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<!DOCTYPE html> <html class="is-article-page js-is-ios hegvcfup idc0_340 single-file-cut-mode" style lang=nl-NL><!--
Page saved with SingleFile
url: https://www.trouw.nl/editie/20220528/als-de-woorden-van-de-arts-je-ziek-maken~bcb315da/
saved date: Mon May 30 2022 12:50:13 GMT+0200 (Central European Summer Time)
--><meta charset=utf-8><meta http-equiv=x-ua-compatible content="ie=edge"><meta name=viewport content="width=device-width,initial-scale=1,viewport-fit=cover"><title>‘U zal ermee moeten leren leven’, wat als de woorden van de arts je ziek maken? </title><meta property=article:published_time content=2022-05-29T10:45+02:00><meta property=article:author content="Sofie Rozendaal"><meta property=article:tag content=gezondheid><meta property=article:tag content=ziekten><meta property=article:tag content="Sofie Rozendaal"><meta property=article:tag content=MRI><meta property=article:tag content="Andrea Evers"><meta property=article:tag content="Ambroise Paré"><meta property=article:tag content="Beth Isreal Deaconess Medical Center"><meta property=article:tag content=Boston><meta name=description content="Wat een arts tegen je zegt, en hoe, dóet ertoe, ervoer Sofie Rozendaal. Je kunt daadwerkelijk ziek worden door de verkeerde woorden. Hoe werkt dat?"><meta name=twitter:card content=summary_large_image><meta name=twitter:title content="‘U zal ermee moeten leren leven’, wat als de woorden van de arts je ziek maken?"><meta name=twitter:description content="Wat een arts tegen je zegt, en hoe, dóet ertoe, ervoer Sofie Rozendaal. Je kunt daadwerkelijk ziek worden door de verkeerde woorden. Hoe werkt dat?"><meta name=twitter:image content="https://images0.persgroep.net/rcs/bI0kYr2SGBAoY6x3sz_V6x-y5Qo/diocontent/216773730/_fitwidth/763?appId=93a17a8fd81db0de025c8abd1cca1279&quality=0.8"><meta property=og:type content=article><meta property=og:site_name content=Trouw><meta property=og:locale content=nl_NL><meta property=og:title content="‘U zal ermee moeten leren leven’, wat als de woorden van de arts je ziek maken?"><meta property=og:description content="Wat een arts tegen je zegt, en hoe, dóet ertoe, ervoer Sofie Rozendaal. Je kunt daadwerkelijk ziek worden door de verkeerde woorden. Hoe werkt dat?"><meta property=og:url content=https://www.trouw.nl/gs-bcb315da><meta property=og:image content="https://images0.persgroep.net/rcs/bI0kYr2SGBAoY6x3sz_V6x-y5Qo/diocontent/216773730/_fitwidth/763?appId=93a17a8fd81db0de025c8abd1cca1279&quality=0.8"><meta name=robots content=noarchive><meta name=robots content=noindex><meta name=robots content="max-snippet:-1, max-image-preview:large, max-video-preview:-1"><link rel=icon type=image/png 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" sizes=196x196><meta http-equiv=content-security-policy content="default-src 'none'; font-src 'self' data:; img-src 'self' data:; style-src 'unsafe-inline'; media-src 'self' data:; script-src 'unsafe-inline' data:;"><style>
/* This Source Code Form is subject to the terms of the Mozilla Public
* License, v. 2.0. If a copy of the MPL was not distributed with this file,
* You can obtain one at http://mozilla.org/MPL/2.0/. */
/* Avoid adding ID selector rules in this style sheet, since they could
* inadvertently match elements in the article content. */
:root {
--body-padding: 64px;
--popup-border: rgba(0, 0, 0, 0.12);
--opaque-popup-border: #e0e0e0;
--popup-shadow: rgba(49, 49, 49, 0.3);
--grey-90-a10: rgba(12, 12, 13, 0.1);
--grey-90-a20: rgba(12, 12, 13, 0.2);
--grey-90-a30: rgba(12, 12, 13, 0.3);
--grey-90-a80: rgba(12, 12, 13, 0.8);
--grey-30: #d7d7db;
--blue-40: #45a1ff;
--blue-40-a30: rgba(69, 161, 255, 0.3);
--blue-60: #0060df;
--active-color: #0B83FF;
--font-size: 12;
--content-width: 30em;
--line-height: 1.6em;
--tooltip-background: var(--grey-90-a80);
--tooltip-foreground: white;
--toolbar-button-hover: var(--grey-90-a10);
--toolbar-button-active: var(--grey-90-a20);
}
body {
--main-background: #fff;
--main-foreground: #333;
--toolbar-border: var(--grey-90-a20);
--toolbar-box-shadow: var(--grey-90-a10);
--popup-button-hover: hsla(0,0%,70%,.4);
--popup-button-active: hsla(240,5%,5%,.15);
--popup-bgcolor: white;
--popup-button: #edecf0;
--selected-background: var(--blue-40-a30);
--selected-border: var(--blue-40);
--popup-line: var(--grey-30);
--font-value-border: var(--grey-30);
--font-color: #000000;
--icon-fill: #3b3b3c;
--icon-disabled-fill: #8080807F;
--link-foreground: var(--blue-60);
--link-selected-foreground: #333;
--visited-link-foreground: #b5007f;
/* light colours */
