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Monday, April 19, 2021

Hypnosis

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Case Examples


Over the past several years, I have treated with medical hypnosis a number of patients referred to me from SCPMG's Department of Preventive Medicine in San Diego. A brief outline of five cases will illustrate the range of possibilities for treatment and provide examples of the unusual statements made on the home page.


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Case 1


PF# 4688 is a 57 year-old male physician who had a mild, right, posterior inferior cerebellar artery thrombosis demonstrated on cerebral angiography.


Intractable hiccups ensued as a recognized complication of the MRI-demonstrable brain lesion he sustained; they were unresponsive to trials of several medications.


Two weeks after the event, a one and one half hour hypnotherapy session immediately and permanently terminated the hiccups.


Although he did not feel he was hypnotized, he described several psychophysiologic changes that he had never experienced prior to this session a complex visual hallucination, brief but pronounced sialorrhea, and brief periods of marked acoustic and olfactory hyperacuity.


Three months later he suddenly realized that he no longer used the bronchodilator and steroid inhalers previously used twice daily for ten years.


I made no suggestions specifically relevant to the physiologic changes he manifested and was not aware that he had asthma. Seven years later, he remains free of hiccups and asthma; pulmonary function tests are normal.


Case


PF# 604800 is a 41 year-old, obese, chronically depressed, ICU nurse who spent her childhood in an abusive household. She later married an abusive man and developed a pattern where she would have the Sheriff remove her husband during moments of violence and then relent and forgive him.


After one such episode of removal, she compulsively became unable to dispose of the kitchen garbage. She stored this garbage, wrapped in plastic bags, in the bedrooms of her home. She complained to her physician that the odor did not allow her to invite anyone into her home.


Although stating, If my house is dirty, then no man will want to come in my house. she saw no link between this and the problems with her husband


After three hypnotherapy sessions, she spontaneously cleaned her house; she saw no link of this change to the sessions.


I made no specific suggestion during trance that she dispose of the garbage.


Case


PF# 78765 is a 65 year-old housewife, a former war orphan and inmate of Auschwitz and Ravensbruch. Over a ten-year period she had generated 4 volumes of SCPMG medical records, largely centering on recurrent symptoms of being acutely unable to swallow.


She had multiple normal esophagoscopies by two gastroenterologists and also had esophageal dilation carried out a number of times; no obstruction was found.


Three hypnotherapy sessions resolved her problem of choking. She recognized some link of this change to the sessions, stating "I was liberated from my esophagus," an assertion reminiscent of her earlier statement, ". . . when the Russian soldiers liberated me from Ravensbruch." As the photograph demonstrates, her medical utilization plummeted in the 5 years after treatment.


The lower records in the photo are her charts from the ten-year period before hypnotherapy; the upper portion is from the five years after. I gave no direct suggestion relating to choking or dysphagia.


Case 4


PF# 74778 is a 51 year-old, successful professional woman who had a highly abusive childhood. She was seen on an emergency basis because she was concerned that her plan for suicide that day would interfere with her obligation for giving the keynote address at a national meeting later that afternoon.


That is, suicide was not her problem, it was her solution. Her problem was that this solution interfered with her sense of responsibility. A 0 minute hypnotherapy session enabled her successfully to fulfill her obligations. A very few follow up sessions seemed significantly to relieve her depression over the next 18 months.


A videotaped interview with this woman eighteen months later is titled, I'll Be Polite Before I Die and is available from SCPMG's Department of Preventive Medicine.


Case 5


PF# 5877 is a middle-aged woman with demyelinating disease who was seen for treatment of depression that was poorly responsive to anti-depressant medication.


Unexpectedly, she almost immediately had a marked improvement in gait that enabled her to give up using Canadian crutches; her dysarthric speech improved noticeably and her depression reduced. Her physician feels these improvements occurred far too rapidly to attribute to a remission in her illness. They persist two years later.


Healthy Mind Body


Mental Physical Wellbeing


Six Steps to Freedom


Self Hypnosis


Why Self Hypnosis


Addictions of The 1st Century


Relax and Heal


I have obviously selected examples of dramatically successful cases. Of particular interest, Cases 1 and 5 illustrate that certain significant aspects of organic disease are poorly understood; evidently, they are sometimes altered by processes that imply an involuntary neural or neurochemical control about which we know very little. Focusing on these five clinical examples, two obvious questions are


• How did these beneficial physiologic and behavioral changes occur?


• Why did they occur if they were not specifically suggested?


Historically, medical hypnosis was identified with surgical anesthesia1 and symptom removal. Hypnosis was conceived as something done to a patient. However, we have now evolved from hypnosis that commands away the symptom to a subtler form that is more effective in bringing about basic and long lasting change. These cases illustrate our current understanding that the power of hypnosis resides in the patient. The power of hypnosis certainly does not originate in commands because there were none given in these patients.


Moreover, when enhanced physiologic function occurs, as in Case 1, it must result from release phenomena because biologic functions cannot be inserted. This implies there is a wealth of stored material in the unconscious that can be used in healing. It is this that current medical hypnosis techniques attempt to stimulate.


