Suzanne Askham

Goodbye, Dr Nocebo

Easter, three years ago. My teenaged son, Tim, is still convalescing after a critical illness in Florida. We are now back in England, and he has caught a new chest infection. He goes to hospital where he is put on intravenous antibiotics. I stay with him. It’s not really possible to leave Tim on his own, because he has complex learning difficulties and other people don’t understand him.

So we are sitting in the hospital, day after day, and nothing much seems to be happening. Tim’s not getting worse, but he’s not getting better either. Some days I don’t even spot a doctor. Tim is scarcely eating, so I ask to see a nutritionist, but am told that all the paediatric ones are away. After a couple of days, an adult one materializes and gives me some food supplements. I am grateful for those, but surprised that I had to work so hard to get them. Surely this is the sort of thing that Tim’s doctor should pick up on?

To be fair, there are some very good nurses around, and a lovely school teacher. But apart from them, the atmosphere seems lacklustre. I can’t help comparing it with the medical team that saved Tim’s life in Florida. They seemed full of energy and a belief in their skills and medicine. They didn’t think Tim would pull through, but they did everything in their power to help him, and were thrilled when he made it.

Here, in contrast, it feels as though Tim has been somehow written off.

One morning a doctor comes into Tim’s ward. It wouldn’t be fair to give his real name, so I shall call him Doctor Nocebo.

Absolutely, the name is symbolic.

Nocebo effect: when a person in a position of authority, such as a doctor, leads a patient to believe that they are going to get worse. This negatively harnesses the patient’s own unconscious power to alter health outcomes. If the patient believes the doctor, the nocebo prediction can become a self-fulfilling prophecy.

The opposite of the nocebo effect is the better-known placebo effect: the body’s innate ability to heal itself when it believes it can. Drug trials have to take the placebo effect into account because a high percentage of people get better when they believe in an imaginary medicine.

Dr Nocebo is accompanied by a handful of medical students.

While they look on, he gives Tim a cursory examination. He notices Tim’s physical disabilities: his very pronounced spinal curvature, his tendency to lie still while he’s ill.

Then he turns to me and tells me, in graphic detail, how Tim will get more and more chest infections and they will become more and more frequent. And he will die – the implication is sooner rather than later.

As he talks, I feel faint. There is something inhuman about the way Dr Nocebo is delivering this news. It almost feels as though he is showing off his power in front of his students.

That evening, I go to a small parents’ bedroom near the ward. I get into bed. I lie there, in the dark, and worry about Tim’s slow rate of recovery.

And then it happens. I hear a voice: loudly, insistently, inside my mind.

“Suzanne,” it says. That’s all. But accompanying my name comes all sorts of information. It’s a full conversation, delivered in one word.

I realize straight away that I have fallen prey to the nocebo effect on my son’s behalf. I have been picturing Tim getting more and more poorly. I have believed Doctor Nocebo’s words.

I now have an urgent job to do. I must visualize my son well. And I must keep doing it.

The actual visualization comes with great ease. It is as if someone is leading me through it.

First I picture, in great detail, that I am standing in beautiful countryside. There are fruit trees in blossom all around. In front of me is a healing temple. I walk up 10 steps, and enter the temple. I go to the reception desk, and sign in. I am given a special healing disc to wear around my neck, over my heart.

I walk across the light and airy atrium, to the healing centre of the temple. There, I take a seat. In front of me is a shimmering space. I picture Tim in the space, receiving all the healing he requires. Before my eyes, he becomes well and strong.

I leave the temple, still wearing the disc.

The next day, Tim’s dad Steven is the lucky one who gets to see Dr Nocebo. The doctor of doom duly gives Steven the same talk he gave me: your son will soon die, etc.

Steven, being the practical one, asks: “Yes, but what about exercise? Won’t that help?”

Steven is fully aware that Tim normally does lots of physiotherapy and yoga. Dr Nocebo just sees a pale and poorly disabled child. He has no idea that when Tim is well he can be pretty active. He can, for example, stand up on one leg, with support, and do the Tree position in yoga.

Take that, Dr Nocebo!

“Oh yes,” said Dr Nocebo, surprised. “Yes, that could help.”

In my imagination, I return to the temple once a day. Each time, I first go to the reception desk. The healing disc I wear over my heart is checked. Each time it is black and smoky with negative energy. It feels polluted. So I hand it in and receive a new one. And then I go to the healing area in the centre of the temple, and picture Tim strong and well.

In real life, Tim does get better, and we leave hospital. But even at home, whenever I feel the need, I continue to visit the healing temple, in my imagination, on his behalf.

I notice, on my visits, that the healing discs aren’t getting so polluted. Then, on one visit, I am given a special, permanent healing disc to wear. People gather round to congratulate me. I realize that I have graduated to a new level. This new disc is gold and iridescent. It will stay naturally clean of negative pollution. However, I will still get it checked at the reception desk from time to time.

~ ~ ~ ~ ~ ~ ~

Soon after Tim’s encounter with Dr Nocebo, I realize that there is just one more thing to do: we need to change hospitals. So I arrange for Tim’s care to be transferred to a newer and better hospital. We don’t get to see the new consultant for 18 months though. There is no need. Despite his disabilities, Tim enjoys a period of excellent health.

~ ~ ~ ~ ~ ~ ~

Unfortunately, Dr Nocebo has many cousins, all equally negative and miserable. So if you happen to encounter one of them, remember this: when Dr (or Mr or Ms) Nocebo talks negative, it’s up to you to visualize positive.