}
body.sepia {
--main-background: #f4ecd8;
--main-foreground: #5b4636;
--toolbar-border: #5b4636;
}
body.dark {
--main-background: rgb(28, 27, 34);
--main-foreground: #eee;
--toolbar-border: #4a4a4b;
--toolbar-box-shadow: black;
--toolbar-button-hover: var(--grey-90-a30);
--toolbar-button-active: var(--grey-90-a80);
--popup-button-active: hsla(0,0%,70%,.6);
--popup-bgcolor: rgb(66,65,77);
--popup-button: #5c5c61;
--popup-line: rgb(82, 82, 94);
--selected-background: #3E6D9A;
--link-foreground: #45a1ff;
--visited-link-foreground: #e675fd;
--link-selected-foreground: #fff;
--opaque-popup-border: #434146;
--font-value-border: #656468;
--font-color: #fff;
--icon-fill: #fff;
--icon-disabled-fill: #ffffff66;
--tooltip-background: black;
--tooltip-foreground: white;
/* dark colours */
}
body {
margin: 0;
padding: var(--body-padding);
background-color: var(--main-background);
color: var(--main-foreground);
}
body.loaded {
transition: color 0.4s, background-color 0.4s;
}
body.dark *::-moz-selection {
background-color: var(--selected-background);
}
a::-moz-selection {
color: var(--link-selected-foreground);
}
body.sans-serif,
body.sans-serif .remove-button {
font-family: Helvetica, Arial, sans-serif;
}
body.serif,
body.serif .remove-button {
font-family: Georgia, "Times New Roman", serif;
}
.container {
margin: 0 auto;
font-size: var(--font-size);
max-width: var(--content-width);
line-height: var(--line-height);
}
/* Override some controls and content styles based on color scheme */
body.light > .container > .header > .domain {
border-bottom-color: #333333 !important;
}
body.sepia > .container > .header > .domain {
border-bottom-color: #5b4636 !important;
}
body.dark > .container > .header > .domain {
border-bottom-color: #eeeeee !important;
}
body.sepia > .container > .footer {
background-color: #dedad4 !important;
}
body.light blockquote {
border-inline-start: 2px solid #333333 !important;
}
body.sepia blockquote {
border-inline-start: 2px solid #5b4636 !important;
}
body.dark blockquote {
border-inline-start: 2px solid #eeeeee !important;
}
.light-button {
color: #333333;
background-color: #ffffff;
}
.dark-button {
color: #eeeeee;
background-color: #1c1b22;
}
.sepia-button {
color: #5b4636;
background-color: #f4ecd8;
}
/* Loading/error message */
.reader-message {
margin-top: 40px;
display: none;
text-align: center;
width: 100%;
font-size: 0.9em;
}
/* Detector element to see if we're at the top of the doc or not. */
.top-anchor {
position: absolute;
top: 0;
width: 0;
height: 5px;
pointer-events: none;
}
/* Header */
.header {
text-align: start;
display: none;
}
.domain {
font-size: 0.9em;
line-height: 1.48em;
padding-bottom: 4px;
font-family: Helvetica, Arial, sans-serif;
text-decoration: none;
border-bottom: 1px solid;
color: var(--link-foreground);
}
.header > h1 {
font-size: 1.6em;
line-height: 1.25em;
width: 100%;
margin: 30px 0;
padding: 0;
}
.header > .credits {
font-size: 0.9em;
line-height: 1.48em;
margin: 0 0 10px;
padding: 0;
font-style: italic;
}
.header > .meta-data {
font-size: 0.65em;
margin: 0 0 15px;
}
.reader-estimated-time {
text-align: match-parent;
}
/*======= Controls toolbar =======*/
.toolbar-container {
position: sticky;
z-index: 2;
top: 32px;
height: 0; /* take up no space, so body is at the top. */
/* As a stick container, we're positioned relative to the body. Move us to
* the edge of the viewport using margins, and take the width of
* the body padding into account for calculating our width.
*/
margin-inline-start: calc(-1 * var(--body-padding));
width: max(var(--body-padding), calc((100% - var(--content-width)) / 2 + var(--body-padding)));
font-size: var(--font-size); /* Needed to ensure em units match, is reset for .reader-controls */
}
.toolbar {
padding-block: 16px;
border: 1px solid var(--toolbar-border);
border-radius: 6px;
box-shadow: 0 2px 8px var(--toolbar-box-shadow);
width: 32px; /* basic width, without padding/border */
/* padding should be 16px, except if there's not enough space for that, in
* which case use half the available space for padding (=25% on each side).
* The 34px here is the width + borders. We use a variable because we need
* to know this size for the margin calculation.
*/
--inline-padding: min(16px, calc(25% - 0.25 * 34px));
padding-inline: var(--inline-padding);
/* Keep a maximum of 96px distance to the body, but center once the margin
* gets too small. We need to set the start margin, however...
* To center, we'd want 50% of the container, but we'd subtract half our
* own width (16px) and half the border (1px) and the inline padding.
