Clinical Applications of Hypnosis to Psychiatry
Hypnosis is no miracle. It is primarily a method of approaching a patient, a means of securing his attention and cooperation; therein lies its significance. Nor is hypnosis a cure-all. It is a tool, an instrument, an adjuvant to any medical or psychiatric procedure one wants to employ. It can be used as a means of making the patient feel at ease within himself and at ease in the situation in which he finds himself. Furthermore, in trying to deal with the patient as a personality, the use of hypnosis allows the patient to develop a certain amount of competence and security in his relationship to the therapist. This is the first orientation of hypnosis in the areas of medical and psychiatric problems.
In trying to explore and investigate a patient psychiatrically for the purpose of bringing about changes in his personality, one has to map out the personality and get some understanding of the individual. Having secured that understanding, therapy proceeds in accordance with the patient’s needs.
Need of unconscious to express aggression
One sometimes encounters a patient who has directed aggression toward himself, his family, his total life situation. It is evidently necessary for this patient to express aggression toward someone. Therapy can help him to direct it in more constructive channels.
CASE OF MARGARET E.
Margaret E, a hysterically paralyzed girl, was asked during a deep trance why she no longer walked. In answer, she merely set her jaw. She had been approached directly and most indirectly. The girl’s reaction to the very indirect approach was, “He is probably getting at something. I can’t see how but I know he is getting at something.”
She was therefore usually allowed to think that the indirect approach was on some irrelevant matter. Frequently, when she was sitting in her wheelchair, the psychiatrist sat directly in front of her. She often became so irritated with him that she raised her paralyzed legs and kicked him on the shins, without realizing what she was doing. Since it was exceedingly important for her unconsicious mind to express the aggression, the doctor carefully chose that position for himself.
Need of patient to retaliate against hypnosis
In hypnosis, one must respect the need of the other person to retaliate in some way. Each time one tries to use hypnosis on a psychiatric patient, a psychoneurotic patient, a psychosomatic patient, one is rushing in on a personality defense. It is a disordered personality defense, but nevertheless a defense that the patient has established. When something is taken away from a person, he does not like it.
Consider the small child with a knife in his hands. If the mother tries to take the knife away from the child, even when it is cutting the child, he lets the mother know that she has not that right. The child needs to be approached in such fashion that he willingly accepts something else in place of that knife. So it is with the psychoneurotic or the psychosomatic patient. He must be given something in place of the neurotic defense that he has. Furthermore, the therapist must have it clearly in mind that what he is going to give him is something that will increase the patient’s satisfactions as a personality.
One never really reaches into the mind of a patient and says, “This is the problem.” Actually one never quite knows what the problem is until it has finally been corrected. One factor may be part of the problem. Another may be in some way related to the problem.
Too much has been written lately about the need for the unconscious to be made conscious. Many a patient prefers to get well without consciously knowing the reasons why. One of the purposes hypnosis and hypnotherapy should accomplish is to make plain to the patient that he has not only a past that is highly important to him; he also has a present that is more important, and a future even more so than the present or the past.
Many patients think that the experiences they have had in their lives before they come to therapy are the only things that are important. The essential objective is their adjustment at the present time and in the future—if they are to be happy—with whatever understandings they can achieve of the past. They must start making plans for the present and the future with a willingness to abstract from the past only what they need to promote their current and future adjustments.
Psychotherapy sometimes seems overoriented to an academic understanding of the past. Consider the girl with claustrophobia, who can’t stand to be in a small room with the door shut. Perhaps her grandmother did lock her in the closet to punish her; that entire history can be obtained from her in the trance state. But is that really where her claustrophobia started? Her claustrophobia actually started, while she was locked in the closet, when she heard her mother’s footsteps going down the hall, down the steps, and down the sidewalk. That tied into every other situation in which her mother had deserted her. Being locked in the closet by her grandmother was only the creation of the situation where she could sense and become keenly aware of the various desertions that her mother had committed.
When certain traumatic incidents are uncovered in therapy, it is important to discover what the associations are in relation to the incidents. It is the way the traumatic incident is used that determines whether or not there is to be a neurotic response and the building up of neurotic habit patterns.
