The psychosomatic entities treated in this chapter which are amenable to hypnotherapy include hysterical blindness and deafness, globus hystericus, aphonia, dysphonia, and certain types of dysphagia. Most resemble conversion hysteria reactions. A psychogenic component has been recognized in tinnitus, glaucoma, and blepharo-spasm.
When a symptom has a minimal defensive function, it is readily removed by hypnosis, especially if the physical discomfort is severe and a hysterical makeup is present. This is not surprising, since most psychosomatic symptoms involving the eyes, the ears, the nose, and the throat are brought about by harmful suggestions and disturb the normal functioning of the individual.
Hypnosis, together with reeducation, reassurance, support, directive measures, and persuasion are necessary if relapses occur. Often the symptom is needed for sympathy, absolution of guilt, escape from intolerable situations, denial of aggression, or the necessity for manipulating the environment in a neurotic manner (secondary gain) because of inability to handle problems in a healthy manner.
Relapses occur if the individual is unable to adjust to his environmental difficulties and continues to overreact to anxiety-provoking tensions. Refusal to recognize that the symptom represents a reaction to unpleasant circumstances (which only mobilizes inner conflicts) also can result in a relapse. Likewise, when the symptom provides vicarious gratification for sexual and hostile impulses, it often returns, especially if authoritative hypnosis is used for its dissolution.
These difficulties can be avoided if autohypnosis and sensory-imagery conditioning are incorporated in a permissive approach. These, together with understanding, give the individual the capacity to face his difficulties without resorting to regressive behavior, repression, and the resultant symptom formation.
OPHTHALMOLOGY
Reduction in blood flow in vascular anastamosis and engorgement of the vessels of the sclera has been noted.39 It was speculated that hypnosis might produce relaxation of the cornea so as to allow it to assume a more rounded shape, thus reducing astigmatism. A case was reported in which an 8-year-old girl was able to control voluntarily her pupillary response through hypnosis.12Other investigators used oculograms to detect presence of optokinetic nystagmus (rhythmical oscillations of the eyes with a slow and fast component) in subjects hypnotically hallucinating a visual situation.5 An objective criterion by electro-oculograms is thus provided for presence of visual hallucinations. Optokinetic nystgamus, undoubtedly organically based, was abolished by utilizing a negative hallucination for the normal appearance of the room.1 It was surmised that the optokinetic reflex response was not definitive means of differentiating hysterical and true amblyopia. Schneck alleviated symptoms associated with cataract, such as anxiety, eye tension, blurring of vision, and self-consciousness.34 He stresses that underlying deficits must not be masked.
Suppression Amblyopia
In suppression amblyopia, the eyes are not coordinated, and the visual images are not fused. Once the pattern becomes fixed, the child is virtually sightless in the suppressed eye even though the retina and optic nerve are unimpaired. A patch is worn to improve function in the involved eye. Browning and Crasilneck found that eight out of nine cases improved through hypnotherapy.6 Follow-up studies 3 years later on eight cases showed that even though there was some decrement in visual improvement, the improvement previously attained was restored with a single session of hypnosis! This is a remarkable study. In a later one, improvement was not obtained with suggestions at nonhypnotic levels.37
Crasilneck and Hall state: “At present the use of hypnosis in treating suppression amblyopia in adults remains uncertain, but with children results appear to be favorable and encouraging.”10
Effects of Suggestion on Visual Acuity
The effects of hypnotic suggestion in relieving myopia have been reported.20 Subjects with the poorest acuity did the best. The effects were carried over into the normal state. Suggestion without hypnosis was equally effective, but no carryover occurred. Also, no effects were obtained in hyperopic persons. Optometric examination before, during, and after the experiment indicated that refractive power in the eye could not account for the dramatic changes in visual acuity.
