HYPNOSIS IN NONCONVULSIVE AND ELECTROCONVULSIVE THERAPY
Posthypnotic suggestions have been used to decrease apprehension in patients undergoing nonconvulsive and electroconvulsive shock therapy (E.C.T.).43,70 There is also a report of a disturbed patient treated successfully by simulated or “as-if” electroshock therapy under hypnosis.57
Hypnosis reputedly has helped to recover the loss of memory commonly noted after E.C.T. The few cases, however, in which the author attempted restoration of important memory gaps were not benefited by hypnotic age regression or revivification. Apparently, damage of the association pathways is irreversible. Bowers and Beckowitz contend, however, that if hypnosis were administered preceding E.C.T., some of its disturbing effects could be mitigated.7
IMPROVEMENT IN LEARNING AND PERCEPTION
Recent data indicate that both hypnotic and posthypnotic suggestions improve various task performances,30 whereas, by comparison, waking suggestion is unsatisfactory.55,72 Swiercinsky and Coe contend that hypnosis does not facilitate learning in short-term experimental situations.68 Other studies in this area have been made.20,42 Time distortion often facilitates recall in highly motivated persons.13,14 Those investigators who disagree with these findings, unfortunately, did not use time distortion, and studied only the permanence of learning, not its immediate effects.16,28,67 Another report indicated that learning was increased in a group of students given special remedial learning sessions under hypnosis.63 All of the students had tried the more conventional methods without success.44 Reading speed and comprehension were significantly increased and maintained by hypnosis.18 Stage fright and examination anxiety also have been eased hypnotically.27,47 Posthypnotic suggestions directed to more favorable attitudes and moods facilitated problem-solving behavior.17,26 Thus favorable results can be expected when there is good motivation, hypnotic rapport, time distortion, and relaxation. Other investigators believe that the associated relaxation neutralizes the anxiety and thus increases learning. The degree of meaningfulness of the learned material is an important variable.75
Krippner showed that a group receiving hypnosis improved their reading capacity over a control group.37 Others have demonstrated that creativity can be stimulated.6,53 In the Soviet Union, musicians, mathematicians, artists, and chess players have shown improvement.53 In all cases, the subjects utilized images of being renowned leaders in their respective fields. Follow up studies were made for 8 years, and the subjects invariably continued their improvement following hypnosis. Hoskovec quotes numerous Russian researchers who have found that hypnopedia (sleep-learning) is of benefit in selected subjects.24,34
Erickson reports several hundred persons who had examination “jitters.” On highly motivated persons he uses a technic in which the subject is instructed not to try for high grades, as this only reinforces panic states, but rather to try for passing grades. Oetting uses an “alert trance” to improve concentration.51
Some of the methods discussed above have been particularly suitable for actors, actresses, and musicians, as the following case reports show:
A famous singer always developed “mike fright” and usually required from six to ten retakes when she recorded an album. Using autohypnosis, sensory-imagery conditioning, and time distortion, she sang beautifully without a single mistake on her first attempt. Tape recordings, made by the author, were used in the presleep period to reinforce the posthypnotic suggestions. According to her severest critics, she performed better than at any other time in her entire career. Posthypnotic suggestions to really “live the song” and allay nervousness were important factors. Also, she was cued to enter hypnosis over the telephone. Several months later she was hypnotized during a long-distance telephone call to allay her opening night nervousness, and gave a very successful performance. This has been done for other prominent performers.
A well-known stage and screen star, who was an alcoholic and very undependable, always had trouble remembering his lines. Concurrently, while being treated for his alcoholism, he memorized an entire script after it was read to him while he was in a somnambulistic state in a single 3-hour session. Once, when he was regressed to the age of 5, he spoke in a foreign language. Upon dehypnotization, he emphatically stated that he had forgotten his native tongue, as he had emigrated to America when he was 6 years old. Although he never overcame his drinking, he gave many sterling film and stage performances and never again had trouble remembering his roles.
