The Witch in the Waiting Room: A Physician Investigates Paranormal Phenomena in Medicine

by Robert S. Bobrow M. D. M. D.

  Ironically, Victor Rausch would not have been considered a very good subject by the eye-roll test. In hypnosis, the art and the science, like newlyweds, are presently inseparable.

  These scales, and others, can also be used to grade depth of hypnosis. The above-mentioned trance levels are scored, with additional items. One of these is somnambulism-literally, "sleepwalking"-which is considered a facet of heavier hypnotic states. Sleepwalking itself is common, particularly in children, and occurs during non-REM sleep. While psychiatrists don't consider it a form of dissociation, a sleepwalker and a person in a dissociative state have much in common, including an amnesia of the events transpiring, and being observably "not themselves." Weitzenhoffer considers hypnotic somnambulism to be relatively rare and differentiates it from "classical" hypnosis.

  Regardless of how hypnosis is defined, or how profound the trance is, there are no objective, physiological measurements that are unique to the state. Brain waves (electroencephalogram, or EEG) are basically the same as when you're awake. Occasionally, subtle EEG changes have been reported, but without consistency or smoking-gun clarity.

  Recently, positron emission tomography (PET scans, in the vernacular), which measure regional blood flow and elucidate areas where the brain is active, have shown that the brain seems to perceive what the hypnotist suggests. If the hypnotist suggests that black-and-white pictures are really color pictures, they register in the "color" area of the brain's visual cortex. Hypnotically suggested sounds register as real; imagined sounds do not.

  That latter tidbit comes from a 1998 work: "Where the Imaginal Appears Real: A PET Study of Auditory Hallucinations." Volunteers in their early twenties who were easily hypnotizable were divided into two groups. This was not a random separation; one group had the ability to actually hallucinate, if asked to do so, under hypnosis. The authors estimate that only about four percent of highly hypnotizable subjects can do this; these were designated "hallucinators." The other group were "nonhallucinators." The hallucinators' brains had more energetic auditory responses even to normal hearing, suggesting some baseline difference in how their minds processed sounds.

  For the experiment, all subjects were hypnotized, and then they listened to a two-and-a-halt-minute tape recording of a voice repeating a phrase over and over. "Normal" hearing consisted of just listening to the tape. Imagined hearing consisted of asking the subjects to imagine they were hearing the tape (both groups could do this), without the recorder being turned on again. Hallucinated hearing was obtained by asking the hallucinators to do their thing, and then clicking on the recorder, as if to play the tape, followed by silence. Afterwards, the participants evaluated the sounds they heard, as "external" (hallucinated) or "inside their own heads" (imagined).

  Hallucinated sounds produced PET responses similar to those of ordinary hearing; imagined sounds did not. The nonhallucinators' brains did not "hear" mind-produced sounds, as far as the PET scanner was concerned. The implication is that some peoples' brains, at some times, may perceive unreal sounds as real. The authors feel that the auditory hallucinations of schizophrenics share a similar mechanism, and cite studies showing similar brain-site activation during psychotic hallucinations.

  (Interestingly, true schizophrenic hallucinations are perceived as external. When a patient describes a voice as originating inside his or her own head, that's technically considered a pseudohallucination. According to the above research, a PET scan could tell the difference.)

  It should be added that a flurry of subsequent studies on how schizophrenics' brains perceive auditory hallucinations, using techniques that indicate sites of brain activity (via PET or functional MRI scans), have been a bit contradictory and inconclusive.

  While a PET scan may say something about how a hypnotic brain reacts, it does not indicate whether a given person is really hypnotized. There are some, in fact, who question the very existence of a true hypnotic state. In a 1981 paper in Psychiatry, "Was I Hypnotized?: A Social Psychological Analysis of Hypnotic Depth Reports," the authors feel that a patient's perception of being hypnotized may reflect the context of the questioning and his or her preconceived ideas about the process, "rather than accurately reflecting a unique state of the person."