* When the other margin would be 96px, we want 100% - 96px - the complete
* width of the actual toolbar (34px + 2 * padding)
*/
margin-inline-start: max(calc(50% - 17px - var(--inline-padding)), calc(100% - 96px - 34px - 2 * var(--inline-padding)));
font-family: Helvetica, Arial, sans-serif;
list-style: none;
user-select: none;
}
@media (prefers-reduced-motion: no-preference) {
.toolbar {
transition-property: border-color, box-shadow;
transition-duration: 250ms;
}
.toolbar .button {
transition-property: opacity;
transition-duration: 250ms;
}
.toolbar-container.scrolled .toolbar:not(:hover, :focus-within) {
border-color: transparent;
box-shadow: 0 2px 8px transparent;
}
.toolbar-container.scrolled .toolbar:not(:hover, :focus-within) .button {
opacity: 0.6;
}
.toolbar-container.transition-location {
transition-duration: 250ms;
transition-property: width;
}
}
.toolbar-container.overlaps .button {
opacity: 0.1;
}
.dropdown-open .toolbar {
border-color: transparent;
box-shadow: 0 2px 8px transparent;
}
.reader-controls {
/* We use ems above this node to get it to the right size. However,
* the UI inside the toolbar should use a fixed, smaller size. */
font-size: 11px;
}
.button {
position: relative;
width: 32px;
height: 32px;
padding: 0;
border: none;
border-radius: 4px;
margin: 4px 0;
background-color: transparent;
background-size: 16px 16px;
background-position: center;
background-repeat: no-repeat;
color: var(--font-color);
}
.button:hover,
.button:-moz-focusring {
background-color: var(--toolbar-button-hover);
}
.open .button,
.button:active {
background-color: var(--toolbar-button-active);
color: var(--active-color);
fill: var(--active-color);
}
.hover-label {
position: absolute;
top: 4px;
inset-inline-start: 36px;
line-height: 16px;
white-space: pre; /* make sure we don't wrap */
background-color: var(--tooltip-background);
color: var(--tooltip-foreground);
padding: 4px 8px;
border-radius: 2px;
visibility: hidden;
pointer-events: none;
/* Put above .dropdown .dropdown-popup, which has z-index: 1000. */
z-index: 1001;
}
/* Show the hover tooltip on non-dropdown buttons. */
.button:not(.dropdown-toggle):hover > .hover-label,
.button:not(.dropdown-toggle):-moz-focusring > .hover-label,
/* Show the hover tooltip for dropdown buttons unless its dropdown is open. */
:not(.open) > li > .dropdown-toggle:hover > .hover-label,
:not(.open) > li > .dropdown-toggle:-moz-focusring > .hover-label {
visibility: visible;
}
button {
-moz-context-properties: fill;
color: var(--font-color);
fill: var(--icon-fill);
}
button:disabled {
fill: var(--icon-disabled-fill);
}
.toolbar button::-moz-focus-inner {
border: 0;
}
.dropdown {
text-align: center;
list-style: none;
margin: 0;
padding: 0;
position: relative;
}
.dropdown li {
margin: 0;
padding: 0;
}
/*======= Popup =======*/
.dropdown .dropdown-popup {
text-align: start;
position: absolute;
inset-inline-start: 40px;
z-index: 1000;
background-color: var(--popup-bgcolor);
visibility: hidden;
border-radius: 4px;
border: 1px solid var(--popup-border);
box-shadow: 0 0px 10px 0 var(--popup-shadow);
border-bottom-width: 0;
top: 0;
}
.open > .dropdown-popup {
visibility: visible;
}
.dropdown-arrow {
position: absolute;
height: 24px;
width: 16px;
inset-inline-start: -16px;
background-image: url("chrome://global/skin/reader/RM-Type-Controls-Arrow.svg");
display: block;
-moz-context-properties: fill, stroke;
fill: var(--popup-bgcolor);
stroke: var(--opaque-popup-border);
pointer-events: none;
}
.dropdown-arrow:dir(rtl) {
transform: scaleX(-1);
}
/* Align the style dropdown arrow (narrate does its own) */
.style-dropdown .dropdown-arrow {
top: 7px;
}
/*======= Font style popup =======*/
.radio-button {
/* We visually hide these, but we keep them around so they can be focused
* and changed by interacting with them via the label, or the keyboard, or
* assistive technology.
*/
opacity: 0;
pointer-events: none;
position: absolute;
}
.radiorow,
.buttonrow {
display: flex;
}
.content-width-value,
.font-size-value,
.line-height-value {
box-sizing: border-box;
width: 36px;
height: 15px;
line-height: 15px;
display: flex;
justify-content: center;
align-content: center;
margin: auto;
border-radius: 10px;
border: 1px solid var(--font-value-border);
background-color: var(--popup-button);
}
.buttonrow > button {
border: 0;
height: 60px;
width: 90px;
background-color: transparent;
background-repeat: no-repeat;
background-position: center;
}
.buttonrow > button:enabled:hover,
.buttonrow > button:enabled:-moz-focusring {
background-color: var(--popup-button-hover);
}
.buttonrow > button:enabled:active {
background-color: var(--popup-button-active);
}
.radiorow:not(:last-child),
.buttonrow:not(:last-child) {
border-bottom: 1px solid var(--popup-line);
}
.radiorow > label {
position: relative;
box-sizing: border-box;
border-radius: 2px;
border: 2px solid var(--popup-border);
}
.radiorow > label[checked] {
border-color: var(--selected-border);
}
/* For the hover style, we draw a line under the item by means of a
* pseudo-element. Because these items are variable height, and
* because their contents are variable height, position it absolutely,
* and give it a width of 100% (the content width) + 4px for the 2 * 2px
* border width.
