Originally published in Comfort Zone Newsletter: May 2009.
II. “Are HSPs more suggestible? …easily hypnotized? Would placebos work better on us? When I hear about an illness… I often think I have it? So am I a hypochondriac?”
These are complex questions. Hypnotizability is a well studied subject and thought to be partially innate. Although others see it entirely as a social role we learn–the hypnotic subject. Either way, it is not clear to me how hypnotizability is related to high sensitivity, since HSPs are 20% of the population and almost everyone is hypnotizable. Most likely, being highly sensitive does have an effect, but not a simple one. Perhaps most HSPs, being more empathic and less “boundaried,” would be quicker to comply with requests or agree with suggestions. But other HSPs might be more skeptical than other people, as an attempt to compensate for this open mindedness, having felt in the past that they were too gullible or easily swayed.
As for placebos, these are treatments that have an effect through suggestion. This effect works better on symptoms that are fairly subjective, such as pain or depression. Placebo controls are standard in many drug studies in order to see if a medication adds anything over a placebo. Some studies have found that placebo pills for pain or depression work almost as well as the real thing.
But recently that has been questioned. Placebos rarely cure for long any real health problem, including pain and depression. When they do, those given no treatment at all often get well too: With time a certain number of people will always improve spontaneously. Again, placebos seem to work best when a diagnosis is not exact or an improvement has to be subjective and cannot be measured by anything outside of you, such as a lab test.
Many reasons for the placebo effect have been put forward. People of course want to get better and so look for improvement, which then can reduce their focus on their pain. Or they expect that the treatment, or treatments in general, or their doctor can help them. Some may want to feel better to make their doctor feel better! Sometimes simply being attended to and nurtured, even by merely being prescribed something, can be very healing.
If you suspect a placebo effect has helped you, was your problem “all in your head” and nothing was physically wrong? Well, what’s in the head? A brain, which is affected by every experience it registers, past or present, as well as affecting and being affected by the rest of the body. Something physically happened, and perhaps the mechanism does not matter if you are truly better.
Compared to others, would HSPs be more or less helped by a placebo? We could be skeptical about whatever is tried, having been disappointed in the past by other treatments. On the other hand, being easily overaroused and stressed, merely thinking, or someone else thinking, that we will improve through a pill or treatment could calm us enough actually to improve us. Or, yes, we could be trying to please our doctor. Or we could be so deprived of nurturing and quick to perceive it that receiving even a little of that helps us more than others.
Another source of placebo effects for us arises from mistrust of “regular” doctors and so more trust in alternative medicine. Because HSPs report more symptoms and side effects, non-HSP medical doctors often assume these are all neurotic symptoms–that is, signs of underlying anxiety or emotional distress and deprivation. Some HSPs are neurotic in this sense, of course, due to their troubled childhoods, and they further validate doctors’ views about all of us.
This response from most doctors can make us the best customers of those who provide alternative treatments, including those that mostly work through the placebo effect. Of course many DO work, but there is less solid research done on alternative treatments, which would determine which are placebos and eliminate them. To win us over for years, all the alternative medical professional has to do, whether a quack or healing genius, is to take seriously our fears and give us a little TLC. Most of us have probably fallen into this trap–spent precious time or lots of money on a treatment that seemed to help at first, but then not much more happened and the underlying problem remained. We benefited briefly, from the placebo effect.
Imagined symptoms and illnesses, like the placebo effect, are tough to sort out when a definite diagnosis is not possible. Usually you have enough tests to determine if you really have the problem your symptoms seem to point to, but sometimes the tests have many false positives or false negatives. There may be still more tests that are possible, but you can start to feel you are being tested to death, and sometimes there is just no way to know for sure that you are going to be okay or not. So why would HSPs be more likely under these circumstances to make the mistake of a false positive–think we have something when we don’t (rather than a false negative and think we don’t have it when we do)? I can think of a number of reasons why we would:
- We tend to think ahead and try to avoid risks, and ignoring a symptom is always a risk. Our general strategy is “better safe than sorry.”
- We don’t trust scientific medicine after all those times of being told we were “just imagining something,” especially if even once we were right that it was more than imagination.
- We try to be conscientious. We hear all the time about the dangers of ignoring a symptom, both from the media and from those who really have the disorder. We also know being ill affects those around us as well as ourselves, so we rightly feel we owe it to others to stay well.
- We are more sensitive to subtle stimulation, including that coming from within our own body. Studies have found that sensitive children, thanks to their acute awareness of their pain and other symptoms, receive more unnecessary treatments for the same disorder as their non-sensitive siblings.
- We are more easily overaroused, so once we are worried we are likely to become stressed out, which can make many symptoms worse.
- We often feel there is something wrong with us anyway! Being sick only confirms it.
- Since we’re often more stressed out and tired than others, it seems something must be wrong with us (and maybe we’d prefer to know we have a disorder over having to accept that as an HSP we simply need more down time).
- If we had a troubled childhood, we were more affected by that, and there is considerable evidence that for anyone, having a troubled childhood is associated with more than average illness and injury.
- Especially if we had a troubled childhood, we may be struggling to deal with the world and very unconsciously find it a relief to be so ill that we do not have to “go out there,” where we expect to fail. Under those circumstances it would feel better to anyone to stay in and take care of yourself, even for the rest of your life.
Here’s a fine example of an imagined illness. A few years ago, a test report showed that I had a serious leak in one of my heart valves. This later turned out to be untrue, but by the time my doctor figured this out I was having intense chest pain, shortness of breath, and irregular heart beats. Sometimes I could hardly walk a block. None of these are typical results of a leaky heart valve, but I did not know this.
