If the brains of hypnotized subjects show such activation, while those of unhypnotized subjects do not, it looks as though there is something real going on. The role-players, complying with the operator's instructions but without being hypnotized, can simulate the experience verbally, but their brains cannot lie. Doubters, the anti-state theorists, suggest that these neurophysiological results are no more than the traces of the cognitive strategies subjects come up with which enable them to comply with the operator's instructions (to see a chair, or whatever). But this response is looking increasingly implausible. Both the reals and the simulators were responding to the same set of instructions, yet the neurophysiology of only the reals showed the appropriate response. It very much looks as though there is a real ASC which is hypnosis. The Holy Grail of identifiable brain activities which are unique to the hypnotic trance still remains elusive, but they're getting closer to it.
If there is such a thing as the hypnotic trance, what kind of a state is it? Milton Erickson's definition, penned for the 1954 Encyclopedia Britannica, seems admirable. It is
a special psychological state with certain physiological attributes, resembling sleep only superficially, and characterized by a functioning of the individual at a level of awareness other than the ordinary state, a level of awareness termed, for convenience in conceptualization, unconscious or subconscious awareness.
The ASC which is the hypnotic trance is not a state that makes anything happen; it is a state in which certain things happen – chiefly absorption, dissociation and suggestibility. These phenomena allow direct access to the wisdom (as Erickson would put it) of the unconscious mind.
I have nailed my colours to the mast in this chapter. The evidence compels me to believe that there is a special state, an altered state of consciousness (ASC), that deserves to be called the hypnotic trance. There is so much that is strange and currently inexplicable about the phenomena of hypnosis that it seems more economical to think in terms of an ASC than to try to account for them all in different ways. Perhaps the most remarkable phenomenon of all is the ability of hypnosis to relieve pain and to enhance healing, and that is the topic to which we must now turn.
11
Hypnotherapy: Mind and Body
The controversy which occupied our attention in the last chapter rages between experimental psychologists – those who work in university departments, away from the realities of trying to cure physical and psychological ailments. It is not too surprising, then, to find that the debate has had hardly any effect on working hypnotherapists. Whether or not there is such a thing as hypnosis, or the hypnotic trance, they have a tool which works over a wide range of disorders, so they just get on with it.
There are very many articles and books describing cases of hypnotherapy, assessing the successes or failures, giving recommendations for methods, suggesting for what conditions hypnosis should not be used, and so on. There is no point in my repeating the substance of works which are designed for clinicians. What I want to do in this chapter is give some idea of the range of disorders for which hypnosis may be effective, show how hypnosis works in practice in the case of a few of these disorders, and then go on to related questions which will bring us back to one of the main themes of this book: the potential of the human mind.
Hypnosis Works
When I first heard about her problem, I was not optimistic that I could be of any help. The patient, a 40-year-old woman, had literally dozens of open sores the size of silver dollars all over her body. They were extremely tender and sensitive when touched – and it was impossible for all of them to remain untouched at the same time … The patient had suffered this malady for more than 20 years and had received the attention of some of the most competent medical authorities on the continent. They had virtually guaranteed the patient that a very expensive operation to remove all the sores would not prevent their return … The patient was desperate, but she had also become convinced that hypnosis could be of help.
As a clinical psychologist who had worked with hypnosis both in treatment and in research contexts, I was willing to try to help her … As it happens, the patient was an excellent hypnotic subject, who readily behaved and experienced in accordance with suggestions. We met more or less regularly for about three months, with one prolonged interruption necessitated by the patient's hospitalization.
During the course of treatment, I administered repeated suggestions for the patient to imagine herself being sprayed by or swimming in shimmering, sunlit liquids that would purify and cleanse her skin. I also told her to become aware of her skin and to experience it as warm and cold, as prickly and smooth and so on – suggestions that constituted lessons in skin awareness and control, so to speak. She was instructed to practice these exercises by herself and, especially, to imagine her skin as smooth and unblemished.
