According to the U.S. National Library of Medicine, fibromyalgia causes fatigue, musculoskeletal pain, spasms, and stiffness, numb extremities, and “tender points” sensitive to tactile stimulation and pressure. Other symptoms it causes include insomnia, headaches, anxiety and depression, dry eyes or mouth, impaired proprioception, and cognitive disturbance known as “fibro fog” (familydoctor.org, 2010). A disease of unknown etiology, fibromyalgia commonly afflicts middle-aged women and is often comorbid with other autoimmune conditions. As mentioned by the author of the fibromyalgia blog, American popular culture portrayals and in particular the image propagated by the pharmaceutical industry in media advertisements, can influence the illness experience of someone with fibromyalgia. By distilling fibromyalgia down to an overgeneralization such as, “Fibromyalgia is explained as widespread pain that doesn’t go away,” this minimizes the debilitating nature of the disorder and neglects the multitude of symptoms that plague sufferers, such as what toydiva65 describes as “morning wood,” “the potty dance,” “the faux heart attack,” “sleeping beauty,” “the carnival dizzies,” and “tummy troubles,” (toydiva65, 2010). Moreover, claims of commercials to provide “significant relief” perpetuate the notion that fibromyalgia is temporary and fixable, which gives the public the impression that a magic bullet cure is available, diminishing the permanent disablement of the chronic illness experience (Lyrica Ad, 2011).
Moreover, these oversimplifications perpetuated by the biomedical community downplay the severity of fibromyalgia, making it harder for patients to mobilize social support and adopt aspects of the sick role such as abdicating regular responsibilities. In addition, because the pathophysiology of fibromyalgia is idiopathic and because symptoms are subjective, facets of this syndrome are not amenable to clinical, biomedical measures and are subject to interpretation by the physician. As lecture noted, the “effective communication of pain or suffering is essential to legitimizing the sick role” (Karim, 2012). Hence, failure of the practitioner to acknowledge the condition due to insufficient relaying of the illness narrative means the illness will not be identified and therefore not validated by the larger community. In turn, this affects potential for recovery, as patient and doctor must reach a consensus about the illness in order for therapeutic course to be pursued. Also, because biomedicine represents authoritative knowledge, failure of the practitioner to legitimize fibromyalgia means the patients’ symptoms will be dismissed by friends and family (perhaps to the point of the patient being called a hypochondriac or malinger), remedies will not be employed, and poor prognosis will ensue.
If the doctor does not authenticate the patient’s condition or have faith in medications to treat it, this doubt will be translated to the patient. Therefore, the nocebo effect, or the negative effect of beliefs and expectations on health, will come into play and negate the therapeutic action of any drugs. The connection between belief and healing is that the effect elicited by a treatment is congruent with a patient’s belief in the efficacy of that treatment. For instance, in “Placebo: Cracking the Code,” when Benedetti gives Andre an inert placebo but describes it as a painkiller, Andre reports less pain upon administration of an electric shock due to his expectation of its analgesic effects. Similarly, in my own experience, my belief in the potency of a medicine allows it to provide me greater relief; for example, I have noticed that I prefer the name brand Advil over the generic Ibuprofen despite identical active ingredients. The micro-context or rituals associated with a treatment also impinge upon its success via expectancy effects. This is illustrated in the case of Jean Pierre Bely, who was cured of multiple sclerosis upon his pilgrimage to St. Bernadette, which is a testament to the mind-body connection and power of belief.
The placebo effect may be mediated by the power of suggestion, symbolic healing, the meaning of drugs ingested, or the attitude conveyed by healer. The last case is demonstrated by Dr. Albert Mason and his patient with congenital ichthyosiform erythroderma. The physician’s confidence that hypnosis would eliminate warts was communicated to the patient, heightening his suggestibility, and generating a cure. Most likely, the physiological mechanism of the placebo effect is activation of the patient’s endogenous reservoir of healing substances, such as enkephalins.
Familydoctor.org editorial staff. (February 2010). Fibromyalgia. MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/fibromyalgia.html
Karim, T. (July 2012).Week 4: Lecture 1 – Experiencing Illness. Retrieved from http://anthropology.msu.edu/anp204-us12/schedule/week-4/
Lyrica Ad [Video file]. (October 17, 2011). Retrieved from http://www.youtube.com/watch?v=HSqRBMjEWvY
Placebo: Cracking the Code [Video file]. (November 5, 2011). Retrieved from http://www.youtube.com/watch?v=QvbQnMvhQFw
Toydiva65. (March 16, 2010). Fibromyalgia + The Type “A” Personality = Chaos, Frustration, and Near Insanity! [Web log comment]. Retrieved from http://www.blogher.com/fibromyalgia-type-personality-chaos-frustration-and-near-insanity?page=full