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An Evaluation of Hypnosis and Suggestion As Treatment for Warts
An Evaluation of Hypnosis and Suggestion As Treatment for Warts JAMES H. 'fENZEL, M.D. and ROBERT L. TAYLOR, M.D.
"Barley-eorn, Barley-corn, injun-meal shorts, Spunk-water, spunk-water, swaller warts." "Say-what is dead cats good for, Huck?" "Good for? Cure warts with." "No! is that so? I know something that's better." "I bet you don't. What is it?" "Why, spunk-water! "Spunk-water! I wouldn't give a dern for spunk-water." "You wouldn't, wouldn't you! D'you ever try it?" "No, I hain't. But Bob Tanner did." "Who told you so?" "Why, he told Jeff Thatcher, and Jeff told Johnny Baker, and Johnny told Jim Hollis and Jim told Ben Rogers, and Ben told. .." From THE ADVENTURES OF TOM SAWYER. • Up to the present day the folklore concerning the removal of warts has continued to be expanded and embellished. The medical literature has likewise contributed its share of numerous anecdotal reports, not unlike the methods of Tom Sawyer and Huckleberry Finn. In the past ten years several better controlled studies on the treatment of warts by suggestion and hypnosis have been published. Stankler in a recent research and review article negates quite convincingly the efficacy of non-hypnotic suggestion as a mode of therapy for the treatment of warts';. However, other well-controlled studies by Sinclair-Gieben and Chalmers" and Ullman and Dudek 7 present the opposite view for the treatment of warts by hypnosis. Both of their studies indicate that hypnosis is one of the most From Department of Psychiatry, Stanford University School of Medicine, Stanford Medical Center, Stanford, California 94305.
252
effective modalities for removing warts. Despite these studies, however, considerable question concerning the role of suggestion and hypnosis as a treatment for warts persists. In 1961 Mendelson and Kligman" successfully isolated a wart virus in tissue culture and were able to inoculate humans with resulting wart production. The established viral etiology of warts gave the age-old question concerning the effects of suggestion and hypnosis on warts new relevance. In a time when the viral etiology of certain forms of human cancer is strongly suspected, the implications of altering warts through suggestion or hypnosis are of no little significance. The present study represents an attempt to confirm the results of the existing literature and to differentiate if possible the effects of hypnosis from those of suggestion. METHODS
General The experimental design was developed an attempt to match the general criteria for patients and technique used in the two studies by Ullman and Dudek 7 and SinclairGieben and Chalmersr.. Patients with bilateral upper extremity warts received hypnotic suggestion on one side and a medical placebo on the other. Approximately half the patients were interviewed and treated by each therapist. 10
Subjects All volunteers who responded to an advertisement in a local newspaper were interviewed for the experiment if they had bilateral upper extremity common warts. No limits were placed on age, sex, or duration of warts, with the exception that the warts could not have changed in appearance for Volume X
HYPNOSIS WART TREATMENT-TENZEL AND TAYLOR
at least one month prior to the study. All volunteers were seen for an initial 1 to 1% hour interview, during which time the project was briefly explained and they were tested for hypnotic suggestibility. The major factor qualifying an individual for inclusion in the study was his or her ability to achieve posthypnotic suggestion during the first interview.
Induction Technique - First Interview Induction technique cons~sted of first testing for postural sway, then eye fixation and closure, followed by hand levitation. A series of tasks conforming to the Hilgard Stanford Hypnotic Susceptibility Scale Form A were performed and rated. This included testing for post-hypnotic suggestion. Subjects were then immediately re-hypnotized a second time and given as a post-hypnotic suggestion, a key word which would result in their immediately achieving deep hypnosis. Finally, they were re-hypnotized a third time, using the key word and during deep hypnosis
an attempt was made to achieve positive and! or negative visual hallucinations. At the end of this first interview subjects were chosen and informed that the study was to compare the effects of hypnotic therapy with the best known medical treatment for the removal of warts. Subjects were given a second appointment for approximately one week following the initial interview. It should be noted that the ability to achieve post-hypnotic suggestion rather than a score on the Hilgard Stanford Susceptibility Scale was used to select subjects since this best conformed to the studies done previously.
