When the Prophet (صلى الله عليه وسلم) used to enter upon the ill when visiting them he would say: “Don’t worry, it is purification, if Allāh wills.” So he entered upon a bedouin that he was visiting and said to him: “Don’t worry, it is purification, if Allāh wills.” But the bedouin replied: “You said purification? Rather, it is a fever that boils within a man and sends him to the graves.” So the Prophet (صلى الله عليه وسلم) said: “Then yes, it is (as you think it to be).”

Meaning, he did not accept the [element of] purification in the fever, and he spoke of his fever in the way he informed about it from his own self, so that which he chose for himself is what happened to him.

Its meaning is: If you refuse [that it is but purification], then, yes, meaning, it will be as you think it to be.

Emotions have a great effect on weakening a person. So sometimes the healthy person might think he is ill and thus becomes ill. And sometimes a person ignores illness while he is ill and he becomes healthy. Thus, the soul being emotionally affected by something has a far-reaching effect.

Nocebo: The psychologic induction of pain^[6]

More than two-thirds of an unselected sample of 34 college students reported mild headaches when told that a (nonexistent) electric current was passing through their heads. These reports appeared independent of whether the instructions emphasized the headache-producing effect of the current or whether the emphasis was on a perceptual task, with headache as only a possible side effect. The results are consistent with a view of pain as localized stress. They provide additional grounds for the suspicion that clinical focusing on pain may itself be a cause of pain.

Psychogenic Illnesses^[7]

The mind’s unfortunate ability to cause suffering is well established, and this phenomenon lies at the heart of the nocebo effect. One such example, known as “The June Bug,” occurred in a textile factory in the United States in the early 1960s. Many employees began to feel dizzy and had an upset stomach. Some people vomited. Rumors of a mysterious bug that was biting employees began to circulate, and eventually sixty-two people who worked at the factory became ill. So what were these mysterious bugs? According to experts, they were nothing—literally. The CDC investigated this outbreak, but no bugs or any other cause of the illnesses could be identified. It instead appears to have been a case of what has often been labeled “mass hysteria,” though it is now called psychogenic illness.

Objective: This study explores the hypothesis that cognitive expectations of catching influenza-like symptoms increase the chances of developing the symptoms over the winter season.

Design: Self-reported data from 247 healthy volunteers were obtained twice, before and after the winter season. In the first assessment, expectations about developing influenza-like symptoms in the incoming months were charted. This data was matched with a post-winter assessment of the actual development of the symptoms.

Results: The odds of developing symptoms were highly associated with the expectations declared months before (OR = 1.776), and the association remained stable (OR = 1.453) even when accounting for previous influenza-like illnesses and the perception of general health. In contrast with previous findings, perceived stress was not associated with symptom development.

Conclusions: These results support the hypothesis of a self-fulfilling prophecy mechanism related to influenza-like symptoms.

The term nocebo effect refers to the harmful outcomes that result from people's negative beliefs, anticipations, or experiences related to the treatment rather than the pharmacological properties of the treatment. These outcomes may include a worsening of symptoms, a lack of expected improvement, or adverse events, and they may occur after the active treatment and the placebo that is supposed to imitate it. The nocebo effect is always unwanted and may distort estimates of treatment effectiveness and safety; moreover, it may cause discontinuation of therapy or withdrawal from a trial. The nocebo effect may be unintentionally evoked by the explanations given by healthcare professionals during a clinical consultation or consent procedures, or by information from other patients, the media, or the Internet.

The role of psychological mechanisms in the treatment process cannot be underestimated, the well-known placebo effect unquestionably being a factor in treatment. However, there is also a dark side to the impact of mental processes on health/illness as exemplified by the nocebo effect. This phenomenon includes the emergence or exacerbation of negative symptoms associated with the therapy, but arising as a result of the patient's expectations, rather than being an actual complication of treatment. The exact biological mechanisms of this process are not known, but cholecystokinergic and dopaminergic systems, changes in the HPA axis, and the endogenous secretion of opioids are thought to be involved. The nocebo effect can affect a significant proportion of people undergoing treatment, including cancer patients, leading in some cases to the cessation of potentially effective therapy, because of adverse effects that are not actually part of the biological effect of treatment. In extreme cases, as a result of suggestions and expectations, a paradoxical effect, biologically opposite to the mechanism of the action of the drug, may occur. In addition, the nocebo effect may significantly interfere with the results of clinical trials, being the cause of a significant proportion of complications reported. Knowledge of the phenomenon is thus necessary in order to facilitate its minimalization and thus improve the quality of life of patients and the effectiveness of treatment.

A growing body of evidence is emerging for a phenomenon known as the nocebo effect. This is when a person is conditioned to expect a negative response, or to anticipate negative effects from an experience. These findings highlight the importantance of effective communication with patients and the influence that good anxiety and pain management control can have in improving treatment outcomes. The placebo effect has been widely researched, but new studies have shown that nocebo can have a greater effect than placebo The nocebo effect is prevalent in interactions between patients and healthcare workers. Research has demonstrated that if a patient deems a healthcare professional not to understand or believe them, this can cause distress, and the physiological effect can reduce the prognosis of treatment. It has also been demonstrated that patients who are anxious or expect pain during a procedure, feel more pain because of this negative expectation.

The nocebo effect, the inverse of the placebo effect, is a well-established phenomenon, yet under-appreciated. It refers to nonpharmacological, harmful, or undesirable effects occurring after active or inactive therapy. The frequency of adverse events can dramatically increase by informing patients about the possible side effects of the treatment, and by negative expectations on the part of the patient. Patients who were told that they might experience sexual side effects after treatment with β-blocker drugs reported these symptoms between three and four times more often than patients in a control group who were not informed about these symptoms. Nocebo effect has been reported in several neurological diseases such as migraine, epilepsy, multiple sclerosis, Parkinson's disease and neuropathic pain, and in patients with depression. The investigation of the biological and theoretical underpinning of the nocebo phenomenon is at an early stage, and more research is required. Physicians need to be aware of the influence of nocebo phenomenon and be able to recognize it and minimize its effects.