An actress had to learn a difficult role in 3 days. She was the star of a stage play and carried the bulk of the dialogue. She, too, was trained in autohypnosis, time distortion, and sensory-imagery conditioning. Suggestions were given that 1 hour of action dialogue, as measured by the clock, would be condensed into 5 minutes of subjective time. In other words, 1 hour of the play would be “seen” and “heard” in her mind's “eye” and “ear,” respectively, in one twelfth of the actual time. In this way, she could have 12 “dry runs” or rehearsals for every hour that she spent rehearsing under hypnosis. According to the reviews, she gave one of the most magnificent performances ever seen on the American stage, and she received world-wide acclaim not only for her marvelous performance, but also for the means through which it was accomplished!
The author has utilized the technics described above for concert violinists, pianists, and even writers who just “went stale.” Rachmaninoff, who had been unproductive for several years, reportedly composed one of his famous concertos following posthypnotic suggestion.
These are only a few of many interesting cases. It is the author's impression that this increase in performance occurs not only because of attitudinal changes, but also because the inhibitory factors are reduced. The reader must not infer that all subjects respond as well as those just described; failures do occur. It may be that the confidence and enthusiasm of the operator and the creation of a proper mind-set were the responsible factors. Nevertheless, from an objective viewpoint, most patients were pleased with their increased self-confidence and greater ability to concentrate and learn.
PERCEPTION DURING ANESTHESIA
Cheek contends that much of what is said during surgery can later be recalled by age-regression technics.9,11,68 Ideomotor signaling was employed under hypnosis to give “yes” or “no” answers as to the validity of the supposedly “heard” conversation. He admits that recollection of the operating-room experiences may have been colored by what one imagines goes on during surgery, or that the productions may have been an attempt to please the formulations of the investigator. However, the material obtained under hypnosis, when compared with the data obtained by a tape recorder set up in the operating room, showed some startling similarities.
Cheek's experiments were not rigidly controlled as to the depth of anesthesia and the evocation of irrelevant conversation. It is only natural to assume that “meaningful” data pertinent to the type of surgery readily could be fabricated by intelligent patients. “Talking to the subconscious,” developed on the basis of ideomotor responses, is also open to question.77
Another one of Cheek's findings that should be explored is the distinct possibility of engrafting constructive posthypnotic suggestions on surgical and obstetrical patients who are coming out of anesthesia. During a light plane of anesthesia the sensory input channels are open and, where criticalness is reduced, constructive “programming” can be achieved. If Cheek's contentions are validated, all personnel must be careful about what is said and done in the operating room.
Another interesting speculation adduced by Cheek is that confidence can be instilled during anesthesia to improve the outlook for hopeless cancer patients. Suggestions inspiring faith and confidence are certainly helpful at all levels of awareness. However, in attributing all sorts of benefits to hypnosis, we must not, as serious-minded scientists, allow our enthusiasm to claim that hypnosis is going to solve all the ills and tribulations of mankind. However, the modern physician, with emphasis on pharmacologic therapies, laboratory investigations, and physical modalities, has grossly underestimated the “power of the mind.” Figuratively, “faith can move mountains” and should not be neglected!
Several other investigators have shown that awareness occurs in the deeply hypnotized surgical patient.10,12,41 Levinson has corroborated Cheek's earlier observation that surgeons should be very careful about what they say when a patient is deeply anesthesized.41 It is reported that various sequelae during and following the induction of hypnosis may have been related to earlier and unpleasant experiences with chemical anesthesia.31,33 Perception under anesthesia has been referred to as parahypnosis, a term originated by Van Dyke.73
RETROGRADE AMNESIA
Hypnotherapists frequently are asked to see cases of retrograde amnesia following trauma. Milos reported 20 cases of serious head injuries in which, after recovery, the anterograde and retrograde amnesias were explored by hypnosis. Seven cases cleared up. The duration of the posttraumatic coma did not seem to effect the outcome of the hypnotic exploration. Severe cases of amnesia have been helped.36 The author has had about the same percentage of success.
HYPNOSIS IN RADIOLOGY*
Radiologists report that hypnotic relaxation in selected patients facilitates diagnostic procedures. In gastrointestinal work-ups on tense, anxiety-ridden patients, pathology often may be observed by bowel spasm, flatus, extreme alterations in motility, delayed or rapid emptying time, forceful evacuation of the barium enema, eructations, and vomiting of the barium meal, esophageal spasm, and aerophagia.