Experimental Procedure - Second Interview After plotting the location of all warts, the hand for hypnotic suggestion was chosen by flipping a coin. Patients were hypnotized by the key word and tested again for post-hypnotic phenomena. They were then re-hypnotized and given a suggestion that as each wart was touched with an applicator stick it
TABLE I
Response to Hilsard Stanford Hypnotic SusceptabiIity Scale DP
KA
GS
VP
VJ
PM
JS
PP
DT
MM
MS
MH
ED
JE
SW
OS
KJ
EB
JC
VH
I.
Postural Sway
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
2.
Eye Closure
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
3.
Hand lOl'le ring
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
4.
Immobilization
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
5.
Finger lock
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
6.
A rl"S Rig i d i t Y
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
7.
Hands Together
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
8.
Verbal
+
+
+
+
+
+
+
+
+
+
+
+
+
+
9.
Ha I I uc ina t i on
+
+
+
+
+
+
+
+
+
+
+
10.
Eye Catalepsy
+
+
+
+
+
+
+
+
+
+
+
+
+
II.
Pas t { J nit i a I; + Hypnot i c Suqqestion Treat-
+
+
+
+
+
+
+
+
+
+
+
:-
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Inhibi t ion
-
12.
ment
Amnesia Test
JUly-August 1969
+
+ +
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
253
PSYCHOSOMATICS
would tingle and would start to regress. It was suggested that the tingling would stop after approximately three minutes but the warts would continue to regress and within two weeks would be completely gone. The patient was again given a test post-hypnotic suggestion and awakened. The placebo hand was treated by applying fluoroscene to each wart and shining a "Wood's lamp" on the hand. The impression was given that the efficacy of this treatment was not in doubt and that the warts thus treated would certainly resolve within two weeks.
Follow-up Subjects were then seen again three weeks and five weeks post-treatment and both hands re-evaluated. At the end of the five-week period several of the subjects from the initial experiment were given repeated hypnotic suggestions on a daily basis (3-5 days) that the warts would disappear within a two-week period and again followed for several weeks. Fifteen of the twenty subjects were contacted by telephone after a five-month period and a check on the status of their warts was made. RESULTS
Twenty-eight persons were seen as potential subjects for this study. Of these, six failed to meet the criteria of a positive response to post-hypnotic suggestion and were subsequently excluded. Two persons demonstrated changes in their warts prior to treatment and were eliminated. This left twenty subjects that participated in the study. All cases were examined at three weeks and five weeks post-treatment. At the end of these intervals the findings were remarkably consistent: in all subjects no change in the appearance of warts occurred on either the hand treated with suggestion alone or the hand treated with suggestion under hypnosis. After the five-week interval two of the original subjects received a similar hypnotic suggestion repeated for five consecutive days, and a third subject received hypnotic suggestion for three consecutive days. These three 254