After many tests to rule out other problems, my doctor concluded that there was simply nothing wrong with me, except maybe CSX: “Cardiac Syndrome X.” I went home and looked it up. CSX is not “just in your head”–I can certainly vouch that it causes real pain and real symptoms. But how does it do that in the absence of a serious heart abnormality? One theory is that worry causes constriction of the tiny capillaries in the heart, which is generally harmless but very painful. Another theory is that some sensitivepeople feel sensations in their heart that others do not, and are more alarmed by any pain there, so that they can go into a spiral of pain causing worry and worry causing pain.
All the standard treatments for angina due to coronary artery disease also help Syndrome X, because it really hurts. But I had no intention of taking beta blockers or nitroglycerine for the rest of my life. (I did find that magnesium helped the irregular heartbeats.) The only actual cures have come from reassuring the patient through tests that nothing is wrong, as my doctor had done. So I was now reassured. I was so reassured, and mad at myself, that the symptoms immediately stopped and have never returned. “All in my head?” Yes. But understandable.
Other problems that can have multiple or unclear causes, or treatments that are inconsistently effective, include back and neck pain, allergies, irritable bowel syndrome, chronic fatigue, Lyme disease, ADD, migraines, dry mouth, panic attacks, depression, fibromyalgia, environmental sensitivities, eczema, menstrual pain, sexual dysfunction, and of course chest pain and shortness of breath. All of these are physiological problems with organ-specific causes and cures and that can cause horrible pain and suffering, but for some people they are also greatly aggravated by fears and expectations. This is fertile ground for an HSP to be especially hard hit, for the reasons I’ve already given.
On top of that, almost all of these complex illnesses have drawn together people who have, for healthy or neurotic reasons (who can tell in an individual case), made the study and treatment of their disease a lifestyle. The internet if full of misinformation and rumor, intermingled with solid facts, new discoveries, and creative ideas for treatment from the sufferers themselves. It is especially confusing when a disease becomes a “cultural complex,” and everyone has an opinion about it. “It’s real.” “It’s all in their heads.” “The medical establishment is deliberately ignoring us.” “We doctors do our best, but some of these patients don’t even seem to want to get well.” Etc., etc., etc. The energy around the disorder in question becomes intense, at least for awhile, until things are sorted out.
So are we hypochondriacs? Technically, only when we pursue a false positive for too long. If we correct a false negative we showed admirable persistence. But it’s rarely that easy to see what is false at the time. So I hope by now you can appreciate that for an HSP especially, few illnesses are either entirely “in your head” or entirely free of psychological influence. At one time or another, every HSP has probably fit the Mayo Clinic’s definition of hypochondria:
- “Excessive fear or anxiety about having a particular disease or condition
- Worry that minor symptoms mean you have a serious illness
- Seeking repeated medical exams or consultations
- “Doctor shopping,” or frequently switching doctors
- Frustration with doctors or medical care
- Strained social relationships
- Obsessive health research
- Emotional distress
- Frequent checking of your body for problems, such as lumps or sores
- Frequent checking of vital signs, such as pulse or blood pressure
- Inability to be reassured by medical exams
- Thinking you have a disease after reading or hearing about it
- Avoidance of situations that make you feel anxious, such as being in a hospital”
After my experience with a heart problem that was “all in my head”–and a back problem that was not when I was told it was–here’s my wish. I wish that all of us, doctors included, could avoid this “either-or” outlook on symptoms that are hard to diagnose or treat. Why can’t a doctor (or a doctor dedicated to helping HSPs) view things holistically and get a thorough history of a person’s other illnesses and stressors, get to know their temperament, listen carefully to how the problem began and when the symptoms occur, and then discuss a wide range of potential causes, including it being psychosomatic (involving mind and body together)? Such a doctor would test very thoroughly and have a lot of knowledge and experience about what the tests mean. She should then take a collaborative approach, urging that together we be open to all possibilities and try various hypotheses in the order of their likelihood. “We’ll start by assuming it’s this and try this treatment. If that doesn’t work, let’s try hypothesis B.”
When this doctor is suspecting a hypothesis that your fears or misinformation may be playing a heavy role, he should be open about this and never condescending. Maybe he would share with you a time when he had symptoms that were similarly influenced by thoughts and feelings. Then if that were the case, you could just feel relieved, not also ashamed.
Some doctors sincerely try to do some of this, but no doctor can do all of it. It would take a lifetime to study any single patient that well, much less conduct a treatment that included healing the effect of past psychological stressors. But you have been studying yourself for a lifetime, and together with the rare holistic doctor, the two of you may be able to come close. If you have experienced a great deal of trauma in the past, perhaps you’ll need to add a psychotherapist to the team, because we know HSPs are more affected by this, and that deep stress of this sort always affects health and how vulnerable you are to a given illness, from migraines to allergies. Too often the suggestion that you see a psychotherapist about your illness sounds, to all involved, that it is after all, “just in your head.” But again, our brain is in our head, and our head is at the top of the body, sending out constant messages. For an HSP to leave out the experiences stored there in memory, especially if we know them to have been very stressful, would be strange indeed.
In parting, may every suggestion be a good one, every placebo have a permanent effect, and every illness be your teacher. Know that as an HSP you can take especially good care of yourself if you do not mind being called a hypochondriac for your thoroughness, and sometimes finding out you have been just that. If so, there’s no shame in an occasional false positive. Everyone seeking the truth will make them.