During fluoroscopy, reassuring suggestions improve patient cooperation. The following suggestions are even more effective when given under hypnosis: “Let your arms drop limply to your sides. Lean forward. Allow your chin to touch the front of your chest. Relax your abdomen and stick it out as far as you can. Now take a deep breath. Loosen up all over.”
Some apprehensive patients undergoing fluoroscopy are frightened by the darkness, the awesome sounds and the lights; therefore, any degree of physical and mental relaxation is worthwhile. All such patients should be hypnotized beforehand as it is virtually impossible to do it during the examination, especially if they are uncomfortable from the barium or have the desire to expel it. Hence, in order to ensure optimal relaxation, hypnotic conditioning must be established before fluoroscopy is performed.
Edel states:
During the initial interview, even if I am familiar with the symptoms, I have him discuss his present complaints and past history for the psychotherapeutic value. By evincing further interest, better rapport is established. I try to evaluate his present emotional status. If he appears tense, I ask if he is apprehensive about the examination. I always stress the importance of relaxation during the examination and ascertain if he would like to learn hypnorelaxation. If “yes,” I then proceed with hypnotic induction and conditioning, stressing the advantages of relaxation. If induction fails, an antispasmodic and sedative are prescribed just before the next examination. This relaxes the patient so that hypnosis is readily induced just prior to the examination.
The technic for the initial induction depends on a number of factors; it should be informal, and one that effectively employs a posthypnotic suggestion for rapid reinduction. The shoulder cue is readily reproducible and easily remembered. Technics which involve sensory-imagery conditioning are the best for controlling involuntary functioning of the viscera. In accordance with the law of dominant effect, one must have the subject revivify a relaxing episode that actually happened. Therefore, specific suggestions for gastrointestinal relaxation will not work unless previous associational reflexes have been reactivated. Relaxation through autohypnosis is even more effective. Well-trained patients can enter a very satisfactory state of autohypnosis in a matter of seconds during the roentgenographic examination.
Edel states:
The use of more complex hypnotic technics as revivification and age regression depends on the discretion and training of the radiologist. This also depends on the evaluation of the personality and the relationship. If one feels insecure in the use of hypnosis and if one constantly seems to accentuate and amplify its dangers rather than its potentialities, it would be wise to resolve this insecurity before one proceeds further.
In properly conditioned patients, the characteristic patterns of gastrointestinal functioning can be observed during fluoroscopy. If the diagnosis is evident, no further procedures are necessary. When in doubt, the cue for hypnotic induction can be given, and, in the vast majority of cases, immediate relaxation of bowel spasm and diminution of intestinal peristalsis occur. During deep hypnosis, there is almost complete cessation of peristaltic activity, and all manifestations of spasm disappear. The gastrointestinal relaxation permits the examination to be made in half the time, and with less chance that hidden lesions might be overlooked. Hazards due to repeated examinations are obviated and there is no loss of prestige. During a barium enema examination, a patient who formerly squirmed, groaned, and evacuated on the table, experiences minimal discomfort when hypnotized. The patient should be dehypnotized slowly after the examination, and given the usual suggestions of well-being.
Other conditions in which the roentgenographic diagnosis can be facilitated by hypnotic relaxation are given below:
Respiratory:
1. Bronchography, whether by bronchoscopy, tracheal catheterization, or drip method;
2. Diagnostic pneumothorax;
3. Antral puncture and oil contrast studies.
Cardiovascular:
1. Arteriography;
2. Cardiac catheterization;
3. Angiocardiography;
4. Retrograde thoracic aortography.
Gastrointestinal:
1. G. I. series;
2. Esophagus, stomach, and duodenum;
3. Barium enema.
Genitourinary:
1. Retrograde urography;
2. Intravenous urography;
3. Rubin's test and other patency tests;
4. Hysterogram and pneumoperitoneum.
Neurologic:
1. Pneumoencephalography;
2. Ventriculography;
3. Cerebral angiography;
4. Myelography;
5. Diskography.
In these specialized examinations, hypnosis is used for anesthesia, analgesia, and relief of tension, anxiety, and fear. Psychogenic and allergic reactions secondary to injections can be controlled by hypnosis and drugs. During intravenous urography, the hypnotized patient is much more at ease and does not mind being strapped to the table with a pressure bag for 1 to 2 hours. There is a better concentration of dye, less gas to obscure film detail and, when hypnotic induction precedes injection, the reactions are minimal.
