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Sultan (who had studied psychology) and his “lie-detecting” donkey. Lore has it that the Sultan was missing a valuable vase from his estate and suspected that one of his servants had stolen the piece. To identify the culprit, the Sultan gathered his servants in front of a dark room in which a donkey was tied, and then asked each of his servants if they had stolen the item. Each said “no”. The Sultan explained that inside the room was a magical donkey, specially trained to detect liars, who would bray when slapped by someone who had lied. The servants were sent into the room, one by one, and were instructed to close the door, slap the donkey and return. “When the donkey brays,” the Sultan proclaimed, “I will have my culprit”. The first servant was sent into the room and returned shortly thereafter-- tremendously relieved as the donkey had not brayed. One by one, the remaining servants entered the room and returned. The donkey had not brayed and all the servants looked quite relaxed. The Sultan was sanguine -- he knew this donkey never brayed under any circumstances. The Sultan asked the servants to show him their hands. He then pointed to one of them and declared “we have our thief,” instructing the guards to take him away. How had he identified the culprit? Rather than relying on a magical donkey, the Sultan, who recall was a student of psychology, took a more rational approach. Understanding the impact of beliefs on behavior, the Sultan had surreptitiously infiltrated powdered charcoal into the donkey’s hair. When the servants slapped the donkey, the charcoal marked their hands—with the exception of the guilty servant who had not slapped the donkey, out of a belief and associated fear that the donkey could detect a liar!

Power of Beliefs

Beliefs may be potent determinants of behavior, but can they kill? And if so, how? How can these invisible, intangible entities impact health? In a now classic article published in the American Anthropologist in 1942, Walter Cannon, a leading Harvard physiologist and expert on the autonomic nervous system, proposed an answer (1). Investigating phenomena such as voodoo practices of the Haitians and “bone-pointing” among Australian aborigines, Cannon found a common feature among the victims of such rituals was a strong belief in the curse and an associated morbid fear of the outcome. That fear, he argued, could trigger a “fight-or-flight reaction” (a phrase he had earlier coined), characterized by powerful and exaggerated activation of the sympathetic nervous system. The resulting vascular constriction diminishes blood flow to critical tissues (i.e., ischemia), with consequent hypoxia (decreased oxygen) and disturbances in normal metabolism and cellular function. These reactions may be exacerbated by the lack of food and water as the victim “pines away.” Cannon argued that these reactions could become life-threatening—fulfilling the gruesome legacy of the ritual—based on a belief in the supernatural, the veracity of which is largely irrelevant. More relevant is the emotion triggered by the belief, specious as it may be.

Beliefs and emotions have consequences, both behavioral and physiological. A recent example comes from the contemporary medical literature. There is now a well-documented condition, sometimes triggered by something as innocuous as a spousal argument or a surprise birthday party, which entails the hallmark clinical

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