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Hypnosis in dermatology
Hypnosis in Dermatology MARY ANN BELLINI, MA
F
ranz Anton Mesmer is often credited with the discovery of hypnosis in the late 18th century. He believed that a “rarefied fluid, or animal magnetism” controlled health and that he could cure disease by correcting imbalances in this fluid through the use of magnetism. Mesmer’s theories about magnetism were discounted by a French investigating commission, although he did cure some patients. Later his cures were ascribed to suggestion. Mesmerism was for many years the term for what is now called hypnosis. The use of hypnosis to look for possible emotional factors in human illness seems to have originated with Josef Breuer, a physician in Vienna in his work with the famous “Anno O” from 1880 to 1882. Breuer observed that there seemed to be some relationship between a traumatic experience and a state that he believed was very much like hypnosis. He called the original traumatic experience “hypnoid” and initiated the trauma theory for hysteria. He felt that through hypnosis of his patients he might be able to discover some of the causal events in psychological illnesses. He interested Freud in the use of hypnosis for the treatment of hysteria; then, even after Breuer himself ended his work with hypnosis, Freud continued, collaborating for a time for Berheim and Charcot, the well known French physicians. Carl Jung also used hypnosis as an analytic took, having been attracted to it by Freud’s work. Then both Freud, in 1909, and Jung, in 1913, gave up hypnosis and searched for other ways for learning about repressed or suppressed traumatic events. Freud invented psychoanalysis and Jung searched for dream content in accessing amnesic material. Hypnosis came back into favor during World War II for the treatment of war neuroses contracted near the front lines and posttraumatic stress disorder in soldiers returning home from combat. Important contributions to modern hypnosis were made by the late Milton Erickson (1901–1980) of Phoenix, Arizona.1
Definition and Explanation Hypnosis can be defined as an altered state of consciousness in which the individual’s imagination creates vivid reality from suggestions either that are ofFrom the Department of Dermatology, University of Florence, Florence, Italy. Address correspondence to Mary Ann Bellini, MA, Instituto di Clinica Dermosifilopatica, Universita Degli Studi di Firenze, 37, Via Degli Alfani, 50121 Firenze, Italy. © 1999 by Elsevier Science Inc. All rights reserved. 655 Avenue of the Americas, New York, NY 10010
fered by someone else, coming from environmental cues, or that originate from within the individual. This condition allows one to be responsive to suggestions, such that perception, memory and physiological processes can be altered. Usually, under ordinary conditions these functions are not susceptible to conscious control. Erickson had great faith in the ability of his patients to tap personal resources, and he stressed the following essential aspects of the hypnotic experience: Y People go into hypnosis when they are trying to remember sequential events. Y Dissociative methods for pain relief and time distortion in hypnosis are important tools. Y Patients return to a hypnotic state when they carry out a posthypnotic suggestion. Y Body image can be the cause of endocrine disturbances, and hypnotic techniques can be therapeutic in improving endocrine balance.1 The fact that hypnosis can occur even without attempted induction is a very important consideration. It is essential for physicians and psychotherapists to be aware of the situations in which hypnosis can occur spontaneously and be able to recognize the facial expressions, voice tones and general behavior that characterize a person in a hypnotic state. Understanding under hypnosis is literal and childlike very different from the reasoning that occurs at conscious levels. Hypnosis can occur spontaneously with sensory repetition. Examples include the driver of an automobile or the pilot of a plane who is lulled by the sound of the engine, or when the eyes are drawn downward by the regularly interrupted, white divider-strip markings on a highway, raindrops, or the repetitive sweeps of a windshield wiper. Hypnosis can also occur at moments of great fear or great personal loss, when one is disoriented in time or space due to trauma, general anesthesia, hallucinatory drugs or alcohol. Watching television or a movie can be so absorbing that one becomes completely unaware of his or her surroundings and can spontaneously enter a trance like state.