Heyer investigated digestive disturbances in women by means of hypnosis.32 He observed gastrointestinal functioning at hypnotic and nonhypnotic levels. He remarks: “Most impressive were the disturbances in passage of the meal in patients who had in addition to their psychogenic disturbances organic complications such as adhesions.”
Kroger and Freed noted that irritability of the reproductive tract is a manifestation of autonomic disharmony and is the commonest cause for the erroneous diagnosis of tubal occlusion made by the radiologist.39 However, spasm at the uterotubal or the isthmotubal portion of the fallopian tubes, which often is not relieved by sedation, can be relaxed during tubal insufflation in tense and anxious individuals by hypnosis; this can obviate mistaken diagnoses.
Hypnosis reduces the side reactions associated with radiation sickness and can decrease the pain of carcinoma in selected patients.65 Radiologists trained in hypnosis can prepare such patients in groups. As more radiologists employ hypnosis for diagnostic procedures and report their results, it is certain that Edel's and Heyer's observations will be confirmed.
HYPNOSIS IN GERIATRICS
Posthypnotic suggestions, in responsive persons, can effectively raise the aged patient's confidence and help direct thoughts from himself to external events; this can minimize depressive reactions and hypochondriasis. The suggestions also can help establish closer interpersonal relationships; many are quarrelsome, hostile over their infirmities, and envious of younger and more agile persons.
Definitive suggestions potentiated by hypnosis can be directed to (1) taking an interest in the plans of younger persons (in this way the tragedy associated with the loss of friends or a mate is reduced); (2) developing avocational interests concerned with creativity, the acquisition of special motor skills, and cultural activities; (3) exercise, such as walking, as much as possible; (4) watching the diet and the weight; (5) correcting elimination; (6) overcoming insomnia; and (7) physical involvements, such as cardiac congestion, arthritis, and neuromuscular involvements.
HYPNOSIS IN SPORTS
Hypnosis can be an effective method for increasing athletic performance. In one form or another, it has been used to motivate athletes for many years. As Orne demonstrated, it is the motivation to perform well that has been increased; this often can be done as well at nonhypnotic levels.
The author has used hypnosis for improving the ability of a considerable number of athletes competing in baseball, football, boxing, and golf. The results ranged from good to spectacular. The following case is illustrative:
A leading professional golfer was referred to the author for hypnorelaxation to improve his putting, especially during tournament play, when large crowds around the green caused him to become so nervous that his booming long drives and approaches were nullified by his miserable putting. He was taught self-hypnosis and sensory-imagery conditioning and within four sessions was able readily to enter a somnambulistic state. It was suggested that he could become completely oblivious to spectators any time he wished, and that, furthermore, he would “see” a dotted line between his ball and the cup. As further insurance of success, he was to suggest that the cup would appear from two to three times its normal size. He was also given suggestions that his self-confidence would not be shaken when he made a bad shot. Rather, he would imagine every stroke successful before it was played! To do this, he would “feel” the impact of the club and “see” the flight of the ball as if he had actually hit it.*
Although this golfer normally hit a long ball, it was suggested that he would have unusual driving power. Through this conditioning, both his putting and his driving improved greatly. A short time later he tied the course record in the National Open and missed winning only because of one bad hole when his ball hit a spectator and caromed into a trap. Several months later, he won a coveted championship. He attributed a good measure of his success to the hypnotic conditioning.
The daily press contains examples of basketball players who have scored a phenomenal number of points after hypnotic conditioning, boxers who have become veritable champions, and trackmen who have far surpassed their best previous records. There is no danger that an athlete will go beyond his physiologic limit. The built-in or involuntary reflexes protect the individual against danger at all levels.
One of the author's close personal friends is a former track star, who, in college, participated unknowingly in experiments conducted by the psychology department of the University of Illinois. As a quarter-miler, he customarily ran just slightly faster than a teammate who was given a placebo pill and told that he would beat my friend that day. Beat him he did, and my friend recalls that he was really beaten from the time that his teammate took the pill. The following week my friend was given a pill and broke the “Big Ten” record, while the man who had beaten him the week before, minus his pill, finished exhausted and sick.
