Have You Been Medically Hexed? The Power of Words to Heal and to Harm

I want to start with a story that has really stuck with me. Over 35 years ago, a pregnant woman came to me, and she was clearly carrying a burden. She'd been to her obstetrician for a prenatal checkup, and he, during a routine pelvic exam in the first trimester – which, by the way, isn't always necessary for healthy pregnancies that early on – told her, based on her slight build, around 5'2″, and her husband's 6'2″ height, that she'd “never be able to push that baby out” and would need a cesarean. Now, that's not a legitimate prognosis, right? You can’t assess someone's ability to birth vaginally in the first trimester based on those parameters.

Fortunately, her intuition kicked in. She switched to me, a midwife, and prepared for a home birth. She really found her power and confidence throughout her pregnancy. She had a beautiful labor, progressing smoothly, overnight and into the early morning hours. But just before her baby's head emerged, she froze, terrified, and whispered, “Is this baby too big for me to get out?” That seed of doubt, planted by an authority figure, had lingered throughout her pregnancy.

I immediately reassured her that her baby’s head was well on its way out – crowning in fact – with plenty of room, and that she could toss that concern away forever. Then, with one more gentle deep breath and spontaneous push, her beautiful boy was born. A few days after the birth we discussed how she’d been secretly and not even fully consciously burdened by this worrisome seed of doubt planted deeply in her psyche, by an authority figure, for her entire pregnancy.

But imagine if she'd been in a hospital with that obstetrician. It makes you wonder, doesn't it? Could these negative beliefs, this “medical hexing,” be contributing to our alarmingly high national cesarean section rate of 32 percent than has been acknowledged and studied. And it’s not just in obstetrics that women hear similarly discouraging and disparaging comments about their bodies, health, and healing potential – negative messaging is rampant in medical care. 

Hey everyone, and welcome back to On Health for Women. Today, we're diving into something that's been on my mind for a long time, something I've seen play out in the lives of so many women who reach out to me about their experiences receiving healthcare – and in the wider world of medicine. It’s the power of words, and how they can both heal and harm. Are we, in a way, being medically hexed?

The Power of Words to Heal and to Harm

Words are among the most powerful healing tools we have in medicine. They can inspire hope, inform and empower you, catalyze healing, and offer comfort. But as Bernard Lown, MD said, “…words, like a two-edged sword, can maim as well as heal.”  Words, used without care, can instill fear, create doubt, and perpetuate suffering. And, as you'll learn, they may even have an impact on our health outcomes. 

This power of language and belief in shaping health outcomes raises an urgent question: Are we being medically hexed? At first glance, the idea of medical hexing may sound far-fetched or ‘woowoo,’ but as we dive deeper into the neurobiological, psychological, and cultural aspects of healthcare, it becomes clear that this phenomenon is not only real, but scientifically validated. From the nocebo effect – the harm caused by negative expectations – to the entrenched power dynamics between doctors and patients, it’s clear that the words and beliefs surrounding health can have profound consequences.

This (episode/article) asks us to take a bold look at the messages we receive about our health and ask whether they could be – unwittingly or intentionally – disempowering us. And while it explores the risks, it also offers a path forward: how to break the spell and reclaim our power.

The Placebo Effect: The Power of Positive Thinking

The best place to begin to understand medical hexing is with the opposite: the placebo effect, which you’ve likely heard of. The word placebo translates literally as “I will please,” and is the phenomenon whereby the positive belief in a treatment or substance to improve health, alleviate a symptom, or cause a positive outcome, is associated with an improvement in health related to that intervention.

The placebo effect is well-established and well-studied. Thousands of scientific papers demonstrate its existence. In fact, about 30 percent of the positive outcomes seen in clinical trials are thought to be due to the placebo effect. That’s why in medical research, the placebo-controlled study is the gold standard for demonstrating the effectiveness of an intervention. To be considered effective, a treatment or medication must have an effect greater than the placebo, usually an inert substance or sham treatment that in some way mimics the actual treatment.

Studies that demonstrate the power and pervasiveness of the placebo effect are many and varied – from sham open heart surgery in which patients who underwent a surgical incision to the chest but had no procedure demonstrated the benefits that were expected with the actual surgery, to reduced pain with analgesia when the patient is told “this will not hurt much.”

The Nocebo Effect: Medical Hexing in Action

The nocebo effect has sometimes been called “the evil twin” of the placebo effect. Though not as robustly studied as it’s more famous ‘sibling’, there is a wealth of research on its impact.