At the end of treatment, the patient was virtually free of sores. The tendency for pustules to form remained, but, instead of progressing to monstrous open wounds, they retreated promptly and soon disappeared. Her dermatologist was amazed, and, frankly, so was I. A recent two-year follow-up revealed that the problem was still under control.
This is one modern story among many – very many. Healing through hypnosis is not just something that happened in the last century and then went out of fashion when more stringent clinical methods came into practice. Even in those times when hypnosis was out of fashion, there was always a quiet underground continuing to make use of its remarkable properties. Of course, it is not a panacea. If you had a broken leg, you wouldn't go to a hypnotherapist (unless you wanted help with pain). But it is one of a number of complementary treatments which are effective over a surprisingly wide range of disorders, and which should therefore be brought into the mainstream. This is especially so in the case of hypnosis, because it is far more gentle and non-invasive than the alternatives. We live in a materialistic age: faced with something that can be prodded by a scalpel, doctors assume that a scalpel is what they had better use. But times are changing, and the shallowness of this assumption is fast being exposed.
At the moment, hypnotherapy is recognized by the public as the treatment of choice for a small range of problems, such as nicotine addiction, but it is usually a last resort (as it has been throughout its history). But the cumulative weight of the success stories from anecdotal evidence and clinical trials is now so enormous that it is time for this situation to change, and for hypnotherapy to be less meekly acknowledged by the medical authorities as a genuine and useful tool. It should be stressed, however, that cases where hypnosis has an automatic effect are rare; when I say something like ‘Hypnosis has cured or alleviated an enormous range of illnesses and ailments’, I mean that it does so by means of the suggestions of cure or alleviation proposed by the therapist and accepted by the patient.
Hypnosis has cured or alleviated an enormous range of illnesses and ailments. Even a partial list is astonishing – and too long and full of technical terms to bother with in a book of this kind. But any such list can be broken down into categories, and that is more useful. First, hypnosis is excellent for the alleviation of pain; hence its use as an anaesthetic, on victims of burns, on terminal cancer patients, in childbirth, and for arthritis, rheumatism and so on. Second, hypnosis boosts the immune system. This is helpful in the case of allergies (which often have a psychosomatic element anyway) and arthritis, and in the fight against cancer, because cancer cells are always there in the body, just waiting for the right conditions (which include a depressed immune system) to multiply. Third, hypnosis acts on the body's nervous systems, and this enables it to deal with all kinds of post-traumatic inflammations, a wide range of skin conditions (acne, eczema, urticaria and so on), gastro-intestinal problems, tics, cramps and certain speech disorders. Fourth, relaxation dilates the blood vessels, and so hypnosis can cause changes in skin temperature, control bleeding in haemophiliacs and menstrual problems, cut off the blood supply to warts (and perhaps this is how it might deal with tumours too), c
ure migraine, and even enlarge breast size. Finally, hypnosis is an extremely powerful tool in all stress-related and obviously psychological ailments, such as various addictions, obesity, bed-wetting, eating disorders, learning disabilities, phobias, stage fright, stammering, post-traumatic stress disorder, depression, fugue states, psychosexual problems, asthma and insomnia. Since all major illnesses cause stress, which both aggravates the illness and increases the patient's suffering, hypnosis is a useful weapon in the doctor's arsenal across the board. A surprising number of disorders have a psychosomatic component anyway – even haemophilia and asthma – and these are all helped by hypnosis. In short, the body and mind have huge resources for self-healing, and hypnosis can unlock them.
Hypnosis in the Treatment of Pain
The evidence for the effectiveness of hypnosis in dealing with pain is overwhelming. On top of anecdotal evidence, and even if the clinical trials of people like Esdaile in the nineteenth century should be taken with a pinch of salt, since we cannot be there to review their techniques and results, there is also a great deal of watertight modern clinical and experimental research. For instance, to take just one example, thirty burn patients were due to have their burns debrided – an excruciating process in which dead or infected tissue is scraped from the burn site. The patients were assigned randomly to three groups. One group was genuinely hypnotized, the second group was told to relax, as placebo hypnosis, and the third group was left to its own devices. Only the genuinely hypnotized patients had genuine pain relief. Of course, opioid drugs remain the mainstay in the management of burns, but experiments like this one just show the power of hypnosis.