individuals were again followed for five weeks and at the end of this period none showed any change in the warts. Fifteen of the twenty subjects were contacted by telephone five months after the initial treatment. Nine subjects reported no changes in the warts on either hand. Four subjects reported the disappearance of all warts on both hands. Two individuals experienced the selective disappearance of warts on the hand treated with hypnotic suggestion without concommitant changes of the warts on the opposite hand. In the latter case these represented single rather than multiple warts. No instances of selective disappearance of warts from the placebo hand occurred. DISCUSSION
One of the difficulties encountered in assessing the effect on warts of any form of therapy stems from the demonstrated incidence of spontaneous regression. Massing and Epstein" studied the natural history of warts in institutionalized, mentally defective children. These investigators examined the children for warts occurring on the hands and feet. This initial examination was followed up at yearly intervals for two years. No treatment was administered. At the end of one year 53% of 163 children showed complete regression of all original warts. This figure increased to 67% at the end of the two-year period. This study strongly suggests that the natural history of warts may account for the complete regression of approximately one half of existing warts after a single year and twothirds in two years. Accordingly, unless a particular therapeutic modality can be demonstrated to increase the complete regression rate of warts above that accounted for by the natural life history of warts, claims for efficacy are ill founded. Allington' in an excellent review article discusses the literature prior to 1951 on the psychotherapy of warts. Despite the strongly suggestive evidence that he cites in his article, he concludes: "It is difficult to draw definite conclusions regarding the efficacy of the psyVolume X
HYPNOSIS WART TREATMENT-TENZEL AND TAYLOR
chotherapy of warts. No matter how much circumstantial evidence suggests that in individual cases warts have cleared as the result of psychotherapy, it is impossible to rule out coincidence". Over the past decade at least four reports of controlled studies concerning suggestion, hypnosis and warts have appeared. Ullman and Dudek' reported the disappearance of warts at the end of four weeks in eight of
fifteen subjects treated with "deep hypnosis" as contrasted to only two cures in forty-seven patients who could not be deeply hypnotized. Their criteria for deep hypnosis was the occurrence of at least two of the following: (1) abolition of sensory modality, (2) pronounced motor effects, (3) amnesia, (4) post-hypnotic phenomena. Although the investigators report total regression of warts in eight out of fifteen of the selected population, in actuality their
TABLE II Results Pos t Hypnot i c Sugges t ion Hilgard ~
~~
op'·.. ·:..
20
KI\
.!..!li.li..2..
Time of Trea t me n t
Hand Wart Resolut ion Treated wi th 5 months 3 weeks .?: !{' Left Hypnosis S·:.. H'"
No. Warts per Hand ~
Right
o
0
o
0
o
0
Right
o
0
o
0
o
0
+
Left
o
0
o
0
o
0
+
Lef t
o
0
o
0
o
+
+
+
Right
o
0
o
0
o
0
12
+
+
Righ t
o
0
o
0
+
+
10
+
+
Right
o
0
o
0
25
II
+
+
15
Lef t
o
0
o
0
OT
25
II
+
2
Right
o
0
o
0
o
0
~'M
18
12
+
+
3
Right
o
0
o
0
o
0
MS
15
M
12
+
+
6
12
Le f
o
0
o
0
o
0
JH
18
M
10
+
+
8
10
Right
o
0
o
0
o
0
ED
24
11
12
+
+
II
12
Right
o
0
o
0
JE
II
M
12
+
12
Right
o
0
o
0
+
+
SW
22
11
,2
+
+
12
Right
o
0
o
0
OS
28
M
II
+
II
Lef t
o
0
o
0
o
0
KJ
25
II
11
Ri ght
o
0
o
0
o
+
[s····
24
II
JC .....
17
M
VH
19
M
10
H
II
+
21
F
10
+
+
GS
17
M
10
+
VP
40
10
VS
26
II
PM
18
M
JS
22
M
PP
S ....
