- Email: [email protected]
Hypnosis and its Misconceptions
HYPNOSIS AND ITS MISCONCEPTIONS Willifred C. McCall, M.D.
Dr. McCall, author of a number of articles on the use of hypnosis, in 1962 received a citation from the American Institute of Hypnosis for his outstanding contributions to medical literature in the field of hypnosis. In World War II he served as an apprentice in an Army Hospital and in 1955 graduated from the University of Southern California Medical School. His internship was at Orange County Hospital, Orange, California, and he had a one-year residency at San Luis Obispo County Hospital. Dr. McCall says he “belongs to all the usual medical societies,” as well as the Orange County and the California Medical Societies, the American Association of Physicians and Surgeons, and the American Institute of Hypnosis, of which he is a past president. Dr. McCall owns his own plane and is a member of the Flying Phy. sicians Association. He is married and has four children, and currently is conducting the Hypnosis Workshop in Los Angeles in which doctors using hypnosis discuss problems, techniques, and means of treating different illnesses. He has been in private practice in Anaheim, California, for seven years.
July-August 1964
Hypnosis is one of the oldest medical arts. Before discussing the principles and misconceptions of modern hypnotherapy, it is necessary to review briefly some of the history and expose how many of these misconceptions gained their footing. Hypnosis has been practiced under numerous labels and in different places since time immemorial, Tribal medicine men, witch doctors, and religious leaders have applied it in various forms to heal the sick, usually ascribing the cures to miracles performed by the Gods. The Ebers Papyrus, over 3000 years old, describes how Egyptian soothsayers used hypnotic-like procedures similar to those practiced today. Centuries ago, the Greek oracles, the Persian magi, the Hindu fakirs and the Indian yogi used hypnosis without even realizing it. The earliest medical records described miraculous healing by priests or demigods who induced a sleep-like state by ceremonial rites in the Escapalian temples. Both the Talmud and the Bible contain many allusions to the laying on of hands and other hypnotic techinques. One practitioner was a healer by the name of Yalen-
45
tine Greatrakes who lived in the neighborhood of 1650 and was known as “The Great Irish Stroker.” Francisco Bagnone was operating in Italy in a similar manner and with equal success. Apparently he had only to touch the sick with his hands or with a religious relic to accomplish astonishing cures. Paracelsus pointed out the healing effect of the astrobodies and the magnet, and felt that the latter could cure most diseases. It was from this that Frans Mesmer got his idea of animal magnetism. Mesmer developed a rather large tuh, filled with iron filings. To this tub iron rods were attached which patients grasped, thereby receiving a magnetic flow. Thirty or more persons could be connected with each other by cords and could also be magnetized as Mesmer touched each person in turn with a glass rod. Many developed seizures or underwent crises similar to those observed in the religious sects. At first he contended that the magnetism emanated from the astrobodies but later, that it was transferred from himself to the patient by his magnetic wand. Mesmer became so impressed with his powers that he claimed he could touch any tree in a forest with his wand and a hypnotized person could pick that tree out of all the others. Since this was an impossible feat, he was exposed in front of a Royal Commission in France, of which one member was Benjamin Franklin. The Commission concluded that the cures were due to imagination and not to magnetism. Hypnoanesthesia was first used in 1821 by Recamier who performed operations on patients under mesmeric coma. In 1837, John Elliottson, at that time one of the most able physicians in England and one of the most well known and respected, became infatuated with and an enthusiastic advocate of mesmerism. He was not afraid of innovation or criticism and, as a result, was severely censored by editorials in the
46
Bettman Archive, Inc.
“The Grrat Irish Strokcr,” Greatrakes, ~ 1 6 5 0 .
British Medical Journal “Lancet,” for charlatanism. Although he had introduced the stethescope to England, he was called a quack and an imposter, apparently because of the fantastic claims made about hypnosis. Subsequently, the University banned the use of mesmerism and the church opposed its use. Elliottson, a dedicated and fearless scientist, promptly resigned and for many years he published his “Zoist,” the journal of hypnosis in which numerous painless operations and other mesmeric phenomena were recorded. In spite of the censure placed upon mesmerism by the uninformed of that time, the phenomenon attracted more and more disciples. Among them was a Scottish surgeon practicing in India by the name of James Esdale who between 1840-50reported hundreds of painless operations. Another was James Braid who observed a demonstration in Manchester by a Swiss magnetizer and contended that the degree of expectation increased the subject’s susceptibility to suggestion. He is the one who coined the terms “hypnotism and hypnosis” from the
AORN Journal
Greek word “hypnos,” meaning sleep. Later he recognized that hypnosis was not sleep but the term had gained common usage and it was too late to change it. He was the first to realize that hypnosis could be induced without a formalistic induction and with the eyes open. In 1882 a society for psychical research was founded to investigate the therapeutic uses of hypnotism. Many prominent doctors were enrolled and in 1891 their published report contained the opinion that as a therapeutic agent hypnotism was frequently effective in relieving pain, procuring sleep, and relieving many functional ailments. Le Beau, a Frenchman who is considered the real father of modern hypnotism, was one of the first physicians to experiment with the therapeutic value of hypnosis on a large scale. Without pay, he treated thousands of patients suffering from a great assortment of physical symptoms. He believed that hypnosis could favorably influence not only functional but also organic diseases. Le Beau imagined that it might cure cancer and that it might also act as an antidote to poisoning. He claimed cures for anemia, intermittent fever, pulmonary tuberculosis, menstrual difficulties, neuralgia, and migraine. Le Beau even published a book on hypnosis but medical skepticism was so great that he was able to sell only one copy-to a gentleman by the name of Bernheim, a professor at the Nancy Medical School who bought the book only in order to expose him as a quack. He was, instead, so amazed at Le Beau’s work that he undertook a study of hypnotism and soon became one of its most ardent devotees. Burnheim also published a book, in which he claimed cures for hysterical hemiplegia, aphonia, hysteric crises, gastric difficulties, loss of appetite, depression of the spirit, pains, tremors, fixed ideas, sleep walking, and a number of other functional diseases.