Current Research in the Use of Hypnosis in Dermatology Hypnosis, generally regarded as an altered state of consciousness associated with concentration, relaxation, and imagination, and an enhanced responsive0738-081X/98/$–see front matter PII S0738-081X(98)00054-6
Clinics in Dermatology
726 BELLINI
ness to suggestion, has long been thought to be effective in the improvement of various skin disorders. The hypnotic state appears capable of a bridging or mediating function in the supposed body-mind dualism. Many recent studies have shown a link between the use of hypnosis and changed skin response in certain dermatologic affections, such as atopic dermatitis, warts, alopecia areata, psoriasis, and others.2– 6 In his book Hypnosis, David Cheek explains his use of hypnotic techniques to treat various cutaneous manifestations, in particular herpes genitalis infections.5 According to Cheek, getting the affected skin to feel cool through the use of hypnosis can be much more “effective than any chemicals prescribed.” In light hypnosis Cheek sets up finger signals and asks for permission to get the tissues cool and to keep them cool for periods of 2 hours. He starts with an unimportant area for the production of a coolness sensation by having his patients imagine that they are sucking on a “peppermint and breathing in”. This is an effective way to imagine coolness in the mouth, according to Cheek. With the patient in trance, he requests the the “yes” finger lift when the mouth feels cool and that the patient tell him when there is a conscious awareness of the coolness. When the patient is confident about sensing the change, the therapist tells her to experience that same coolness in the lesioned area.6 Cheek also uses hypnosis to help the patient develop a more positive attitude toward him/herself, as well as to help the patient imagine him/herself in the future without skin problems. He uses hypnotic trance phenomena, such as the increased ability to focus, time distortion, amnesia, flashback memories, analgesia, catalepsy, etc., to achieve his goals.7 Other techniques used in hypnosis are the white movie screen on which the patient can project him/ herself and see the body without the current skin problem or imagine that hair is beginning to grow again, while in hypnotic trance. In trance, the patient can also imagine him/herself using a brush to scrub away the pimples on the back or hands, to clean and polish the body so that it becomes healthy again. Published, controlled studies of the use of hypnosis to cure warts usually use direct suggestion in hypnosis (DSIH) with success rates of 27% to 55%. Children respond to DSIH almost without exception, but adults often do not. In a study published in 1992, Ewin of Tulane Medical School used individual hypnoanalysis
Y
1998;16:725–726
on adults who failed to respond to DSIH, with positive results in 33 of 41 cases studied; two were lost in follow up and six did not respond to the treatment. Selfhypnosis was not used.2 In a more recent article published in the British Journal of Dermatology, Stewart and Thomas3 used hypnotherapy to treat atopic dermatitis in adults and children. Eighteen adults with extensive atopic dermatitis, resistant to conventional treatment, were treated by hypnotherapy, with statistically significant benefit, which was maintained for up to two years where follow-up was available. Twenty children with severe, resistant atopic dermatitis were treated by hypnosis; all but one showed immediate improvement, which was maintained at two follow-up examinations. In 12 other cases involving children, replies to a questionnaire at up to 18 months after treatment showed that 10 had maintained improvement in itching and scratching, nine in sleep disturbance, and seven in mood.3 Other recent scientific studies point to the role of stress in the onset and/or exacerbation of many dermatological problems. These studies indicate the need for stress-reduction techniques, of which hypnosis is one. Hypnosis is used together with other techniques, such as autogenic training and mediation, to induce relaxation and reduce the negative effects of tachycardia, high blood pressure, and other stress related physiological reactions, including those involved in dematological affections.
References 1. Erickson MH. Advanced techniques of hypnosis and therapy. New York: Grune and Stratton, 1967. 2. Ewin DM. Hypnotherapy for warts (Verruca Vulgaris): 41 Consecutive cases with 33 cures. Am J Clin Hypn 1992;35: 1–10. 3. Stewart AC, Thomas SE. Hypnotherapy as a treatment for atopic dermatitis in adults and children. Br J Dermatol 1995;132:778 – 83. 4. Thompson W, Shapiro J. Alopecia areata: Understanding and coping with hair loss. Baltimore: Johns Hopkins University Press, 1996. 5. Cheek DB. Possible uses of hypnosis in dermatology. Med Times 1961;89:76 – 82. 6. Cheek DB. Hypnosis: The application of ideomotor techniques. New York: Paramount, 1989. 7. Cheek DB. Short term hypnotherapy for frigidity using exploitation of early life attitudes. Am J Clin Hypn 1976; 19:20 –7.