I refer to the nocebo effect as medical hexing. In fact, some of the earliest research on the nocebo effect was inspired by the phenomenon of voodoo ‘curses.’

Voodoo (or voodon, as it is called in Haiti) is just one of many spiritual belief systems and forms of practice that can be found around the world, rooted in the deep belief that an external power, deity, or authority has profound power over our consciousness and health, enough so that it can cause illness and death simply by believing it will.  

In the 1940s, Harvard Researcher Walter Cannon (a major force in the research behind the adrenal stress response) proposed a scientific explanation for the seemingly “magical” phenomenon of “voodoo death” – sudden, unexplained death resulting from a voodoo curse – suggested that the mere fear of death could, through physiological response mechanisms initiated by fear, cause death itself. 

Soon after, in 1961, Harvard researcher Walter Kennedy first coined the term “nocebo reaction” to describe negative health effects that occur as a result of the expectation that they will. The term nocebo means “I will harm,” and simply put, could be summarized as ‘If you believe harm will happen, it appears to increase your risk that it will.' 

The nocebo effect is a neurobiological phenomenon tied to the perception or anticipation of harm. As neuroscientist Robert Hahn, author of the article The Nocebo Phenomenon, says, “Beliefs and expectations are not only conscious, logical phenomena, they also have physical consequences.” 

The nocebo effect can arise in various ways. In some cases, negative expectations are created by prior experiences – if we had a bad experience with a treatment in the past, that can influence how we respond in the present through conditioning. This is why people with cancer who are being treated with chemotherapy sometimes experience nausea when they enter the room even before they get hooked up to the IV. 

But, in clinical settings, the nocebo effect is often induced by a health care provider verbally setting up a negative expectation. For example, in a 2010 study involving women in labor receiving epidural anesthesia, researchers found that the way the anesthetic was described significantly impacted the women’s perception of pain. Some women were told, “We are going to give you a local anesthetic that will numb the area, and you will be comfortable during the procedure.” Others were warned, “You are going to feel a big bee sting; this is the worst part of the procedure.” The women who were warned about the “bee sting” and “worst” part reported feeling more pain. In contrast, those given a more positive and reassuring description experienced less pain. This example underscores how language and framing can profoundly influence physical sensations and outcomes.

One dramatic example of the nocebo effect was seen in a study in the 1990s when researchers discovered that women who believed that they were prone to heart disease were almost four times as likely to die of heart disease as women with similar risk factors who didn't have this belief. This was regardless of their age, blood pressure, weight, and cholesterol levels. What did they share? The belief that they were likely to get sick. 

The nocebo effect is the part of the reason that people often report more side effects from a treatment when they’ve been told what side effects to expect – or even experience side effects when they haven’t even received an active drug. For example, in a 2003 study of beta-blockers, among patients told that side effects might include erectile dysfunction, there were twice as many patients reporting this problem compared with those not given information about ED risk. A 2022 review of clinical trials found that 29 percent of people reported having fatigue and 27 percent reported a headache after being given a placebo (inactive) coronavirus vaccine.

Frighteningly, the effect also appears to sometimes become “contagious.” In a study done at a university in the UK, a group of students was instructed to inhale a sample of air, which they were told contained a “suspected environmental toxin” that could cause headache, nausea, itchy skin and drowsiness. Half of the students then watched a woman inhale a sample of this air, after which she immediately appeared to exhibit those symptoms. While the sample contained regular, run-of-the-mill, uncontaminated air, students who then inhaled the air were more likely to develop these same symptoms, particularly women who had seen another student inhale it and show symptoms!

Sticks and Stones May Break Our Bones, But Words Can Also Harm

The nocebo effect is, often unwittingly, imposed on patients by doctors in the form of direct statements that are commonly inherent to the communication style and facts that doctors have been taught. For example, doctors will often say, “This is because you’re a women, and you’ll just have to get used to it,” when discussing a condition like endometriosis, period pain, menopausal symptoms, and more, or, “Why are you using herbal remedies – those things never work,” when discussing unconventional approaches. Fixed labels, such as designations like “high risk” or “advanced maternal age” for childbearing women, can have a nocebo effect by planting the suggestion of risks that may not apply to the individual. Even indirect verbal cues, for example, a condescending verbal tone, and indirect non-verbal cues, like a dismissive shrug of the shoulder or even a subtle eye-roll or eyebrow raise, may have a nocebo effect.

