Is It All in Your Head?! Labelling & The Nocebo Effect
9 min read. Guest blog by Jenni Sanders
If someone tells you that your pain is “all in your head” it feels soo frustrating, patronising, maddening! What do you mean iTs aLl iN mY hEaD – it’s real!! I FEEL IT!
It makes you feel stupid, misunderstood and just downright annoyed.
But the thing is, it IS in your head. All pain is in your head. Absolutely everything you feel is in your head. Hansen’s Disease (or Leprosy) damages nerve cells, disrupting their ability to feed information back to the brain, causing the sufferer to not sense pain from very real injuries. This leads to infections and further damage because they simply feel nothing.
Your brain controls the pain you feel, regardless of the damage in your body.
Most of the time, your brain and body match up very well – you cut your finger? You’ll know about it instantly, clean it up and avoid touching things with it for a while.
You break your leg? You’ll definitely know about it, head to the hospital, get it treated and work on your recovery.
But what about injuries you can’t see? Things you can’t point to and go “ah look, there’s the damage!”. Things like back pain, vague hip pains, neck tightness, pops & clicks in your knees, etc. there’s nothing wrong per say… it just hurts.
It must be a part of human nature because we always want to get to the bottom of it. What’s causing the pain? What muscle? What did I do? What will make it better? What makes it worse? And probably the worst of all: Is there a name for what I’m feeling?
When we have these questions, we can be very suggestable to anyone and anything that may hold an answer.
The Nocebo Effect
You probably will have heard of the Placebo Effect (a positive effect arising from someone believing that something/a treatment will work) but today we’re going to talk about it’s lesser-known dark cousin: the Nocebo Effect.
Nocebo translated from Latin literally means “I Shall Harm”. Sometimes, when someone is told about a negative side effect, negative consequence or even that there’s a chance treatment might be ineffective… those people genuinely suffer the negative effects in the same way people genuinely have the positive effects from the Placebo Effect.
These effects, positive or negative, along with any disorders, pain, or symptoms which originate in the mind rather than a result of stress on the body are called psychogenic, but don’t get me wrong, any symptoms arising from a psychogenic source feel just as real as those caused by a physical source.
Let’s look at an example of how suggestable your mind can be when assessing your own pain levels.
A study in 2001 took a group of 50 people suffering from chronic back pain and randomly split them into two groups. Both groups were required to do a seated leg flexion test using a leg curl machine, set up so that the weight was individually calculated to be moderate for each individual – overall the test should not have put any strain on the lower back or aggravate their pain.
The first group was told: “The movement will not influence your back pain and will not lead to any increase of your pain”
The second group was told: “The movement may lead to a slight but short increase of your back pain, but it will not be harmful”.
Both before, during and after the test, both groups were asked (among other questions) about the pain intensity and any fear they felt. And what do you think happened?
Before the experiment started, both groups rated their pain and fear almost identically.
But, during & after the experiment the second group, (who were told the test might cause them a slight increase in pain) rated both their levels of pain and fear as 60% higher than those who were told the test won’t increase their back pain.
They did the exact same test, in the exact same situation, with the same starting levels of pain as the first group, yet they felt 60% more pain & fear during and after.
Because they were told they might.
And these people aren’t making up their pain, they genuinely felt it the same way that we would in the same situation. It’s just the crazy suggestibility of your brain who, at the end of the day, is just trying to keep you safe. Pain is your brain’s best way of getting you to stop doing something, if someone (especially someone in authority such as a doctor) tells you something might hurt, then by-jove we shouldn’t be doing it!
Time and time again, clinical studies have shown that people who have been told a negative effect could happen, genuinely experience them – even if they’re given a sugar pill. For our brain, the anticipation of threat is enough to bring on a response.
Labels & Diagnosis
Labelling Theory describes how the social behaviour of people can be influenced by the labels people give them. Initially it was only really used to describe criminals and “deviants”, with one theorist making the observation that: criminals are criminals because we call them criminals (think about a person killing someone in the streets: criminal, vs a soldier killing someone in a war: legitimate).
Once someone is assigned a deviant label by others, it can become internalised, making it a part of their identity, which makes them much more likely to repeat deviant behaviour.
It’s really interesting and if you’re into your psychology & sociology you should find out more about it. But since the 60s when it was first proposed, this theory has expanded to many different aspects of social life, such as medical diagnosis.
