# Nocebo Viral Epidemic

If one had sufficient control of the correct institutions, how difficult would it be to create a "pandemic" that is simply a result of the nocebo effect? In other words, can the nocebo effect have such far-flung consequences as described below?

For example (this may not be completely accurate, just something from a biology noob), let's assume that one entity controlled all sample testing locations and decided to return a result for 90% of people with the flu or some common disease saying that have Virus. Let us also assume that there is a paper published about VirusX saying that it has CommonDisease-esque symptoms but more serious and deadlier. Would it be possible to enough people display the nocebo symptoms that it becomes newsworthy, causing people to unexpectedly come down with "VirusX" even though this is just the nocebo effect?

Just to clarify, I do not think Covid-19 is fake. For anyone who does, I would highly recommend a visit to the CDC's or the WHO's website to convince yourself otherwise. This is simply a thought experiment to help better understand the implications of the nocebo effect.

• Welcome to psych.SE. I am concerned that this question may be soliciting opinion-based answers, which is discouraged on this forum. If it can be modified so as to ask a question that can be answered with available evidence from experiments that can reasonably and ethically have been conducted, then that would be better. For example, a question about the known power of the nocebo effect. – Arnon Weinberg May 24 at 20:29
• @ArnonWeinberg I mean to ask about the known power of the nocebo effect; I'm trying to ask it it has a certain level of power based on conducted experiments. How would I phrase this question (sorry, english isn't my first language) – qag54938bcaoo May 24 at 22:53

A historical example of what you describe is the 14-17th centuries "dancing manias" where hundred of people would start dancing to exhaustion for no apparent reasons. Sometimes causing death. There are many case studies of mass psychogenic illness, you'll find examples in the wikipedia page of this topic. Note that this is typically the default diagnostic: because there seem to be no biological cause for the mass illness, it is assumed to be of psychogenic cause.

I've also found 1 paper testing this question explicitly (ref below). They brought groups of participants to a research center supposedly "to test the side effects of a new carrier compound for an antiviral medication", a placebo participants had to ingest. In a "Pill" group actors feigned to feel suddenly sick with flu-like symptoms. In a "Pill+Media" group participants also then viewed a 1h long documentary on the 1918 flu epidemics. Both groups were compared to "control" group without pills, without actors, without the documentary. Experimenters assessed the participants well-being in different ways, both physiological and psychological. They found far more reported symptoms (by a factor of 11) in the 2 experimental groups than the control group, but not more in the Pill+Media than the Pill alone group. They also found no difference in the physiological variables between groups (heart rate and blood pressure). It's a hard experiment to conduct and it seems reasonably well done (although I'm admittedly not very knowledgeable in social psychology). It suggests that it is quite easy to induce psychogenic symptoms in an otherwise healthy population. However medias didn't seem to increase the effect (at least a documentary about a 100 years old epidemics, and at such a short term) and there seem to be no physiological effects of the nocebo stimulus (again, at least at such a short term).

https://en.wikipedia.org/wiki/Dancing_mania

https://en.wikipedia.org/wiki/Mass_psychogenic_illness

Broderick, J. E., Kaplan-Liss, E., & Bass, E. (2011). Experimental induction of psychogenic illness in the context of a medical event and media exposure. American journal of disaster medicine, 6(3), 163.

• Thank you! I wonder if the reason the Pill+Media group did not exhibit more symptoms was because the Media was not about that pill in particular, but rather about a (semi)unrelated disease. Media seems to check all the boxes for nocebo so I wonder if, given relevant media, it may be significantly more effective. My question was also touching upon something like the (fake?) 5 monkey experiment. Given enough space (ie. the original media doesn't disseminate everywhere), can the nocebo effect be contagious to beyond the original actors? – qag54938bcaoo May 27 at 20:09
• Oh man. I work with monkeys, I can tell there is no way this experiment has actually been done. At least not the way it is described. There are 2 examples that come to my mind regarding the disseminating role of medias (1) Orson Welles "War of the Worlds" radio prank, although it is contested whether it created the panic originally reported. (2) The recent "sonic" attacks in US embassy in Cuba. I've read that cases in other embassies are suspected to be most likely psychogenic. But it's hard to know if it's true or not. – baca May 27 at 20:24
• I don't want to be too critical because I think the authors have done quite a good job on a very difficult experiment. They are also explicit about the limitations of their own study. I don't see how you could conduct a larger scale experiment ethically. But it would have been nice if they had had a slightly better media (like "fake news" reports), as well as a Media only group. Maybe it was prevented as too realistic by their IRB (ethics committee). Also an epidemics in 2011 seemed quite far-fetched to most people. – baca May 27 at 20:33
• Of course. Given the considerations, the experiment seems very well done. I can't comment on (2), although it seems to be closer to the above question. Regarding (1), that's not really nocebo effect because it is just people telling others that Martians are invading. It's not psychogenic in nature to the best of my understanding. Given that you work with monkeys, if the 5 monkeys experiment or something similar were to happen, what would you predict would happen? Would you expect similar results? – qag54938bcaoo May 27 at 20:47
• Speaking for macaques (but I would expect the same for chimps). 1st good luck making monkeys understand the contingency between 1 monkey getting the banana and the others getting doused. It typically takes days or weeks to train them to understand something as simple as pressing a button for juice. 2nd you would typically see the dominant monkey go get the banana, and you never see other monkeys team up against him. If they did, he would then pick them up one by one and absolutely destroy them. Other monkeys would probably join him too hoping it would calm him and they would not be next. – baca May 27 at 22:43