  Real or not, some strange things happen to the hypnotized. As shown in the example at the beginning of this chapter, enough anesthesia can be produced to perform surgery. People can have no memory of what went on, particularly if the therapist suggests to them that they won't remember. How can you lose your memory of something, simply by being told to forget about it? It happens; I just can't say that I understand how. Other times, hypnosis has been used to enhance memory, although it's not always clear whether these memories are accurate.

  Then there's age regression. Certain "highly susceptible" subjects can be taken back to their childhoods, and they will be seen acting and sounding like a child, describing things from a child's point of view. I once attended a hypnotherapist's demonstration at my hospital where a woman, who was a suitable subject and had worked with the therapist before, was quickly regressed before an audience of physicians. To my eye, she could have been acting, but I assumed that she and her hypnotherapist did not come to our hospital to play games.

  Early in the twentieth century, questions were raised as to the validity of hypnotic regression. Was it actual, or a reenactment based on a patient's concept of childhood combined with suggestibility? In the 1930s, two experiments were done. Both employed intelligence tests administered to hypnotized, regressed subjects, who then performed only at grade level for their stage of regression. In the second of these studies, adults were taken back to ages four, six, and ten. Their intelligence and behavior during the tests were appropriate for their "age."

  In a 1948 study, regression to infancy produced neurologic reflexes seen only in infants. In 1952, a symposium presented patients whose handwritings and vocabularies regressed in parallel with their ages. There was even knowledge of the correct day of the week for events during the period to which the subject was spirited back in time. The textbook considers these phenomena "controversial," but acknowledges that some of the material may be useful in therapy.

  A Little History

  However it's defined, hypnosis, or something like it, has been around for ages. It wasn't always called hypnosis. In his 1948 book, Medical Hypnaoaw, assistant professor of psychiatry Lewis Wolberg begins with a historical note, referring to hypnosis as "one of the oldest of the medical arts." In ancient Egypt and Persia, trance states were felt to be of a divine nature. With the establishment of Christianity, however, trances were considered witchcraft, and anything of the sort went underground.

  And then along came Austrian physician Anton Mesmer. In 1766, he presented a thesis to the faculty at the University of Vienna claiming that some sort of universal fluid or invisible gas permeated the universe and all things. Man and the planets were thus interconnected, similarly to the way gravity binds the solar system; and what's more, human will could manipulate or redirect this force, as could properly placed magnets. He ultimately named this force "animal magnetism."

  Mesmer believed he and others could channel this energy to effect healing. Often the patient was brought into a sort of trance and awoke healthy. Mesmer emphasized the importance of rapport between "magnetizer" and subject, in a way reminiscent of current concepts of hypnosis. Mesmer was also charismatic, flamboyant, mysterious, and theatric, and soon ran afoul of the authorities. He was run out of Vienna to Paris, where in 1784 King Louis XVI appointed a commission, headed by Benjamin Franklin, to evaluate his methods and claims.

  The Franklin commission concluded that animal magnetism did not exist, and that any improvements in illness could be accounted for by imagination, imitation, and touch. A 2002 paper in the Lltrrnational Journal o` Clinical Hypnoh Lr remarked that imagination is part of the hypnotic process, regardless of magnetism's existence. Mesmer was discredited and his popularity waned, but words like "mesmerized" in our lexicon atte
st to his mark on history.

  One of Mesmer's disciples, the Marquis de Puysegur, observed and described three cardinal features of what is now known as hypnosis: The "magnetized" subject was only attentive to the "magnetizer" (and to nothing else); the subject was extremely suggestible; the subject had no memory of events during the trance. Puysegur was a nobleman, and he entranced a young servant on his estate who then fell into a strange type of sleep, during which he was ambulatory and hyperalert. He spoke freely and confided family problems that had hitherto been unspoken. Awakened, he had no recollection of what had happened. Puysegur labeled this "artificial somnambulism."

  Puysegur believed, as did Mesmer, that the operator's faith in an ability to cure was essential to the process. Positive thinking by practitioner and patient has always been an element of medical care, and that's no less true today. That's why the placebo effect-the improvement reported after mock therapy-tends to be 40 percent, whether you're treating angina, eczyma, or the common cold.