Once a person is diagnosed with a syndrome, or disorder or given any sort of label to describe their pains it becomes a part of them almost immediately.
We love having an identity!
“I’m a CrossFitter”
“I’m a Graphic Designer”
“I’m a shy person”
“I’m an organised person”
So, when we’re told that that shoulder pain can be described as “Shoulder Impingement”, or that pain around your hips is actually “Piriformis Syndrome” … it can slot right in as a part of you.
“I’ve got Shoulder Impingement”
“I’ve got Piriformis Syndrome”
That’s just a part of you now.
Diagnosis gives your pain a legitimacy – which on one hand is great! You have validation that yes there was something wrong with you after all! Now you can finally get treatment for it!
Or it can become a crutch, a fallback, and the Nocebo Effect rears its ugly head. Now you know about your problem you can read about it, doctors can tell you things about it, you might suddenly realise that “yeah, I do actually get tingles down my leg when I do that”. You might start avoiding things because it could aggravate your Sciatica, or your Patellofemoral syndrome.
You’ve internalised your diagnosis as part of your identity and there’s this strange part of you that doesn’t want to give it back up. That’d be difficult, and then you’d have no excuses.
Fighting the Nocebo Effect & Labelling
So, here’s the problem (the same problem that doctors and other medical professionals run into too): we can’t just ignore the fact that negative side effects can happen, neither should we dismiss pain and refuse to get it diagnosed… but sometimes this knowledge does more harm than good… so what the heck do we do?!
1.Admit your problem, but know that it’s changeable
One of the best things you can do is to face the problem head on and completely acknowledge what’s happening:
“Yes I have x” / “I feel y”
But one of the most powerful little things you can add to that little confession is “at the moment” or “for now”:
“Yes, I have x, for now”
“I feel y, at the moment”
But it won’t be forever. Tell yourself that this situation you find yourself in, no matter what it’s name, no matter what side effects or consequences, is TEMPORARY. Your body is changeable and adapts to the stimulus it’s given.
“I have back pain on my right side when I bend forwards right now, but if I work on it, it will get better”
2.Get a good support system
One really interesting thing about both the nocebo effect & labelling theory is they both hinge on other people telling you negative stuff.
It’s much easier to dismiss things you make up yourself as not important, but when a person, video or article tell you something that seems to make sense it’s much harder to forget about. If you add people around you who, no doubt have your best interests at heart, but tell you to just rest or stop doing something you love for fear of aggravating a pain then it can really bring you down.
You may know or have heard of people with the same diagnosis who ended up giving up their sport, getting grumpy, lazy, overweight and just downright miserable. Is that really gonna be your future? Well that’s what they’re saying might happen…
One of the amazing things about the Simplistic Mobility Method is the community that comes with it. When you have people around you who’ve suffered the way you have and come out the other side? Well, that’s a punch in the face to that damned label. People who encourage you to act and not just rest and hope it goes away are the best kind of people.
3.Challenge your negative thoughts & symptoms
You’re allowed to feel bad, and you’re allowed to have bad days where everything just seems pointless and nothing seems to be helping, but then you need to pick yourself up and get back on with it afterwards.
When you’re feeling symptoms that you normally feel, just stop, close your eyes, and really evaluate what it is you’re feeling. Send a little probe out from your brain and mentally poke the area.
Does it really hurt where I think it does?
Are there other areas of tightness?
What if I wiggle this way a bit?
Ooo my sides actually are feeling a bit tight
Wow I’m really holding my breath, what if I slow down my breathing and breathe into my belly?
Get curious and explore your pain, really get to know what’s going on and you might realise the symptoms you’re feeling aren’t as powerful as they first seemed.
Exploration like this might even lead to discoveries or epiphanies. Sometimes labelling ourselves with a diagnosis can stop us searching, causing us to miss a more subtle underlying cause.
Coming back from an injury, or just overcoming long-term pain can be a very long, scary and depressing road, but realising and accepting how much of that is actually psychogenic can be a really useful tool to taking those first positive steps.
If you don’t know where to start, I’d highly recommend the Simplistic Mobility Method, where not only will you get lifetime access to an awesome program to build mobility & stability which balances your body and can combat all sorts of common syndromes… but you also become a part of one of the best communities in the world! Check it out here!