Psychiatric Labelling is the Ultimate Nocebo

Dr Jess explains the Nocebo effect of being told that you are mentally ill…

Most people have heard of the placebo effect - the idea that if you believe a treatment is going to help you, it often does, even if the treatment is fake.

Your brain is that powerful. Truly.

You believe the pill will reduce your pain, and so it does. You believe the injection will make you better, and your symptoms improve - sometimes drastically - even when the substance was nothing but saline or sugar.

It’s fascinating, isn’t it? Your brain and body working together to create change based purely on what you believe. We don’t talk about this power enough, in my view.

But almost no one talks about the other side of that coin.

The Nocebo Effect.

Nocebo is Latin for “I shall harm” - and that’s exactly what it does.

Where placebo heals, nocebo harms. If you believe something will make you worse, it often does. If you’re told a drug will cause side effects, you’re far more likely to develop those exact symptoms - even when the drug was a sugar pill. If a doctor tells you your illness is terminal, your condition may deteriorate faster, even if they were wrong. One famous study describes a man who died after being given an incorrect terminal diagnosis of lung cancer - and yet his post-mortem showed that he didn’t have cancer at all, the test results had been misinterpreted. He deteriorated from the moment of the conversation with his doctor who told him he only had a short time left - so what really killed him? How did he actually die?

This isn’t pseudoscience - it’s well established across decades of research in neuroscience, pharmacology, and psychology.

And I believe psychiatric labelling, especially after trauma, is one of the most dangerous and under-recognised forms of Nocebo in our society.

Let me explain why.

The Nocebo Effect: An Introduction

Before we talk about psychiatry, let’s look at a few examples of the Nocebo effect in action.

• In a 2007 study, men were given a sugar pill and told it was a drug that would cause erectile dysfunction. Over 40% of them developed erectile dysfunction, despite taking no active drug.

• In another trial, healthy participants were given lactose (basically, milk sugar) but were told it was a drug that might cause gastrointestinal distress. Over 70% of participants reported symptoms like bloating, nausea, and stomach cramps. Again: nothing but belief.

• A particularly shocking case reported in The Lancet involved a young man who attempted suicide by taking 29 capsules of a placebo he believed to be a powerful antidepressant. He collapsed, became hypotensive, and was rushed to hospital. In a critical condition, doctors rushed to find out what he had taken from the trial so they knew how to treat him. Only after doctors discovered the capsules were inert did his symptoms rapidly resolve.

These examples show how powerful the Nocebo effect is: expectation alone can cause genuine physical and psychological symptoms. If you believe you’re going to suffer, your body often obliges. If you believe you’re getting worse, you probably will.

Which brings us to psychiatry…

Pathologising Trauma: When a Diagnosis Becomes a Curse

Imagine this.

You’re going through hell. You’ve just left an abusive relationship. You’re grieving the loss of a loved one. You’re reliving trauma from your childhood that’s suddenly resurfaced. You’re having nightmares, flashbacks, panic attacks. You can’t focus. You feel numb, then terrified, then deeply sad. You feel like you’re losing your mind.

You go to a GP, or a mental health practitioner, or a psychiatrist, desperate for help, wondering if there is something wrong with you…

Instead of hearing what you truly needed, “What happened to you? These are understandable responses to trauma. You’re not broken - you’re overwhelmed,”

You hear:

“You have generalised anxiety disorder.”

Or: “This sounds like major depressive disorder, you’ll need antidepressants.”

Or worse: “You meet the criteria for borderline personality disorder, and need a referral to a PD team and medication.”

That moment - right there - is the Nocebo effect in action.

Because what you’ve just been handed is not support.

It’s a deterministic, pathologising label. A label that often comes with bleak predictions: this is chronic. This is who you are. This is your identity now. This might get much worse. You may need medication for life. You’re high risk. You’re unpredictable. You’re unstable.

And the most dangerous part?

You believe them.

You believe that your reactions aren’t just valid responses to extreme distress - they’re signs of disorder. You stop thinking, “I’m traumatised,” and start thinking, “I’m mentally ill.”

