PRECAUTIONS
There are certain precautions that one should use when dehypnotizing a patient. As the result of the increased amount of concentration required for successful hypnosis, many subjects state, upon termination of the hypnosis, “I have a terrible headache.” Therefore, the operator should remark, “Your eyes will open at the count of 3; you will feel perfectly wonderful; you will be completely refreshed and relaxed.”
Always give posthypnotic suggestions so that hypnosis can readily be reinduced. The touch on the right shoulder is a good one, because one can remember “right” to induce, and “left” for dehypnotization. The same standardized procedure for each patient should be used in order not to become confused.
All posthypnotic suggestions, as anesthesia or hyperesthesia induced over any part of the body, should be removed by the statement, “You are going to feel fine. All of the suggestions that I have given you except the ones you wish to retain will disappear.” Even though a subject is in control, one also should suggest, “Nobody can ever induce hypnosis without your permission, and this includes myself.” This pleases most individuals, as so many patients fear they will be hypnotized against their will. This procedure nullifies the unfounded criticism that hypnosis can be produced against a subject's wishes.
Be sure to say over and over, “Now, remember, you were not asleep, you were not unconscious, you were not in any kind of trance, and you heard everything I said.” In spite of these clear-cut suggestions, subjects who were deeply hypnotized, but who do not understand the nature of hypnosis, state, “Doctor, I know I wasn't hypnotized. I heard everything you said.” On the other hand, those who are conversant with hypnosis remark afterward how alert they were and how everything was heard clearly. I assure patients that this hyperacuity is characteristic of hypnosis. Patients who confuse hypnosis with sleep should be informed: “I am using hypnosis because I want you to be more ‘awake.’ If you are paying full attention to me, I can get more meaningful suggestions across to you.” Patients then understand more about the nature of hypnosis.
All patients can be dehypnotized readily. This author, in several thousand patients and lecture demonstrations, has never had a patient who would not or could not come out of hypnosis. However, there are several reports on difficulties of dehypnotization.1,2,3 The author remembers a case in which an amateur hypnotist could not dehypnotize a patient because he neglected to remove a suggested anesthesia from a subject's arm. The patient, naturally, did not wish to have a part of the body anesthetized. It was only when he informed the hypnotist about the arm that he allowed himself to be dehypnotized. Therefore, one must be careful to recheck all suggestions whenever a patient cannot be dehypnotized.
There is also the rare possibility that a somnambulist, who has been deeply hypnotized for a long period, may spontaneously reenter hypnosis unless completely dehypnotized after the initial induction. Therefore, it is always wise to keep such patients in the office for an hour or more, especially if they have to drive. Failure to do this might invite a lawsuit if an accident occurred.
Even though it would be difficult to prove negligence, the situation could prove very trouble some. Often, too, subjects who are reacting to a posthypnotic suggestion are not fully dehypnotized; some look “sleepy.” Therefore, here too, sufficient time must be allowed for the relaxing effects of the hypnosis to be dissipated.
The pattern of actual sleep and the ease of awakening may be related to the ease of dehypnotization; heavy sleepers theoretically dehypnotize slowly. The particular mood of the subject at the time of dehypnotization can determine the way he feels and acts after the induction is terminated. Some cry, while others laugh—either is dependent on the type of associations stimulated during the hypnosis. Often the specific personality needs of the hypnotized subject can be correlated with the manner in which dehypnotization occurs. This is affected by the ability of the subject to face reality—a person who has a difficult life situation to face may prefer to remain in hypnosis.
Williams has described the difficulties associated with dehypnotization.2 He points out that some individuals are only partially dehypnotized and then can lapse into deep hypnosis spontaneously. He also cites2 three cases in which dehypnotization was delayed by the subjects' refusal to terminate the hypnosis. One subject became belligerent but finally was dehypnotized; another, who had been given a posthypnotic suggestion to misspell his name, was dehypnotized only after he had carried out the suggested act. The third subject refused to be dehypnotized because some preservation of highly charged emotional material of the preinduction period persisted during the hypnosis.
Bramwell cites two cases in which the subjects were reluctant to terminate the hypnosis (in both, disagreeable posthypnotic suggestions had been given).1 Williams discusses other cases in which the hypnotist attempted to reinstitute an aphasia while the patient was being treated for hysteric aphasia. One patient told the physician-hypnotist that, if he persisted, she would refuse to “wake up.” Another wanted to see a hallucinated movie again. He told the hypnotist he intended to remain in the hypnotic state.
Williams reviewed 30 cases in which difficulty in dehypnotization had occurred. In some, carry over of the preinduction mood, malingering, incompetency of the hypnotist and other factors were responsible. Only scant data are available as to the exact time required for dehypnotization, but the periods ranged from one to several hours, despite medical intervention.
One of the “psychological” factors responsible for difficult dehypnotization is that the subject often deliberately attempts to test the hypnotist's ability to dehypnotize him. Frequently there is collusion with friends merely to embarrass the hypnotist. Errors and ambiguities in instruction, as well as omission of a relevant detail which is disturbing to the subject, can be responsible, as, for instance, failure to remove a suggested paralysis of the limbs, as mentioned above. Other factors include aggression toward the therapist, reliving of highly charged emotional material, association with what happened on television or in the movies associated with hypnosis, and combat fatigue treated by hypnoanalysis.
When some psychoneurotics fail to dehypnotize, the responsible factors often can be those which are also behind their symptoms—the behavior in hypnosis fits in with their emotional needs. This is borne out by the cases just described: the subjects were in control and decided how they wished to react.
DEHYPNOTIZING THE DIFFICULT PATIENT
Treat every patient with respect, as hypnosis is a dignified procedure which should be used only for medical reasons. Understanding the emotional needs of the patient who is to be dehypnotized is imperative. If an individual refuses to be dehypnotized, one can do several things. One can suggest that the hypnosis will merge with true sleep and that the subject will awaken from it none the worse for the experience, or that he will come out of it spontaneously.
If these measures fail, one can use time distortion, as follows: the patient can be informed that 1 minute of subjective or experimential time will seem like half an hour of clock or chronologic time. If 1 minute is equated to a half hour, then if he remains in hypnosis for 10 minutes it will seem as if 5 hours have elapsed. Thus he will have had his full measure of revenge. Now he will dehypnotize himself, because he has proved his point. If these methods are of no avail, one can resort to mild electroshock or Metrazol.
The best method is to superinduce another hypnotic state and make every effort to recognize and understand the specific behavior involved in the subject's refusal to be dehypnotized. If the hypnosis still cannot be terminated, another hypnotist can deepen the hypnosis and then impose his own conditions for dehypnotization. Sometimes further psychotherapy must be promised to get disturbed individuals, who demand more attention from the therapist, out of hypnosis.
REFERENCES
1. Bramwell, J.M.: Hypnotism. London, Rider & Son, 1921.
2. Williams, G.W.: Difficulty in dehypnotizing. J. Clin. Exp. Hypn., 1:3, 1953.
3. _________: The termination of the hypnotic state. In Introductory Lectures in Medical Hypnosis. New York, The Institute for Research in Hypnosis, 1958, pp. 62-69.