The greater the power differential between the person making the statement or facial expression, and the person receiving it, the greater the nocebo effect may be. And in our culture, we have been deeply acculturated to believe that medical doctors have a tremendous level of not only knowledge, but authority. The “Doctor as God” phenomenon is well recognized and goes far back in the history of medicine. We too often inadvertently (and culturally) hand over a staggering amount of power to physicians – all the more so when we are in a medical exam setting, or are concerned about a possible diagnosis, which accentuates the power differential: We’re in an exam gown, butt naked in the back while the doctor is clothed; we address the doctor with a title, while we’re addressed often by our first name, unless we’re elderly, then as Mr. or Mrs, and we feel vulnerable – even scared. 

Our risk of nocebo effects is even higher when we feel at risk, because we are more open to negative suggestions, vague communications, and misunderstandings. Why? All of us, when we are in an extreme situation or we feel exceptionally vulnerable go into a semi-trancelike state that makes us even more susceptible to the power of unclear communication, imposed doubt about our health and body, and negative suggestions.There may also be gender differences in response. A 2017 systematic review concludes that “males responded more strongly to placebo treatment, and females responded more strongly to nocebo treatment.”

Here are just a few ways medical hexing commonly show up: 

• Negative Prognoses: When healthcare providers say, “You’ll never recover fully,” or “You’ll have to live with this condition,” it plants a seed of doubt and fear. This can lead to the nocebo effect – where negative expectations worsen outcomes.
• Overemphasis on Disease: Conventional medicine often focuses on diagnosing and treating pathology rather than fostering health. This can lead to people over-identifying with their diagnosis, viewing it as their destiny rather than one piece of their overall story.
• Disempowering Language: Phrases like “Your body is failing you,” “You’re too old for this to change,” or “You’ll need this medication forever” can strip people of agency and hope.
• Fear-Based Messaging: Whether it’s from pharmaceutical companies, wellness influencers or brands, or health or medical practitioners, fear-driven language can cause people to feel inadequate, at fault,  and overwhelmed – and doomed – if they don’t ‘comply’ with certain protocols or purchase specific products.

Sadly, since the medical model is steeped in fear-based communication, there’s a good chance that you – or someone you love – has experienced, or will experience, some level of medical hexing, at some time. As stated in an article in the American Journal of Bioethics in 2012, “The physician’s words not only describe reality, but they modify and create reality.” It’s not just sticks and stones that can break our bones. Words can harm too. 

The Neurobiology of the Nocebo Effect

The power of words is not just metaphorical; it’s hard-wired into our neurobiology. The areas of the brain that process language are deeply intertwined with the systems that regulate our internal organs, our stress responses, and even our immune system. Words can influence how fast or slow your heart beats, the amount of glucose, adrenaline, and cortisol entering your bloodstream, and the immunoglobulins supporting your immune function. The words we hear and internalize directly shape our physiological state – often without our conscious awareness. This makes communication not just a tool for connection, but also a profound mechanism for regulating health.

The impact of both the placebo effect and the nocebo effect is visible using PET scans of the brain. The placebo effect increases dopamine and opioid activity, to name just a couple of the changes, leading to a sense of well-being and pain alleviation, whereas the nocebo response is associated with both reduced dopamine and opioids, and a sense of dread and, depending on the setting, increased perception of pain. 

Also impacted are the adrenal stress response system leading to changes in cortisol production, the immune system, and the cardiovascular system, including changes in blood pressure and heart rate. The neurobiologic and physiological bases for the nocebo effect are actively being explored and likely have to do with various aspects of individual programming, from past perceived negative medical experiences, even going back the being an infant and receiving repeated ‘sticks’ for lab work, to adult medical trauma, to historical programming (i.e., fear of medical treatment based on historical evidence of medical harms as in the Tuskegee experiments) to activation of the HPA Axis (the stress response) which is very common in chronic illnesses. 

These can all impact the brain in such a way as to cause us to lean in a direction known as ‘negativity bias’ that may impact us in complex ways. As a result we may experience: 

• Stress and Hormonal Disruption: Fear activates our stress response, leading to inflammation, hormonal imbalances, and suppressed immune function.
• Loss of Self-Trust: We stop listening to our intuition and natural rhythms, becoming overly reliant on external systems rather than cultivating inner knowing.
• Discouragement: Believing we’re doomed can cause us to stop pursuing lifestyle changes or integrative strategies that could genuinely help. 