That belief - that internalisation of the psychiatric diagnosis - begins to shape your mind, your behaviour, and your sense of self.

Just like the Nocebo.

The Nocebo of the Label

Once a person receives a psychiatric label, especially in the midst of trauma, several things happen - none of them good.

1. Your symptoms may worsen

You’ve been told your brain is disordered. That your condition is likely lifelong. That your emotions aren’t understandable - they’re pathological. So you start expecting to feel worse. -‘d you do feel worse. You interpret every bad day, every panic attack, every wave of grief as proof that the doctor was right. You’re losing your mind. You have mental health issues. You begin to spiral, not because you were doomed from the start, but because you now believe you are.

2. You start monitoring and mistrusting yourself

Every thought becomes suspect. Every feeling gets pathologised. Was that reaction too extreme? Am I dissociating again? What if I’m getting worse? What if I hurt someone? Am I relapsing? Am I paranoid? Maybe I can’t cope anymore. Am I normal? Am I broken now? This hypervigilance can make you more anxious, more traumatised, more afraid. Again - this is the Nocebo at work.

3. You internalise the identity

Instead of seeing yourself as a traumatised person with a valid history of suffering, you now see yourself as “mentally ill”. The diagnosis isn’t just a label - it becomes a lens. It affects how you talk about yourself. How others treat you. What jobs you think you can do. What relationships you pursue. The diagnosis becomes you.

4. You expect to stay stuck

You’ve been told you’re disordered. So now, every time you try to work on stuff or recover, you expect to relapse. If you feel good for a while, you brace for the crash. If you try therapy, you doubt it will work. If you take medication, you worry you’ll need it forever. Hope becomes dangerous. The belief in your own healing has been stolen.

Real Talk: Psychiatric labels are not neutral terms

People defend psychiatric diagnosis by claiming it’s neutral. That it helps people access services. That it’s “just a description”. That it’s the same as physical illnesses.

But in practice, diagnosis is almost never neutral. It’s delivered by an authority figure, often during a period of vulnerability, and it comes with immense social and psychological weight.

It carries implications about your character, your prognosis, your safety, and your future. It changes how your distress is understood - not as “something happened to you” but as “something is wrong with you.”

This is why psychiatric labelling after trauma is such a potent Nocebo. It creates fear. It creates expectation of decline. It strips people of their agency. And then it points to their worsening symptoms as proof that the diagnosis was correct all along.

Like I’ve said for years - it’s gaslighting - but medicalised. But authoritative. But legitimised.

‘The Body Keeps the Score’… But the System Writes the Script

So many of the people I work with, write for, and hear from every day have told me some version of this story:

“I was trying to cope. I was grieving. I was struggling. But it wasn’t until I was diagnosed with depression/anxiety/BPD that I actually started to fall apart. Suddenly everything I felt was ‘wrong’. I lost my confidence. I started thinking of myself as broken. Everyone judged me and treated me differently. I got worse after the diagnosis, not better.”

This isn’t a coincidence.

This is the Nocebo effect - turned loose in our mental health system.

It’s what happens when we take trauma, grief, loss, and abuse - and we respond with medicalisation instead of validation. When we give people labels instead of listening. When we teach them to fear their own minds instead of trusting their process of healing.

So What Would Jess Say?

I’d say we need to wake up to the harm we’re doing in the name of help. I’d say we need to urgently teach people about placebo versus Nocebo, which I’ve written about before too!

Psychiatric labels are not neutral. They can act as Nocebo - turning distress into disorder, hope into fear, and identity into illness. Especially for traumatised people, especially for women, especially for those who’ve been gaslit their entire lives - psychiatric diagnosis often functions as a final betrayal.

We must stop pathologising trauma.

We must stop handing people prophecies of deterioration dressed up as clinical insight.

And we must stop pretending that labelling someone is the same as understanding them.

Your brain is powerful. What you believe about yourself matters. If we can believe ourselves into suffering - then we can also believe ourselves into healing.

But only if this toxic system gets out of the way.