
- Vol 38, Issue 11
A Role for Psychiatry in Understanding and Overcoming Vaccine Hesitancy
Can our training and experience as psychiatrists shed light on vaccine hesitancy and the thought process behind it?
COMMENTARY
I hope to inspire you to apply your understanding of the human psyche to the curious matter of people who are contracting a life-threatening infection because they are reluctant to heed the advice of their physicians and the public health community. An exuberance of irrationality, not mental illness, seems to be at play here. Can our training and experience as psychiatrists shed light on a flawed decision-making process that leads some people to throw caution to the wind?
Commonplace self-defeating behaviors may be understood from the perspective of those hypothetical constructs known as immature defense mechanisms.1 However, since the 1990s, the so-called Decade of the Brain,2 such psychodynamic concepts have been receding into our profession’s collective unconscious.3 Instead, I will endeavor to gain an understanding of our “culture of hesitancy”4 by invoking the “nocebo effect,” a pharmacotherapeutic construct that is carefully considered by clinical researchers who perform randomized controlled trials of new medications.4,5
The nocebo effect is at play when individuals receiving an inert or effective medical treatment harbor the expectation that the therapeutic intervention will harm them. Just as placebos have the potential to cure, nocebos can cause pain.6 These days, many anticipate and imagine that a potentially life-preserving inoculation is likely to be harmful. The psychic pain engendered by this negative expectancy may qualify as an anticipatory nocebo effect, akin to anticipatory anxiety.
Regarding
Bagus et al, in Spain, have written extensively about the relationship between nocebo effects, fear, anxiety, and mass hysteria.9 Their view is that media outlets and governments may inadvertently spread a contagion of fear and anxiety that culminates in a set of pathological beliefs and behaviors akin to mass hysteria. This “infectious” disease of pathological belief systems may spread virally through social media and culminate in a shared anticipatory nocebo effect that may manifest as vaccine hesitancy.
Ironically, this discussion of nocebos, a relevant concept in today’s world of randomized controlled trials, has led us to retreat to the somewhat retro and uncomfortable territory of poorly understood sociological phenomena like mass hysteria. Psychosocial speculation of this sort harks back to expansive and speculative works of Sigmund Freud like Totem and Taboo (1913), Civilization and Its Discontents (1929), and Moses and Monotheism (1939).
Psychiatry, a field once dominated by psychoanalytic theory, has robustly embraced neuroscience, brain chemistry, and pharmacotherapy in the past 4 decades. Countless mentally ill patients have benefited greatly from biological psychiatry’s advances. Although we have transcended our mid–20th century love affair with all concepts Freudian, it may be important for us to tap into old-fashioned techniques, such as careful listening, psychosocial formulation, and precise communication, to help patients and colleagues manage better in this challenging era of pseudo-information and reductionistic thinking.10
References
1. Vaillant GE.
2. Jones EG, Mendell LM.
3. Hunt HT.
4. Williams S.
5. Data-Franco J, Berk M.
6. Colloca L.
7. Amanzio M, Cipriani GE, Bartoli M.
8. Kristensen LE, Alten R, Puig L, et al.
9. Bagus P, Peña-Ramos JA, Sánchez-Bayón A.
10. Kallivayalil RA.
Articles in this issue
almost 4 years ago
PTSD in Late Life: An Update on Clinical Issuesalmost 4 years ago
Recognizing and Addressing Psychiatric Implications of Sleep Disordersalmost 4 years ago
COVID-19, Cognition, and Dementias: What Role Has the Pandemic Played?almost 4 years ago
Caring for Older Adults With Mental Health Disorders During the Pandemicalmost 4 years ago
Heal Thyself, Then Heal Others? The Power of Lived Experiencesalmost 4 years ago
Mirrors and Jeweled Netsalmost 4 years ago
Psychiatric Views on the Daily Newsalmost 4 years ago
Majority of Americans Favor President’s Vaccine Mandate: Pollalmost 4 years ago
Sorting Out Comorbiditiesalmost 4 years ago
Listening to Terry GrossNewsletter
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