Nocebo Effects and Mild Traumatic Brain Injury: Legal Implications

Expectations may play a large role in health-related outcomes, but they may not be fully addressed or considered in medical–legal contexts. Contextual factors can influence a patient’s expectations for recovery following a concussion, including explicit or implicit messages from the media, healthcare providers and systems of care, and the forensic arena. This article discusses these factors as nocebo effects, that is, various inherently “inert” factors may create negative expectancies for recovery and therefore impede a given patient’s progress and recovery. It is argued that the negligence theory upon which the legal system is based tends to compound these nocebo effects. In accident-related concussions, both the accident itself and subsequent nocebo effects including potential healthcare and medical–legal provider negligence can create legal liability.