F
ranz Anton Mesmer is often credited with the discovery of hypnosis in the late 18th century. He believed that a “rarefied fluid, or animal magnetism” controlled health and that he could cure disease by correcting imbalances in this fluid through the use of magnetism. Mesmer’s theories about magnetism were discounted by a French investigating commission, although he did cure some patients. Later his cures were ascribed to suggestion. Mesmerism was for many years the term for what is now called hypnosis. The use of hypnosis to look for possible emotional factors in human illness seems to have originated with Josef Breuer, a physician in Vienna in his work with the famous “Anno O” from 1880 to 1882. Breuer observed that there seemed to be some relationship between a traumatic experience and a state that he believed was very much like hypnosis. He called the original traumatic experience “hypnoid” and initiated the trauma theory for hysteria. He felt that through hypnosis of his patients he might be able to discover some of the causal events in psychological illnesses. He interested Freud in the use of hypnosis for the treatment of hysteria; then, even after Breuer himself ended his work with hypnosis, Freud continued, collaborating for a time for Berheim and Charcot, the well known French physicians. Carl Jung also used hypnosis as an analytic took, having been attracted to it by Freud’s work. Then both Freud, in 1909, and Jung, in 1913, gave up hypnosis and searched for other ways for learning about repressed or suppressed traumatic events. Freud invented psychoanalysis and Jung searched for dream content in accessing amnesic material. Hypnosis came back into favor during World War II for the treatment of war neuroses contracted near the front lines and posttraumatic stress disorder in soldiers returning home from combat. Important contributions to modern hypnosis were made by the late Milton Erickson (1901–1980) of Phoenix, Arizona.1
Definition and Explanation Hypnosis can be defined as an altered state of consciousness in which the individual’s imagination creates vivid reality from suggestions either that are ofFrom the Department of Dermatology, University of Florence, Florence, Italy. Address correspondence to Mary Ann Bellini, MA, Instituto di Clinica Dermosifilopatica, Universita Degli Studi di Firenze, 37, Via Degli Alfani, 50121 Firenze, Italy. © 1999 by Elsevier Science Inc. All rights reserved. 655 Avenue of the Americas, New York, NY 10010
fered by someone else, coming from environmental cues, or that originate from within the individual. This condition allows one to be responsive to suggestions, such that perception, memory and physiological processes can be altered. Usually, under ordinary conditions these functions are not susceptible to conscious control. Erickson had great faith in the ability of his patients to tap personal resources, and he stressed the following essential aspects of the hypnotic experience: Y People go into hypnosis when they are trying to remember sequential events. Y Dissociative methods for pain relief and time distortion in hypnosis are important tools. Y Patients return to a hypnotic state when they carry out a posthypnotic suggestion. Y Body image can be the cause of endocrine disturbances, and hypnotic techniques can be therapeutic in improving endocrine balance.1 The fact that hypnosis can occur even without attempted induction is a very important consideration. It is essential for physicians and psychotherapists to be aware of the situations in which hypnosis can occur spontaneously and be able to recognize the facial expressions, voice tones and general behavior that characterize a person in a hypnotic state. Understanding under hypnosis is literal and childlike very different from the reasoning that occurs at conscious levels. Hypnosis can occur spontaneously with sensory repetition. Examples include the driver of an automobile or the pilot of a plane who is lulled by the sound of the engine, or when the eyes are drawn downward by the regularly interrupted, white divider-strip markings on a highway, raindrops, or the repetitive sweeps of a windshield wiper. Hypnosis can also occur at moments of great fear or great personal loss, when one is disoriented in time or space due to trauma, general anesthesia, hallucinatory drugs or alcohol. Watching television or a movie can be so absorbing that one becomes completely unaware of his or her surroundings and can spontaneously enter a trance like state.