*/
.radiorow > input[type=radio]:-moz-focusring + label::after,
.radiorow > label:hover::after {
content: "";
display: block;
border-bottom: 2px solid var(--blue-40);
width: calc(100% + 4px);
position: absolute;
/* to skip the 2 * 2px border + 2px spacing. */
bottom: -6px;
/* Match the start of the 2px border of the element: */
inset-inline-start: -2px;
}
.color-scheme-buttons > label {
height: 34px;
width: 70px;
font-size: 12px;
/* Center the labels horizontally as well as vertically */
display: inline-flex;
align-items: center;
justify-content: center;
/* We want 10px between items, but there's no margin collapsing in flexbox. */
margin: 10px 5px;
}
.color-scheme-buttons > input:first-child + label {
margin-inline-start: 10px;
}
.color-scheme-buttons > label:last-child {
margin-inline-end: 10px;
}
.font-type-buttons > label {
height: 64px;
width: 105px;
/* Slightly more space between these items. */
margin: 10px;
/* Center the Sans-serif / Serif labels */
text-align: center;
background-size: 63px 39px;
background-repeat: no-repeat;
background-position: center 18px;
background-color: var(--popup-button);
fill: currentColor;
-moz-context-properties: fill;
/* This mostly matches baselines, but because of differences in font
* baselines between serif and sans-serif, this isn't always enough. */
line-height: 1;
padding-top: 2px;
}
.font-type-buttons > label[checked] {
background-color: var(--selected-background);
}
.sans-serif-button {
font-family: Helvetica, Arial, sans-serif;
background-image: url("chrome://global/skin/reader/RM-Sans-Serif.svg");
}
/* Tweak padding to match the baseline on mac */
:root[platform=macosx] .sans-serif-button {
padding-top: 3px;
}
.serif-button {
font-family: Georgia, "Times New Roman", serif;
background-image: url("chrome://global/skin/reader/RM-Serif.svg");
}
/*======= Toolbar icons =======*/
.close-button {
-moz-context-properties: fill;
background-image: url("chrome://global/skin/icons/close.svg");
}
.style-button {
background-image: url("chrome://global/skin/reader/RM-Type-Controls-24x24.svg");
}
.minus-button {
background-size: 18px 18px;
background-image: url("chrome://global/skin/reader/RM-Minus-24x24.svg");
}
.plus-button {
background-size: 18px 18px;
background-image: url("chrome://global/skin/reader/RM-Plus-24x24.svg");
}
.content-width-minus-button {
background-size: 42px 16px;
background-image: url("chrome://global/skin/reader/RM-Content-Width-Minus-42x16.svg");
}
.content-width-plus-button {
background-size: 44px 16px;
background-image: url("chrome://global/skin/reader/RM-Content-Width-Plus-44x16.svg");
}
.line-height-minus-button {
background-size: 34px 14px;
background-image: url("chrome://global/skin/reader/RM-Line-Height-Minus-38x14.svg");
}
.line-height-plus-button {
background-size: 34px 24px;
background-image: url("chrome://global/skin/reader/RM-Line-Height-Plus-38x24.svg");
}
/* Mirror the line height buttons if the article is RTL. */
.reader-controls[articledir="rtl"] .line-height-minus-button,
.reader-controls[articledir="rtl"] .line-height-plus-button {
transform: scaleX(-1);
}
@media print {
.toolbar {
display: none !important;
}
}
/*======= Article content =======*/
/* Note that any class names from the original article that we want to match on
* must be added to CLASSES_TO_PRESERVE in ReaderMode.jsm, so that
* Readability.js doesn't strip them out */
.moz-reader-content {
display: none;
font-size: 1em;
}
@media print {
.moz-reader-content p,
.moz-reader-content code,
.moz-reader-content pre,
.moz-reader-content blockquote,
.moz-reader-content ul,
.moz-reader-content ol,
.moz-reader-content li,
.moz-reader-content figure,
.moz-reader-content .wp-caption {
margin: 0 0 10px !important;
padding: 0 !important;
}
}
.moz-reader-content h1,
.moz-reader-content h2,
.moz-reader-content h3 {
font-weight: bold;
}
.moz-reader-content h1 {
font-size: 1.6em;
line-height: 1.25em;
}
.moz-reader-content h2 {
font-size: 1.2em;
line-height: 1.51em;
}
.moz-reader-content h3 {
font-size: 1em;
line-height: 1.66em;
}
.moz-reader-content a:link {
text-decoration: underline;
font-weight: normal;
}
.moz-reader-content a:link,
.moz-reader-content a:link:hover,
.moz-reader-content a:link:active {
color: var(--link-foreground);
}
.moz-reader-content a:visited {
color: var(--visited-link-foreground);
}
.moz-reader-content * {
max-width: 100%;
height: auto;
}
.moz-reader-content p,
.moz-reader-content p,
.moz-reader-content code,
