Bhasmasur* and The Art of Self Sabotage 

“The body listens carefully to the stories the mind keeps repeating.”

Doctor, I Don’t Trust You 

There is perhaps no relationship in modern India more paradoxical than the one between patients and doctors.

People enter hospitals with folded hands and simmering suspicions. They distrust the doctor, distrust the hospital, distrust the pharmaceutical industry, distrust “modern medicine,” distrust antibiotics, distrust stents, distrust vaccines, distrust billing systems—and then proceed to ask, often urgently, “Doctor saab, what should we do now?”

Medicine has always depended partly on chemistry and partly on faith. Penicillin kills bacteria, but reassurance lowers cortisol. A surgeon repairs anatomy, but trust calms physiology. The body, unfortunately for sceptics, listens more to patient’s fears than to external chemical molecules. Today, the trust has become so endangered that some patients suspect even reassurance. “Don’t worry” is interpreted as evidence that worrying is urgently require

The Biology of Distrust – The “Nocebo” Effect

Roald Dahl once wrote, “If a person has ugly thoughts, it begins to show on the face.” Neuroscience has now shown that chronic suspicion, fear, and negative expectation often begin to show in body physiology.

Gossip-mill idle chatter such as “Doctors are greedy,” “Doctors take cuts from laboratories,” “Big pharma bribes doctors to prescribe medicine,” “Modern medicine is harmful,” are some of the thoughts bouncing in a patient’s mind as he enters the hospital. This toxic internal environment robs him of nearly 50% benefits that could accrue from faith. 

When a patient views medicine as a “poison” or a “scam,” his/her nervous system follows suit. This is the “nocebo effect”—the “evil twin” of the ‘placebo effect’—where negative expectations actually worsen physical health. The research shows that the nocebo effect is a powerful neurobiological phenomenon.^[1]

1. There is Neurochemical Sabotage: When a patient is suspicious of a doctor’s motives, his/her brain may trigger the release of cholecystokinin, a peptide that facilitates pain transmission and heightens anxiety. Essentially, by expecting the medicine to be a “poison” or a “scam,” the patient’s nervous system begins to treat it as such.^[2]
2. Negative emotions make the patient pay a Physiological Tax: A study in Psychosomatic Medicine found that patients with “high cynical distrust” had significantly higher levels of inflammatory markers.[3] When a patient enters a consultation in a state of high suspicion, they trigger a “fight or flight” response. Cortisol levels spike, the immune system takes a back seat, and the body becomes less receptive to the actual therapeutic benefits of the treatment.
3. The Power of Suggestion works against the patients: Scientific studies have shown that merely warning patients about side effects can make those side effects more likely to occur. In placebo-controlled trials, patients taking inert pills often report headaches, nausea, dizziness, fatigue, and pain simply because they expect them. Asthmatic patients inhaling harmless water vapour after being told it contained an irritant; developed wheezing, and some experienced full asthma attacks. The lungs, apparently, are also susceptible to pessimism.^[4]
   
   Where placebo means improvement due to positive expectations, nocebo signifies worsening due to negative expectations. The Latin roots of these terms are wonderfully dramatic: placebo means “I shall please,” while nocebo means “I shall harm.” The astonishing fact is that the harm may occur even when the treatment itself is harmless.

The Three Self-Sabotaging Suspicions

Three types of suspicions lead to self-sabotaging one’s own healing process 

1. The Hidden Motive: This is the suspicion that the doctor is recommending a procedure not for the patient’s health, but to hit a monthly quota or fund a weekend getaway. While healthy scepticism is a virtue, chronic suspicion shifts the patient’s focus from “How do I get well?” to “How am I being cheated?”
2. The Efficacy Enigma: This involves a deep-seated doubt regarding modern medicine itself. The quintessential patient believes that a “natural” herb (which has no standardized dosage) is inherently superior to a “synthetic” drug (which has been through decades of clinical trials). ‘The Liver Doctor’ has made this aspect the subject of his lifetime crusade.^[5]
3. The Paradox of Presence: Perhaps the most sarcastic irony of all is the patient who spends an hour explaining why doctors are untrustworthy, yet remains seated in the exam room. It is the medical equivalent of visiting a chef you believe is a poisoner and then asking for a second helping of the soup.^[6]

The human brain is not an objective observer. It is an overenthusiastic intern constantly trying to identify danger. Evolution rewarded those who overreacted to threats. The caveman who ignored rustling bushes became dinner. The anxious caveman survived to produce anxious descendants—namely, us. Unfortunately, modern humans now apply prehistoric threat detection to laboratory reports. They will worry incessantly even if one of 100 odd lab reports is marginally beyond range.