Glaucoma
Emotional factors affect the fluctuations of intraocular pressure, particularly in glaucoma.2 However, a typical personality profile does not exist for individuals suffering from primary glaucoma.3,4Vulnerability of the eyes as potential organs for the expression of psychic conflicts has been postulated.4
Most afflicted patients are elderly individuals, beset by chronic worries and anxieties over marital conflicts, ill health, unemployment, dependence on family or others, loneliness and, in particular, depression. Exacerbation of eye symptoms in association with emotional upsets is evidenced by statements such as: “My eyes get bleary when I get mad,” “When I get very excited, my eyes throb,” and “My eyes itch and water when I'm tense.”
In glaucoma, hypnotic suggestions for relaxation effected symptomatic relief, with a drop in the intraocular pressure in one or both eyes to a level as low as, and often even lower than, previously recorded pressures.3 The mechanism by which this occurs is not known; the tensions are affected by mood swings. Posthypnotic suggestions directed toward specific symptom removal resulted in fewer headaches, less tearing, more relaxation and sleep, and less pain. Glove anesthesia mitigates discomfort in selected patients.
Hysterical Blindness
Hysterical blindness is a conversion reaction to unpleasant circumstances which stimulate inner conflicts. Clinically, the condition resembles genuine blindness except that remissions and exacerbations may occur spontaneously.
Differential Diagnosis
An individual with functional blindness will react to light with pupillary contraction. Hysterical blindness has been found to have no effect on the appearance or the disappearance of the alpha pattern in EEG records. On the other hand, alpha activity has been recorded in hysterically blind individuals only when their eyes were shut.29 These contradictory studies indicate that physiologic changes associated with artificially induced hypnotic phenomena and conversion reactions are not as clear-cut as those noted for well-established organic disorders.
Treatment
Hypnotic abreaction was utilized to treat cases of hysterical blindness.43 The abreated material was characterized by helpless dependency and the inability to deal with problems realistically.42 Hysterical blindness often can be successfully treated by hypnosis without the necessity of employing a formal induction technic.
Orthoptics
Hypnosis can be used as an auxiliary to orthoptic therapy. In squint, amblyopia, and muscular disturbances involving loss of accommodation, hypnosis can shorten treatment and is less exhausting for the patients.18
Myopia has been improved by the Bates system of eye training under hypnosis. Concomitant psychological factors have been elicited through superficial exploration. In one case, the subject felt that he looked so ugly in glasses that he hated to look at himself. Following strong suggestion, aimed at correcting these attitudes, together with the Bates treatment under hypnosis, the individual was able to discard his glasses. Lock and co-workers reported a case of strabismus which had failed to respond to surgery, but was cured by a combination of orthoptics, refractive correction, and hypnotherapy.28
Other researchers have reported on the value of hypnosis in amblyopia6,7 and in orthoptic training.38 There is an extensive literature on the psychosomatic aspects of ophthalmologic conditions.9,14,17,19,25,27,29,40
Adjustment to Contact Lenses
The increasing popularity of contact lenses has opened up a new field for hypnosis. Many cannot insert the lenses because of blinking and discomfort due to a psychological block. Under hypnosis, blinking while the lens is being inserted can be reduced by sensory imagery and the misdirection of attention, as follows: “Would you mind concentrating on the pressure of your shoes on your feet. Notice that they are rather tight when you concentrate on the shoes.” (The patient nods affirmatively.) “Notice the weight of your watch on your wrist. You do not feel the shoes now, do you?” (Again he nods.) “You see, in this manner you can either become aware of the lens as it comes into contract with the eyeball or you can ignore it by concentrating on your shoes.” This simple procedure often obviates excessive blinking.
In others, the wearing of the lenses results in agonizing pain, lacrimation, and photophobia. If a competent ophthalmologist has ascertained that the lenses fit properly, posthypnotic suggestions can be made as follows: “Although, at first, you will have some sensitivity and discomfort, you will be able to tolerate it.” All sensitivity should not be abolished, as a misplaced or a misfitted lens would not be perceived. Complete anesthesia of the eyeballs would eliminate the essential break-in time, or the lenses would be worn too long, too soon, resulting in conjunctivitis. It is much better to suggest, “You can, if possible, wear them regularly and for longer periods each day.” Such suggestions under autohypnosis are even more effective.