.moz-reader-content pre,
.moz-reader-content blockquote,
.moz-reader-content ul,
.moz-reader-content ol,
.moz-reader-content li,
.moz-reader-content figure,
.moz-reader-content .wp-caption {
margin: -10px -10px 20px;
padding: 10px;
border-radius: 5px;
}
.moz-reader-content li {
margin-bottom: 0;
}
.moz-reader-content li > ul,
.moz-reader-content li > ol {
margin-bottom: -10px;
}
.moz-reader-content p > img:only-child,
.moz-reader-content p > a:only-child > img:only-child,
.moz-reader-content .wp-caption img,
.moz-reader-content figure img {
display: block;
}
.moz-reader-content img[moz-reader-center] {
margin-inline: auto;
}
.moz-reader-content .caption,
.moz-reader-content .wp-caption-text
.moz-reader-content figcaption {
font-size: 0.9em;
line-height: 1.48em;
font-style: italic;
}
.moz-reader-content code,
.moz-reader-content pre {
white-space: pre-wrap;
}
.moz-reader-content blockquote {
padding: 0;
padding-inline-start: 16px;
}
.moz-reader-content ul,
.moz-reader-content ol {
padding: 0;
}
.moz-reader-content ul {
padding-inline-start: 30px;
list-style: disc;
}
.moz-reader-content ol {
padding-inline-start: 30px;
}
table,
th,
td {
border: 1px solid currentColor;
border-collapse: collapse;
padding: 6px;
vertical-align: top;
}
table {
margin: 5px;
}
/* Visually hide (but don't display: none) screen reader elements */
.moz-reader-content .visually-hidden,
.moz-reader-content .visuallyhidden,
.moz-reader-content .sr-only {
display: inline-block;
width: 1px;
height: 1px;
margin: -1px;
overflow: hidden;
padding: 0;
border-width: 0;
}
/* Hide elements with common "hidden" class names */
.moz-reader-content .hidden,
.moz-reader-content .invisible {
display: none;
}
/* Enforce wordpress and similar emoji/smileys aren't sized to be full-width,
* see bug 1399616 for context. */
.moz-reader-content img.wp-smiley,
.moz-reader-content img.emoji {
display: inline-block;
border-width: 0;
/* height: auto is implied from .moz-reader-content * rule. */
width: 1em;
margin: 0 .07em;
padding: 0;
}
.reader-show-element {
display: initial;
}</style><body class="moz-reader-content content-width6 reader-show-element sans-serif container line-height4 dark" style="display: block; padding: 24px;"><div id=readability-page-1 class=page><section class><h3 data-element-id=6ea9-b9b8-f5c2-1a3d-ec90-25a2-7f86-3312 class>
Nocebo-effect
</h3><p data-element-id=67c2-8610-2fde-a00c-9874-596c-a277-99b5 class>
Het nocebo-effect, wat in het Latijn letterlijk betekent ‘ik zal schaden’, werd in 1961 door Walter Kennedy geïntroduceerd. Al was het vermoedelijk al veel langer bekend, want volgens een publicatie in de <i>Wiener klinische Wochenschrift</i> werd het al in de achttiende eeuw herkend binnen een medische context. Toch wordt er pas sinds de jaren negentig meer onderzoek naar gedaan. Voor die tijd werd er vooral gesproken over de positieve tegenhanger, het placebo-effect. Het is een algemeen bekend gegeven: wanneer je een goede uitkomst verwacht rond een ziekte, klacht of behandeling, is de kans groot dat je die ook gaat ervaren. Maar evenzo kunnen bij negatieve verwachtingen problemen verergeren of zelfs ontstaan. Angst is ziekmakend.
<p data-element-id=dc64-18f9-d65e-2010-13b1-22ce-52a3-8907>
Het ligt voor de hand om te denken dat het nocebo-effect tussen je oren zit, dat je klachten puur inbeelding zijn, maar uit meerdere studies blijkt inmiddels dat het ook een fysiologisch verschijnsel is. Subjectieve ervaringen en allerlei onderbewuste lichamelijke processen spelen daar een grote rol bij.
<p data-element-id=c904-ad46-f80c-a82d-af7a-e114-0130-6547>
Zo is er het voorbeeld van de massahysterie rond Belgische Coca-Cola in 1999. Via een school werd het bericht verspreid dat er kinderen ziek waren geworden door het drinken van cola, waarna de pers het oppikte en er vervolgens honderden ziekmeldingen kwamen vanuit het hele land. Een oorzaak werd echter nooit gevonden: volgens een toxicoloog was er sprake van ‘mass sociogenic illness’. Een collectieve psychosomatische reactie, ofwel het nocebo-effect.
<div data-element-id=3d5ff275-cfdb-4b3d-98eb-fc4a2ffbfb86>
</div><p data-element-id=51b6-fab9-95ce-293d-525d-b128-e921-0937 class>
Vergelijkbaar is de elektrosensitiviteit van sommige mensen door telefoonmasten en het 5G-netwerk. Tot op heden zijn er nooit schadelijke effecten gevonden, maar hoe vaker er klachten worden gemeld in de media, hoe meer klachten er worden gerapporteerd.