Charcot, who is famous to this day for his description of different pathological conditions, stated that hypnosis was a sign of weakness and of nervous indisposition. Charcot’s theories, based on working repeatedly with only a dozen hysterical patients at the Salpietre, an insane asylum, were completely discredited. However, the idea persists to this day that in order to be hypnotized one must be weak minded. Bernheim and Le Beau accomplished the first real breakthrough. Bernheim’s repiitation and the publication of his book in 1886 for the first time brought a degree of respectability to hypnosis. Freud too became interested in hypnosis and studied with Charcot and Bernheim but for several reasons he avoided its use. First, he was embarrassed because he could not hypnotize very many patients to sufficient depth. Second, the cures were temporary, inasmuch as the post-hypnotic suggestions could not be maintained and he could not elicit buried traumatic material because of the resistance of his patients. He also felt that hypnosis stripped the patient of his defenses. Freud abandoned hypnosis, not because it was without value as a psychological tool, but because of his inability to incorporate it into his own authoritative hypno-therapeutic approach. It is interesting that at the same time that Freud was abandoning hypnosis, Pavlov did more independent research into hypnosis than probably any other single man. Nonetheless, Pavlov is known in this country only for the salivation that was caused by ringing a bell. Following the acceptance of hypnosis throughout Europe, almost every known disease of that time was listed as having been cured or helped by it. One reason why all of these unfounded claims were made for hypnosis was that very few follow-up studies were done on the patients who were presumably cured. It must be remembered that
47
nothing was then known of the defensive value of symptoms and of their functional utility in the life adjustment of the individual. Hypnosis was used as a bludgeon to crush the patient’s complaints. We must therefore suspect that the failures were far more frequent than the successes, yet the fantastic claims for hypnosis were the things most responsible for its being ridiculed and banned. The worst enemies of hypnosis were the men making the most ardent claims. About 1880, Breuer introduced an important innovation in hypnotic therapy which extended the application of hypnosis beyond simply suggesting that symptoms go away. While treating an hysterical patient whose illness was precipitated by the development of a parapleuritic abscess in her father, he was confounded by the fact that in spite of all hypnotic effects her symptoms became progressively worse. He accidentally discovered that when she was induced to speak freely under hypnosis she exhibited a profound emotional reaction and thereafter experienced a decided relief from her complaints. He traced through many of her complaints very specifically and was able, with thorough investigation, to remove each and every one. It appeared that symptoms disappeared only after the basic cause was discovered. In one instance, the patient detailed 108 examples of her disability before she finally revealed the first, in which her father was involved, and this finally removed the symptoms. The importance of Breuer’s work lies in the change of emphasis in hypnotic therapy from the direct removal of symptoms to dealing with the apparent causes of the symptoms. Breuer and Freud concluded that hysterical symptoms developed as a result of experiences so damaging to the individual that they had been repressed. The mental energy originally associated with the experi-
48
ence was blocked from reaching consciousness by the mechanism of repression. The energy was then converted into bodily enervations, accounting for bodily symptoms. Under hypnotic treatment the discharge of the strangulated effect into normal channels of consciousness made it unnecessary to convert the energy into symptoms. More and more Freud became conscious of the purposeful nature of the symptoms and stated that they represented defenses against the repressed instinctive strivings produced by the conflict. He pointed out that these symptoms served an economic function in the psychic life of the individual. He lent further emphasis to the irrationality of the strict use of hypnosis for the removal of symptoms. Freud’s discoveries, as well as a current disappointment in hypnosis as a permanent cure of hysteria, almost succeeded in dealing hypnosis a death blow. In spite of the work of many other famous men of that time, the growth of the psychoanalytic movement and development of other forms of psychotherapy reduced hypnosis to a place of relatively minor importance. Hypnotism became subject to the attack of the medical profession on the basis that it was allied to quackery and was a source of moral danger. Janet continued to believe that hypnosis was a most effective treatment for neurosis, but in spite of the fact that he showed that hypnotic suggestion could produce no action beyond the power of the normal will, most physicians felt hypnosis was a relic of the past. Although it was politely mentioned in textbooks of psychiatry, it was considered in the category of such aged practices as cupping, leaching and blood letting. Critics seldom realize that hypnosis is a meaningful interpersonal relationship involving real patient participation because of increased receptivity, and that the productive involvement of the patient with the
AOHN Journal
“Ten Francs an Hour,” title of Daumier cartoon ridiculiug hypnotism, 1852.
therapist results in a more ready acceptance of suggestions. Contrarily, the hypnosis they
rightfully criticized was the dramatic symptom removal type used at the turn of the century which was essentially commanding and authoritative. Today, however, the techniques are permissive and oriented around the patient’s needs, rather than being doctor-directed. These factors, together with the utilization of auto-hypnosis and auto-conditioning, have resulted in a type of hypnotherapy that is vastly different from the hypnosis that Freud rejected. With this background, we can now discuss more completely some of the modern misconceptions of hypnosis. One of the most common and widely held misconceptions is that when you are hypnotized you lose consciousness. The professional stage hypnotist has contributed to this widely held notion that hypnosis is a sleep-like trance, or an uncon-
July-August 1964
Bettman Archive, Inc.
scious involuntary state. It is probably this part of stage hypnotism which does the most damage so far as the ethical hypnotist is concerned. Because of the misconceptions that are created by these people, the patients who desire hypnosis and would ordinarily benefit from it, expect bizarre, out-of-thisworld symptoms which actually never develop. This, then, destroys or impairs their confidence in hypnosis and makes its beneficial effects much more difficult to obtain. In my own practice, I inform all of my patients that they will never lose full sense of awareness nor fall asleep. Actually they will be more awake. All levels of hypnosis, including deepest stages, are characterized by increased attention to the operator’s suggestions and this concentration facilitates receptivity to further suggestions. The profound concentration thus achieved is the main reason for the use of hypnosis. Most ideas equating sleep
49
to hypnosis stem from motion picture films
portraying a hypnotized individual with his eyes closed. Even after it has been emphasized repeatedly that the hypnotized individual does not fall asleep, patients frequently state, “Doctor, 1know that I was not hypnotized, 1 heard everything you said.” Another common misconception is that in order for a person to be hypnotized, and to benefit from the hypnosis, he must surrender his will to the hypnotist. This misconception has been attributed to the Svengali-Trilby novel, comic strips, television programs, and so on, with which you are familiar. The capacity to be hypnotized is a subjective experience and therefore nothing could be further from the truth. Patients also feel that under hypnosis they can be made to do anything against their wishes and this is likewise completely false since the subject is never dominated by the will of the hypnotist. One is always fully capable of making decisions at all times. It is remotely conceivable that an unscrupulous hypnotist, by producing a total amnesia and establishing a valid motive, could get an individual to commit a criminal or an anti-social act if he is already pre-disposed to lie, steal or kill. However, I feel that this is more theoretical than real. In the 1880’s Dr. Bramwell performed an experiment in which he obtained a patient who had subconscious hatred toward her mother and placed her in a situation in which she was told under hypnosis that the sugar bowl contained arsenic and that if she would put this arsenic in her mother’s tea she would then be rid of her mother and all of her troubles. The patient performed exactly as she was told to do under the hypnosis, placing the so-called arsenic in her mother’s tea and sat there delightedly watching her drink it. However, when questioned as to why she did this, the daughter told them she knew it was really only sugar and that, therefore.