The Complexity of Chronic Illness

The placebo effect and the nocebo effect illustrate how the mind can influence physical health, but I want to emphasize that this is nuanced. For many individuals, especially women, the suggestion, prevalent in the wellness world, that one can “think themselves sick” or, conversely, that positive thinking alone can cure illness, can also cause harm. These oversimplifications can diminish the very real struggles of those living with complex, mutlifactorial conditions such as ME/CFS, endometriosis, PCOS, chronic Lyme disease, depression, and anxiety, to name just a few. 

Women, in particular, have historically faced dismissal or minimization of their symptoms and conditions, with phrases like “it’s all in your head” weaponized to invalidate their lived experiences. Many of the patients who reach out to me have already long struggled with thinking they were doing something wrong that caused or perpetuated their symptoms or condition, while simultaneously, the burden of long-term symptoms has created a sense of disconnection from their previous, healthier selves. It’s important to avoid language that implies blame or suggests that mindset alone is cause of illness, or the key to recovery, as this can perpetuate stigma and discourage women from seeking needed care.

At the same time, it’s worth exploring how external factors, such as diagnostic labels and health care providers' words, shape our experience of illness – and our beliefs in our ability to heal, or find hope and optimism and wholeness within the context of an ongoing health concern.

Protecting Yourself from the Nocebo Effect: The Role of Mindset 

Importantly, we have to break the spell of seeing doctors as gods, as having greater power over, or wisdom about our bodies, than we do. It’s an illusion based on centuries of medical hegemony, not truth. Medicine is not infallible. Guidelines are not set in stone. Prognoses are not divine. And doctors are not gods. Let’s stop giving over our power as if they are, and instead work in healing collaborations. We’re all just human.

So how can you start to do this? 

In their book The Nocebo Effect, researchers Michael H. Bernstein, Charlotte Blease, Cosima Locher, and Walter A. Brown urge individuals to protect themselves from the nocebo effect by remembering that doctors have a limited arena of expertise. “First, remind yourself that you are the expert on who you are, not the doctor,” they write. “They may be an authority on how a certain condition affects a certain group, but they truly do not know you. And they cannot know your future. Even if the practitioner is a clinician whom you admire, if they are casting negative comments inadvertently, say to yourself as they speak, ‘You don’t know me.’”

And here’s an important point we don’t always give ourselves permission to do: If your doctor is consistently negative, find a new one. You have the right to a provider with both a healing attitude within the context of being honest, direct, and giving you the whole picture and all the facts you need to make the best decisions for yourself. In fact, trusting a doctor is considered to generate positive placebo effects. So, if your doctor isn’t instilling a sense of trust, or your doctor is instilling a negative belief about your ability to heal, either have the courageous conversation that you need with him or her to be more uplifting, healing, and supportive, or change practitioners. This nocebo stuff is no joke and staying in a bad relationship just to be polite is not in your best interest. It can, in fact, be deadly. And a trusting one can be therapeutic on many levels.

Reclaiming Your Power

In order to reclaim our power, we must develop a sense of health self-efficacy and agency.

Your health journey is yours, and you’re an active participant in it. Learn to ask questions, seek clarity, and trust your instincts. When you make decisions that feel aligned with your values and needs, you’re fostering a sense of self-reliance and resilience that strengthens your ability to navigate challenges.

The medical profession, from which most of the healing and disease beliefs we have been instilled with since childhood arise, has led us to believe that our bodies are lemons or machines that are going to chronically break down, that disease is inevitable, that the only ‘real solutions’ and ‘right answers’ are pharmaceuticals, surgery and other potentially invasive interventions, and that science always trumps nature. We do not, as a culture, hold and nourish the belief that the body has an innate healing capacity, and that we can enhance and support, or dampen and destroy this capacity, with our thoughts, feelings, and beliefs. 

Yet the science on the placebo effect and the nocebo effect leaves no doubt that this is the case. 

A quote that I often share with my patients, because I have seen the incredible healing capacity of the body, women’s power to give birth, goes like this: 

Your body has the capacity to heal beyond what you’ve ever been led to believe.

Digest that for a minute. Turn it over in your mind. Let it sink into your being. It’s a powerful dose of medicine you can give to yourself every day, whatever the healing journey you’re on.