Then there is the use of hypnosis in surgery. Cancerous tumours have been cut out; cardiac and brain surgery have been performed; haemorrhoids (‘piles’) have been excised; vaginal hysterectomies have been carried out; appendixes have been removed; eye cataracts have had done to them whatever it is that eye cataracts need; and so on. In theory, any surgical procedure can be carried out on a hypnotized patient.
The source of pain we are all probably most familiar with is a visit to the dentist. Hypnosis had been used for dental operations since 1837, but it was the Second World War which really brought its benefits to the attention of modern dentists. In the prisoner-ofwar camps, few or no anaesthetics were available, and so interned dentists had to do without when operating on their fellow prisoners. They discovered – or rediscovered – the use of hypnosis. As usual, hypnosis helps not just with the actual pain of extracting a tooth or filling a cavity, but also with the pre-operational apprehension that most people feel. Some people have such a phobia of dentists that the dentist has had to practise a bit of psychotherapy – regressing the patient to discover the source of the phobia and cure it. Other dental problems, such as control of bleeding or of tooth-grinding, can also be helped by hypnosis.
I'm not a woman, but it seems obvious to me that chemical intervention at childbirth is undesirable if it can be avoided. Hypnosis has an excellent, proven track record in alleviating the pains of labour and of obstetric surgery (if needed), and in helping the new mother cope with any anxieties or depression that may arise after the birth. If there is a problem with lactation, hypnosis can even help with that too. A hypnotherapist will give the expectant mother lessons in self-hypnosis that she can practise during labour. Reports say that the pain of even a difficult labour is reduced to a ‘light tingling’.
I feel relaxed – no tensions, no fears, no anxieties … I know the pain perception should be pretty rough at this point … but I am comfortable … very comfortable … just a dull pain … like having a period and yet I normally have a low pain tolerance … I should be perceiving pain, but I'm not … I almost feel like a 3+ drunk, relaxed, lethargic, but my brain is functioning so clearly, only a tight band about my abdomen occasionally.
Once, visiting my daughter in hospital, I met and chatted to children with sickle cell disease, a genetic disorder that afflicts many children of African heritage and causes a great deal of pain. So far, it has resisted attempts to find a cure, and the main recourse is management of the pain it causes these children. Hypnosis has proved effective in reducing their pain. Hypnosis is a good thing. We can relieve these children's pain without having recourse to drugs, with all their complications. They already have to take enough drugs.
A large number of clinical trials have demonstrated that hypnosis helps to relieve pain for cancer patients and after all kinds of surgery. For any condition involving pain, hypnosis has a three-pronged benefit. First, relaxation takes the edge off the pain; second, the compression of time that occurs in any trance state makes the pain seem to pass more quickly; third, the anxiety that naturally accompanies pain is reduced. On the issue of the ability of hypnosis to control pain, I can only echo Robert Temple's indignation:
Hypnosis has the wonderful advantage that when it can be used against pain, it carries no side effects. Unlike morphine, it does not cloud the mind. Terminal cancer patients are amongst the most urgent cases needing hypnosis. There is no need for the hypnotizable terminal cancer patient to be doped up and to die in a haze of confusion … With hypnosis, he or she can die in dignity with a clear head up to the last moments of life, free from agony and enjoying the company of loved ones. It is an outrage that this possibility has been denied to all but a fraction of those terminal cancer patients who have died in the past century or so.
There are three strategies in hypnosis to decrease pain, over and above the natural effect of relaxation. First, the operator might make a direct suggestion that the subject cannot feel the pain; alternatively, he might, in the case of diffuse pain, concentrate it to a small area and then relocate it to somewhere else in the body where it is more tolerable; or, thirdly, he might turn the subject's attention away from the pain.