Hypnosis in Eye Surgery
Surgery of the eye under hypnosis is still practiced in India for cataract removal. Esdaile, whose extensive experience with mesmeric coma was described in Chapter 34, described how he enucleated a diseased eye with the good eye watching the surgeon's manipulations.13
Cohen reported an unusual use for hypnosis in surgery depending upon the ability of the pupil to contract at the right time to an appropriate suggestion.8 The hypnosis was used also to achieve relaxation and to relieve fear and anxiety. However, its most useful application was manifested by the conditioned reaction of the pupil which contributed to the successful outcome of the Ridley operation (insertion of a plastic lens while the pupil is contracted).8
Blepharospasm
Involuntary blinking movements of the eyelids are related to tics. Ambrose states: “The treatment of tics is an extremely unsatisfactory matter and there appears to be only one therapeutic measure which has any direct effect upon them, namely, hypnosis.” This author heartily agrees with this statement, as he has cured many bizarre tics through symptom transformation under hypnosis. The transfer to the finger twitch is employed, as described in the treatment of dermatitis factitia in Chapter 38.
One of the worst cases, involving a 65-year-old male, was cured in four sessions by this procedure. This patient had seen more than 18 physicians in a 10-year period. The blinking prevented him from working, and a constant conjunctivitis was present, accompanied by lacrimation and edema of the eyelids. No attempt to understand the underlying psychological factors was made in this case. A follow-up 6 months later revealed that the symptom had completely disappeared and had not been replaced by another.
Cases of blepharospasm treated by hypnosis and behavior therapy were recently described.26,41
OTOLOGY
Tinnitus
Etiology
The auditory pathways are one of the most delicate and reactive mechanisms of the body. Since these are directly associated with the nervous system, their responses are in direct proportion to the sufferer's anxiety state.
The emotional factors associated with tinnitus or Meniere's disease have been attributed to fear of the attacks of vertigo and nausea, fear of deafness, and excessive preoccupation over the symptom. Emotional upsets have also been implicated in the production of the vasomotor changes in the labyrinth or its connections; spasm and hemorrhage of the blood vessels occur (labyrinthine angiospasm). Edema of the labyrinth has been found with advanced involvement. Reflex irritation of the geniculate ganglion of the tympanic plexus is increased by grinding of the teeth and tension upon the jaws in association with suppressed rage.35
In this respect, a group of patients with Meniere's disease demonstrated that the paroxysmal attacks of vertigo, and often the onset of tinnitus and deafness, were definitely related to stressful situations.15Another investigation revealed that the circulation of the conjunctiva “sludged” following strong psychic stimulation; the blood clumping occluded the capillaries in the labyrinth, resulting in local disturbances. These, in turn, produced symptoms and, if the vascular pathology persisted, the labyrinthine hydrops characteristic of Meniere's disease occurred.
Treatment
A temporomandibular subluxation must be considered in all cases of tinnitus. Since many patients have bruxism, or grinding of the teeth, wearing a bite plate at night helps them. All organic factors must be ruled out before instituting psychotherapy. The author remembers a patient whom he treated unsuccessfully and who was cured after the separation between the upper and the lower jaws was increased by building up the posterior teeth.
Every effort to avoid nervous tension must be made. The existence of the head noise as an annoying reality should be accepted and, if possible, ignored. An elevated position is often helpful as less congestion of the head results, and as a result the tinnitus may be less noticeable.
Direct posthypnotic suggestions can be used for hysterical tinnitus. Tinnitus varies from person to person and even varies in intensity in the same person from time to time. Ask the individual what he hears. Is it a seashell kind of noise? Is it a high- or a low-pitched squeak? In what situation does it occur most frequently—when alone or when talking with others? Does it occur more often around certain persons than others? All of these are important.