50
she had nothing to be concerned about. It is my personal feeling that no patient would ever commit an immoral or asocial act while under the influence of hypnosis, unless he would have done so anyway. Many people believe that morons, imbeciles and weak minded persons make the best hypnotic subjects. This could not be more false. People who are above average in intelligence and who are capable of concentrating make the best subjects. In this connection, constant hypnotic induction does not weaken the mind or make an individual more suggestible. Thousands of subjects have been hypnotized hundreds of times without the slightest demonstrable harm. I remember very clearly a patient who came to me for hypnosis and we were having a great deal of difficulty in producing a satisfactory trance state, at which time she blurted out, “I don’t want to be hypnotized because I might tell you something that I don’t want to tell you.” This then is a misconception. Patients are aware of everything that is going on while they are being hypnotized and even afterward, unless a specific amnesia is suggested. They will reveal no facts or conditions which they do not want to reveal or that they would not be willing to reveal in their conscious mind. Hypnosis frequently permits them to uncover or recall an incident or a fact which occurred in the long forgotten past. However, at no time would a patient ever tell the hypnotist anything against his will. I have read a great deal about people who fear they might not be able to be de-hypnotized or awakened. I have had no personal experience with this matter since I have never run into a patient who had this particular fear. This is obviously the statement of a person who knows nothing about hppnosis since the hypnosis is induced completely by the patient-the therapist’s only role is that of guidance, leading them down
AORA’ Journal
the path to a satisfactory hypnotic trance. Therefore, the patient can de-hypnotize himself at any time he chooses. He can open his eyes, he can move, he can get up, he can walk out, he can do anything that he chooses at any time he chooses. Any time a posthypnotic suggestion contrary to the wish of the patient is given, spontaneous de-hypnotization invariably occurs and breaks the rapport. For example, if I had a patient in a deep hypnotic trance and told him to take off all of his clothes and run around the building, he would either totally ignore the suggestion or wake up out of the trance, and it would probably be very difficult to re-hypnotize him after that. Inasmuch as nearly all of my patients are taught autohypnosis, they can terminate it at any time. Some persons believe that if they are hypnotizable it indicates that they are gullible and will believe everything told to them. Mental discrimination is not impaired with regard to stimuli which could threaten the integrity of the organism. I feel that no person will do anything under hypnosis that would endanger his life or make him more emotionally upset. Another widely held misconception is that one has to have a strong personality to be a hypnotist and that therefore males are better hypnotists than females because they are supposedly dominant personalities. This is another falsity, since one of the leading stage hypnotists today is a woman-Pat Collins, whom many of you have probably seen. In summary then, the already mentioned misconceptions of hypnosis, so far as the laity is concerned, reveal that hypnosis is not a sleep state trance or state of unconsciousness. Rather, it closely resembles the waking state. It has often been likened to the condition that occurs just before one falls asleep at night. The will is not surrendered. Intelligent individuals usually make the best subjects. A hypnotized person does not lose
control, nor does he reveal intimate material unless he wishes to do so. Susceptibility to hypnosis is not related to gullibility or submissiveness; hypnosis can be terminated readily by either the subject or the operator. The subject is never helpless to resist undesirable post-hypnotic suggestions, and it is important to remove these doubts and misconceptions in order to establish a closer rapport and to obtain the motivation necessary for successful hypnotic induction and therapy. Some valid objections to hypnosis are that it has been hailed as a panacea by overenthusiastic medical practitioners as well as by unscrupulous lay healers and charlatans. Legislation is currently being enacted to ban its use by the latter, and overly zealous physicians are being cautioned by their more informed colleagues. Many conclusions have been drawn from uncontrolled research experiments. What is needed are more experimental designs for control of such significant variables as operator attitude, the effects of the interpersonal relationship, and subject selection but not, as some think, of indoctrination. Another valid objection is the extravagant claims based on extrapalating data from observations made on somnambules, thus making it appear that complex hypnoanalytic techniques can be readily and universally applied. It is doubtful that more than 20 per cent of the well trained hypnotic subjects can ever reach deep hypnotic states or, for that matter, do they need to. Members of the medical profession commonly state that hypnosis is worthless because nobody knows how it works. They state that hypnosis tends to produce extreme dependency upon the therapist. However, it is felt that this dependency is not due to the hypnotherapy itself but to the manner in which the interpersonal relationship is utilized. Any therapist who acts as an authorita-
51
tive figure will foster dependency, irrespective of the therapeutic system utilized. It is felt by some that hypnotherapy sexualizes the doctor-patient relationship, yet we have all heard that the patient is likely to fall in love with the therapist and this applies not to hypnosis but to the psycho or hypnoanalyst. Authorities agree that a hypnotized person is not likely to violate his moral code and it is felt that alcohol or sedatives would serve better than psychotherapy or hypnosis if a person had rape on his mind. It is said that “Candy’s dandy but liquor’s quicker’’ and both would be faster than hypnosis. One of the most current and biggest hullabaloos regarding hypnosis is that it is dangerous. It is this concept which has possessed many executive committees on many hospitals to pass a rule that hypnosis may not be used in a hospital unless a psychiatrist is in attendance. Hypnosis per se is not dangerous but careless remarks can lead to iatrogenic disorders. Those who contend that hypnosis is dangerous seldom mention the possibility of psychotherapeutic mismanagement, ineptitude, improper selection of cases, and the possibility that they are transmitting their own anxieties to apprehensive patients because of their own feelings of insecurity. Most experienced hypnotherapists agree that there are no dangers from hypnosis when it is properly used according to the skill and training of the therapist. I fell that the dangers attributed to hypnosis have been sensationally publicized and when mishaps occur they are due to the exacerbation of personality problems that would have become pronounced through non-hypnotic intervention and mismanagement. No one has ever died from hypnotism. The same cannot be said about certain tranquilizers and shock therapy. There is no modality less dangerous than hypnosis. The question as to whether symptom removal is dangerous unless the cause is un-
