TERRORISM HIGH ALERTS AS VOODOO-LIKE NOCEBOS:
The Impact On Health

By Nicholas Regush

INTRODUCTION

We are still in the Dark Ages when it comes to understanding the interaction between mind and body. But we are slowly unraveling some of the mystery. Scientific studies over the years have provided us with tantalizing clues about the dynamic nature and complexity of this close relationship. These revelations suggest that we potentially have enormous positive mental and emotional powers at our command to enhance our wellbeing. That same core of scientific data suggests that, on the other hand, we can turn these powers into negative forces against our very own bodies.

In the flow of daily life, those mental and emotional powers, both positive and negative, are mediated by the words, actions and emotions of others: family, friends, media, politicians, and a wide range of individuals involved in numerous spheres of cultural, social, economic and political influence.

In times of crisis, when routines are shattered, dreams erode or collapse, and it becomes more difficult to set goals, some people will rise to the challenge but many others will not be capable of doing so. In the wake of the savage terrorist attacks of September 11, the anthrax scares and the continuing threats of mayhem, there are signs that more and more people are losing a sense of control over their lives. In New York City alone, more than one million people will require some form of mental health counseling, according to an estimate of the New York State Office of Mental Health.

Many individuals feel stressed and depressed, cannot sleep, and live with feelings of doom.

In recent weeks, there have been many concerns raised in the public health field about how a loss of commitment to a job or goal and feelings of alienation in stressful times can prove to be so overwhelming that people will become physically ill.

Studies, for example, show that chronic stress is associated with high circulating levels of cortisol, one of numerous chemical messengers released by the adrenals. Cortisol can change both the numbers of immune cells and their function, leaving an individual more vulnerable to disease. One study showed that wound healing took 24 per cent longer in highly stressed people who cared for Alzheimer’s patients than in people who were not stressed. This suggests that stress-related changes in immunity may contribute to a health effect.

Lately, there also have been questions raised about whether the public should be alerted to vague terrorist threats. It has been suggested that non-specific high alerts made public by the government only produce greater anxiety and make many individuals feel even more helpless.

Government officials have stated that they believe Americans can "accommodate" the high alert information. The implication is that most people have sufficient means to cope effectively with high stress-producing events.

Or are terrorism high alerts a potentially damaging form of hexing that can have widespread impact on health?

And, if so, are there ways to protect ourselves against steady waves or sudden bursts of disturbing and threatening information?

"VOODOO DEATH"

In 1942, an article, entitled "Voodoo Death" appeared in the American Anthropologist. In a world now held hostage by terrorism, this scientific classic may help us to understand how terror can harm, and even kill, a human being. Written by Walter B. Cannon, a pioneering American physiologist, the article proposed how a lethal response to fear might be biologically feasible.

Cannon had heard many stories told by anthropologists about how people in primitive cultures could be killed after being subjected to a sorcerer’s spell or hex. This was sometimes done by "bone pointing." Cannon wrote very vividly about what occurred after someone discovered he had been hexed by having a finger or bone pointed at him.

"He stands aghast, with his eyes staring at the treacherous pointer, with his hands lifted as though to ward off the lethal medium, which he imagines is pouring into his body. His cheeks blanch and his eyes become glassy and the expression on his face becomes horribly distorted."

After eliminating the possibility that such a victim could have been poisoned or had suffered physically in some way, Cannon attempted to explain the physiological processes that led to death, the major psychological requisite being a strong belief in sorcery and its magical powers.

Because of the fear and danger that boning triggered, Cannon proposed that the victim’s body went through a number of physiological reactions (rise of heart rate, increase in muscle tension, rise of blood sugar levels, the release of adrenaline and other hormones) that prepared it to confront an emergency.

When there actually was no emergency to confront and the threat was prolonged, a state of shock could result, thereby reducing blood pressure. This could, for example, lead to heart damage.

Cannon also ventured that a lack of food and water would make things even worse. Death could come quickly.

Some two decades earlier, Cannon had already shown in experiments that animals suffered digestive problems when they were restrained and could neither fight nor flee in the face of danger.

Though one should not bank on Cannon’s early efforts as a satisfactory explanation or template of how terror can be manipulated to cause harm, he did provide insight into a complex dynamic process, involving culture, psychology and biology. And scientific interest in phenomena similar to voodoo death is on the rise.

NOCEBO

Doctors sometimes tell their patients that they may only have a few months to live. Is this a modern form of a sorcerer’s hex?

The patient (victim) may feel a lack of control in the presence of a doctor and believe that he is doomed. Can a biological change occur in the patient following feelings of helplessness?

This is not farfetched. Medical conferences are held to explore this type of issue. Although scientific data are piecemeal, they suggest that expectations of sickness promote sickness. In one study, women who expected a heart attack were almost four times more likely to die from a heart condition than women who did not expect one. In another study, patients who had a shortage of blood flow to the heart and who suffered from depression had 1.6 times as many so-called "ischemic" episodes and were 1.5 times as likely to die as a result of an episode than those heart patients who were not depressed. Other studies show that blood pressure rises in the doctor’s office. This has been referred to as "white-coat hypertension." And other research reveals how a pessimistic attitude is a risk factor for illness.