Therapy of habits
One ought to be alert to the fact that many a problem is no more than a habit. It may have started originally as a profoundly neurotic response. As the years passed, it became a physical habit.
CASE OF WILLIAM A.
Seven-year-old William had a very distressing habit. About once every minute, all day long, he made a noise that sounded like “eek, eek.” His mother, father, teachers, and everyone else were frantic. But it was no more than a habit pattern. Treatment consisted of regarding it as such.
In this case, therapy was achieved in one week’s time. A psychiatrist, a friend of the family, happened to be visiting. He sent the boy to his room with the understanding that, instead of once a minute, he was to make the sound twice a minute. He had to make the sound twice a minute before he could come out of his room.
When the boy finally got impatient about being locked up in the bedroom, he gave up, agreed to make the sound twice a minute. What was he actually doing? He was voluntarily taking control of a habit. One entire day went by with that “eeking” twice a minute, with his mother and the psychiatrist insisting that he ought to watch the clock for if he didn’t practice the “eek” twice a minute, he would have to be sent back to his bedroom.
The next day he was asked, “How about three times a minute? How about four times a minute?” The boy knew that the question was completely serious. The doctor was explanatory, reassuring, telling him it was important to find out why he made the noise. The boy could understand that a doctor makes examinations and studies results. The psychiatrist, he thought, was very stupid to need so much time, but he could see where his own days were going, practicing that “eek” sound. Within a week’s time he had deliberately taken control of the habit. He did not dare to have it.
That was several years ago. He hasn’t “eeked” since then, nor has he developed any other symptomatology.
USE OF A PAINFUL TASK TO DISCOURAGE A HABIT
CASE OF MR. VINCENT C.
Mr. Vincent C, age sixty-five, sought help, explaining that he had lost his wife the previous August. He felt very much lost and alone, though he was living with his son, a bachelor. He explained further that he had been suffering from insomnia for the last fifteen years. He had been taking barbiturates. Gradually, over the years, his dosage had increased. The death of his wife had stepped up his nightly dosage from twelve to fifteen grams of sodium amytal; he had just visited his family physician to get a nightly increase in allowance to eighteen grams. He took the medicine at about midnight, slept for about an hour and a half. For the rest of the night, his sleep was completely unsatisfactory.
The psychiatrist listened to his account of his wife and of how much he missed her. He also listened to Mr. C tell how he went to bed at 8 o’clock, rolled and tossed, and wished he could sleep without drugs; Mr. C always weakened and took that excessive dose of sodium amytal, drifting off to his hour and a half of sleep, then rolled and tossed again until it was time to get up in the morning. The psychiatrist spent perhaps two or three hours with Mr. C, explaining that it was perfectly possible to learn to sleep all night long without sedation. When Mr. C was asked if he would really give his cooperation, he was led along that line of thought until he had committed himself unreservedly to cooperation. Then he was given the explanation that cooperation and the correction of his insomnia would be a bit expensive, not financially, but in the way of effort. Mr. C agreed; “Hang the expense,” was his attitude, “I’ll do anything.”
In taking the history, it had been discovered that Mr. C abhorred the housework. He did the cooking for his son, but the son, in turn, did the dishes and all the waxing of the floors. Mr. C always went outside when the son waxed floors; he could not tolerate the odor of floor wax. The psychiatrist told Mr. C, “Tonight, you get out the floor wax and some rags. You have hardwood floors in every room in your home. You start at 8:00 P.M. That’s the time you usually start to toss and roll in bed. You will wax the floor all night long, over and over again. It will only cost you an hour and a half of sleep—that’s all. You are going to wax the floors and you can hate it all night long, just as you can hate me all night long. You can actually enjoy hating the floors and hating me, but do it.” The old man said, “Well, you’ve talked me into it and I’ll do it.” He waxed the floors that night. He waxed the floors the next night. He waxed the floors the third night.
On the fourth night, at 7:30, he lay down on the bed with his shoes on, “just to rest my eyes.” He awakened at 7:00 A.M. He has been sleeping every night since, without any sedation. He had promised that any time he couldn’t get to sleep within half an hour, he would get up and wax the floor all night again. He preferred to sleep.
