Abstract
The COVID-19 pandemic is a major health issue, which leads to psychological and behavioural changes. In particular, among various negative feelings, fear seems to be one of the main emotional reactions that can be as contagious as the virus itself. The actual pandemic is likely to function as an important stressor, especially in terms of chronic anxiety and lack of control over the succession of unforeseeable environmental events. In this direction, the psychological impact of previous quarantine measures showed important negative psychological effects, including post-traumatic stress symptoms (PTTS) with long-lasting effects. The presence of psychological discomfort and disturbances due to negative contextual factors can be studied using the nocebo phenomenon as a possible theoretical explanatory framework. Although in the absence of studies linking nocebo to Covid-19 and data-driven evidence, the context of the actual pandemic may be seen as a fertile ground for amplified discomfort and anxiety. The media provide dramatic and negative descriptions and often present conflicting sources of information, which can lead to physical and mental health problems, diminishing response to treatment. This can be worse when supported by conspiracy theories or misinformation. The aim of this perspective review is to propose a new theoretical framework for the COVID-19 pandemic, which should be supported by future empirical studies. In particular, the negative contextual factors, which can predispose individuals to psychological distress and the onset of the nocebo phenomena will be presented here, in order to suggest possible guidelines to mitigate the devastating effects of COVID-19.
IntroductIon
The COVID-19 pandemic includes a perfect storm in which powerful nocebo effects may be flourishing. The nocebo effect can be mediated by situational-contextual factors (such as verbal information and suggestions, healthcare beliefs and health professional interactions, exposure to negative media campaigns, or previous personal experience) and by individual factors.
In
Hahn and Kleinman (1983) published, in the prestigious Medical Anthropology Quarterly, a short article on the effects of belief. In particular, the authors underlined that beliefs may “kill” and beliefs may “heal” and what a person believes within a society plays a significant role both in producing disease and as a remedy. The authors illustrated different forms of the nocebo effect, as beliefs influence outcomes, particularly in the absence of specific events or communications: fear of heart disease increases the risk of ischemic attack; similarly, depressive states – i.e., a generalised sense of impotence – increase the probability of death as a result of ischemic events. Moreover,
it is important to note how Cannon (1942) had already previously defined the phenomenon of “voodoo death” as a dramatic nocebo effect, following the induction of a pervasive state of terror. Prolonged stress events due to different adverse environmental contexts can cause the collapse of the neurovegetative balance and this can be so serious that it paralyses vital functions and induces death, even in the absence of organic lesions. In particular, the death may be caused by lasting and intense action of the sympathico-adrenal system. Since Cannon’s observations, accumulated evidence supported his concept of “voodoo death” and nowadays it is considered as a real phenomenon, but far from being limited to ancient peoples. It can be defined as a basic biological principle that provides an important clue to understand the phenomenon of sudden death, as well as to provide an explanation for neurovisceral diseases (
Samuels, 2007).
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