Kindness is the best placebo.

Kindness, being nice, cheerful, helpful, may be the best medicine after all, because it may be helping ourselves and others with a placebo effect. - Smile and the muscles involved with smiling help activate the positive mood areas of our brain. Think positive and our brain and body may feel more healthy too.


See the last post for more about the placebo effect - positive beliefs may have positive effects on health; and the nocebo effect - negative beliefs may be able to have negative effects on health - especially if either belief was instilled by someone who seems like an authority figure and may have used a complex process of some sort for the evaluation or treatment ritual.


"Tenderness and kindness are not signs of weakness and despair, but manifestations of strength and resolution." - Khalil Gibran (goodreads)

“If you love somebody, let them go, for if they return, they were always yours. If they don't, they never were.” - attributed to Khalil Gibran, yet it does not sound like his writing, and quoteinvestigator has different information, basically stating unknown source, possibly a college student. The quote may be based on a passage from the book The Prophet by Khalil Gibran:


Let there be spaces in your togetherness, And let the winds of the heavens dance between you. Love one another but make not a bond of love: Let it rather be a moving sea between the shores of your souls. Fill each other's cup but drink not from one cup. Give one another of your bread but eat not from the same loaf. Sing and dance together and be joyous, but let each one of you be alone, Even as the strings of a lute are alone though they quiver with the same music. Give your hearts, but not into each other's keeping. For only the hand of Life can contain your hearts. And stand together, yet not too near together: For the pillars of the temple stand apart, And the oak tree and the cypress grow not in each other's shadow.”

Khalil Gibran, The Prophet" (goodreads)


It is a good sentiment about love. Feeling trapped is not a loving feeling and low grade stress may have negative effects on health. Hearing negative messages of devaluing a person or their beliefs or values may also have a negative effect on health from physical effects of oxidative stress and possibly a nocebo effect.


The relationships section of the Topics forum (Peace is Freedom to Love) has a few posts about trauma recovery and long term effects on difficulty with trusting others. Patience may be needed by friends of a trauma survivor. The body and mind may have trained responses of defensiveness because of the history of negative things happening - can expecting negative things increase the risk of that expectation being fulfilled however?

Possibly.

The placebo and nocebo effects do involve physical changes in body chemistry involving dopamine reward system and our endogenous opioid pain killing system. During a positive placebo effect the dopamine and endogenous opioid receptor activity increases - more pain killing benefits and positive mood; and decreases during a nocebo effect - less pain killing benefits and reduced motivation and possibly a more depressed mood.

"Placebo and nocebo effects are associated with opposite responses of DA [dopamine] and endogenous opioid neurotransmission in a distributed network of regions. The brain areas involved in these phenomena form part of the circuit typically implicated in reward responses and motivated behavior." (Scott, et al, 2008)

The evolutionary/long-term benefits of the placebo or nocebo effect may be involved with motivating us to take more care to avoid some negative concern, or to work harder to achieve some positive goal. The negative concern or positive goal would be the belief shared by a trusted authority - believing in the authority figure's experience and knowledge and trusting they are correct.

Warnings of potential symptoms or side effects of a medication or psychiatric treatment (2, 3, 4) may lead to an increased risk of them occurring due to a nocebo effect. "A combined manipulation of experience and expectation led to a significant modulation of pain. Even abstract treatments might alter the perception of pain. The authors' manipulation induced stronger nocebo than placebo responses. The results demonstrate the need for further research on the prevention of nocebo effects." (5)


Encouraging patients to call regarding any changes that occur to report on their progress, leaving it open as to whether the change may be positive or negative might lead to less placebo or nocebo type manipulation of the person's expectations.

Screening with a simple questionnaire might help identify patients more at risk of a nocebo effect from educational messages, rather than needing a genetic screening (last post, COMT gene). People who are more anxious and have stronger harm avoidance responses on a survey were more likely to have a nocebo effect. "Anxiety and harm avoidance correlate positively with nocebo effects" (2) Past experiences may also effect our later experiences - those who expected more pain tended to perceive more pain than those who expected something to not hurt too bad. (5)

Trauma survivors might have a stored memory of pain and may tend to be more anxious than average - there can be a heightened fear response for trauma survivors. It would be defensive and life saving when there is risk, but physically damaging as oxidative stress chemicals when it is long term. Living in a tense or emotionally manipulative environment may be damaging the body from the inside even though there are no visible bruises or broken bones. The placebo and nocebo effects have had more study in the area of medical authority figures than in other areas of life, such as a parent, caregiver, teacher, or peer group, however the research may suggest a need for care in how we speak to children and each other.