Were these performances the result of suggestion or hypnosis? Just one thing is certain: the cause of victory was the elimination of inhibiting psychological factors. There was nothing physiologic in the process.
Naruse describes the use of hypnosis in conjunction with autogenic training and progressive relaxation for relieving “stage fright” in 125 Japanese athletes participating in the 1960 Olympic games.49,62Counterconditioning anxiety as well as “mental rehearsals” were employed. Additional encouragement and counseling were provided by a “psychological trainer.” Gymnasts, volleyball and baseball players, and weight-lifters were among the champions who underwent psychological and physical training. Similar results were noted by Bankov.3
The Soviets have developed the practice of “psyching up” athletes for sports competition into a science. They, too, have used hypnosis, autogenic training, and other psychologic methods. These technics were first employed on the Soviet bicycling team with such great success that they won a gold medal at the 1972 Olympic games in Munich. The technics were especially valuable for those facing a competitor who had always beat them. An institute in Kharkhov holds regular classes for coaches who specialize in psychological technics to be used in preparing Soviet athletes for the 1980 Olympics. I cannot understand why more amateur and professional coaches do not use qualified, psychologically trained hypnotists to potentiate physical performance. The results speak for themselves.
In conclusion, it should be stated that there is no known reason why a competent hypnotherapist should not use his skill in helping an athlete to eliminate detracting psychological factors which prevent him from operating at his highest efficiency. There are no indications that he will drop dead “in the stretch,” at least not from the effects of hypnosis.
HYPNOSIS IN SPACE TRAVEL
Physicians and psychologists are being called upon to utilize their knowledge in the rapidly expanding experimentation to make safe man's flight into space. Hypnosis is a seemingly neglected but potentially useful tool for learning more about man's ability to survive and function efficiently in space. For instance, in the interest of realism, hypnosis may be used to convince the space candidate that he is undergoing an actual, rather than a simulated, test.
Hypnotic relaxation can be utilized to reduce the metabolic rate and the oxygen consumption. Hypnosis would be of inestimable value in helping spacemen to maintain uncomfortable positions for long intervals. These conditions might be intolerable under normal circumstances. Hindu fakirs who allow themselves to be buried in a sealed coffin for several hours actually do so under autohypnosis. Since the number of cubic feet of air in the casket is known, the slowing down of respiration to 5 or 10 breaths per minute enables the individual to remain underground for what seems to be an incredible period of time. Thus suggestions of calmness and drowsiness slow down metabolic and oxygen requirements as well as digestive processes. The maintenance of “unbearable” positions under hypnosis was described in the section on plastic surgery. Moreover, it is known that hypnotic subjects can submit to tremendous amounts of physical stress without apparent reactions.
The nonspecific and the specific stress induced by weightlessness, cramped quarters, unnatural living conditions, and other psychophysiologic factors encountered by space travelers can be reduced. At least, their adaptive responses can be raised through conditioning under hypnosis.
Another potent tool to overcome boredom is the use of time condensation to speed up time. Although drugs can be employed for nearly all the above-mentioned purposes, subjects under their influence cannot awaken completely and respond or perform as effectively as they can under hypnosis. Well-trained subjects can be conditioned to enter into relaxed states for any desired period upon a designated signal. They also could be rapidly dehypnotized with a different signal.
These are only a few of the uses of hypnosis which can aid in testing space survival. The illusions of reality, the alteration of physiologic functioning, and other phenomena associated with hypnosis may play an important role in interplanetary travel. The author has acted in the capacity of consultant for these and other matters pertaining to utilization of hypnosis for space medicine. Halleck McCord, in a personal communication, has indicated his interest in the research possibilities of hypnosis in these areas.
HOMOSEXUALITY AND SEXUAL DEVIANCE
Homosexuality is no longer considered to be perverse behavior. The subject has been reviewed by Bergler and Kroger.5 The hypnotic treatment of female homosexuality has been described by Kroger and Freed.39 Kroger and Fezler have discussed the use of the hypnobehavioral approach for homosexuality and sexual deviance.38 It is important to determine whether or not a feeling of guilt is present and if the patient really desires therapy. It is surprising how few homosexuals desire to change. There are two main types: the passive-feminine and the active-aggressive. Also, there are mixed types, as well as borderline cases who are bisexual. Every individual has latent homosexual tendencies which are more or less repressed and can be activated under conducive circumstances.