  In the early 1800s, there emerged a sense that mesmerism was actually a neurophysiological variant of sleep. That's when it became "hypnosis." A proponent of this theory, James Braid, believed that an intelligent secondary consciousness must exist, which could be unmasked by the hypnotic process.

  As the nineteenth century proceeded, many reports came in-particularly from Britain and India-of surgical procedures, some major, performed with only hypnosis for anesthesia. According to Wolberg's book, in 1891 the British Medical Association issued an opinion that "as a therapeutic agent, hypnotism is frequently effective in relieving pain, procuring sleep and alleviating many functional ailments."

  In the 1880s, Josef Breuer, a colleague of Sigmund Freud, was treating a young woman known as Anna O. for a multitude of physical and mental problems. He diagnosed her as a hysteric. One symptom she developed was an inability to swallow water. On hot days, she had to quench her thirst with melons and fruit. Under hypnosis, she angrily recounted an incident where she had watched a dog drink water out of a glass, which struck her as disgusting. After venting, she asked for a glass of water, awakened while drinking it, and never had the problem again. This was considered the first case of psychoanalysiswhere an unconscious memory causing a symptom was brought to the surface, resulting in the symptom's disappearance. Freud, just beginning his career, found this case fascinating; the rest is history.

  In A Haotory of Medical Hypnoaiw (mentioned earlier), authors Joy Dana Riskin and Fred Frankel, of the Harvard Medical School Department of Psychiatry, feel that the domain of modern hypnosis contains elements of suggestion, which they see as Mesmer's legacy, as well as aspects of dissociation, which they attribute to the work of Puyseger and Pierre Janet. The Frenchman Janet was a physician, psychiatrist, and philosopher, and believed that hypnosis and hysteria were mentally similar.

  The "History" also remarks that a given individual's hypno- tizablity is consistent over time, and that it correlates with certain types of problems. Patients with phobias, eating disorders, post-traumatic stress disorder, and multiple personality disorder tend to be good hypnotic subjects. MPD is also associated with dissociative tendencies, suggesting that hypnosis may be relevant in understanding and treating multiple personalities.

  Hypnosis in Medicine

  Irritable bowel syndrome afflicts about 15 percent of the American population. Somewhere between 30 and 70 percent of visits to gastroenterologists in the United States are for IBS, depending on whose figures you use. IBS tends to be recurrent, annoying, and painful, and there is no consistently helpful treatment. Pills are dispensed. Diets are suggested. Tests are negative and are only useful to rule out other things.

  A unifying feature of the disease is a sensitivity of the colon, or large intestine, to pressure. In a classic experiment, published in the Lancet in 1980, a balloon inflated in varying parts of the colon at measurable, equivalent pressures caused more pain over a wider area in IBS patients than in nonafllicted controls. It was as if the patients' colons were overwired with nerve connections, and were thus extra-sensitive.

  In 1984, the Laneet published a "Controlled Trial of Hypnotherapy in the Treatment of Severe Refractory IrritableBowel Syndrome." Thirty IBS patients were randomly assigned to psychotherapy or hypnotherapy. Psychotherapy had some success, with a small improvement in some symptoms. But hypnotherapy patients "showed a dramatic improvement in all features," and were notably better served than the other group.

  Three months later, none of the hypnotherapy-treated patients had relapsed. Gastroenterologist Peter Whorwell, lead author of the study, which was done in South Manchester in Britain, later published an eighteen-month follow-up of the patients. All remained in remission. Two had had exacerbations, which were effectively treated with a single additional hypnotherapy session. Reporting on an additional thirty-five IBS patients, Dr. Whorwell remarked that patients with typical IBS who were under age fifty had 100 percent response rates. In a 2003 study at the same institution, the majority of 204 patients treated with hypnotherapy for IBS were better five years later, and needed fewer consultations and medications. Treatment consisted of twelve sessions, over three months, of "gut-directed" therapy, aimed at having patients "visualize" their intestines to gain some measure of control.