Negative expectations activate anxiety pathways. Anxiety alters autonomic tone, increases sympathetic activity, heightens pain perception, amplifies bodily sensations, worsens insomnia, and increases vigilance toward symptoms. ^[7]

The Side-Effect Olympics

Pharmaceutical leaflets are masterpieces of legal paranoia. To avoid lawsuits, they list every symptom ever reported within a 200-kilometer radius of the drug trial. After reading them, even distilled water appears hazardous.

After reading the leaflets, some patients enter a remarkable psychological state in which every bodily sensation becomes attributable to the medicine. A patient starts ‘statin’ and two days later, his eyebrows feel heavy, and his legs have a constant ache. And yet, studies repeatedly show that expectation strongly influences side-effect reporting. In many trials, placebo recipients report side effects nearly as frequently as those receiving active drugs. 

The body is not lying. The symptoms are often real. But their origin may lie partly in expectation rather than pharmacology. This is where medicine becomes philosophically uncomfortable. We like diseases with visible villains: bacteria, tumors, viruses, plaques. But nocebo effects reveal something deeply unsettling—that belief itself can become biologically active. The mind is not outside the body commenting on events. It is the event.^[8]

The “Digital Umbrella” of Misinformation

Social media has become the world’s largest nocebo generator. If medieval societies had witches, modern societies have forwarded messages. The modern patient arrives for consultation already pre-inflamed by Google, YouTube, and three family WhatsApp groups. The social reels can be heard blaring at every street-corner tea shop:

“Doctors don’t want you to know this……….”
“Pharma companies hide this cure………….”
“This common medicine silently destroys kidneys……………”
“A famous actor cured cirrhosis with papaya leaves……………”
“One spoon of turmeric reverses all inflammation…………..”

Modern misinformation is, every minute, manufacturing distrust followed by anxiety in every innocent person looking for some entertainment in reels. The patient who reads twenty alarming posts before sleeping will often wake up with symptoms. Not imaginary symptoms—experienced symptoms.

A nocebo effect is not a fake illness. It is real suffering generated through expectation and fear. Researchers studying mass psychogenic illness have shown how fear and expectation can spread symptoms through groups and communities. Today social media acts as a giant amplifier of collective anxiety.

Previously, a worried aunt could frighten only the family. Now she has global reach. Historically, the doctor-patient relationship was shielded by a “sacred canopy” of trust. In our information-dense age, that canopy has been replaced by a “digital umbrella” of conflicting WhatsApp Forwards.

This “selective scepticism” is absolutely fascinating: a patient will question decades of pharmacology but blindly trust a shirtless man on YouTube holding a celery smoothie. Every ‘Samosa-devouring’, ‘Gol-gappa-crunching’, and ‘roadside-chat-eating’ man is worried about side effects of his life-saving antibiotics. 

The Feedback Loop

Healers occupy a peculiar moral territory. Society expects them to be scientifically infallible, emotionally available, financially disinterested, endlessly patient, technologically updated, compassionate saints, who are available on WhatsApp even at 2:13 AM.

When outcomes are good, medicine is science. When the disease progresses despite treatment, patients often feel personally betrayed and the healers become immoral. This may be understandable in a sense. Illness creates vulnerability, and vulnerability seeks certainty. But medicine operates in probabilities, not prophecies. Doctors do not operate from a position of omnipotence. They just work to achieve a statistical advantage. The suspicious patient expects certainty from an uncertain universe. This expectation itself breeds disappointment.

So, distrust creates a self-fulfilling prophecy. Distrust leads to reduced adherence to treatment prescribed. Poor adherence worsens the disease. Worsening disease is then used as “proof” that medicine doesn’t work, further increasing distrust.^[9]

Doctors Are Not Innocent Either

To be fair, medicine has earned this distrust. Doctors often communicate poorly. Hospitals become impersonal. Corporatisation of medicine has distorted priorities. Not uncommonly, the physicians are rushed, dismissive, arrogant, or financially conflicted.^[10]

Research shows that poor communication itself can intensify nocebo responses. Negative wording, rushed explanations, and emotionally cold encounters may worsen symptoms and anxiety. 

The trust is not a moral entitlement automatically granted by a medical degree. It is a two way street. It must be earned repeatedly. A physician who behaves mechanically should not be surprised when patients seek humanity elsewhere—even if elsewhere happens to be a man selling detox juices on Instagram.

The challenge for modern medicine is therefore not merely scientific competence but relational maturity. The consultation itself should be a part of the treatment.

The Final Irony

Most suspicious patients deeply believe that stress causes diabetes, anxiety causes hypertension, anger causes heart attacks, loneliness worsens cancer outcomes, and depression weakens immunity. But when told that trust, reassurance, confidence, and therapeutic relationships also influence health, suddenly this sounds “unscientific.”

Psycho-neuro-immunology tells us that emotions often cause disease, and can also assist healing. Human beings are biopsychosocial creatures. Expectations do affect symptoms, and outcomes. This does not replace pharmacology or surgery—but it powerfully interacts with them. A good doctor is neither magician nor mechanic. He is part scientist, part interpreter, part counsellor, part risk manager, and occasionally part emotional shock absorber.