Psychiatrically the matter of guarding the interests and needs of the patient is most important. Actually, it is equally important in the practice of obstetrics, dentistry, dermatology, or the general practice of medicine.
Being put to test
In experimental work with college students, graduates in psychology, or medical students, workers in the field of hypnosis have been put to the test many times by naïve hypnotic subjects.
CASE OF BARBARA L.
A psychiatrist demonstrating at a midwestern university was looking for a hypnotic subject. Early in the afternoon he was introduced to a number of graduate students, among them a girl named Barbara. He looked her over, chatting with her in that group situation, and decided that Barbara would make a good hypnotic subject. He induced relaxation and a very light trance, just to find out how she would react. Then he asked Barbara if she would serve as a demon stration subject that night. She replied that she would be delighted. When she was asked if an experimental procedure that might interest her could be carried out, she willingly gave her consent, both in that light trance state and in the waking state.
The doctor suggested automatic writing. He instructed her to write automatically some harmless little sentence that she would be willing to have him read, and everyone else who would be present. He placed her at the end of the table and took his position at the other end of the table. Barbara looked at him with a smile, then proceeded to write something automatically. After she had written (which she did without her own knowledge), the hypnotist walked over, picked up the sheet of paper, and turned it face down without looking at it. He asked Barbara if he could read it. She asked, “Read what?” He replied, “You did some automatic writing on that sheet of paper.” Barbara looked down and stated there was no writing on it. She was told, “No, I turned it over.” The doctor told her he had no intention of reading it until given permission to do so. She granted that permission, but then he suggested that perhaps they had better just take that sheet of paper and fold it. He took it, folded it so that she could not possibly see the writing, and told her that she had better put it away. She looked at him, shrugged her shoulders, and put it in her purse.
When she was asked to do some more automatic writing, she wrote, “This is a beautiful day in June.” After she had written that, she was asked if it could be read. She extended it to the doctor so that he could read it. He asked her immediately, “May I pick it up and read it? When she replied “yes,” he picked it up and read, “This is a beautiful day in June.” Then he told her in the trance state, by inducing another trance, that there was that folded sheet of paper in her purse, that she had better keep it there absent-mindedly. Some time later she might want to read it.
She came to his lecture that evening and said, “During this afternoon, I had a feeling that I could trust you to do anything, so feel perfectly free to experiment with me during the course of the lecture, because I really trust you and I don’t know why.”
About two weeks later she came in to see the doctor. She said, “I’ve found a folded sheet of paper in my purse. It has a rather curious message on it and I recognize it as my own automatic writing. I also know this, that I wrote that unconsciously, automatically, to find out if I could trust you. I know that you didn’t read it. I know you don’t know what’s on that paper. But you were willing to let me write it and you were willing not to read it. Now I can trust you as a psychotherapist.” And she showed the psychiatrist that sheet of paper. On it was written, “Will I marry Harry?” She said, “I don’t understand that, because I’m engaged to Tom. We’re going to get married next summer. I don’t even know a Harry, or Harold.” She was told the question related to something in her unconscious, that if she wanted to let it come to the foreground, into her consciousness, gradually, systematically, at a rate she could understand it, then she would know what, “Will I marry Harry?” meant.
Some time later she came in and said, “I have broken my engagement to Tom. I don’t know why, but I just can’t stand that man. He’s a nice guy, but personally I can’t stand him, but I don’t know any Harry.” Still later, she reported that she had met a man named Harry. Barbara married this man Harry, whose real name was Harold.
Barbara had actually met Harold previously, had formed her own unconscious impression of him, noted that he was commonly called Harry, but had then “forgotten” him. She had also realized unconsciously that she was not in love with Tom. Thus, she put the whole problem in a nutshell on a sheet of paper. As visiting lecturer, the psychiatrist did not have the right to intrude upon her personal life. But she thought he might be a competent therapist, and she tested him.
One protects the patient in every regard. One does not intrude upon his personal life. One merely expresses a willingness to help the patient—and only at the rate he can tolerate.
When deep trances are needed
One of the things a hypnotist must bear in mind is that there is sometimes a need for a deep trance, no matter what the situation is. One should be able to induce a trance that may help uncover factors related to a patient’s particular problem.