52
derstood is continually emphasized by the critics of hypnotherapy. The validity of this criticism is open to serious question as only the extremely disturbed patient will relinquish one symptom and substitute another. The far greater tendency is to replace the symptom with something constructive. It appears that hypnotherapy can be prescribed in selected cases for symptomatic relief in the same manner as tranquilizers or other psychopharmacological agents are prescribed. Many symptoms have become just a habit and as such can be removed without danger. An example of this is fingernail biting. The symptom removal seldom triggers a psychotic break unless the psychotic process has been going on for years before it becomes overt. Some psychiatrists contend that hypnosis can cause a psychosis, even though they are fully aware that any strong affective reaction can precipitate the recognition of a hitherto unsuspected psychosis and that this could happen with all forms of psychotherapy, even casual events of daily life. Freud noted that hypnosis had no deleterious effects and that it was not a dangerous tool. He also stated that if the general public were ever to achieve the benefits of analysis it would have to be done through the means of hypnosis. Many competent therapists have treated various syndromes by hypnotic symptom removal, leading to the finding that dealing with symptoms and current problems does not necessarily produce other symptoms nor recurrence of old symptoms. While it is agreed that sometimes understanding of the underlying psychodynamics leads to a higher percentage of cures, there are no accurately controlled data to indicate that this is always so. It is, therefore, concluded that symptom removal by any properly trained person is not dangerous and that usually the other symptom equivalents do not take the place
AORN Journal
“Experiment in Hypnotism,” 1893 painting by R. Falkenberg.
of the removed one. The objection that symptom removal is dangerous applies to only a limited number of patients since it applies only to those who cannot endure living without their neurotic defenses and is therefore expressive of diagnostic incompetence. The widespread use of psychotropic drugs, often without knowing the causes of the symptomatology, has drastically changed the basic approach to many psychiatric problems, The original report on the medical use of hypnosis by the British Medical Association and the American Medical Association stated that the surgeon, obstetrician, anesthesiologist and general practitioner may legitimately utilize hypnosis within the framework of his own particular field of competence. The report pointed out that controversy exists only as to the hazards of hypnosis.
July-August 1964
Bettman Archive, Inc.
However, when the American Medical Association was recently asked “Has the American Medical Association Committee on Hypnosis ever published officially any statement defining or implying the dangers of hypnosis by physicians?”, the official answer was that it had not done so, nor had it authorized anyone to do so, and that any member of the committee who does so is expressing his own personal opinion! Yet, one hears the accusation again and again that the non-psvchiatrically oriented physician will open up the patient’s Pandora’s box of substitute symptoms that lead to anti-social acting out or self-destructive behavior if hypnosis is used purely for symptom removal. It has become more widely recognized that insight is not actually necessary in order to remove a patient’s neuroses. Nearly all ex-
53
perienced psychotherapists accept the empirical findings that a therapist’s personality, his confidence with the method, as well as the patient’s expectations and beliefs, all are more important than recovering repressed material. Dorcus, Kroeger, Bryan, and other reputable investigators have noted that hypnotherapy, without insight, is often as effective in dealing with symptomatic behavior as therapies which provide insight. Furthermore, the recovery persists as long as the cures of those treated by insight therapy. Many deep-seated conflicts are resolved with the passing of time and without insight ever being achieved. Often, insight is not the patient’s insight, but the therapist’s preconceived notion of what insight the patient should have. The patient merely takes over the value systems of faith and the confidence of the therapist and this is actually what makes emotionally disturbed individuals better. Auto-hypnosis in one ritual or another is employed in Zen, Buddhist, Yoga, and other religious rites. A degree of autohypnosis, even though its use is denied, is also responsible for the recoveries obtained by Christian Science, Science of the Mind, Theosophy, the Emmanuel Movement, and many other spiritualistic religious healing modalities. The concentration and narrowing of attention (hypnotic induction) in these religious prayer states may not be considered necessary nor even desirable by a non-believer, but they are never called dangerous. Hypnosis should never again fall into undeserved oblivion. We must challenge those who, on the basis of a few inadequately documented cases or poorly controlled and inadequate questionnaire material, continually warn about the dangers of hypnosis, especially as employed by the non-psychiatrist. We must particularly challenge the use of questionnaires to prove pre-conceived ideas,
not to determine scientific truth. It is repeatedly stated that hypnotherapy is a cure that can be dynamite, that patients have suffered irrevocable harm as a result of symptom removal, and that self-hypnosis can be potentially dangerous to those who practice it or those who submit to it. If there is any truth in these allegations, then every physician who prescribes a tranquilizer for symptomatic control of a depressed patient is guilty of malpractice. If these claims regarding auto-hypnosis are valid, then the disassociated states characteristic of different types of prayer are potentially dangerous.
I have delved quite strongly into the psychoanalytic portion of hypnosis. This is a very valuable field. However, we have mentioned nothing at all about the advantages of hypnosis in other fields of medicine. It is my feeling that any illness that can be caused by the mind, for example, duodenal ulcers, asthma, ulcerative colitis, neuro-dermatitis, or rheumatoid arthritis, can also he cured by the mind. The production of anesthesia with hypnosis is an extremely valuable adjunct in minimizing the emotional trauma of childbirth. Often the use of hypnosis will permit the easy and rapid reduction of fractures. the suture of superficial lacerations, and even the performance of major surgery with no other agent. Hypnosis is utilized successfully in the treatment of enuresis, stuttering, thumb sucking, fingernail biting, behavior problems, alcoholism, smoking, and narcotic addiction. It is used successfully also for many procedures in dentistry, particularly in an effort to make a person’s false teeth fit. It is used to improve learning and perception during schooling, and to increase performance during sports events. Hypnosis is probably the cheapest, most effective, long lasting tranquilizer that is available in medicine today.