Current Research in the Use of Hypnosis in Dermatology Hypnosis, generally regarded as an altered state of consciousness associated with concentration, relaxation, and imagination, and an enhanced responsive0738-081X/98/$–see front matter PII S0738-081X(98)00054-6
Clinics in Dermatology
726 BELLINI
ness to suggestion, has long been thought to be effective in the improvement of various skin disorders. The hypnotic state appears capable of a bridging or mediating function in the supposed body-mind dualism. Many recent studies have shown a link between the use of hypnosis and changed skin response in certain dermatologic affections, such as atopic dermatitis, warts, alopecia areata, psoriasis, and others.2– 6 In his book Hypnosis, David Cheek explains his use of hypnotic techniques to treat various cutaneous manifestations, in particular herpes genitalis infections.5 According to Cheek, getting the affected skin to feel cool through the use of hypnosis can be much more “effective than any chemicals prescribed.” In light hypnosis Cheek sets up finger signals and asks for permission to get the tissues cool and to keep them cool for periods of 2 hours. He starts with an unimportant area for the production of a coolness sensation by having his patients imagine that they are sucking on a “peppermint and breathing in”. This is an effective way to imagine coolness in the mouth, according to Cheek. With the patient in trance, he requests the the “yes” finger lift when the mouth feels cool and that the patient tell him when there is a conscious awareness of the coolness. When the patient is confident about sensing the change, the therapist tells her to experience that same coolness in the lesioned area.6 Cheek also uses hypnosis to help the patient develop a more positive attitude toward him/herself, as well as to help the patient imagine him/herself in the future without skin problems. He uses hypnotic trance phenomena, such as the increased ability to focus, time distortion, amnesia, flashback memories, analgesia, catalepsy, etc., to achieve his goals.7 Other techniques used in hypnosis are the white movie screen on which the patient can project him/ herself and see the body without the current skin problem or imagine that hair is beginning to grow again, while in hypnotic trance. In trance, the patient can also imagine him/herself using a brush to scrub away the pimples on the back or hands, to clean and polish the body so that it becomes healthy again. Published, controlled studies of the use of hypnosis to cure warts usually use direct suggestion in hypnosis (DSIH) with success rates of 27% to 55%. Children respond to DSIH almost without exception, but adults often do not. In a study published in 1992, Ewin of Tulane Medical School used individual hypnoanalysis
Y
1998;16:725–726
on adults who failed to respond to DSIH, with positive results in 33 of 41 cases studied; two were lost in follow up and six did not respond to the treatment. Selfhypnosis was not used.2 In a more recent article published in the British Journal of Dermatology, Stewart and Thomas3 used hypnotherapy to treat atopic dermatitis in adults and children. Eighteen adults with extensive atopic dermatitis, resistant to conventional treatment, were treated by hypnotherapy, with statistically significant benefit, which was maintained for up to two years where follow-up was available. Twenty children with severe, resistant atopic dermatitis were treated by hypnosis; all but one showed immediate improvement, which was maintained at two follow-up examinations. In 12 other cases involving children, replies to a questionnaire at up to 18 months after treatment showed that 10 had maintained improvement in itching and scratching, nine in sleep disturbance, and seven in mood.3 Other recent scientific studies point to the role of stress in the onset and/or exacerbation of many dermatological problems. These studies indicate the need for stress-reduction techniques, of which hypnosis is one. Hypnosis is used together with other techniques, such as autogenic training and mediation, to induce relaxation and reduce the negative effects of tachycardia, high blood pressure, and other stress related physiological reactions, including those involved in dematological affections.
References 1. Erickson MH. Advanced techniques of hypnosis and therapy. New York: Grune and Stratton, 1967. 2. Ewin DM. Hypnotherapy for warts (Verruca Vulgaris): 41 Consecutive cases with 33 cures. Am J Clin Hypn 1992;35: 1–10. 3. Stewart AC, Thomas SE. Hypnotherapy as a treatment for atopic dermatitis in adults and children. Br J Dermatol 1995;132:778 – 83. 4. Thompson W, Shapiro J. Alopecia areata: Understanding and coping with hair loss. Baltimore: Johns Hopkins University Press, 1996. 5. Cheek DB. Possible uses of hypnosis in dermatology. Med Times 1961;89:76 – 82. 6. Cheek DB. Hypnosis: The application of ideomotor techniques. New York: Paramount, 1989. 7. Cheek DB. Short term hypnotherapy for frigidity using exploitation of early life attitudes. Am J Clin Hypn 1976; 19:20 –7.