= Suggestion;
H
9
4
4
+
t
+
10
II
Ri ght
o
0
o
0
+
+
II
+
2
II
Right
o
0
o
0
+
+
10
+
4
10
Right
o
0
o
0
+
= Hypnosis
Subsequen t to
week follow-up. received hypnotic treatment for 3 consecutive days,
Subsequent to
week follow-up. received hypnotic treatment for 5 consecutive days,
July-August 1969
255
PSYCHOSOMATICS
results equal ten out of the sixty-two subjects who participated in the hypnotic experiment. This percentage is consistent with the known spontaneous regression of warts. There is also a suggestion that different wart characteristics were present in their experimental and control populations. It appears that these two groups had different amounts of prior therapy. In the group that achieved deep levels of hypnosis over 50% (8 individuals) had the warts previously treated by cauterization and only 20% (3 individuals) had no previous therapy of any kind. In contrast 50% (23 individuals) of the control group had no previous therapy for the warts, and no individual from this group had prior cauterization. Although Ullman and Dudek suggest the therapeutic efficacy of hypnosis in wart regression, the above criticisms make these results less certain. Sinclair-Gieben and Chalmers" using subjects with bilateral warts and defining "deep or moderate hypnosis" in terms of the performance of post-hypnotic suggestion demonstrated that: "In nine of the ten patients in whom deep or moderate hypnosis was achieved, the warts on the 'treated' side disappeared while those on the control side remained unchanged". These results appeared in a time period of five weeks to three months. Except for a lengthy observation period this study is difficult to criticize. The results indicate that suggestion under moderate to deep hypnosis is predictably effective in accelerating the rate of wart regression and that this effect is quite specific resulting in unilateral involution in the case of bilateral warts. Our own study failed to support this contention. We found no changes in warts of twenty-two subjects over a five-week period. In an attempt to counter the argument that "not enough" hypnosis had been used, three subjects received "intensive therapy" consisting of repeated hypnotic sessions on a daily basis after the initial five-week observation. This procedure failed to alter the consistently negative findings observed after the initial five weeks. The consistency of these results 256
is especially impressive when one considers that two hypnotists were involved and both registered similar results. Most of the proponents of hypnotic therapy for warts including Ullman and Dudek note changes occurring in the warts within a two-week period and complete regression within a four week period. Therefore the follow-up period of our experiment was originally restricted to five weeks in an attempt to achieve greater specificity than that afforded by the three-month period in the SinclairGieben and Chalmers study. Because of the consistent negative findings a subsequent check was made at five months. Examination at this time revealed the complete regression of warts bilaterally in four cases and in two cases complete regression occurred selectively on the hand treated with hypnotic suggestion. These findings are compatible with the natural history of warts, and a time period of five months is excessively long to justify considering that the observed changes resulted from treatment. The selective disappearance of warts from the hand on which hypnosis was used as opposed to no cases of selective disappearance from the hand treated with suggestion alone is not statistically significant (p = .25). Our findings support those of Clarke 2 and Stankler 5 • Studying the effects of non-hypnotic suggestion on warts under controlled conditions these investigators concluded independently that suggestion was ineffective in the treatment of warts, i.e., that the results from treating warts with suggestion did not vary significantly from those results one would predict on the basis of the known natural history of warts. In summary, the study of Sinclair-Gieben and Chalmers produced impressive evidence for the efficacy of hypnosis in wart regression. Combining this evidence with the reports of Clarke and Stankler that strongly argued against the effectiveness of suggestion alone, we constructed an experimental design attempting to demonstrate this difference. Using suggestion under hypnosis as treatment on Volume X
HYPNOSIS WART TREATMENT-TENZEL AND TAYLOR
one side and suggestion without hypnosis on the opposite side in patients with bilateral warts, the authors on the basis of the literature predicated a unilateral regression on the side treated with hypnosis. This prediction proved incorrect. The results of our study are consistent with the natural life cycle of warts. There was no increase in regressive rate following either suggestion alone or under hypnosis, an increase which would have been expected if warts were responding to either of these treatment methods. We therefore conclude that neither hypnotic suggestion nor
suggestion alone are efficacious therapies for the removal of warts. REFERENCES 1. Allington, H.V.: A.M.A. Archives of Derma.tology and Syphilology, 66: 316-326, 1952. 2. Clarke, G.H.V.: The Journal of Investigative Dermatology 45: 1'5.21, 1965. 3. Massing, A., and Epstein, W.: A.M.A. Archives of Dermatology 87: 306-310, 1963. 4. Mendelson, C.G., and Kligman, A.M.; A.M.A. Archives of Dermatology 83: 559, 1961. 5. Sinclair-Gieben, A.H.C., and Chalmers, D.: The Lancet ii: 480-482, 1959. 6. Stankler, L.: Practitioner 198: 690-694, 1967. 7. Ullman, M., and DUdek, S.: Psychosomatic Medicine 22:68-72, 1960.
Can't thou not minister to a mind diseas'd, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain, And with some sweet oblivious antidote Cleanse the stuff'd bosom of that perilous stuff Which weights upon the heart? Macbeth WILUAM SHAKESPEARE (1564-1616).