Presented at the AORN Regional Instilute at Los Angeles, California, July, 1962.
54
A O R N Journal
Dr. McCall, author of a number of articles on the use of hypnosis, in 1962 received a citation from the American Institute of Hypnosis for his outstanding contributions to medical literature in the field of hypnosis. In World War II he served as an apprentice in an Army Hospital and in 1955 graduated from the University of Southern California Medical School. His internship was at Orange County Hospital, Orange, California, and he had a one-year residency at San Luis Obispo County Hospital. Dr. McCall says he “belongs to all the usual medical societies,” as well as the Orange County and the California Medical Societies, the American Association of Physicians and Surgeons, and the American Institute of Hypnosis, of which he is a past president. Dr. McCall owns his own plane and is a member of the Flying Phy. sicians Association. He is married and has four children, and currently is conducting the Hypnosis Workshop in Los Angeles in which doctors using hypnosis discuss problems, techniques, and means of treating different illnesses. He has been in private practice in Anaheim, California, for seven years.
July-August 1964
Hypnosis is one of the oldest medical arts. Before discussing the principles and misconceptions of modern hypnotherapy, it is necessary to review briefly some of the history and expose how many of these misconceptions gained their footing. Hypnosis has been practiced under numerous labels and in different places since time immemorial, Tribal medicine men, witch doctors, and religious leaders have applied it in various forms to heal the sick, usually ascribing the cures to miracles performed by the Gods. The Ebers Papyrus, over 3000 years old, describes how Egyptian soothsayers used hypnotic-like procedures similar to those practiced today. Centuries ago, the Greek oracles, the Persian magi, the Hindu fakirs and the Indian yogi used hypnosis without even realizing it. The earliest medical records described miraculous healing by priests or demigods who induced a sleep-like state by ceremonial rites in the Escapalian temples. Both the Talmud and the Bible contain many allusions to the laying on of hands and other hypnotic techinques. One practitioner was a healer by the name of Yalen-
45
tine Greatrakes who lived in the neighborhood of 1650 and was known as “The Great Irish Stroker.” Francisco Bagnone was operating in Italy in a similar manner and with equal success. Apparently he had only to touch the sick with his hands or with a religious relic to accomplish astonishing cures. Paracelsus pointed out the healing effect of the astrobodies and the magnet, and felt that the latter could cure most diseases. It was from this that Frans Mesmer got his idea of animal magnetism. Mesmer developed a rather large tuh, filled with iron filings. To this tub iron rods were attached which patients grasped, thereby receiving a magnetic flow. Thirty or more persons could be connected with each other by cords and could also be magnetized as Mesmer touched each person in turn with a glass rod. Many developed seizures or underwent crises similar to those observed in the religious sects. At first he contended that the magnetism emanated from the astrobodies but later, that it was transferred from himself to the patient by his magnetic wand. Mesmer became so impressed with his powers that he claimed he could touch any tree in a forest with his wand and a hypnotized person could pick that tree out of all the others. Since this was an impossible feat, he was exposed in front of a Royal Commission in France, of which one member was Benjamin Franklin. The Commission concluded that the cures were due to imagination and not to magnetism. Hypnoanesthesia was first used in 1821 by Recamier who performed operations on patients under mesmeric coma. In 1837, John Elliottson, at that time one of the most able physicians in England and one of the most well known and respected, became infatuated with and an enthusiastic advocate of mesmerism. He was not afraid of innovation or criticism and, as a result, was severely censored by editorials in the
46
Bettman Archive, Inc.
“The Grrat Irish Strokcr,” Greatrakes, ~ 1 6 5 0 .
British Medical Journal “Lancet,” for charlatanism. Although he had introduced the stethescope to England, he was called a quack and an imposter, apparently because of the fantastic claims made about hypnosis. Subsequently, the University banned the use of mesmerism and the church opposed its use. Elliottson, a dedicated and fearless scientist, promptly resigned and for many years he published his “Zoist,” the journal of hypnosis in which numerous painless operations and other mesmeric phenomena were recorded. In spite of the censure placed upon mesmerism by the uninformed of that time, the phenomenon attracted more and more disciples. Among them was a Scottish surgeon practicing in India by the name of James Esdale who between 1840-50reported hundreds of painless operations. Another was James Braid who observed a demonstration in Manchester by a Swiss magnetizer and contended that the degree of expectation increased the subject’s susceptibility to suggestion. He is the one who coined the terms “hypnotism and hypnosis” from the
AORN Journal
Greek word “hypnos,” meaning sleep. Later he recognized that hypnosis was not sleep but the term had gained common usage and it was too late to change it. He was the first to realize that hypnosis could be induced without a formalistic induction and with the eyes open. In 1882 a society for psychical research was founded to investigate the therapeutic uses of hypnotism. Many prominent doctors were enrolled and in 1891 their published report contained the opinion that as a therapeutic agent hypnotism was frequently effective in relieving pain, procuring sleep, and relieving many functional ailments. Le Beau, a Frenchman who is considered the real father of modern hypnotism, was one of the first physicians to experiment with the therapeutic value of hypnosis on a large scale. Without pay, he treated thousands of patients suffering from a great assortment of physical symptoms. He believed that hypnosis could favorably influence not only functional but also organic diseases. Le Beau imagined that it might cure cancer and that it might also act as an antidote to poisoning. He claimed cures for anemia, intermittent fever, pulmonary tuberculosis, menstrual difficulties, neuralgia, and migraine. Le Beau even published a book on hypnosis but medical skepticism was so great that he was able to sell only one copy-to a gentleman by the name of Bernheim, a professor at the Nancy Medical School who bought the book only in order to expose him as a quack. He was, instead, so amazed at Le Beau’s work that he undertook a study of hypnotism and soon became one of its most ardent devotees. Burnheim also published a book, in which he claimed cures for hysterical hemiplegia, aphonia, hysteric crises, gastric difficulties, loss of appetite, depression of the spirit, pains, tremors, fixed ideas, sleep walking, and a number of other functional diseases.