<p data-element-id=c07d-e584-7e9e-97dd-ef9b-4bbc-7ac1-b2c7>
Zo zijn er nog veel meer opmerkelijke voorbeelden van het nocebo-effect. Er is een studie bekend waarbij mensen met knieartrose werden onderverdeeld in twee groepen. De ene groep kreeg een echte operatie, de andere groep een nep-operatie. Beide groepen herstelden even goed. En uit zo’n vergelijkende studie van het Beth Isreal Deaconess Medical Center in Boston blijkt dat een flink deel van de gerapporteerde bijwerkingen van coronavaccins waarschijnlijk een nocebo-reactie is. In tijdschrift <i>Medical Hypotheses </i>waarschuwden Belgische artsen zelfs expliciet voor het mogelijk ziekmakende effect van afschrikwekkende plaatjes op tabaksverpakkingen, hoe effectief die ook kunnen zijn om mensen van het roken af te houden.
<p data-element-id=2f02-614f-9b9f-06b8-8e12-ae43-f1f7-6ec7>
Het mag duidelijk zijn dat het nocebo-effect allerlei klachten kan veroorzaken of verergeren. Maar hoe werkt dat dan precies?
<h3 data-element-id=bff0-56ff-dfcb-5279-30be-40ba-5082-3bca>
Onverklaarbare klachten
</h3><p data-element-id=0d24-e691-6b74-07b4-a594-bfd6-a546-43ab>
Daar is nog geen eenduidig antwoord op, zegt Peter Lucassen. Hij is gepensioneerd huisarts en onderzoeker aan het Radboud UMC, waar hij zich bezighoudt met onverklaarbare klachten. “Het nocebo-effect heeft onder andere te maken met verwachtingen, conditionering, stress en de relatie tussen behandelaar en patiënt.”
<p data-element-id=8599-3fd3-7418-3814-d63e-a698-6be2-47e4>
Bij een positieve benadering, legt hij uit, worden bepaalde hersensystemen die met pijn te maken hebben gedempt. Een proces waarbij lichaamseigen opiaten zoals endorfine en dopamine vermoedelijk een rol spelen.
<p data-element-id=1b70-0727-6a66-6675-7cda-0204-5460-573c>
Bij het nocebo-effect werkt dat echter andersom. “Negatieve verwachtingen en angst maken mensen alerter op lichamelijke sensaties. Daarbij kan een toevallige, veelvoorkomende klacht zoals duizeligheid worden geïnterpreteerd als een bijwerking van een medicijn of behandeling.” Ook negatieve ervaringen van een bekende kunnen een rol spelen, of berichten in de media.
<p data-element-id=70d5-6faa-02de-5cc6-5bc1-a776-2fc7-cfb3>
Daarnaast speelt de relatie met de arts een grote rol, weet Lucassen. “Veel mensen gaan met buikpijn naar de dokter. Negen van de tien keer wordt er geen oorzaak gevonden. Maar wanneer de arts de tijd neemt om te luisteren, goed onderzoek doet en een gevoel van vertrouwen geeft, verdwijnt de buikpijn vaak vanzelf. Als een arts amper kijkt en lomp reageert, zal er eerder een toename zijn van de klachten.’’
<p data-element-id=3875-bea9-7026-85f9-9b13-e429-8bdf-15ef>
Lucassen hield daar altijd rekening mee, zegt hij. Hoewel patiënten vanzelfsprekend recht hebben op de juiste informatie, zijn er volgens hem manieren om het nocebo-effect zoveel mogelijk te omzeilen. “Ik was altijd voorzichtig in mijn bewoording rond een prognose. En bij het voorschrijven van medicatie zei ik bijvoorbeeld: ik kan u alle mogelijke bijwerkingen vertellen, maar dan krijgt u gegarandeerd meer last dan als ik het niet vertel.”
<p data-element-id=afa4-642f-5bf0-b02e-3aa2-72e4-c9a3-4f12>
En dan zijn er ook nog de fysiologische reacties. Bij een onderzoek naar elektrohypersensiviteit werd gekeken of een nep-mobieltje in staat is om klachten op te roepen, via MRI-scans van de hersenen. Wat bleek: zodra mensen dénken dat ze klachten kunnen krijgen, worden er al verschillende hersengebieden gestimuleerd. Precies de gebieden die betrokken zijn bij de verwerking van lichamelijke sensaties.
<h3 data-element-id=85ca-d2f3-c003-6735-1d34-5acb-e2ef-5cae>
Selffulfilling prophecy
</h3><p data-element-id=f70b-60c2-ef34-7e79-8c1b-d163-430f-e231>
Ziek worden omdat je ervan overtuigd bent dat je dat wordt, met ‘echte’ lichamelijke klachten aangestuurd vanuit de hersenen: je zou het een <i>selffulfilling prophecy</i> kunnen noemen, zegt Andrea Evers. Ze is hoogleraar gezondheidspsychologie aan de Universiteit Leiden en won in 2019 de Stevinpremie voor haar inzet rond het placebo- en nocebo-effect. “Het principe kennen we allemaal: als je bijvoorbeeld denkt dat de buurman boos op je is ga je hem anders aankijken, waardoor hij echt boos wordt. Dat zoiets ook op fysiologisch niveau gebeurt, is veel minder bekend. Maar het is juist ontzettend belangrijk dat we ons daar allemaal bewust van zijn, zodat we er meer rekening mee kunnen houden.”
