Abstract
Context: Use of hypnosis in medical practice has long been controversial, but recent developments in medical hypnosis--in particular, the understanding that the power of hypnosis resides mainly in the patient--have profound implications for treatment.
Objective: To illustrate and explain the therapeutically useful application of hypnosis in medical practice.
Design: Case series.
Setting: Department of Preventive Medicine at Kaiser Permanente Medical Center, San Diego.
Patients: Five outpatient Health Plan members referred to a department of preventive medicine for alleviation of physical, emotional, or behavioral symptoms.
Main outcome measures: Extent and duration of clinical recovery.
Results: Patients in all five cases had dramatically successful clinical outcomes after three or fewer intensive hypnotherapeutic sessions.
Conclusions: Medical hypnosis is an underutilized therapeutic modality which can be learned easily for everyday use in medical practice, especially when taking the medical history. In this era of emphasis on cost-effectiveness, both medical hypnosis and certain parahypnotic techniques (eg, closed-eye history taking) may be of special interest to physicians.
Introduction
Hypnosis is a state of highly focused attention (trance) in which external stimuli are disattended and suggestion becomes far more effective than usual.1 The fundamental usefulness of hypnosis in medicine and healing has been controversial for more than 200 years, ie, since Anton Mesmer produced the body of work now recognized as the beginning of clinical hypnosis. Does medical hypnosis work? If so, how? Does it produce real bodily healing at the physiologic level, or is its therapeutic effect merely the result of imagined comfort--and thus to be found in the mind only? These questions are reasonable and can best be addressed by clinical observation aided by modern technology.
The most clinically significant recent development in medical hypnosis is our understanding that the power of hypnosis actually resides in the patient and not in the doctor. This simple statement has profound implications because it implies existence of useful potential within each patient. The goal of modern medical hypnosis is to help patients use this unconscious potential--a revolutionary shift from the direction-focused, authoritarian therapeutic techniques of the past.
By contrast, modern medicine involves a highly rational belief system that minimizes the importance of autonomous therapeutic processes. This belief system has created an expectation that everything can be accomplished on a conscious and voluntary level, even though such voluntary efforts can sometimes obstruct natural healing processes. Notwithstanding this possible obstruction, a cumulative effect can be attained by simultaneously using the opposing concept that underlies modern medicine with medical hypnosis.
To support these statements and to illustrate the range of possible treatments, this article describes five patients who were treated with medical hypnosis after being referred to me from the Kaiser Permanente (KP) Department of Preventive Medicine in San Diego. Focusing on these five clinical examples presents the opportunity to answer three questions:
What is medical hypnosis?
How does medical hypnosis work, especially when no specific directions or suggestions are given?
When should medical hypnosis be used?
Discussion
Historically, medical hypnosis was identified with surgical anesthesia2 and with removal of symptoms. Medical hypnosis was defined as a state of heightened suggestibility in which something is done to a patient. From this interpretation--one in which hypnosis commands away the symptom--our definition has evolved to a subtler form that more effectively brings basic, long-lasting change. Because this description may seem undramatic to those who are familiar only with the commands of stage hypnosis--or with its often magical depiction in motion pictures--the distinction bears some elaboration.3
Medical hypnosis is quite different from the "command performance" of stage hypnosis, an activity that depends heavily on the practitioner's ability to quickly select from an audience those subjects who can be readily hypnotized.4 Stage hypnosis is also highly directed as to outcome ("You will sing like Frank Sinatra," "You will quack like a duck," etc). This directiveness can be dramatic and engaging, but it has limited utility. Unlike practitioners of stage hypnosis, physicians do not have the luxury of selecting subjects on the basis of perceived ease of outcome. In fact, for many patients, the problem is so complex that its resolution requires total dependence on unconscious processes occurring within the patient.5 For example, in none of the cases described were outcomes suggested; indeed, some outcomes were unanticipated. Research has shown that attempts to cure by specific direction and command have a high failure rate because of the unrecognized complexity underlying many patient problems.6
When we speak of medical hypnosis, we refer to a special type of interchange between two people--an interchange that involves trance. Trance can occur at many levels ranging from rapt attention with eyes open (entranced) to deep states that resemble somnolence. Whatever its depth, hypnotic trance has consistently been determined to have no relation to the state of sleep; hypnotic trance is physiologically a type of waking state. Moreover, just as an abdominal incision is itself not treatment but is instead the means through which surgical treatment may be done, hypnotic trance is not a treatment per se; instead, hypnotic trance is the framework in which treatment can more effectively be carried out. The goal is not to hypnotize someone; the goal is to accomplish a therapeutically valuable result during hypnotic trance.
Foundational Theories of Medical Hypnosis
Dr Milton Erickson--physician, psychotherapist, teacher, and arguably the consummate medical hypnotherapist of the 20th century--emphasized the need for practitioners to individualize their approach to hypnosis.9 Erickson believed that the hypnotherapist must understand, evaluate, accept, and use the unique aspects of each patient. Erickson's often-extraordinary results occurred precisely because they activated and further developed what was already within the patient instead of trying to impose from the outside an element that might be unacceptable for that individual's personality. Although easy to describe, this process is difficult to accomplish without extensive practice. To understand what can be accomplished in medical hypnosis--and to obtain a detailed explanation of the underlying concepts--I suggest you read "The February Man."10 This monograph provides a verbatim transcript and detailed explanation of one remarkable case in which Dr Erickson definitively treated the patient in four sessions, during which the patient believed that she was merely providing background information as the prelude to treatment.
In Dr Erickson's approach, all symptoms are viewed as signals. In this approach, the hypotherapist asks, "What is this patient trying to tell us with a headache, chronic fatigue, or recurring, stress-related skin disorder?" Some patients may present through their own imagery a metaphor about their emotions that ultimately helps expand the patient's conscious understanding.11
How Hypnosis Works
That medical hypnosis works is clear from the case examples given and from extensive clinical and experimental literature. However, the mechanisms of hypnosis and reasons for its effectiveness raise vastly more complex questions. Nonetheless, this situation is not different from that of aspirin, which was used effectively for more than half a century without anyone understanding how or why it worked. Like uses of hypnosis, some of aspirin's uses have been discovered only recently--and more may well be found. The five cases described in this article illustrate only our current understanding that the power of hypnosis resides in the patient.9,12 The power of hypnosis certainly need not originate in commands; indeed, none were given to our patients. Moreover, enhanced physiologic function (as in Case 1) must be interpreted as resulting from release phenomena, because biologic functions cannot be inserted. This interpretation implies existence of a wealth of material in the patient's unconscious that can be used in healing. This wealth of material is what current medical hypnosis techniques attempt to stimulate.
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