Hypnosis is useful in medicine because patients often have physical and emotional problems due to unconscious limitation of their capacities. Medical hypnosis helps them break through these limitations to free their unconscious potential for problem solving. Trance and problem-solving are used to circumvent the patient's rigid and learned limitations.4


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What is Hypnosis?


Hypnosis is actually a state of highly focused attention (trance) in which external stimuli are diminished and suggestion becomes far more effective than usual.5


This is a surprisingly undramatic description to those who are familiar only with the commands of stage hypnosis or its often magical depiction in motion pictures; it therefore bears some elaboration.6


When we speak of medical hypnosis, we refer to a special type of interchange between two people, involving trance. Just as an abdominal incision is not treatment but the means through which a surgical treatment may be carried out, hypnotic trance is not a treatment per se, but the framework in which treatment can more effectively be carried out. Trances occur in many levels from rapt attention with eyes open (entranced) to deep states that can resemble somnolence.


It has consistently been determined that the hypnotic trances, whatever their depth, have nothing to do with sleep; they are physiologically characteristic of a waking state. This conclusion was drawn from a number of famous experimental studies in the 10's using such variables as EEG measurements, cerebral circulation, heart rate, respiration, basal metabolism, and various behavioral parameters.7


One easily realizes that important or difficult matters are likely to have complex and covert underpinnings with strong forces in place that block change. Therefore, even though the power of suggestion is greatly increased in trance, one takes certain steps to avoid the patient's rejection of suggestions. Two common ways of avoiding rejection are offering several choices and providing the suggestion as a metaphor.8


Metaphor is the language of the unconscious and often will be accepted when direct suggestion would be rejected. Equally as helpful as suggestion is the observation that, in trance states, we sometimes solve complex problems orgain a fresh perspective. A famous example of the latter is the great German chemist, Kekule, who conceived the structure of the benzene ring after dreaming of a snake swallowing its own tail.10


Dr. Milton Erickson, a physician, psychotherapist, teacher, and arguably the consummate practitioner of medical hypnosis in the 0th century, emphasized the need to individualize hypnotic approaches.11


He felt it was essential for the doctor to accept, evaluate, and utilize the unique aspects of each patient. His often extraordinary results occurred precisely because they activated and further developed what was already within the patient rather than trying to impose something from the outside that might be unacceptable for that individual's personality.


While easy to describe, and perhaps even to understand, this 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.


This monograph providing a verbatim transcript and detailed explanation of one remarkable case that Dr. Erickson definitively treated in four sessions, during which the patient felt he was merely obtaining background information as the prelude to treatment.1


In this approach, all symptoms may be viewed as signals. In medical hypnosis we are asking, "What is this patient trying to tell us with a headache, chronic fatigue, or a recurring, stress-related skin disorder?"


We are accepting of the symptom/signal and then facilitate creative processes that may transform the negative aspects of the symptom into therapeutic responses.1


Emotional understandings can be profound, yet totally unconscious. Some patients may present through their own imagery a metaphor about their emotions that is ultimately helpful in expanding their conscious understanding, leading to more awareness about their difficulties.14 Here is an example of what you might do with a patient complaining of headaches "Tell me what you are experiencing with that headache right now.


How can you best describe the feelings or sensations? Just continue to receive whatever comes to you all by itself now, only telling me what I really need to know to help you further. I wonder what it is. Only tell me what I need to know to help you further."


Medical hypnosis is thus quite different from the 'command' performance of stage hypnosis. Stage hypnosis depends heavily on the rapid ability to select from an audience subjects who are readily hypnotizable.15 Moreover, stage hypnosis is highly directed as to outcome. "You will sing like Frank Sinatra, quack like a duck, etc." This can be dramatic and engaging, but has limited utility.


By contrast, physicians do not have the luxury of case selection based on perceived ease of outcome. In fact, the resolution to many patient problems is so complex that we must totally depend on the unconscious processes of the patient to conceive the resolution.16 For example, in none of the cases discussed were the outcomes suggested. Indeed, some of the outcomes were quite unanticipated. Attempting to cure by specific direction and command has a high failure rate because of the often unrecognized complexity underlying most patient problems.17


Medical hypnosis or therapeutic trance involves carefully planned extensions of certain everyday processes of normal living. This careful planning places significant demands on the hypnotherapist and initially requires an allocation of uninterrupted time.18


This, the need for experience from frequent use, and the unfamiliar therapeutic use of metaphor are probably the factors that explain the infrequent use of hypnosis in medicine today even though a surprising number of physicians have been trained in its use. Nevertheless, when such treatment plans are well made and executed, significant change can occur in hypnotherapy. We have seen the initial investment of time in this manner save large amounts of physician time later on. Case is a clear illustration.