It is tragic that patients are frittering away a valuable source of healing. They also have responsibility towards healing. Trust does not mean blind obedience. Questions are healthy. Second opinions are reasonable. Scientific scepticism is valuable. But perpetual suspicion is not wisdom. At some point, a patient must decide: “If I have chosen this doctor, will I allow the treatment a fair chance to work?”

Swallowing a tablet while simultaneously believing it is poison is biologically confusing behaviour. The body hears both messages. And unfortunately, it often listens to fear more carefully than hope. Healing requires a degree of surrender—a “leap of faith” to break the loop of biological stress.

Bhasmasur* and The Art of Self Sabotage

The modern patient is, in some ways, a digital Bhasmasur. The ancient demon performed severe penance to obtain divine power, only to turn that power recklessly upon the very source from which it came—and eventually upon himself.

Today, the penance is different. It is hours spent on Google searches, medical chat forums, YouTube videos, and artificial intelligence applications. The boon being sought is access to medical knowledge. But information without judgment can become its own curse.

A patient may spend three hours online and suddenly feel equipped to challenge twenty years of clinical experience. Suspicion then quietly replaces curiosity. Anxiety replaces understanding. Every doctor appears corrupt and every prescription begins to look like a conspiracy.

The tragedy is that the patient believes he is attacking the doctor, the hospital, or the pharmaceutical industry. But often, suspicion harms the patient first.

In the original myth, Bhasmasur* destroys himself by placing his own hand upon his head. In modern medicine, fear and distrust can sometimes do something remarkably similar.

Yet the answer is not blind faith. Medicine does not ask patients to stop questioning. It asks only that suspicion does not become stronger than the desire to heal.

The doctor and patient are not adversaries negotiating a conspiracy. They are two anxious human beings standing together against disease.

Medicine works best when evidence and trust stand on the same side. Healing begins when suspicion loosens its grip just enough for hope to enter the room.

Notes: 

1. *The mythological story of Bhasmasur can be read at https://en.wikipedia.org/wiki/Bhasmasura. Last accessed on 14 May 2025.
2. It is given that every doctor is not corrupt, nor every patient suspicious. A good communication between the two is all that is needed to dissolve everything that has been said above. Unfortunately, if communications were good and easy, no wars would be fought.

References

• ^[i]  Häuser W, Hansen E, Enck P. Nocebo phenomena in medicine: their relevance in everyday clinical practice. Dtsch Arztebl Int. 2012 Jun;109(26):459-65. doi: 10.3238/arztebl.2012.0459.
• ^[2]  Enck P, Benedetti F, Schedlowski M. New insights into the placebo and nocebo responses. Neuron. 2008 Jul 31;59(2):195-206. doi: 10.1016/j.neuron.2008.06.030.
•  ^[3] Olshansky B. Placebo and nocebo in cardiovascular health: implications for healthcare, research, and the doctor-patient relationship. J Am Coll Cardiol. 2007 Jan 30;49(4):415-21. doi: 10.1016/j.jacc.2006.09.036.
• ^[4] Pilcher H. I made my husband ill with a few words – nobody is immune to the power of the nocebo effect. The Guardian. Available at https://www.theguardian.com/commentisfree/2026/may/08/nocebo-effect-science-health?utm_source=chatgpt.com accessed on 14 May 2026
• ^[5] Philips CA. The Liver Doctor: Stories of Love, Loss and Regeneration. Available at https://harpercollins.co.in/press-release/the-liver-doctor-stories-of-love-loss-and-regeneration-by-dr-cyriac-abby-philips/ accessed on 14 May 2026
• ^[6] Souvatzi E, et al. Trust in Healthcare, Medical Mistrust, and Health Outcomes in Times of Health Crisis: A Narrative Review. Societies. 2024;14(12):269.
•  ^[7] Benedetti F, Carlino E, Piedimonte A. Increasing uncertainty in CNS clinical trials: the role of placebo, nocebo, and Hawthorne effects. The Lancet Neurology, 2016; 15, 736-747t.
• ^[8] Hansen E and Zech N (2019) Nocebo Effects and Negative Suggestions in Daily Clinical Practice – Forms, Impact and Approaches to Avoid Them. Front. Pharmacol. 10:77. doi: 10.3389/fphar.2019.00077
• ^[8] Pilcher H. This Book May Cause Side Effects: Why Our Minds Are Making Us Sick. Published by Atlanta Books. Available at https://books.google.co.in/books/about/This_Book_May_Cause_Side_Effects.html?id=Vimi0QEACAAJ&redir_esc=y accessed on 14 May 2026.
• ^[10] Anand AC. Speaking for myself ‘Prisoner of War-Sold for six lakhs’. Natl Med J India. 2014 Jan-Feb;27(1):30-4