One strong implication from this body of research is that stress, fear, and pessimism may exacerbate existing medical problems, particularly in those people who already have weak or damaged immune systems.

As in primitive cultures, modern ones also are driven by beliefs, attitudes and expectations. Some medical researchers believe that negative expectations may contribute to a lot of pathology.

Such a negative belief system is sometimes termed a "nocebo," which comes from the latin, nocere (I will harm). Some like to refer to the nocebo as the placebo’s evil twin. Placebo (I will please) is a term often used to characterize some positive attitude in the form of words, or a sugar pill, that can lead to a positive response in a patient.

Herbert Benson of Harvard Medical School says both the placebo and nocebo appear to work via the "mind-body connection." For example, in the case of a nocebo, it may mean the chemicals that fear produces stimulate the brain, and, in turn, this action could affect the heart, leading to ventricular fibrillation or uncontrolled fluttering, and possibly death. There is strong evidence that the brain can activate the release of stress hormones. The hypothalamus sends electrical and chemical signals to the pituitary gland. Then the pituitary sends the hormone ACTH to the adrenals where, as previously mentioned, the chemical messengers are released, including cortisol.

While the exact mechanism of how this would work still remains unclear long after Walter B. Cannon took a crack at explaining the phenomenon of voodoo death, the field of "psychoneuroimmunology," as it is often called, is definitely on the upswing. According to Robert Ader, professor of psychosocial medicine at the University of Rochester who coined the term in 1975, there are likely many medical phenomena for which the exact mechanisms remain undefined. Ader is convinced that there are enough data to show that psychosocial factors can influence a person’s vulnerability to disease.

More research is obviously needed in this cutting edge field of inquiry to determine how factors such as stress and fear change immunity, but the strong clues stemming from this growing body of work suggest that negative beliefs and expectations built on pessimism and terror could affect the health of some individuals and perhaps many in times of crisis.

TERRORISM HIGH ALERTS

Government officials who issue vague terrorism high alerts at a time when the United States is already on an "indefinite" high state of alert, may well be playing with fire. The threat is announced, fear and anxiety spread in a population that is already highly vulnerable to bad news and then the threat of major catastrophe doesn’t occur within the announced time frame. And the cycle is repeated. One would have to assume that many people treat these high alerts seriously and become stressed and fearful as they follow news events very closely.

This process, while by no means identical to Cannon’s characterization of the steps required for a voodoo death, has some striking similarities, particularly in the terrorized state of mind that is achieved by the "hex." What we don’t really understand yet in sufficiently detailed scientific terms is how this psychological process turns on biology, even to the point of affecting longevity. But because we don’t understand the process, this is no reason to assume that some elements of what Cannon described in his voodoo death article do not apply to modern times.

Is there a method to fight off a hex that could damage health? Certainly not a scientifically proven one. But again, there are some clues that emerge from the scientific literature. First, one’s beliefs appear to be important in the mix. Strong belief in the government’s hands-on knowledge of emerging threats, however vaguely publicized, may set the stage for a high degree of fear in some people. A more critical, yet still attentive attitude, might lessen the build-up of terror and its potential medical consequences.

Psychologists have long argued that ways of coping with stress effectively include maintaining a commitment to one’s goals and life principles. This may be more difficult to achieve in times of crisis, but a strong effort to do so may prove invaluable in fighting off a general atmosphere of fear and helplessness. In short, it adds up to facing the challenge, becoming more engaged in life, rather than watching cable news all day long, and feeling more in control.

A helpful mantra here may be: The present is the point of power.

RECOMMENDED READING

Benson, H, "The Nocebo Effect: History and Physiology," Preventive Medicine, Vol. 26, 1997

Cannon, Walter B., "Voodoo Death," American Anthropologist, Vol. 33, 1942.

Freedman, M, Pathogenesis of Coronary Artery Disease. McGraw-Hill, New York, 1969

Glaser, R. et. al., "Stress-Related Immune Suppression: Health Implications," Brain, Behavior and Immunity, Vol. 1, 1987

Kobassa, S.C., "Personality and Resistance to Illness," American Journal of Community Psychology, Vol. 7, 1979

Meador, C.K. "Hex Death: Voodoo Magic or Persuasion?" Southern Medical Journal, Vol. 85, 1992

Snyder, B.K. et. al., "Stress and Psychological Factors: Effects on Primary Cellular Immune Response," Journal of Behavioral Medicine," Vol. 16, 1993

Voelker, Rebecca, "Nocebos Contribute to a Host of Ills," Journal of the American Medical Association, Vol. 275, 1996

Wole, E.L., et. al., Walter B. Cannon: Science and Society, Harvard University Press, 2000

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