JUly-August 1969
257
"Barley-eorn, Barley-corn, injun-meal shorts, Spunk-water, spunk-water, swaller warts." "Say-what is dead cats good for, Huck?" "Good for? Cure warts with." "No! is that so? I know something that's better." "I bet you don't. What is it?" "Why, spunk-water! "Spunk-water! I wouldn't give a dern for spunk-water." "You wouldn't, wouldn't you! D'you ever try it?" "No, I hain't. But Bob Tanner did." "Who told you so?" "Why, he told Jeff Thatcher, and Jeff told Johnny Baker, and Johnny told Jim Hollis and Jim told Ben Rogers, and Ben told. .." From THE ADVENTURES OF TOM SAWYER. • Up to the present day the folklore concerning the removal of warts has continued to be expanded and embellished. The medical literature has likewise contributed its share of numerous anecdotal reports, not unlike the methods of Tom Sawyer and Huckleberry Finn. In the past ten years several better controlled studies on the treatment of warts by suggestion and hypnosis have been published. Stankler in a recent research and review article negates quite convincingly the efficacy of non-hypnotic suggestion as a mode of therapy for the treatment of warts';. However, other well-controlled studies by Sinclair-Gieben and Chalmers" and Ullman and Dudek 7 present the opposite view for the treatment of warts by hypnosis. Both of their studies indicate that hypnosis is one of the most From Department of Psychiatry, Stanford University School of Medicine, Stanford Medical Center, Stanford, California 94305.
252
effective modalities for removing warts. Despite these studies, however, considerable question concerning the role of suggestion and hypnosis as a treatment for warts persists. In 1961 Mendelson and Kligman" successfully isolated a wart virus in tissue culture and were able to inoculate humans with resulting wart production. The established viral etiology of warts gave the age-old question concerning the effects of suggestion and hypnosis on warts new relevance. In a time when the viral etiology of certain forms of human cancer is strongly suspected, the implications of altering warts through suggestion or hypnosis are of no little significance. The present study represents an attempt to confirm the results of the existing literature and to differentiate if possible the effects of hypnosis from those of suggestion. METHODS
General The experimental design was developed an attempt to match the general criteria for patients and technique used in the two studies by Ullman and Dudek 7 and SinclairGieben and Chalmersr.. Patients with bilateral upper extremity warts received hypnotic suggestion on one side and a medical placebo on the other. Approximately half the patients were interviewed and treated by each therapist. 10
Subjects All volunteers who responded to an advertisement in a local newspaper were interviewed for the experiment if they had bilateral upper extremity common warts. No limits were placed on age, sex, or duration of warts, with the exception that the warts could not have changed in appearance for Volume X
HYPNOSIS WART TREATMENT-TENZEL AND TAYLOR
at least one month prior to the study. All volunteers were seen for an initial 1 to 1% hour interview, during which time the project was briefly explained and they were tested for hypnotic suggestibility. The major factor qualifying an individual for inclusion in the study was his or her ability to achieve posthypnotic suggestion during the first interview.
Induction Technique - First Interview Induction technique cons~sted of first testing for postural sway, then eye fixation and closure, followed by hand levitation. A series of tasks conforming to the Hilgard Stanford Hypnotic Susceptibility Scale Form A were performed and rated. This included testing for post-hypnotic suggestion. Subjects were then immediately re-hypnotized a second time and given as a post-hypnotic suggestion, a key word which would result in their immediately achieving deep hypnosis. Finally, they were re-hypnotized a third time, using the key word and during deep hypnosis
an attempt was made to achieve positive and! or negative visual hallucinations. At the end of this first interview subjects were chosen and informed that the study was to compare the effects of hypnotic therapy with the best known medical treatment for the removal of warts. Subjects were given a second appointment for approximately one week following the initial interview. It should be noted that the ability to achieve post-hypnotic suggestion rather than a score on the Hilgard Stanford Susceptibility Scale was used to select subjects since this best conformed to the studies done previously.