There are several reports on the use of hypnosis in the treatment of homosexuality.1,2,45 Gilbert noted that the active-aggressive (male partner) was resistant to therapy.25 The degree of success depends not only on the motivation, but also on the type of technic employed. An authoritarian approach is apt to be more successful with the passive-feminine type of homosexual, while a permissive approach is more effective with the active-aggressive type. Therefore, before instituting hypnotherapy or any other reconstructive therapy, the physician must ascertain the type and the degree of homosexual involvement. Some authors contend that latent homosexuality decreases susceptibility to hypnosis.58,59 This has not been the author's experience. It may be that those who have only a dim awareness of their homosexual tendencies will deny or resist recognizing the need for correcting these elements of their personalities.
Kroger and Fezler utilize erotic images, arranged in a hierarchy, under hypnosis to attain desired changes.39 They also discuss similar technics of deconditioning for various types of sexual deviance, such as fetishism, voyeurism, and transvestism.
Unfortunately, those who evince a strong desire to change usually have deep-seated needs which prevent them from making heterosexual adjustments. Even though this type is readily hypnotizable, few permanently recover. Some make a temporary adjustment but quickly relapse.
Homosexuality should not be treated except by a psychiatrically oriented therapist. Homosexuals who are able to function adequately in their life situations without symptoms often are better off if they are not treated. For those malcontents who are continually involving themselves with the law, psychotherapy is indicated, rather than punishment.
The author has used a permissive hypnotherapeutic approach on selected homosexuals. However, rapid results are not obtained, as a considerable amount of time is necessary for psychobiologic reorganization of the personality. As the patient begins to show improvement, the sessions are further apart so that he can test his ability to face his problems and decide whether he really wishes to change. The goal of all psychotherapy in homosexuality is to enable successful adjustment to the opposite sex to take place. Posthypnotic suggestions to have intercourse with females are never successful.
The results depend on the therapist's ability to relieve guilt, anxiety and tensions and to guide the patient toward a mature orientation. The strong dependency created by the hypnotic relationship is advantageous and is deliberately fostered in order to keep the patient in therapy during the initial phases when resistances to change are marked. Later, the utilization of autohypnosis and sensory-imagery conditioning enables the patient to develop fantasies which ultimately will attract him to the opposite sex. By the time he makes the transition to the opposite sex, he is ready to be “weaned off” the therapist. The reasons for the dependency are made clear to him. Often it is the desire to please the therapist that enhances the motivation of the patient. One must continually bear in mind that a “flight into health” can and does occur with this approach; the homosexual has a flurry of heterosexual affairs but ultimately reverts to his previous patterns. Reinforcement hypnotic suggestions should be given at monthly intervals after the patient has been discharged from regular hypnotherapy.
MULTIPLE PERSONALITY
Dual and multiple personalities have been described from the earliest recorded history until modern times. They undoubtedly occur more frequently than is commonly supposed. Multiple personality must be distinguished from dissociation due to hypnosis, schizophrenia, hysteria, mediumistic trances, and simulation by spiritualists. Often multiple personalities are spontaneously or deliberately brought out by hypnosis.48,61 The induced personality then functions as the representative of the repressed facets of the individual's primary personality.
In true multiple personality, the other personalities usually have no knowledge of each other's existence: they are repressed from awareness. However, during hypnosis one or more of the personalities may have a complete or a fragmentary knowledge of the memories of the others, and the primary personality may interact with the repressed ones.
The production of multiple personalities by hypnosis has been discussed.29,74 Studies indicate that the induced personality takes on many of the characteristics of the subject's overt personality, as well as the ones hidden from awareness. Recently a case of multiple personality was reported which appeared to be bound up by a severely obsessive-compulsive defense, so that the “conscious personality” was constricted, rigid, and cold.8 The Rorschach responses revealed that one of the personalities was schizophrenic. It was felt that studies of this type might be helpful in understanding psychotic development.
