What if I told you that I had something that could make you happier, healthier, and even feel more connected to people?  And what if I told you it had zero side effects and was absolutely free?  Too good to be true?  Actually, not!  In fact, it’s pretty awesome!  Literally.  The complex and mysterious emotion known as “awe” has recently been given more attention and a growing body of literature supports what mystics and philosophers have known for generations.  Experiencing awe has a magical effect of making us feel simultaneously both humble, compared to something that is vast and transcendent, and more connected, in a way that makes us more generous and open hearted.  

Selfishly, I am moved to write about awe after having been to Death Valley this past weekend.  For me, it was like the Disneyland of natural wonder.  I walked on a basin of salt, climbed and ran down sand dunes (giggling like a kid), hiked to the base of rainbow and red rock canyons, and viewed the bright starscape enveloped in a very dark night sky. I was so overdosed with awe that it felt like a drug I want to keep taking!  What struck me most was the intense experience of simultaneously recognizing both my absolute insignificance and my complete uniqueness.  I felt insignificant compared to the tremendous forces and time that created these monuments of nature and completely special in how lucky I was to be alive and to have the gift of the ability, with my senses and human capacities, to take in the beauty.

Fortunately, research shows you don’t have to travel to natural wonders to experience awe.  You can find it in watching the birds in our backyard, listening to a great piece of music, or taking in a moving piece of artwork.  Some research shows that watching awe inspiring videos or reading a story can elicit our sense of awe with all its benefits.  In fact, there was a direct correlation in most studies between the level of awe reportedly evoked in a subject and the amount of improvement in stress reduction and well being.  Overall, research shows that people who reported more “wonder and sense of amazement” had lower levels of inflammation (linked to chronic disease).  

One of the most profound effects of awe is how it can change our perspective.  Awe can lead to what is referred to as the “smaller self” effect.  We literally perceive ourselves as smaller in relation to the rest of the world.  Awed people are able to see the balance of strengths and weaknesses within themselves more clearly and, in addition, to recognize how outside forces contributed to their successes.  In other words, awe brought a sense of humility and a less self centered point of view.  This may be why people who experience awe are more likely to offer help or be more generous.  

Too busy to take the time to experience awe?  Awe can even help with that!  Several studies have found that awe tends to expand our perception of time.  Study participants who were induced to feel awe agreed more strongly with statements suggesting that time was plentiful and expansive compared to control subjects induced to feel general happiness.  I know, personally, standing next to layers of striated rock that took millions of years to form certainly made me feel time on a much grander scale.  Feeling rushed felt kind of silly, noting that my entire lifetime was represented by less than a millimeter of rock in the immense wall I was standing next to.  

Finding awe can be a daily practice, fortunately.  Most practitioners who study or work in fields promoting awe explain that awe can be a matter of attitude.  When we look for it there are awe inducing phenomena all around us.  Taking an awe walk, for example, can lead to hearing or seeing things in a  different way.  Just by looking up at tall trees has been shown to induce awe!  Or you can read awe inspiring stories or watch awe inspiring videos on the internet.  Even watching a talented performer or athlete can evoke awe or having thoughts about someone you love.  The good feelings will be well worth the effort. And as far as I know, there are no rehab centers for awe junkies.  The high you experience is totally natural and is not illegal in any states I know of, yet. 

Most of us have heard of the placebo effect, yes?  In medical studies, a group of participants known as the “control group” will be given a sham treatment, often a sugar pill, that they believe is the real treatment. As a result of believing the pill is real, participants will sometimes have positive results such as feeling better or improvement in their symptoms (there are often real chemical or physical changes involved).  In other words, the expectation that they are getting helpful treatment has an actual beneficial effect!  Pretty cool, right? But in today’s post, I want to introduce you to its less known counterpart, the “nocebo effect,” as it likely is also having an effect on you, and may actually be making uncomfortable situations more uncomfortable.

The nocebo effect happens when a person’s negative expectations of treatment lead to negative side effects.  Where the placebo effect makes a person feel better beyond the actual therapeutic effects of a treatment, the nocebo effect causes people to feel worse.  Most often the nocebo effect involves mild symptoms that are noted to be common side effects of a given treatment, such as headache, dizziness, or nausea and vary significantly between individuals.  But it has been known to cause people to drop out of studies and clinical trials or decline treatment that may be helpful.  For example, in fibromyalgia studies on treatments, as many as eleven percent of people drop out of studies because of debilitating side effects from the equivalent of sugar pills.  Research also suggests that the cost of treatment can influence perceptions of how effective it is and that how doctors or nurses talk about the effects of treatment, such as expressing uncertainty or emphasizing the negative, can have a large effect on a patient’s responses.  Patients warned that a procedure might cause pain were much more likely to report higher levels of pain.

In 2007, a case study in General Hospital Psychiatry (a journal, not a soap) highlighted how powerful the nocebo effect can be.  A 26 year old man enrolled in a study of antidepressant medication. For the first month of the trial he reported improvements in his mood and functioning.  But after an argument with his girlfriend, he took all 29 of the capsules left in the bottle in a suicide attempt.  He went to the emergency room asking for help. ER doctors noted he was pale with heavy sweating, his blood pressure was abnormally low, his pulse was elevated and despite receiving intravenous fluids over four hours, remained sluggish and his heart rate remained abnormal.  At this point a researcher from the trial came to the hospital revealing that the man had received the placebo, or the inert substance.  Within 15 minutes of receiving the news, he was alert, revived, and his blood pressure and heart rate had both returned to normal. In another notable example, after a rumored toxic leak in Japan the hospitals were flooded with patients experiencing nausea, headaches, and dizziness. Investigators found no evidence of a leak and the patients fortunately quickly returned to normal.