<p data-element-id=4bf1-8027-e5e3-4c41-9dc5-83e9-2040-6613>
Placebo-effecten kunnen een kwart tot de helft van het behandeleffect veroorzaken, aldus Evers. Dat heeft te maken met verwachtingen, en niet per se met geloven in beterschap. Die verwachtingen zijn namelijk concreet te meten in de hersenen. Probeer je maar eens voor te stellen dat je in een citroen bijt: wellicht beginnen je speekselklieren al te werken. “Maar het nocebo-effect is eigenlijk veel relevanter dan het placebo-effect, omdat het in klinische praktijk zo’n grote rol speelt. Bij de zin ‘het kan even pijn doen’ worden er in die hersengebieden al stofjes aangemaakt vergelijkbaar met de reactie op een pijnprikkel.”
<p data-element-id=b4f4-11a2-43fb-9fa5-3949-342e-a9ea-221f>
Door gebruik te maken van het placebo-effect, en nocebo-effecten te voorkomen, hoopt Evers dat het medicijngebruik omlaag kan; in enkele onderzoeken is dat al aangetoond. “Placebo’s kunnen nooit alle medicijnen vervangen, want er zitten natuurlijk wel degelijk werkende stoffen in die bij allerlei aandoeningen en ziektebeelden nodig zijn. Maar vooral bij lichamelijke klachten is het placebo- en nocebo-effect al heel goed onderzocht en kunnen we veel winst behalen.”
<h3 data-element-id=2429-4d0d-48d5-ed4b-62a1-4355-ec41-442c>
Het alternatieve circuit
</h3><p data-element-id=7e0e-7f7e-ff25-c4ef-904a-5425-4c8f-ccd7>
Dat laatste is herkenbaar. In mijn leven heb ik tal van vage klachten gehad waarbij geen oorzaak werd gevonden. Meestal zocht ik mijn heil binnen het alternatieve circuit. Manuele therapie, osteopathie, acupunctuur en body stress release: alles werkte, soms voelde ik me al beter als ik in de wachtruimte zat. Nu pas begrijp ik waarom. Want hoewel de behandelingen uiteenlopend waren en meestal niet wetenschappelijk bewezen, was er iets gemeenschappelijks: aandacht.
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Sander Kales, osteopaat met een achtergrond in epidemiologie en psychologie, legt uit hoe dat werkt. “De reguliere zorg is overbelast. Patiënten krijgen hooguit een paar minuten en veel mensen voelen zich een nummer. Bij een complementair therapeut is de benadering totaal anders.” Een prettige ruimte, iets te drinken, persoonlijke aandacht, inspraak, het draagt allemaal bij, zegt hij.
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Kales is een voorstander van meer communicatie tussen reguliere behandelaars en complementair therapeuten, want juist die combinatie zou veel voor mensen kunnen betekenen. “Het ritueel rond een behandeling lijkt in sommige gevallen belangrijker dan de behandeling zelf”, voegt hij toe.
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</picture>
<p><figcaption><span>Beeld Claudie de Cleen</span></figcaption><p></p>
</figure><p data-element-id=9e65-509b-3925-d1af-518b-e8e9-fcda-f61e>
Ik begrijp waar hij het over heeft. Achttien jaar geleden verbrijzelde ik mijn enkel door een scooter-ongeval. Na vijf operaties waren de artsen in het revalidatiecentrum weinig optimistisch: dit zou nooit meer goed komen. Ik moest rekening houden met chronische pijn en snelle slijtage. Per toeval kwam ik terecht bij een kundige fysio- en manueel therapeut die op vaderlijke toon zei: “Ik hou jou wel op de been”. Sindsdien kom ik maandelijks bij die man. Soms is een lichte aanraking voldoende om wekenlang soepeler te lopen en relatief weinig last te hebben.
<p data-element-id=1258-07dc-a892-4222-c434-a99b-7583-f0f3>
Recentelijk besloot ik weer eens naar een orthopeed te gaan om te kijken hoe het er inmiddels voor staat. De MRI-scan bleek schokkend voor iemand van mijn leeftijd. Mijn gewrichten zijn dusdanig beschadigd, dat de orthopeed het onvoorstelbaar vond dat ik nog zo sportief ben.
<h3 data-element-id=be5e-f2e1-972c-1db9-a658-4f8a-d9b9-092b>
‘Dat pootje van jou doet het supergoed’
</h3><p data-element-id=ca89-0629-e536-160f-4edc-914e-6917-5b35>
Tegen het einde van het gesprek voelde ik de pijn in mijn gehele been aanzwellen en verliet ik bijna kreupel haar kamer. Bij elke stap zag ik dat kapotte gewricht voor me en hoorde ik die vernietigende diagnose. Maar deze keer was ik alert op wat er gebeurde. Ik maakte zo snel mogelijk een afspraak bij mijn vertrouwde manueel therapeut. “Het valt toch zeker allemaal wel mee?”, vroeg ik hem nadat ik mijn hart had uitgestort. Hij knikte geruststellend, terwijl hij liefdevol mijn enkel begon te behandelen. “Dat pootje van jou doet het supergoed”, zei hij opbeurend. Even later liep ik weer soepel naar buiten.
