“The Problem of Suggestibility In COVID-19 Diagnosis”

For those who are not familiar with medical jargon, it is important to learn that in medicine there are two types of animals: “horses” and “Zebras”. These are the two words used by doctors to describe commonly occurring diseases (horses) and rare conditions (Zebras). This differentiation is important to understand before we get into the subject of suggestibility and the COVID-19 pandemic. Colds and the Flu are horses, COVID-19 is a Zebra.

First of all, what is suggestibility?

Suggestibility is a universal condition of humans’s minds, that is, it is the tendency to fall under the spell of suggestion by what others around us say or do. A “suggestible state” can happen because one is told (suggested) something by a person that is considered an expert or who is in a position of authority (a doctor, a dentist, a pharmacist, etc). Much more often it happens by the effect of someone else’s attitudes and/or by the statements they make. The effect is more powerful if the person making the affirmations are close to us. But it gets particularly strong if the person is someone whose opinion we respect (a family member, a friend, a teacher).

In lay terms, “Suggestion” means believing that something is real or actually going on with us because somebody else indicates that this is the case. Suggestion is amplified when people see others doing something or suffering from a medical condition. Examples of this phenomenon are multiple. Common situations of suggestion are seen when we sneeze when others do, coughing when others cough, or yawning when the person in front of us is yawning. This is evidence of the fact that our minds are strongly regulated by identification. Identification is a psychological mechanism of unconscious imitation of other people’s behaviors; it is our main form of connection to the external world.

Understanding Identification and Mirroring

In the last few years, the neural basis of this psychological mechanism has been traced to what are now known as “mirror neurons.” These imitative neurons are a part of the prefrontal area of our brains’ frontal lobes. Suggestibility and “mirroring” then are at the basis of our ability to empathize with others (to be able to identify with their feelings). Identification is the basis of the psychological mechanisms at the core of the feelings of compassion for others.

“Compassion” is a word that has a Latin root. It has two particles–the prefix “com” which means “with,” and the word “passion,” which means “to suffer with.” So, to be compassionate means to suffer with others.

This ability to identify with other people’s suffering is essential for us human as a species for survival purposes. However, is we “over-identify” with someone, then we become one with them. That means that their pain becomes our pain and we become ill. This is commonly the case in situations in which close family members take care of their love ones that are ill. The classical example of this situation is the mother experiencing in her body the same pains of her child.

So, the main point to remember when addressing the phenomenon of suggestibility is that is has a positive side (called in medicine a “placebo effect”) and a negative side to it (known as the “nocebo effect”). We need to keep in mind the powerful effects of our minds in determining how we feel and how we make others feel by the unconscious use of the suggestions we absorb or send off . It will depend on whether our suggestions become placebos or nocebos for others and ourselves.

Suggestibility and the COVID-19 pandemic

In situations of global disease events, such as a pandemic, we all become hyper-suggestible. This is due to the fact that everybody around us talks about the same things–and there is psychological contagion. This reality is exacerbated by the media that shows us, day after day, the same types of images. The media are relentlessly feeding us scary information of disease and death. So, the suggestibility level in all of us is markedly ramped up during times of pandemics. During times like the one we are living now, WE ARE ALL IN A HYPER-SUGGESTIBLE STATE.

Now, how is this relevant to our coping and managing the challenges we face with the COVID-19 pandemic?

It is essential to rule out states of suggestibility to determine when we need to be tested for COVID-19. And this is important knowledge for doctors, nurses, and health care providers in order to determine the differential diagnoses in themselves and in the people they see.

I will not be able to address this subject in depth in this post as there are multiple implications to the effects of suggestibility (both positive and negative) on humans.

Remember: Suggestibility can be expressed both in positive and negative ways. But, I will start by opening the discussion on this important topic by stating the following effects of negative suggestibility in our current circumstances:

12 things to consider before you consult your Doctor to be checked for COVID-19

1. At the present time, many people feel they are “short of breath” and they often ascribe this sensations to being “probably infected” with COVID-19. As a result, they rush off to see their doctors terrified by the possibility of COVID-19 infection.
2. It is essential to understand that there are multiple reasons for people to feel “short of breath” that are not caused by COVID-19. I will point out here a few that are important when trying to figure out whether you should go for COVID-19 testing
3. Shortness of breath can be caused by organic causes--the two most common being heart and lung conditions. In these cases the shortness of breath tends to occur more intensely while exercising, walking, or moving fast. It is rare to experience it while resting.
4. In COVID-19 infection, on the other hand, the shortness of breath begins after a few days of other cold-like symptoms or after developing a dry cough and a fever.
5. Keep in mind that shortness of breath (SOB) can have psychological origins. The most common causes of shortness of breath of psychological origin are: The “sighing dyspnea” (which is a state of sighing very frequently and feeling “air hunger”). This is the sensation that you cannot get fully satisfied with the amount of air entering your lungs. This type of SOB happens very frequently in people that suffer from chronic Generalized Anxiety and Panic Disorder.
6. In people with panic attacks, the SOB is much more sudden and dramatic. It is usually accompanied by other physical symptoms of anxiety such as rapid heart beat (palpitations), sweating, nausea, dizziness, or gastrointestinal discomfort.
7. Other causes of psychogenic (of psychological origin) dyspnea (dyspnea is the medical term for the sensation of shortness of breath) are the frequent use of asthma inhalers and the excess use of stimulants such as Caffeine, Nicotine, Amphetamines, Cocaine, Aspartame, and Nasal decongestants.
8. More benign forms of shortness of breath can be the result of chronic asthma or bronchial spasms. In those cases, the differential diagnosis is established because the person has a history of Asthma or Chronic Obstructive Pulmonary Disease (COPD). The main symptomatic difference there is that the affected individual hears a high pitch sound while breathing, but particularly when exhaling. So, when you consider going for a COVID-19?
9. If there is a history of any of these conditions, you should first consider that your shortness of breath may be due to any of the above-mentioned conditions before jumping to the conclusion that you are infected with COVID-19
10. If, on the other hand, you have been in contact with a significant number of people in the last three weeks–and particularly if any of them has had an upper respiratory infection (a cold, a Flu like type set of symptoms)–this should increase the possibility of considering COVID-19 infection.
11. Moreover, if someone else has fallen ill in your household or work-place–and if you are experiencing a new onset of physical aches and pains (malaise), dry cough, runny nose, sore throat, diarrhea, fever–and particularly if you have lost the sense of smell and or taste–then you should consider COVID-19 testing.
12. Finally, even if you should not minimize the risk, and should consult as needed, keep in mind that most people that get this infection has the mild to moderate form of the illness and DO NOT DIE FROM IT.