Charcot, who is famous to this day for his description of different pathological conditions, stated that hypnosis was a sign of weakness and of nervous indisposition. Charcot’s theories, based on working repeatedly with only a dozen hysterical patients at the Salpietre, an insane asylum, were completely discredited. However, the idea persists to this day that in order to be hypnotized one must be weak minded. Bernheim and Le Beau accomplished the first real breakthrough. Bernheim’s repiitation and the publication of his book in 1886 for the first time brought a degree of respectability to hypnosis. Freud too became interested in hypnosis and studied with Charcot and Bernheim but for several reasons he avoided its use. First, he was embarrassed because he could not hypnotize very many patients to sufficient depth. Second, the cures were temporary, inasmuch as the post-hypnotic suggestions could not be maintained and he could not elicit buried traumatic material because of the resistance of his patients. He also felt that hypnosis stripped the patient of his defenses. Freud abandoned hypnosis, not because it was without value as a psychological tool, but because of his inability to incorporate it into his own authoritative hypno-therapeutic approach. It is interesting that at the same time that Freud was abandoning hypnosis, Pavlov did more independent research into hypnosis than probably any other single man. Nonetheless, Pavlov is known in this country only for the salivation that was caused by ringing a bell. Following the acceptance of hypnosis throughout Europe, almost every known disease of that time was listed as having been cured or helped by it. One reason why all of these unfounded claims were made for hypnosis was that very few follow-up studies were done on the patients who were presumably cured. It must be remembered that
47
nothing was then known of the defensive value of symptoms and of their functional utility in the life adjustment of the individual. Hypnosis was used as a bludgeon to crush the patient’s complaints. We must therefore suspect that the failures were far more frequent than the successes, yet the fantastic claims for hypnosis were the things most responsible for its being ridiculed and banned. The worst enemies of hypnosis were the men making the most ardent claims. About 1880, Breuer introduced an important innovation in hypnotic therapy which extended the application of hypnosis beyond simply suggesting that symptoms go away. While treating an hysterical patient whose illness was precipitated by the development of a parapleuritic abscess in her father, he was confounded by the fact that in spite of all hypnotic effects her symptoms became progressively worse. He accidentally discovered that when she was induced to speak freely under hypnosis she exhibited a profound emotional reaction and thereafter experienced a decided relief from her complaints. He traced through many of her complaints very specifically and was able, with thorough investigation, to remove each and every one. It appeared that symptoms disappeared only after the basic cause was discovered. In one instance, the patient detailed 108 examples of her disability before she finally revealed the first, in which her father was involved, and this finally removed the symptoms. The importance of Breuer’s work lies in the change of emphasis in hypnotic therapy from the direct removal of symptoms to dealing with the apparent causes of the symptoms. Breuer and Freud concluded that hysterical symptoms developed as a result of experiences so damaging to the individual that they had been repressed. The mental energy originally associated with the experi-
48
ence was blocked from reaching consciousness by the mechanism of repression. The energy was then converted into bodily enervations, accounting for bodily symptoms. Under hypnotic treatment the discharge of the strangulated effect into normal channels of consciousness made it unnecessary to convert the energy into symptoms. More and more Freud became conscious of the purposeful nature of the symptoms and stated that they represented defenses against the repressed instinctive strivings produced by the conflict. He pointed out that these symptoms served an economic function in the psychic life of the individual. He lent further emphasis to the irrationality of the strict use of hypnosis for the removal of symptoms. Freud’s discoveries, as well as a current disappointment in hypnosis as a permanent cure of hysteria, almost succeeded in dealing hypnosis a death blow. In spite of the work of many other famous men of that time, the growth of the psychoanalytic movement and development of other forms of psychotherapy reduced hypnosis to a place of relatively minor importance. Hypnotism became subject to the attack of the medical profession on the basis that it was allied to quackery and was a source of moral danger. Janet continued to believe that hypnosis was a most effective treatment for neurosis, but in spite of the fact that he showed that hypnotic suggestion could produce no action beyond the power of the normal will, most physicians felt hypnosis was a relic of the past. Although it was politely mentioned in textbooks of psychiatry, it was considered in the category of such aged practices as cupping, leaching and blood letting. Critics seldom realize that hypnosis is a meaningful interpersonal relationship involving real patient participation because of increased receptivity, and that the productive involvement of the patient with the
AOHN Journal
“Ten Francs an Hour,” title of Daumier cartoon ridiculiug hypnotism, 1852.
therapist results in a more ready acceptance of suggestions. Contrarily, the hypnosis they
rightfully criticized was the dramatic symptom removal type used at the turn of the century which was essentially commanding and authoritative. Today, however, the techniques are permissive and oriented around the patient’s needs, rather than being doctor-directed. These factors, together with the utilization of auto-hypnosis and auto-conditioning, have resulted in a type of hypnotherapy that is vastly different from the hypnosis that Freud rejected. With this background, we can now discuss more completely some of the modern misconceptions of hypnosis. One of the most common and widely held misconceptions is that when you are hypnotized you lose consciousness. The professional stage hypnotist has contributed to this widely held notion that hypnosis is a sleep-like trance, or an uncon-
July-August 1964
Bettman Archive, Inc.
scious involuntary state. It is probably this part of stage hypnotism which does the most damage so far as the ethical hypnotist is concerned. Because of the misconceptions that are created by these people, the patients who desire hypnosis and would ordinarily benefit from it, expect bizarre, out-of-thisworld symptoms which actually never develop. This, then, destroys or impairs their confidence in hypnosis and makes its beneficial effects much more difficult to obtain. In my own practice, I inform all of my patients that they will never lose full sense of awareness nor fall asleep. Actually they will be more awake. All levels of hypnosis, including deepest stages, are characterized by increased attention to the operator’s suggestions and this concentration facilitates receptivity to further suggestions. The profound concentration thus achieved is the main reason for the use of hypnosis. Most ideas equating sleep
49
to hypnosis stem from motion picture films
portraying a hypnotized individual with his eyes closed. Even after it has been emphasized repeatedly that the hypnotized individual does not fall asleep, patients frequently state, “Doctor, 1know that I was not hypnotized, 1 heard everything you said.” Another common misconception is that in order for a person to be hypnotized, and to benefit from the hypnosis, he must surrender his will to the hypnotist. This misconception has been attributed to the Svengali-Trilby novel, comic strips, television programs, and so on, with which you are familiar. The capacity to be hypnotized is a subjective experience and therefore nothing could be further from the truth. Patients also feel that under hypnosis they can be made to do anything against their wishes and this is likewise completely false since the subject is never dominated by the will of the hypnotist. One is always fully capable of making decisions at all times. It is remotely conceivable that an unscrupulous hypnotist, by producing a total amnesia and establishing a valid motive, could get an individual to commit a criminal or an anti-social act if he is already pre-disposed to lie, steal or kill. However, I feel that this is more theoretical than real. In the 1880’s Dr. Bramwell performed an experiment in which he obtained a patient who had subconscious hatred toward her mother and placed her in a situation in which she was told under hypnosis that the sugar bowl contained arsenic and that if she would put this arsenic in her mother’s tea she would then be rid of her mother and all of her troubles. The patient performed exactly as she was told to do under the hypnosis, placing the so-called arsenic in her mother’s tea and sat there delightedly watching her drink it. However, when questioned as to why she did this, the daughter told them she knew it was really only sugar and that, therefore.
