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The Psychology of Nothing: Phantom Symptoms

Nocebo effects pose a particular conundrum for doctors who, while they have an obligation to be honest with their patients about the possible effects of a drug, also want to avoid unnecessarily increasing the risk of symptoms

Lovable anti-hero George Costanza is having a salad for lunch when he suddenly clutches at his chest and declares, “I think I’m having a heart attack!” His companions, Jerry and Elaine, seem remarkably unconcerned with George’s seemingly life-threatening predicament. As George breathlessly lists off the symptoms he’s experiencing (Tightness… Shortness of breath… Radiating waves of pain!), Jerry arrives at a less catastrophic diagnosis: “I know what this is. You saw that show on PBS last night, Coronary Country.” Turning to Elaine he explains, “I saw it in the TV Guide. I called him and told him to make sure and not watch it.”

George isn’t faking a heart attack – he’s merely imagining the symptoms after hearing about them on TV. Apparently this isn’t the first time he’s done this. As Jerry tells it, “he saw that show on anorexia last year – ate like an animal for two weeks. […] I could have predicted this to the minute.” He may have been on to something. New research, published this year in the Journal of Psychosomatic Research reveals that this is not a Costanza-specific neurosis.

Photo: Tau Zero

Photo: Tau Zero

Michael Witthöft and G. James Rubin conducted an experiment in which they exposed 147 participants to 15 minutes of a fake Wi-Fi signal and then measured how many symptoms (such as headaches or tingling sensations) they reported experiencing. Before the fake Wi-Fi, though, half of the participants were randomly selected to watch a short documentary about the potential health effects of exposure to Wi-Fi signals that had been previously aired on the BBC; the other half watched a similar documentary about internet security. Despite the fact that there is no solid evidence supporting any of the symptoms, 54% of people who had watched the film about health risks reported experiencing symptoms (a significantly higher proportion than among those who watched the other film). In short, watching the film made people imagine the symptoms. What’s more, George may have made a particularly easy target – according to the research, people who were generally high in anxiety were much more vulnerable to experiencing symptoms following the movie.

Another factor working against George was that heart attack symptoms – tightness, shortness of breath, and pain – are all easy to imagine. Research conducted in the 1980s by Steven Sherman found that people who were asked to imagine the symptoms of a disease thought they were more likely to contract it, but only when those symptoms were easy to imagine, like fatigue or aching muscles. When the symptoms were more abstract, like an inflamed liver or a malfunctioning nervous system, people thought they were less likely to contract it. Broadly speaking, we have a tendency to think that things are more likely to be true the easier it is for us to imagine them (Kahneman and Tversky call this the availability heuristic [PDF]). When we see symptoms vividly illustrated on TV, it just makes it that much easier for us to imagine having them.

Photo: Darren Cullen

Photo: Darren Cullen

Imagined symptoms – also known as psychosomatic symptoms – are not only experienced after watching television shows. They are also common after hearing about the side effects of medicines, a phenomenon known as a nocebo effect (the opposite of the better-known placebo effect). Nocebo effects pose a particular conundrum for doctors who, while they have an obligation to be honest with their patients about the possible effects of a drug, also want to avoid unnecessarily increasing the risk of symptoms. The question for them is: do you tell a patient about a rare side effect of their medication when you know that telling them makes it more likely that they’ll experience it – or do you keep it a secret? The answer is not an easy one. The New Yorker’s Gareth Cooksuggests that doctors could get patients’ permission not to tell them about minor side effects.

Still, this solution doesn’t help the George Costanzas of the world who are intent on watching medical documentaries. The media should certainly be responsible in their reporting and avoid sensationalizing or exaggerating possible concerns – local news reports explaining the countless way you could be killed by ordinary household objects probably don’t help – but even if they stick strictly to the truth, our imaginations are likely to run wild.

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