Research shows that most of us experience the nocebo effect in some form or another.  One of the biggest predictors of the nocebo effect is “social modeling,” or hearing that other people are reporting the problem.  Which leads to a dilemma for us internet prowlers who scour the web for information about our symptoms and possible treatments.  We may be actually planting seeds of negative outcomes when we read about people who have negative experiences with a treatment we are thinking of trying.  And for doctors, it can lead to a conflict, as the ethical thing to do is to inform patients of all the possible negative side effects that can be a result of a course of treatment (those commercials with the crazy side effects that make you think, “who would take this drug”).  

Like most phenomena, being aware of it is the best antidote.  Especially helpful, according to research, is for doctors to be aware of how they present information to their patients.  Medical staff need to be careful of the wording used  to describe potential side effects and concerns of a treatment, making sure to present the positives.  Instructing patients on how to look for the potential improvements may be a way to balance the expectations. 

Even if your provider is not the bright-side-of-life type of person, we can be mindful of our own expectations.  And in a much broader sense, we can ask ourselves in how many other areas of our life do we influence our experience by our expectations?  From the movie we see, to the restaurant we try, to the new neighbor we greet, whatever we encounter, our positive or negative expectations will shape our experience.  We then need to ask ourselves what type of individual do we want to be – a placebo or a nocebo kind of person?

I always find it challenging when I’m asked for advice from someone who wants to be helpful to someone they care about who’s struggling.  It’s such a natural and wonderful thing to want to be a support to someone, but there’s often a fine line between being supportive of someone you care about and enabling them without intending.   Often, if unhealthy behavior is involved, the helper’s actions may be potentially contributing to the situation they seek to ameliorate.  It’s so easy to lose perspective when love is involved.  So this week, given several questions that came up over the past couple of weeks, I decided to step back a bit and gain a broader perspective on how to bring awareness to the difference between enabling and supportive helping behavior.

Especially as a parent you’re faced with a constant and never ending series of choices about when to step in and when to hold back.  Should I let them cry themselves to sleep or pick them up?  Should I talk to their teacher or let it go?  Do I lend them money or do I let them figure it out on their own?  It’s so hard to see someone we care about suffer and it feels so natural to want to lend a hand when we can.   The question that comes up in most literature delineating the line between helping and enabling is the  effect of the longer term consequence of the helping gesture.  Is the helping gesture going to keep someone from being able to grow and be accountable for themselves in the long run or is it a step to help them move forward toward this freedom?  Simply stated, supporting or helping includes assistance with things that a person is incapable of doing for themselves or doing things that help facilitate them gaining control of their behaviors and life.  Enabling on the other hand, is behavior that keeps someone from dealing with the negative consequences of their action, therefore giving the impression that their behavior is somehow acceptable or will be successful in the long term.  For example, a parent who lets a child skip school when they haven’t finished an assignment because they started too late is enabling.  Calling in sick for your partner when they have a hangover is also enabling.  

Enablers often try to solve the problem for the people they are trying to help, believing they are doing something good for them.  Unfortunately, in doing so, they keep the person from learning how to own and conquer the situation, which would build skills, esteem, and resilience. Enabling tends to encourage a negative dynamic in relationships, wherein the person being helped becomes dependent and both parties become resentful.  When a helping behavior is enabling, it tends to perpetuate and keep a stagnant situation stuck, whereas supportive behavior helps to move someone toward greater freedom.

Of course, every person is different and every situation is unique, which makes it so tricky to be sure if what you are doing is helping or hurting.  It may help to ask yourself some clarifying questions to evaluate your intention with the effect of your behavior.  A yes to any of these questions may indicate a need to take a closer look at the results versus hope of your behavior. One question to ask yourself is if you find yourself making excuses for someone, such as “he’s had some bad luck lately” or “it’s just hard for her right now?”  Another question is if you have a feeling that the behavior you are seeing is unhealthy or irresponsible, below what is normal to expect from someone of the person’s age or from their peers?  Have you lied for someone or justified the behavior to others who express concern or question if the situation is healthy if it continues?  Have you kept your helping behavior secret because you sense others would disapprove? And finally, do you avoid talking about the situation directly, but secretly hope that things will change or are you afraid to bring up the situation for fear of the person’s negative reactions?

Most people who come to realize that they are, in fact, enabling, initially started out with firmer boundaries and good intentions.  Over time, the avoidance and or giving in to someone’s requests began to become a habit or expected.  At this point, it becomes hard to undo the situation without feeling you are being too harsh or unrealistic.  But to keep enabling is actually doing more harm in the long run for both of you.  Loving someone means wanting what is best for them.  Often what is best for us in the long run takes sacrifice and short term struggles to obtain.  When we protect someone from the consequences of their poor choices, we rob them of the opportunity for learning and growth. We also give them the message that we don’t believe they can accomplish what is hoped for or expected. 

Healthy and appropriate support is empowering rather than enabling.  It should bring pride and a sense of teamwork and increasing responsibility.  But this can mean setting clear expectations that feel uncomfortable at first.  “Tough love” can sometimes be tougher on the person giving it rather than receiving.  That’s why it’s good to have support in finding balance in a relationship you feel is unhealthy.  It’s easy to get lost in your emotional connection to someone you love and your desire to protect them from the consequences of poor choices.  But good help supports someone in the long term and allows them to be proud of who they are and what they do.  Being a supporter instead of an enabler does not mean you lack empathy, love, or concern.  It just means, as the old adage instructs us, that better than feeding someone is to teach them to fish. Ok, and maybe buying them a fishing pole is all right, too?  And some bait? And a making them a snack?

HAPPY NEW YEAR and thank you for reading my meanderings!!!