  On this side of the pond, IBS hypnotherapy was investigated at the University of North Carolina in 2002. Patients felt better and had less discomfort, although physiological parameters measured, such as rectal pain thresholds for balloon inflation, did not change. Nevertheless, the authors were sufficiently impressed with the results that they are trying, via a Web site, to make hypnotherapy for IBS more widely available.

  Hypnosis has many other medical uses, and these were reviewed by physician James H. Stewart in the April 2005 issue of the Mayo Clinic Proeeeainge. Stewart's definition of hypnosis reflects those I mentioned earlier, and while Stewart makes no attempt to explain how suggested niceties translate into bodily health, he is willing to say that "If positive suggestions for change are accepted by the mind, any physiological changes that follow defy explanation by contemporary medicine...."

  Stewart goes over the published clinical trials of hypnosis. The list is extensive, so we'll just hit the highlights:

  • Allergy. Hypnotizable patients could be "taught" to react on one arm but not the other when scratched with something to which they were allergic.

  • Pain relief. Hypnosis has a history of use for pain; of interest is that it appears different from acupuncture. You don't need to be hypnotizable to respond to acupuncture. Also, the use of a drug that blocks the brain's endorphins (a sort of natural morphine) impedes the pain-relieving effects of acupuncture, but not of hypnosis.

  • Anesthesia. Hypnosis was used as a sole anesthetic agent back in the pre-chloroform era; nowadays it has been used as an adjunct to conscious sedation (where drugs render the patient conscious but dreamy) for procedures that might ordinarily require general anesthesia (like removal of the thyroid, or tubal ligation).

  • Warts. These fickle creatures are caused by a live virus and have minds of their own. Spontaneous clearing is not infrequent, so an experiment was designed thusly: Fourteen patients with bilateral warts were given suggestions to clear one side only. Ten of the patients could be brought into moderate-depth hypnosis. Of these ten, nine cleared the warts only on the suggested side!

  • Headache. Administered hypnosis, as well as teaching patients to do self-hypnosis, has had some success.

  • Stopping smoking or overeating. Some successes, less than dramatic. Nothing deals all that well, particularly over the long term, with these entities.

  • Asthma. Some success, particularly in younger and more hypnotizable people.

  • Cancer. Hypnosis and the teaching of self-hypnosis have been helpful in lessening the nausea and vomiting caused by chemotherapy in children.

  • Erectile dysfunction. One experienced practitioner reported an 88 percent success rate with almost three thousand patients.


  • Urinary incontinence. One trial cured the majority of women in one month.

  All of these treatments require a skilled practitioner and a hypnotizable patient. This is a drawback that limits the usefulness of hypnosis in the all-too-real world.

  Hypnosis and ESP

  Lastly, hypnosis has been used to enhance ESP. Psychologist Thelma Moss, who co-authored the "Study of a Psychic" discussed in chapter 3, wrote an earlier paper (1970), "Hypnosis and ESP: A Controlled Experiment." Using pairs of volunteers, a "transmitter" was shown emotionally charged material with positive or negative content, while a "receiver," at a distance, had to sense which type it was. Hypnosis of one pair member, usually the receiver, was associated with more correct answers. While the statistical results would not be likely to convert a skeptic, they were also not likely to have occurred by chance. Moss cites other work on ESP facilitation by hypnosis.

  Modern practitioners claim that you've experienced a form of hypnosis if you've driven your car along monotonously and don't remember passing a few exits. Can that really be the same phenomenon that cures warts, allows you to undergo major surgery without anesthesia, or takes you back to your childhood? "Hypnosis" obviously means different things to different observers; while it defies precise, objective definition, it has endured in various forms for ages, and is not likely to go away soon.

  Xenoglossy: Speaking in Tongues,

  Coherently

  In Mt. Orab, Ohio, on May 10, 1970, the Reverend Carroll Jav, an ordained minister of the United Methodist Church, hypnotized his forty-seven-year-old wife, Dolores. The reverend was a serious amateur hypnotist, so there was nothing unusual about this situation. Dolores had a backache. The hypnosis, it was hoped, could afford her some relief from pain. During this session, when her husband asked her if she still had pain, Dolores replied "nein"-the German word for "no."