Experimental Procedure - Second Interview After plotting the location of all warts, the hand for hypnotic suggestion was chosen by flipping a coin. Patients were hypnotized by the key word and tested again for post-hypnotic phenomena. They were then re-hypnotized and given a suggestion that as each wart was touched with an applicator stick it
TABLE I
Response to Hilsard Stanford Hypnotic SusceptabiIity Scale DP
KA
GS
VP
VJ
PM
JS
PP
DT
MM
MS
MH
ED
JE
SW
OS
KJ
EB
JC
VH
I.
Postural Sway
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
2.
Eye Closure
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
3.
Hand lOl'le ring
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
4.
Immobilization
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
5.
Finger lock
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
6.
A rl"S Rig i d i t Y
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
7.
Hands Together
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
8.
Verbal
+
+
+
+
+
+
+
+
+
+
+
+
+
+
9.
Ha I I uc ina t i on
+
+
+
+
+
+
+
+
+
+
+
10.
Eye Catalepsy
+
+
+
+
+
+
+
+
+
+
+
+
+
II.
Pas t { J nit i a I; + Hypnot i c Suqqestion Treat-
+
+
+
+
+
+
+
+
+
+
+
:-
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Inhibi t ion
-
12.
ment
Amnesia Test
JUly-August 1969
+
+ +
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
253
PSYCHOSOMATICS
would tingle and would start to regress. It was suggested that the tingling would stop after approximately three minutes but the warts would continue to regress and within two weeks would be completely gone. The patient was again given a test post-hypnotic suggestion and awakened. The placebo hand was treated by applying fluoroscene to each wart and shining a "Wood's lamp" on the hand. The impression was given that the efficacy of this treatment was not in doubt and that the warts thus treated would certainly resolve within two weeks.
Follow-up Subjects were then seen again three weeks and five weeks post-treatment and both hands re-evaluated. At the end of the five-week period several of the subjects from the initial experiment were given repeated hypnotic suggestions on a daily basis (3-5 days) that the warts would disappear within a two-week period and again followed for several weeks. Fifteen of the twenty subjects were contacted by telephone after a five-month period and a check on the status of their warts was made. RESULTS
Twenty-eight persons were seen as potential subjects for this study. Of these, six failed to meet the criteria of a positive response to post-hypnotic suggestion and were subsequently excluded. Two persons demonstrated changes in their warts prior to treatment and were eliminated. This left twenty subjects that participated in the study. All cases were examined at three weeks and five weeks post-treatment. At the end of these intervals the findings were remarkably consistent: in all subjects no change in the appearance of warts occurred on either the hand treated with suggestion alone or the hand treated with suggestion under hypnosis. After the five-week interval two of the original subjects received a similar hypnotic suggestion repeated for five consecutive days, and a third subject received hypnotic suggestion for three consecutive days. These three 254
individuals were again followed for five weeks and at the end of this period none showed any change in the warts. Fifteen of the twenty subjects were contacted by telephone five months after the initial treatment. Nine subjects reported no changes in the warts on either hand. Four subjects reported the disappearance of all warts on both hands. Two individuals experienced the selective disappearance of warts on the hand treated with hypnotic suggestion without concommitant changes of the warts on the opposite hand. In the latter case these represented single rather than multiple warts. No instances of selective disappearance of warts from the placebo hand occurred. DISCUSSION