If a clue is obtained, posthypnotic suggestions directed toward a reduction of the offending situational factors often ameliorate the symptoms. If it is intermittent, suggest that “It will occur somewhat less frequently with a longer interval of time between occurrences.” If, through posthypnotic suggestion, the intensity of the tinnitus can be increased, it can be reduced, and, when this is manipulated slowly, the individual attributes the increase or the decrease to his own emotional control. Thus he finds that the symptom can be altered. If it is changed, his confidence grows; then it can be made less annoying. And if this is accomplished, it can be made to disappear completely. Time expansion or contraction can potentiate therapy.
These procedures must be done slowly; specific posthypnotic suggestions must be given. Never make a general statement that “Your tinnitus is going to be less,” or that “It is going to be reduced,” or that “It is going to disappear,” because this may not be possible. Suggest rather that the pitch is going to become lower or “When the pitch lowers, it is going to be less annoying.” If taught autohypnosis, the patient can imagine via his own thought processes that the ringing in his ears is being replaced by pleasant sensations based on memories of periods when he was free of the tinnitus.
Many patients are making the rounds of physicians' offices, desperately seeking assistance. Unfortunately, the psychogenic factors are seldom treated. Mere relaxation through autohypnosis helps over 60 per cent of the patients. A 50 per cent recovery rate in dizziness due to tinnitus has been reported.10 As is to be expected, failures occur, usually in those who are not good hypnotic subjects. Some patients, who are looking for “magic,” terminate therapy too soon.
The successful use of hypnosis in tinnitus has been reported by others.31,32 Mihalyka and Whanger described a case similar to the author's, which was cured by hypnosis.31
A 36-year-old male with tinnitus, characterized by irregular clicking sounds, fullness in the ears and vertigo, was cured in 4 sessions. He was taught autosuggestion to relax; the tic disappeared for 48 hours. One month later the patient reported that he was “improved”; the clicking only occurred after emotional stress. He stated that he was able to control his symptoms through autosuggestions.
The investigators concluded that hypnosis, limited specifically to the reduction of tension, is often a potent tool. Hypnoanalysis has been used to evaluate the conflicts and the anxieties underlying tinnitus to establish personality integration.21
Tic Douloureux
The author has had very little success with tic douloureux. Of the cases seen during the past several years, he cannot remember a single one that responded permanently to hypnosis. More than half were temporarily relieved by glove anesthesia. However, Esdaile reported a successful cure.13 Elliotson reported several cures at the beginning of the last century.11 More recently two cases were relieved by hypnosis.36 Nevertheless, the author has found this condition difficult to treat by hypnosis per se.
Hysterical Deafness
Hysterical and hypnotically induced deafness are similar in that there is no hearing loss. However, the reaction to strong auditory stimulation is significantly less in hysterical deafness. Electromyographic studies of hysterical and hypnotically induced deafness have been made, and the similarities and the differences in these two entities have been elucidated. The findings corroborated those of Kline, who concluded from the study of delayed speech feedback that hypnotically induced deafness appeared “to represent a valid alteration of hearing function but not a state akin to organic deafness.”23
Differential Diagnosis
Abnormal audiometric readings are indicative of hysterical deafness. This type must be differentiated from organic deafness. A simple test would be to make an unexpected loud noise. If a startle reaction occurred, it would indicate that hearing was unimpaired. According to Kodman and Pattie, quantitative hearing tests should be made, rather than relying on subjective reports in diagnosing cases of psychological deafness.24 There are several methods to measure auditory sensitivity: pure-tone audiometry (air and bone conduction thresholds), speech audiometry (speech perception thresholds and speech discrimination), and the psychogalvanic skin response (in which a conditioned skin response is set up to tonal stimuli). These investigators made hearing tests on children who showed functional hearing losses. Although their hearing was apparently normal, they complained of an inability to hear, particularly in home and classroom situations. Laboratory tests made before and after hypnotherapy indicated that improvement was brought about in every case except one. In some cases the hearing loss inexplicably involved only one ear.
