine going to a uni professor and saying, “I want to conduct a test where I tell someone ‘this is going to hurt’, and then I want to jab them and measure how much it really hurts”… hmmm… hard to see how that is going to pass muster.
Nonetheless, there is plenty of anecdotal evidence of the nocebo effect. You could say vaccine-hesitancy falls into this category, and then there’s my daughter who is even more terrified of needles than me. She pinpoints it to the high school vaccination program which was conducted in front of peers and involved girls fainting and screaming. She is a super-rational person and knows that preventing cervical cancer for life is well worth the discomfort of a single injection, but the process turned the girls into a production line that accidentally set of a mass-hysteria event.
I did a quick search on my favorite medical research paper site: NIH and came across an article called “Ten words to adopt for 1986” by Peter P Morgan, and in that paper, ‘nocebo’ was word number one.
[As an aside, the article had a couple of fabulous metaphorical passages that thrilled me: “The English language is an expanding economy constantly in need of new currency. Throughout its history it has prospered by stealing words from other languages” and then later, “New words broaden our minds and sharpen our wits. […] if we keep loading the language with new goods, it will continue to be a caravan of inexhaustible riches” (p1193). How wonderful!]
A more recent article from 2025 (here) concluded that the nocebo effect is even stronger than the placebo, which they claim is consistent with the evolutionary advantages of a ‘better-safe-than-sorry’ strategy. They end by highlighting the need to mitigate its effect in clinical practice, but I was unable to access the paper to tell you what some of those mitigation strategies might be.
So off I went to look up: how can we reduce the nocebo effect?
A Science Insights site (here) opens with the striking results of a particular study; “90% of the symptoms people reported while taking statins also appeared when they were unknowingly taking a sugar pill.” – ok, wow – it takes a lot of negative expectations to motivate that level of adverse reaction!
One of the most powerful ways to reduce the nocebo effect, they say, is FRAMING: that is, how information is delivered.
They noted that telling someone “70% of patients will not experience headache” as a result of taking this drug, produces fewer side effects than telling the patient “30% will experience headache” as a side-effect. Both statements are IDENTICAL mathematically, but one mentions no-pain rather than the pain.
Energy flows where attention goes.
The article notes however, that sometimes the power of persuasion is not permanent. One study found that positivity worked for 15 minutes, but had effectively worn off 24 hours later. It also noted the power of social settings (if enough people tell you that an experience was “so bad”, it’s not hard to image that you’re going to anticipate “bad” before you get where you’re going). The article refers to this negativity as a “cross-contamination” and that sounds about right to me [and exactly what I was referring to about my daughter’s experience].
Their main advice: seek out balanced information, focus on the success stories, don’t ignore advice about risks but handle it in with an open-mind and keep those positive outcomes in mind, use visualization techniques if you need to.
I’ve written before about how the phrase “don’t hit the pole!” often ends up with people crashing their car into the pole, because it accidentally places the pole front and center of your mind.
“This won’t hurt” is putting the word “hurt” up front.
Which is probably why I have had injections where the nurse has said, “you’ll feel a little tickle” right before the needle goes in – no hurt – just tickle – it’s gentler, funner… if that can be said about injections!
Anyway – lots to think about.
My main takeaways: positivity is powerful & words matter.
Take care taking care,
Linda x
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PS – If you’re new to a migraine diagnosis, I wrote a post in 2024 about the words and phrases that we are supposed to use, and those we’re meant to avoid… you might not agree with all of the distinctions (I know I don’t), but it’s worth a quick read regardless: Migraine terminology (words matter… mostly)
PPS – Disclaimer – please remember that this is not a medical site – you should always talk to your own healthcare provider for information that is relevant to your individual situation.
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