One of the difficulties encountered in assessing the effect on warts of any form of therapy stems from the demonstrated incidence of spontaneous regression. Massing and Epstein" studied the natural history of warts in institutionalized, mentally defective children. These investigators examined the children for warts occurring on the hands and feet. This initial examination was followed up at yearly intervals for two years. No treatment was administered. At the end of one year 53% of 163 children showed complete regression of all original warts. This figure increased to 67% at the end of the two-year period. This study strongly suggests that the natural history of warts may account for the complete regression of approximately one half of existing warts after a single year and twothirds in two years. Accordingly, unless a particular therapeutic modality can be demonstrated to increase the complete regression rate of warts above that accounted for by the natural life history of warts, claims for efficacy are ill founded. Allington' in an excellent review article discusses the literature prior to 1951 on the psychotherapy of warts. Despite the strongly suggestive evidence that he cites in his article, he concludes: "It is difficult to draw definite conclusions regarding the efficacy of the psyVolume X
HYPNOSIS WART TREATMENT-TENZEL AND TAYLOR
chotherapy of warts. No matter how much circumstantial evidence suggests that in individual cases warts have cleared as the result of psychotherapy, it is impossible to rule out coincidence". Over the past decade at least four reports of controlled studies concerning suggestion, hypnosis and warts have appeared. Ullman and Dudek' reported the disappearance of warts at the end of four weeks in eight of
fifteen subjects treated with "deep hypnosis" as contrasted to only two cures in forty-seven patients who could not be deeply hypnotized. Their criteria for deep hypnosis was the occurrence of at least two of the following: (1) abolition of sensory modality, (2) pronounced motor effects, (3) amnesia, (4) post-hypnotic phenomena. Although the investigators report total regression of warts in eight out of fifteen of the selected population, in actuality their
TABLE II Results Pos t Hypnot i c Sugges t ion Hilgard ~
~~
op'·.. ·:..
20
KI\
.!..!li.li..2..
Time of Trea t me n t
Hand Wart Resolut ion Treated wi th 5 months 3 weeks .?: !{' Left Hypnosis S·:.. H'"
No. Warts per Hand ~
Right
o
0
o
0
o
0
Right
o
0
o
0
o
0
+
Left
o
0
o
0
o
0
+
Lef t
o
0
o
0
o
+
+
+
Right
o
0
o
0
o
0
12
+
+
Righ t
o
0
o
0
+
+
10
+
+
Right
o
0
o
0
25
II
+
+
15
Lef t
o
0
o
0
OT
25
II
+
2
Right
o
0
o
0
o
0
~'M
18
12
+
+
3
Right
o
0
o
0
o
0
MS
15
M
12
+
+
6
12
Le f
o
0
o
0
o
0
JH
18
M
10
+
+
8
10
Right
o
0
o
0
o
0
ED
24
11
12
+
+
II
12
Right
o
0
o
0
JE
II
M
12
+
12
Right
o
0
o
0
+
+
SW
22
11
,2
+
+
12
Right
o
0
o
0
OS
28
M
II
+
II
Lef t
o
0
o
0
o
0
KJ
25
II
11
Ri ght
o
0
o
0
o
+
[s····
24
II
JC .....
17
M
VH
19
M
10
H
II
+
21
F
10
+
+
GS
17
M
10
+
VP
40
10
VS
26
II
PM
18
M
JS
22
M
PP
S ....
= Suggestion;
H
9
4
4
+
t
+
10
II
Ri ght
o
0
o
0
+
+
II
+
2
II
Right
o
0
o
0
+
+
10
+
4
10
Right
o
0
o
0
+
= Hypnosis
Subsequen t to
week follow-up. received hypnotic treatment for 3 consecutive days,
Subsequent to
week follow-up. received hypnotic treatment for 5 consecutive days,
July-August 1969
255
PSYCHOSOMATICS
results equal ten out of the sixty-two subjects who participated in the hypnotic experiment. This percentage is consistent with the known spontaneous regression of warts. There is also a suggestion that different wart characteristics were present in their experimental and control populations. It appears that these two groups had different amounts of prior therapy. In the group that achieved deep levels of hypnosis over 50% (8 individuals) had the warts previously treated by cauterization and only 20% (3 individuals) had no previous therapy of any kind. In contrast 50% (23 individuals) of the control group had no previous therapy for the warts, and no individual from this group had prior cauterization. Although Ullman and Dudek suggest the therapeutic efficacy of hypnosis in wart regression, the above criticisms make these results less certain. Sinclair-Gieben and Chalmers" using subjects with bilateral warts and defining "deep or moderate hypnosis" in terms of the performance of post-hypnotic suggestion demonstrated that: "In nine of the ten patients in whom deep or moderate hypnosis was achieved, the warts on the 'treated' side disappeared while those on the control side remained unchanged". These results appeared in a time period of five weeks to three months. Except for a lengthy observation period