Research: SPIEGEL, College of Physi

Listed in Issue 32


SPIEGEL, College of Physicians & Surgeons, Columbia University, New York, New York 10128 USA writes that a useful way to capture the placebo-nocebo theme is to examine the tension and interaction between conviction and responsibility.




Within the mainstream biomedical paradigm today, it is tempting to reply to Dr Engels patient (who characterised his cancer pain in terms of male and female, with female cancers being less painful ): That is utter nonsense. Cancer pain is not classified as male or female pain varies with the location within the body and other factors. Although this response is technically honest, it would in reality have the impact of a nocebo, by impairing the patients hope and morale. The doctors honesty and conviction would serve as blinders to the patients suffering, which would result in a diminished sense of responsibility for the patients well-being. By also considering the biopsychosocial context, Dr Engel achieved a balance between conviction and responsibility. The patients question was understood within the meaning and metaphorical terms of her belief system and his answer was delivered in a way which respected her private view toward pain and utilised her suggestibility, guiding her toward a probable placebo effect. Female cancer resonated with her personal beliefs and wish for less pain. Dr Engel was true both to his conviction and and was responsible for providing the highest standard of care by understanding the patients convictions and needs for comfort. This biopsychosocial concept provides a blueprint to impart the old-fashioned art of humanness to modern scientific care. By identifying the interactions of the problem, the individual within the totality of resources enables a focus upon therapeutic strategies which are capable of promoting placebo effects and preventing the consequences of nocebo.



Spiegel H. Nocebo: the power of suggestibility. Prev Med 26 (5 Pt 1): 616-21. Sep-Oct 1997.

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