50
she had nothing to be concerned about. It is my personal feeling that no patient would ever commit an immoral or asocial act while under the influence of hypnosis, unless he would have done so anyway. Many people believe that morons, imbeciles and weak minded persons make the best hypnotic subjects. This could not be more false. People who are above average in intelligence and who are capable of concentrating make the best subjects. In this connection, constant hypnotic induction does not weaken the mind or make an individual more suggestible. Thousands of subjects have been hypnotized hundreds of times without the slightest demonstrable harm. I remember very clearly a patient who came to me for hypnosis and we were having a great deal of difficulty in producing a satisfactory trance state, at which time she blurted out, “I don’t want to be hypnotized because I might tell you something that I don’t want to tell you.” This then is a misconception. Patients are aware of everything that is going on while they are being hypnotized and even afterward, unless a specific amnesia is suggested. They will reveal no facts or conditions which they do not want to reveal or that they would not be willing to reveal in their conscious mind. Hypnosis frequently permits them to uncover or recall an incident or a fact which occurred in the long forgotten past. However, at no time would a patient ever tell the hypnotist anything against his will. I have read a great deal about people who fear they might not be able to be de-hypnotized or awakened. I have had no personal experience with this matter since I have never run into a patient who had this particular fear. This is obviously the statement of a person who knows nothing about hppnosis since the hypnosis is induced completely by the patient-the therapist’s only role is that of guidance, leading them down
AORA’ Journal
the path to a satisfactory hypnotic trance. Therefore, the patient can de-hypnotize himself at any time he chooses. He can open his eyes, he can move, he can get up, he can walk out, he can do anything that he chooses at any time he chooses. Any time a posthypnotic suggestion contrary to the wish of the patient is given, spontaneous de-hypnotization invariably occurs and breaks the rapport. For example, if I had a patient in a deep hypnotic trance and told him to take off all of his clothes and run around the building, he would either totally ignore the suggestion or wake up out of the trance, and it would probably be very difficult to re-hypnotize him after that. Inasmuch as nearly all of my patients are taught autohypnosis, they can terminate it at any time. Some persons believe that if they are hypnotizable it indicates that they are gullible and will believe everything told to them. Mental discrimination is not impaired with regard to stimuli which could threaten the integrity of the organism. I feel that no person will do anything under hypnosis that would endanger his life or make him more emotionally upset. Another widely held misconception is that one has to have a strong personality to be a hypnotist and that therefore males are better hypnotists than females because they are supposedly dominant personalities. This is another falsity, since one of the leading stage hypnotists today is a woman-Pat Collins, whom many of you have probably seen. In summary then, the already mentioned misconceptions of hypnosis, so far as the laity is concerned, reveal that hypnosis is not a sleep state trance or state of unconsciousness. Rather, it closely resembles the waking state. It has often been likened to the condition that occurs just before one falls asleep at night. The will is not surrendered. Intelligent individuals usually make the best subjects. A hypnotized person does not lose
control, nor does he reveal intimate material unless he wishes to do so. Susceptibility to hypnosis is not related to gullibility or submissiveness; hypnosis can be terminated readily by either the subject or the operator. The subject is never helpless to resist undesirable post-hypnotic suggestions, and it is important to remove these doubts and misconceptions in order to establish a closer rapport and to obtain the motivation necessary for successful hypnotic induction and therapy. Some valid objections to hypnosis are that it has been hailed as a panacea by overenthusiastic medical practitioners as well as by unscrupulous lay healers and charlatans. Legislation is currently being enacted to ban its use by the latter, and overly zealous physicians are being cautioned by their more informed colleagues. Many conclusions have been drawn from uncontrolled research experiments. What is needed are more experimental designs for control of such significant variables as operator attitude, the effects of the interpersonal relationship, and subject selection but not, as some think, of indoctrination. Another valid objection is the extravagant claims based on extrapalating data from observations made on somnambules, thus making it appear that complex hypnoanalytic techniques can be readily and universally applied. It is doubtful that more than 20 per cent of the well trained hypnotic subjects can ever reach deep hypnotic states or, for that matter, do they need to. Members of the medical profession commonly state that hypnosis is worthless because nobody knows how it works. They state that hypnosis tends to produce extreme dependency upon the therapist. However, it is felt that this dependency is not due to the hypnotherapy itself but to the manner in which the interpersonal relationship is utilized. Any therapist who acts as an authorita-
51
tive figure will foster dependency, irrespective of the therapeutic system utilized. It is felt by some that hypnotherapy sexualizes the doctor-patient relationship, yet we have all heard that the patient is likely to fall in love with the therapist and this applies not to hypnosis but to the psycho or hypnoanalyst. Authorities agree that a hypnotized person is not likely to violate his moral code and it is felt that alcohol or sedatives would serve better than psychotherapy or hypnosis if a person had rape on his mind. It is said that “Candy’s dandy but liquor’s quicker’’ and both would be faster than hypnosis. One of the most current and biggest hullabaloos regarding hypnosis is that it is dangerous. It is this concept which has possessed many executive committees on many hospitals to pass a rule that hypnosis may not be used in a hospital unless a psychiatrist is in attendance. Hypnosis per se is not dangerous but careless remarks can lead to iatrogenic disorders. Those who contend that hypnosis is dangerous seldom mention the possibility of psychotherapeutic mismanagement, ineptitude, improper selection of cases, and the possibility that they are transmitting their own anxieties to apprehensive patients because of their own feelings of insecurity. Most experienced hypnotherapists agree that there are no dangers from hypnosis when it is properly used according to the skill and training of the therapist. I fell that the dangers attributed to hypnosis have been sensationally publicized and when mishaps occur they are due to the exacerbation of personality problems that would have become pronounced through non-hypnotic intervention and mismanagement. No one has ever died from hypnotism. The same cannot be said about certain tranquilizers and shock therapy. There is no modality less dangerous than hypnosis. The question as to whether symptom removal is dangerous unless the cause is un-