this study is difficult to criticize. The results indicate that suggestion under moderate to deep hypnosis is predictably effective in accelerating the rate of wart regression and that this effect is quite specific resulting in unilateral involution in the case of bilateral warts. Our own study failed to support this contention. We found no changes in warts of twenty-two subjects over a five-week period. In an attempt to counter the argument that "not enough" hypnosis had been used, three subjects received "intensive therapy" consisting of repeated hypnotic sessions on a daily basis after the initial five-week observation. This procedure failed to alter the consistently negative findings observed after the initial five weeks. The consistency of these results 256
is especially impressive when one considers that two hypnotists were involved and both registered similar results. Most of the proponents of hypnotic therapy for warts including Ullman and Dudek note changes occurring in the warts within a two-week period and complete regression within a four week period. Therefore the follow-up period of our experiment was originally restricted to five weeks in an attempt to achieve greater specificity than that afforded by the three-month period in the SinclairGieben and Chalmers study. Because of the consistent negative findings a subsequent check was made at five months. Examination at this time revealed the complete regression of warts bilaterally in four cases and in two cases complete regression occurred selectively on the hand treated with hypnotic suggestion. These findings are compatible with the natural history of warts, and a time period of five months is excessively long to justify considering that the observed changes resulted from treatment. The selective disappearance of warts from the hand on which hypnosis was used as opposed to no cases of selective disappearance from the hand treated with suggestion alone is not statistically significant (p = .25). Our findings support those of Clarke 2 and Stankler 5 • Studying the effects of non-hypnotic suggestion on warts under controlled conditions these investigators concluded independently that suggestion was ineffective in the treatment of warts, i.e., that the results from treating warts with suggestion did not vary significantly from those results one would predict on the basis of the known natural history of warts. In summary, the study of Sinclair-Gieben and Chalmers produced impressive evidence for the efficacy of hypnosis in wart regression. Combining this evidence with the reports of Clarke and Stankler that strongly argued against the effectiveness of suggestion alone, we constructed an experimental design attempting to demonstrate this difference. Using suggestion under hypnosis as treatment on Volume X
HYPNOSIS WART TREATMENT-TENZEL AND TAYLOR
one side and suggestion without hypnosis on the opposite side in patients with bilateral warts, the authors on the basis of the literature predicated a unilateral regression on the side treated with hypnosis. This prediction proved incorrect. The results of our study are consistent with the natural life cycle of warts. There was no increase in regressive rate following either suggestion alone or under hypnosis, an increase which would have been expected if warts were responding to either of these treatment methods. We therefore conclude that neither hypnotic suggestion nor
suggestion alone are efficacious therapies for the removal of warts. REFERENCES 1. Allington, H.V.: A.M.A. Archives of Derma.tology and Syphilology, 66: 316-326, 1952. 2. Clarke, G.H.V.: The Journal of Investigative Dermatology 45: 1'5.21, 1965. 3. Massing, A., and Epstein, W.: A.M.A. Archives of Dermatology 87: 306-310, 1963. 4. Mendelson, C.G., and Kligman, A.M.; A.M.A. Archives of Dermatology 83: 559, 1961. 5. Sinclair-Gieben, A.H.C., and Chalmers, D.: The Lancet ii: 480-482, 1959. 6. Stankler, L.: Practitioner 198: 690-694, 1967. 7. Ullman, M., and DUdek, S.: Psychosomatic Medicine 22:68-72, 1960.
Can't thou not minister to a mind diseas'd, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain, And with some sweet oblivious antidote Cleanse the stuff'd bosom of that perilous stuff Which weights upon the heart? Macbeth WILUAM SHAKESPEARE (1564-1616).
JUly-August 1969
257