Healthy Mind Body


Mental Physical Wellbeing


Six Steps to Freedom


Self Hypnosis


Why Self Hypnosis


Addictions of The 1st Century


Relax and Heal


By now it should be clear that medical hypnosis is quite different from most forms of psychotherapy, particularly those that are insight-based. This is an advantage with patients who are not introspective, who are amnesic, or who are unwilling to reflect on the psychological significance of particular events in their lives1. The potential loss of insight is of little matter because insight has been shown to have poor correlation with outcomes.0


One of the great surprises of medical hypnosis is that beneficial change can be wrought without the patient's awareness. Cases 1, , and 5 are illustrative of benefit without understanding or insight. However, medical hypnosis can be and is used as an adjunct to conventional psychotherapy. M. Gerald Edelstein, MD, a psychiatrist from The Permanente Medical Group, has written a definitive textbook of medical hypnosis based on his experiences in Kaiser Permanente. By way of amusing contrast, I once successfully treated the secretary of another Permanente psychiatrist who freely proclaimed ". . . hypnosis doesn't work." She did not share her treatment choice with her employer. Thus far, we have discussed hetero-hypnosis; an interesting variant of this is self-hypnosis. Self-hypnosis involves the same processes, but is carried out under one's own direction., 1 It often is initially facilitated through hetero-hypnosis. I teach it to most of my patients as a way of providing affordable reinforcement on a daily basis. There are some similarities to meditation.


Definition Hallucination, figment of the imagination, Phantasm, mirage, illusion, nightmare (dream), delusion, fantasy, delirium.


To experience and be aware of an image or perception


by creation, invention or formation of neuronal activity within the brain or spinal cord


of a sensation, entity or impression of an external stimuli


which does not exist or appear to exist at that time, location and with that structure.


Occur normally in dreaming (REM), can also be associated with mental diseases


Diseases


1. Schizophrenia-Auditory, Hallucination, Hear Voices, From TV, God's Voice Commanding them


. Epilepsy-Aura-Olfactory, Taste, Also primary sensations of Somatosensory, Visua (Lights), Auditory (Sounds) Hallucination


. Alzheimer's Disease-Visual (Very Rare)


4. Alcoholism Withdrawal-Delirium Tremors-Somatosensory Hallucinations


5. Intense Fear, Paranoia …Hear Sounds


Drug Induced


Hallucinogens psychedelics; mind altering drugs


Psychotropic


10% lifetime prevalence; 0% dependency


Naturally ocurring in 100s of plants, Alkaloids


Used for 1000s of years Aztecs, Mayans, etc Almost always Religious Cermony


More recently man-made (LSD, designer drugs)


I. Indolamine


Psilocybin (Magic Mushroom)


Cohoba epena, S American snuff


Bufotenine (frog skin, angry)…WEB site for ordering


Synthetic DET, 5-methoxy DMT (Cohoba) (Businessman high-short action-45 min)


Mechanism of Action


5-HT receptor agonist - hallucination, visual, cortical processing malfunction


5-HT1A receptor agonist- well being, euphoria, stops cocktail, all information equally processed-delusions, religious experience, mind expanding, one with universe, birth experience - many of changes similar to schizophrenia (Psychiatrist heavy users in 150-60).


II. Phenethylamine (amphetamine backbone)


Mescaline ,natural- peyote


- cactus


- Native American Church


Carlos Castenella- Conversations with Don Juan


Eat 5-6 buttons, vomit, get high


Designer Drugs (Shulgin) STP - Serenity, Tranquillity and Peace


MDA


MDMA - Ecatasy, more serotonin


MOA acts as dopamine and norepinephrine agonist


Nausea, Psychosis, Racing, Mania…Panic Attacks


Designers made them more 5-HTA- hallucination, mind expanding


Not 5-HT1A- Peace, insights, tranquillity, euphoria, well-being


III. LSD-Like


Rye Fungus, St Anthonys Fire-delirium, hallucinations, delusions


Caused abortions, gangrene (Effects of Vasodilation)


Ergot Alkaloids


LSM- Bananas, morning glory seeds


Synthetic Albert Hoffman, 15 - LSD5, migraine drug for Sandoz (Delysid)


MOA 5-HTA receptor (works on glutamate system, all pyramidal neurons)and Dopamine, very potent


5-HT1A receptor antagonist (Increased firing)


Hoffman and Osmond- Use in psychotherapy, alcoholism and terminal patients (accept death)


Timothy Leary- Harvard Psychologist


LSD Banned in 165


Problems Flashbacks Leaves deep memort traces


Psychosis underlying deficit


Bad Trip Loss control of situation, emotions, fear terror


Accidents Loss sense of reality


IV. Anticholinergics


V.


Natural Scopolamine, lyoscine, muscarine


Magic Mushrooms (Northern Europe), Barsarks- berserk, Vikings, Finlands- terror, rape, savage rage, feared throughout Europe


Jimson Weed, Mandrake roots (Shakespeare Witchs Brew), Deadly nightshade


MOA Hippocampus Delirium, memory loss, dementia


Amydala and Septum- Rage, violence, anger


Also euphoria and anxiety


Loss of insight


No synthetic drugs


VI. Amino-Acid Targets


Increase GABA (Main inhibitory transmitter), Decrease Glutamate (Main excitatory transmitter)


Gama-hydrozybuyrate


Phencyclidine (PCP)


Ketamine


Similar to Anticholinergics delirium, memory loss, violence, rage, lack of judgement...cortical disconnect


Major Disadvantage Violent crime, injuries


Coma, respiratory depression, DEATH


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