In an interesting series of 78 cases, Kampman found that 32 subjects were able, and 43 were unable, to create multiple personalities after being deeply hypnotized.35 Oddly enough, those who could develop secondary personalities were clinically healthier as ascertained by psychiatric evaluation.
Treatment
Often trauma may be an etiologic factor, as in Prince's famous case of Miss Beauchamp, who had five personalities.52 Therapy should ascertain the reasons for the dissociation. Integrating the various personalities into one is the goal of all successful therapy. Hypnosis speeds up this reintegration, and the secondary personalities or personalities usually can readily be “directed” toward this end. Fortunately, most individuals with multiple personalities are good hypnotic subjects, but the therapy can be difficult in the absence of good rapport with all the hidden personalities.
Odencrants noted that one of the first indications of multiple personality is lapses of consciousness, which often cause confusion and concern to family and friends.50 After hypnotherapy is initiated, the various personalities, be they one or more, must be identified. They may reveal themselves automatically, voluntarily, through automatic writing, and by posthypnotic suggestion. The record is held by a patient who displayed, at one time or another, 23 different personalities.52
Through hypnotic amnesia, the relationship of the various personalities to each other can be understood readily. The hypnotherapist should maintain an interested and sympathetic attitude with the various personalities at all times, or he may lose contact with them. Furthermore, he must not be impatient or surprised, as often the personalities which emerge may be wholly contrary to the patient's primary personality; petulance, immaturity, and sadistic tendencies make their unexpected appearance.
Through hypnosis, any one of the personalities which the therapist wishes to study can be summoned, and invariably the personality will reveal its name. From then on, it is really remarkable how quickly the various personalities can be made to appear and disappear. A now famous book, Three Faces of Eve, described how very dramatic situations arose as the patient switched from one personality to another.69 At times, one personality will be amazingly well developed mentally, and at other times, childlike. Each of the personalities should be evaluated for simulation; chronologic time orientation may show considerable disparity. The therapist must be able to recognize the religious fanatics; they usually represent some departed soul and might be categorized as pseudo-multiple personalities.
Other investigators believe that the personality displayed can be viewed as a conglomerate of pseudoselves and need not be interpreted or analyzed. The therapy is based on restructuring of the family relationships, rather than on the interactions between therapist and patient.
HYPNOSIS IN AMNESIA AND FUGUE STATES
In hysterical amnesia, hypnosis invariably reverses the dissociative reaction. Amnesia serves as a protective defense against traumatic episodes, and, therefore, should be dispelled in a slow and permissive manner.15 This may be true when the amnesia neutralizes severe psychic shock. However, in the amnesia victims the author has seen, especially in those following physical trauma, rapid dissolution of the amnesia has been a blessing.
In 1941, the author saw a case that received national notoriety. A young male had been amnestic for 45 days. He was readily hypnotized and, via scene visualization and age regression, he was told he was going home. A positive auditory hallucination was induced that he was hearing his name called when the front door was being opened by a familiar person (his mother). Instantaneously, he remembered his name, city, and telephone number. Needless to say, his mother was overjoyed at hearing from her missing son, who developed the amnesia after being struck on the head by a piece of lumber while working as a carpenter. Without being aware, he got on a train and arrived in another city, where he was picked up by the police. The author made no attempt to uncover why the amnesia was produced. Other interesting cases of amnesia have been discussed by Schneck,60 and Crasilneck and Hall.15
HYPNOSIS IN CRIMINOLOGY
Utilization of non-drug-induced altered states of consciousness (hypnorelaxation) combined with behavior therapy have lowered the recidivism rate to 5 per cent over a 30-month follow-up period in 49 borderline recidivists.66 The study indicated that this approach may prove to be an effective means of treating these individuals.
Estabrooks has written on the use of hypnosis in criminalogy.23 An interesting possibility is building up an informer service among trained subjects who have been criminals or who are willing to act as “stool pigeons.” If the subject were a somnambulist, he would have no knowledge that he had been given a posthypnotic suggestion to “keep his ear to the ground.” Authorities could plant such individuals in strategic places.
The ability of a hypnotized subject to control his responses to the polygraph has been studied. It can be concluded that a well-trained subject, who has committed a crime, can successfully pass the examination. Also, it has been observed that the apprehensive person may give false positives (see p. 113 for hypnosis in criminal investigation).