52
derstood is continually emphasized by the critics of hypnotherapy. The validity of this criticism is open to serious question as only the extremely disturbed patient will relinquish one symptom and substitute another. The far greater tendency is to replace the symptom with something constructive. It appears that hypnotherapy can be prescribed in selected cases for symptomatic relief in the same manner as tranquilizers or other psychopharmacological agents are prescribed. Many symptoms have become just a habit and as such can be removed without danger. An example of this is fingernail biting. The symptom removal seldom triggers a psychotic break unless the psychotic process has been going on for years before it becomes overt. Some psychiatrists contend that hypnosis can cause a psychosis, even though they are fully aware that any strong affective reaction can precipitate the recognition of a hitherto unsuspected psychosis and that this could happen with all forms of psychotherapy, even casual events of daily life. Freud noted that hypnosis had no deleterious effects and that it was not a dangerous tool. He also stated that if the general public were ever to achieve the benefits of analysis it would have to be done through the means of hypnosis. Many competent therapists have treated various syndromes by hypnotic symptom removal, leading to the finding that dealing with symptoms and current problems does not necessarily produce other symptoms nor recurrence of old symptoms. While it is agreed that sometimes understanding of the underlying psychodynamics leads to a higher percentage of cures, there are no accurately controlled data to indicate that this is always so. It is, therefore, concluded that symptom removal by any properly trained person is not dangerous and that usually the other symptom equivalents do not take the place
AORN Journal
“Experiment in Hypnotism,” 1893 painting by R. Falkenberg.
of the removed one. The objection that symptom removal is dangerous applies to only a limited number of patients since it applies only to those who cannot endure living without their neurotic defenses and is therefore expressive of diagnostic incompetence. The widespread use of psychotropic drugs, often without knowing the causes of the symptomatology, has drastically changed the basic approach to many psychiatric problems, The original report on the medical use of hypnosis by the British Medical Association and the American Medical Association stated that the surgeon, obstetrician, anesthesiologist and general practitioner may legitimately utilize hypnosis within the framework of his own particular field of competence. The report pointed out that controversy exists only as to the hazards of hypnosis.
July-August 1964
Bettman Archive, Inc.
However, when the American Medical Association was recently asked “Has the American Medical Association Committee on Hypnosis ever published officially any statement defining or implying the dangers of hypnosis by physicians?”, the official answer was that it had not done so, nor had it authorized anyone to do so, and that any member of the committee who does so is expressing his own personal opinion! Yet, one hears the accusation again and again that the non-psvchiatrically oriented physician will open up the patient’s Pandora’s box of substitute symptoms that lead to anti-social acting out or self-destructive behavior if hypnosis is used purely for symptom removal. It has become more widely recognized that insight is not actually necessary in order to remove a patient’s neuroses. Nearly all ex-
53
perienced psychotherapists accept the empirical findings that a therapist’s personality, his confidence with the method, as well as the patient’s expectations and beliefs, all are more important than recovering repressed material. Dorcus, Kroeger, Bryan, and other reputable investigators have noted that hypnotherapy, without insight, is often as effective in dealing with symptomatic behavior as therapies which provide insight. Furthermore, the recovery persists as long as the cures of those treated by insight therapy. Many deep-seated conflicts are resolved with the passing of time and without insight ever being achieved. Often, insight is not the patient’s insight, but the therapist’s preconceived notion of what insight the patient should have. The patient merely takes over the value systems of faith and the confidence of the therapist and this is actually what makes emotionally disturbed individuals better. Auto-hypnosis in one ritual or another is employed in Zen, Buddhist, Yoga, and other religious rites. A degree of autohypnosis, even though its use is denied, is also responsible for the recoveries obtained by Christian Science, Science of the Mind, Theosophy, the Emmanuel Movement, and many other spiritualistic religious healing modalities. The concentration and narrowing of attention (hypnotic induction) in these religious prayer states may not be considered necessary nor even desirable by a non-believer, but they are never called dangerous. Hypnosis should never again fall into undeserved oblivion. We must challenge those who, on the basis of a few inadequately documented cases or poorly controlled and inadequate questionnaire material, continually warn about the dangers of hypnosis, especially as employed by the non-psychiatrist. We must particularly challenge the use of questionnaires to prove pre-conceived ideas,
not to determine scientific truth. It is repeatedly stated that hypnotherapy is a cure that can be dynamite, that patients have suffered irrevocable harm as a result of symptom removal, and that self-hypnosis can be potentially dangerous to those who practice it or those who submit to it. If there is any truth in these allegations, then every physician who prescribes a tranquilizer for symptomatic control of a depressed patient is guilty of malpractice. If these claims regarding auto-hypnosis are valid, then the disassociated states characteristic of different types of prayer are potentially dangerous.
I have delved quite strongly into the psychoanalytic portion of hypnosis. This is a very valuable field. However, we have mentioned nothing at all about the advantages of hypnosis in other fields of medicine. It is my feeling that any illness that can be caused by the mind, for example, duodenal ulcers, asthma, ulcerative colitis, neuro-dermatitis, or rheumatoid arthritis, can also he cured by the mind. The production of anesthesia with hypnosis is an extremely valuable adjunct in minimizing the emotional trauma of childbirth. Often the use of hypnosis will permit the easy and rapid reduction of fractures. the suture of superficial lacerations, and even the performance of major surgery with no other agent. Hypnosis is utilized successfully in the treatment of enuresis, stuttering, thumb sucking, fingernail biting, behavior problems, alcoholism, smoking, and narcotic addiction. It is used successfully also for many procedures in dentistry, particularly in an effort to make a person’s false teeth fit. It is used to improve learning and perception during schooling, and to increase performance during sports events. Hypnosis is probably the cheapest, most effective, long lasting tranquilizer that is available in medicine today.
Presented at the AORN Regional Instilute at Los Angeles, California, July, 1962.
54
A O R N Journal