A quote by a survivor of long term child sexual and emotional abuse, (CSA-child sexual abuse, one in six boys or men have experienced sexual abuse 1in6.org):

"I believe a child can be convinced over a period of a couple decades, they are simple-minded & worthless. I believe a #victim can be convinced what happened to them is their own fault. Parents, siblings, church, school, society can switch the blame directly onto the victim. #CSA" - Iam1in6 @billydinkel

Communities are peer groups too and may also be involved in nocebo effect - stigmatizing some members and elevating others. Consider who may be in the stigmatized groups - anxious trauma survivors, who may still be defending against real risks not just remembered ones. Kindness - trauma survivors may crave social connection and just have difficulty responding as expected - their norm may have been an emotional or physical blow followed by a 'treat' - making treats more of a trauma trigger later in life rather than a positive thing.


"Remembered trauma" and "triggered" is referencing brain patterns of nerve cell connections that become strengthened over repeated firing of the sequence - like a long line of dominoes - push the first one over and the rest topple one by one. A trauma memory can become remembered vividly and then strengthened with each repetition, each reminder, trigger, of the memory sequence. Placebo (or nocebo) effects may be stronger with more elaborate ritual (last post) so maybe the repetition is also strengthening the effect - a ritual that is repeated.


Like propaganda - "If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.” - Joseph Goebbels (Nazi, WWII) (jewishvirtuallibrary)


It can be difficult to believe the truth when it is learned - there may be a desire to pretend the lie is still the truth, or the brain patterns may be so habituated that it is difficult to not keep still triggering that belief set.


Children deserve the truth - they are precious - each and every one of them.


"Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.”― Khalil Gibran (goodreads)

Society deserves the truth too.


Is laughter really the best medicine or might kindness be the best? Or does it need to be a competition? Friendly competition can be motivating too, and even peace building. Peace is better for international trade, negotiating water treaties can be a path towards greater trade and improved peace. A few other posts of interest:


Posts about community health and working towards a peaceful and sustainable future

- it is kind to share, it is sensible to plan ahead so there will be enough to share without anyone having to go without:

Posts about individual health and trauma recovery:

  • Finding peace in chaos. - The post focuses on coping with a stressful work environment or boss. It also includes a link to a post about recognizing gaslighting, which is emotional manipulation - lying to control or devalue a person, or society when it is in the form of propaganda and controlled media.

  • Peace is multi-generational - trauma can also affect us generationally through epigenetic changes in our grandparent's gene methylation, or by learned fear being shared with younger generations who are living in more plentiful or peaceful times. Let's share peace instead.

  • Reframing Fear - links to resources and other posts about cognitive therapy and other techniques for moving the fear memory into less emotional and less triggerable long term memory storage.

  • Peace may take practice - mindfulness or meditation tips from a book by Jon Kabat-Zinn.

  • Peace is mental and physical - movement can be meditative, household chores can too.


Disclaimer: This information is provided for educational purposes within guidelines of fair use.



Reference List

  1. Scott DJ, Stohler CS, Egnatuk CM, Wang H, Koeppe RA, Zubieta J. Placebo and Nocebo Effects Are Defined by Opposite Opioid and Dopaminergic Responses. Arch Gen Psychiatry. 2008;65(2):220–231. doi:10.1001/archgenpsychiatry.2007.34 (Scott, et al, 2008) https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482600

  2. Corsi N, Colloca L. Placebo and Nocebo Effects: The Advantage of Measuring Expectations and Psychological Factors. Front Psychol. 2017;8:308. Published 2017 Mar 6. doi:10.3389/fpsyg.2017.00308 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337503/

  3. Bruce Borkosky, Psy.D, PA, Talk of risks, side effects may lead to nocebo effect. Jan 5, 2021, nationalpsychologist.com, https://nationalpsychologist.com/2021/01/talk-of-risks-side-effects-may-lead-to-nocebo-effect/108393.html

  4. Locher C, Koechlin H, Gaab J, Gerger H. The Other Side of the Coin: Nocebo Effects and Psychotherapy. Front Psychiatry. 2019;10:555. Published 2019 Aug 8. doi:10.3389/fpsyt.2019.00555 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694178/

  5. Reicherts P, Gerdes ABM, Paul Pauli P, Wieser MJ, Psychological Placebo and Nocebo Effects on Pain Rely on Expectation and Previous Experience. The Journal of Pain, Vol 17, Issue 2, Feb 2016, pp 203-214 https://www.sciencedirect.com/science/article/pii/S1526590015009256

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