<p data-element-id=9642-76d3-db4e-726a-5a25-607e-eec9-3a56>
Is het probleem over, zijn mijn klachten verdwenen? Nee. Mijn enkel is kapot en dat zal ook zo blijven. Maar zolang ik regelmatig naar de manueel therapeut ga, zijn de klachten stabiel en blijf ik goed bewegen. Als de pijn tijdelijk toeneemt raak ik niet in paniek, maar denk ik aan die opbeurende woorden dat ik heus wel op de been blijf. Het maakt de beleving van de klachten totaal anders.
<p data-element-id=99fb-4f7e-e5b6-5aee-16fc-934d-a790-61d5>
Misschien is dat waar het vooral om gaat. Ambroise Paré, een Franse chirurg uit de zestiende eeuw, wist dat al. Over de taken van een geneesheer zei hij: ‘<i>Guérir quelquefois, soulager souvent, consoler toujours</i>’. Soms genezen, vaak verlichten, altijd troost bieden.
<div data-element-id=fd10ca82-13cf-43be-8a1d-3dea0bbebf5e>
<h4 data-element-id=7423-eb6f-9efa-82d5-0a96-ad8f-2b8c-a9ba>
<svg xmlns=http://www.w3.org/2000/svg>
<path fill=#D00A10 fill-rule=evenodd d="M0 0h6.5l4 4.5-4 4.5H0V0z"></path>
</svg>
Hoe kan het beter?
</h4>
<p data-element-id=e548-620b-cbcc-1b00-1320-6e16-e4c7-5606>
Tips van hoogleraar gezondheidspsychologie Andrea Evers voor <b>behandelaars</b>: “Wees je bewust van de manier waarop je communiceert. Dat kan het beloop van een ziekte en behandeling sterk beïnvloeden. Ook non-verbale signalen zijn daar een onderdeel van. Als arts kun je patiënten goed meenemen in hoe de behandeling werkt, en ze ook informeren over placebo- en nocebo-effecten, zodat ze goed voorbereid zijn op wat er kan gebeuren. Artsen in opleiding zouden hier veel meer over moeten leren.”
</p>
<p data-element-id=37fb-a284-c87e-227d-1f2d-8e2c-49cd-6ab7>
Haar tips voor <b>patiënten</b>: “Gebruik de mogelijkheid om zelf te kiezen hoe je geïnformeerd wilt worden. Wanneer een arts een diagnose stelt en vervolgens een bepaalde behandeling of onderzoek voorstelt, kun je het beste zelf aangeven hoe uitgebreid je geïnformeerd wilt worden over alle mogelijke risico’s, bijwerkingen of de verdere prognose. Sommige mensen willen alles weten, maar anderen liever zo min mogelijk en vinden het voldoende als de informatie ergens op een website beschikbaar is. Ga na wat het beste bij jou past en spreek dat duidelijk uit. Cruciaal is dat jouw zorgen en angst zoveel mogelijk worden weggenomen, terwijl je toch optimaal geïnformeerd bent. Uit een onderzoek onder patiënten die een hartoperatie ondergingen, blijkt dat mensen waarbij ook de langetermijndoelen van de operatie werden besproken, beter herstelden. Als je achter de behandeling staat, is de kans van slagen het grootst.”
</p>
</div><p data-element-id=7ab9-0a0c-90f3-45ad-c922-bd48-60c4-54db>
<i>Welke woorden maakten u ziek/beter? Reacties (max. 150 woorden) zijn welkom via <a href=mailto:[email protected] target=_blank>[email protected]</a>. Graag naam en woonplaats vermelden.</i>
<h3 data-element-id=44c9-67c8-f326-41a5-5a66-b1af-2d38-c0d4>
<i>Lees ook:</i>
</h3><h3 data-element-id=74ba-777d-badf-ca42-4224-721f-2380-9c1d>
<i>Bijwerking coronavaccin zit vooral in het hoofd van ontvanger</i>
</h3><p data-element-id=40b3-b683-c03d-4703-7d03-4396-2822-d4a4>
<i>Mensen die een coronavaccin weigeren, doen dat vaak uit angst voor de bijwerking. Maar die is niet altijd reëel. </i><a href=https://www.trouw.nl/wetenschap/bijwerking-coronavaccin-zit-vooral-in-het-hoofd-van-ontvanger~bd83abf2/ target=_blank><i>De hoofdpijn kan ook een placebo-effect zijn.</i></a>
<h3 data-element-id=2eee-422c-345a-7967-b2b8-be92-c9ea-9718>
<i>Ik wilde maar één ding: mijn vriend redden, die naar de dood verlangde. Maar hoe?</i>
</h3><p data-element-id=f651-f343-b1ea-3052-091e-5b1e-220b-eb5d>
<i>Een half jaar nadat journalist Sofie Rozendaal een relatie met hem kreeg, belandde haar vriend in een zware depressie. Hoe zorg je op zo’n moment ook nog voor jezelf? ‘<a href=https://www.trouw.nl/leven/ik-wilde-maar-een-ding-mijn-vriend-redden-die-naar-de-dood-verlangde-maar-hoe~b8fa3296/ target=_blank>Ik wilde maar één ding: mijn vriend redden.</a>’</i>
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