Treatment
These investigators used the following suggestions while the patient was lightly hypnotized: (1) He might think that there was something wrong with his ears, but actually nothing was wrong; (2) his troubles might come from not listening well, and listening was an important part of hearing and understanding; (3) in the future he would hear and listen much better. They used no challenges except that the patient would find it difficult to open his eyes. A similar approach is described by Hurst, who used strong persuasion to make patients listen more attentively.22
Other researchers have described hypnotic technics which could be used to reeducate and improve hearing acuity.30 It is concluded, from their clinical observations, that hypnotherapy can be effective for abnormal hearing difficulties which are believed to be psychogenic in origin. Symptom substitution was not utilized in any of the series. The hearing behavior improved in nearly all cases.
LARYNGOLOGY
Globus Hystericus
Globus commonly occurs in nervous individuals who are under severe stress. Since the mechanism is based on a conversion reaction, direct symptom removal by hypnosis is effective. When the patient recognizes the psychogenic basis for the symptom, the emphasis should be on present and future adjustment. Other symptom equivalents are not likely to return if permissive technics are utilized.
Hysterical Aphonia and Dysphonia
There are many kinds of speech and vocal conditions that are refractory to therapy, such as hysterical aphonia and dysphonia, and harsh, scratchy, rough voices that are very hard to treat. Nervous individuals who make their livings by using their voices are the ones generally affected. They know that they must sing or speak well; therefore they cannot become tense, or their vocal productions will be endangered. Many orators are nervous when they first start speaking, and the tension immediately shows itself in altered voice qualities. There may be harshness, huskiness, tremolo, or perhaps either an elevation or a depression of pitch.
Platonov described how three or four hypnosuggestive sessions cured opera singers of “footlight neuroses.”33 Psychotherapy administered while the cortex is in a “lowered tone” made it possible to eliminate the neurosis completely.
Gagging
Hypnosis is used to control or eliminate the gag reflex. Generally a light stage is sufficient. Many individuals, on the basis of psychological factors, believe that they will gag. Several technics that are effective in a high per cent of cases will be discussed in Chapter 46.
RHINOLOGY
Epistaxis
Hypnosis has been used to control severe epistaxis.
There are innumerable reports from dentists who contend that bleeding can be stopped and started by hypnotic suggestion. The author believes that more accurately controlled data are needed before the conclusion is reached that bleeding can be stopped so readily by hypnosis.
Rhinitis
Vasomotor rhinitis is astonishingly susceptible to emotional factors in its production and its dissolution. The common cold often responds to hypnosis. The author sees many patients who, coincidental to their chief complaint, have the “sniffles.” Susceptible persons under hypnosis can be told, “Imagine that you are walking home. It's a very hot day, and your nose and throat are very, very dry, real dry!Wouldn't you give anything for a nice, cold drink of water? Your mouth and nose are getting very dry, very dry, are they not?” Or, “Imagine you are in a steam bath and the hot vapor is going up your nose. You've been in this steam bath a long time and you're very parched. …”
As has been mentioned, physiologic effects can be obtained through hypnotic suggestion only by sensory-imagery conditioning and not by direct command. To suggest, “Your nose will stop running” is futile. Suggestions of generalized warmth can also alleviate the rhinitis. The author has often demonstrated how “goose-pimpling,” sneezing, shivers, and a drop in body temperature can be induced by hypnotic suggestion to a good hypnotic subject.
The fact that the common cold responds to a wide variety of medicaments implicates emotional factors, even though a viral etiology has been postulated. It has been demonstrated that specific or non-specific stress lowers the threshold to viral invasion.
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