How does it work? At first, with the discovery in the 1970s that the brain releases endorphins to dampen pain, it was assumed that hypnosis triggered their release. Recent research, however, suggests that this is wrong. Suppose I have chronic back pain, and I use hypnosis to inhibit the pain. If endorphins were released into my bloodstream, the inhibition of the pain would last quite a while – as long as the endorphins were effective. But what we find with hypnosis is this: on the suggestion that the pain is less, the pain grows immediately less; on the suggestion that the pain returns, the pain immediately returns. It all happens too quickly for endorphins to be involved. It is more likely, then, that there is some neural process which inhibits pain, and which is switched on and off by hypnosis. Inhibition of pain stems from the frontal and limbic areas of the brain, and is associated especially with the presence of theta brainwaves. As we have seen, theta brainwaves are produced in deep hypnosis. But this is not to say that ‘lows’ – people who are not deeply hypnotizable – cannot gain relief from pain through hypnosis. A number of studies show that if ‘lows’ are motivated to gain relief, they will do so, and also that through biofeedback they can learn to do better. In other words, astonishing though it may sound, we can train the relevant neural triggers and pathways.
This training also accounts for another puzzling aspect of the way that hypnotism relieves pain. Suppose we follow Ernest Hilgard and say that during hypnosis the pain is hidden behind an amnesia-like barrier, and that this is why we don't feel it. This only explains why we don't feel it during hypnosis. What factors ensure that we don't feel it afterwards? Basically, these are the suggestions put to us during hypnosis by the therapist, and the suggestions triggered afterwards. But pain is a real thing, so in order for the pain not to be noticed afterwards, we have to be affecting the neural pathways even then.
Close to the beginning of this book I said that ‘highs’ are those who are good at deploying attention. This is important because it means that they are also good at deploying disattention. Suppose you have a young child who is screaming at the prospect of having a splinter of wood removed from his hand. There are two ways you might go about a painless removal of the splint
er. First, you could have someone create a diversion, and while the child's attention is distracted you try to remove the splinter. Second, if the child was amenable to reason, you could ask him to turn away and think of something pleasant instead. The first method is distraction, the second is disattention – the deliberate deployment of attention away from something, in this case pain. There is evidence that disattention from pain stimulates the neural pathways that block pain, and so this would explain why ‘highs’ are instinctively good at overcoming pain in hypnosis.
But whatever explanation scientists eventually come up with for the effectiveness of hypnosis in lowering pain, the empirical fact remains that it works. The alleviation of pain is the single most important product of hypnosis in a therapeutic context.
Hypnosis in the Treatment of Psychological Problems
Hypnosis is particularly good at treating problems stemming from or involving anxiety – and there are a lot of these. Not a lot of people know that asthma and over-eating, for instance, are anxiety-related problems: they are at least aggravated by anxiety. Let's take a look at asthma, since it's so widespread these days. An asthmatic attack may be precipitated by taking exercise, by an infection, by an allergy, or by emotions. Studies have found that many emotions can precipitate an attack of asthma: anxiety, the anticipation of pleasure, frustration, anger, resentment, humiliation, depression, laughter, feelings of guilt, and joy. Hypnosis can help with the allergic aspect of asthma, and with the emotions. It cannot cure an attack, but it can prevent one; the patient is taught self-hypnosis to practise at the onset of an attack.
Tinnitus – which is far more widely spread than many people imagine – is another disorder which, like asthma, may have a physiological basis, but is certainly aggravated by psychological factors such as anxiety. Obviously, phobias, psychosexual difficulties, stammering and so on are psychological problems, and so are a range of childhood problems such as bed-wetting, shyness and learning difficulties. Anxiety is also a factor before and after operations, during cancer treatment, when someone has heart disease and so on. Hypnosis can help with all of these, because hypnosis can manage stress.
Hidden Depths: The Story of Hypnosis Page 41