HYPNOSIS IN MILITARY MEDICAL PRACTICE
Hypnosis has been found to be of considerable value in the military setting. Its use in the treatment of acute traumatic neuroses in World Wars I and II has been well documented. Todorovic has reviewed some of the indications in military medical practice.71 Some of these are the treatment of burns, injuries, mass hysteria, and other problems associated with nuclear warfare. He points out that hypnosis might be life-saving and could decrease suffering where there was an unavailability of medical supplies. It could be used, in those who are amenable, as an analgesic or anesthetic agent, as an adjunct to facilitate the healing of severe burns and, finally, in the treatment of shell shock and combat fatigue. With reference to group hypnotherapy, hypnosis could be used to make up for an acute shortage of psychiatrists. Hypnosis has been used with other types of psychotherapy for combat fatigue, hysterical conversion reactions, amnesias, “shellshock,” and other conditions associated with warfare.
Hypnosis is assuming an ever-increasing role in the psychological aspects of warfare. For instance, a good subject can be hypnotized to deliver secret information. The memory of this message could be covered by an artificially induced amnesia. In the event that he should be captured, he naturally could not remember that he had ever been given the message. He would not remember the message. However, since he had been given a posthypnotic suggestion, the message would be subject to recall through a specific cue, this having been given to him in the form of a posthypnotic suggestion.
Hypnosis has also been used to extract information from prisoners. The best way is to talk to the subject while he is asleep and, when the conversation is carried out so that the subject will not be awakened by the talking, a great deal of important data can be revealed. Individuals who are lightly asleep can be readily hypnotized. Posthypnotic suggestions can be engrafted to steal faked military plans. The individuals are then allowed to escape. The consequences are obvious, as the enemy acts upon this information.
Estabrooks has an excellent chapter on other areas, such as the interrogation of prisoners, espionage and counterespionage, sabotage, and brainwashing.23 The reader interested in this latter area is referred to Sargent's excellent book, Battle for the Mind.56
THE “PORT-OF-LAST-CALL” PATIENT
Hippocrates once stated, “… it is impossible to make all the sick well.” This maxim applies to many chronic, emotionally ill persons. Many of these miserable “traveling case histories” have made the rounds of clinics, physicians, and quasimedical healers without success, thus acquiring the sad designation of “port-of-last-call” patients. They constitute a high percentage of the author's practice.
All are desperate for aid and hopeful that the omniscient hypnotherapist can cure them by a “magical gesture.” At the risk of raising false hopes, I must state that some respond surprisingly to hypnotherapy. It is admitted that we do not always know how the recovery forces are unleashed. Not infrequently, the dedicated therapist can provide the vital spark necessary to transform an apparently hopeless situation into one of renewed health. Years of suffering, hopeless resignation, and even suicide have been forestalled in the “port-of-last-call” patient. Often compassion constitutes competence; wisdom and interest are as effective as drugs.
The “will to get well” and the physician's use of his art to its fullest capacity are decisive factors in the alleviation of much misery due to illness. It is here that the hypnotherapist-physician rises to his greatest heights. Because of space limitations, illustrative cases will not be mentioned. Many cases of hysterical blindness, aphonia, amnesias, tics, and other conversion reactions have responded dramatically to symptom removal by hypnosis. Although more difficult to treat, obsessive compulsives of all types have responded to sensory-imagery conditioning and autohypnosis when conventional therapy had failed. Nearly all can be treated within the framework of any type of supportive psychotherapy.
REFERENCES
1. Abarbanst-Brandt, A.: Homosexuals in hypnotherapy. J. Sex Res., 2:127, 1966.
2. Alexander, L.: Clinical experience with hypnosis in psychiatric treatment. Int. J. Neuropsychiatry, 3:118, 1967.
3. Bankov, M.: Autogenic training, hypnosis, revelation, and psychosomatic modeling and psychotherapeutic methods for athletes. Psychother. Psychosom., 21:62, 1973.
4. Barmann, G.J.: Solving crime by hypnosis. Popular Mechanics, April 1960.
5. Bergler, E., and Kroger, W.S.: Kinsey's Myth of Female Sexuality. New York, Grune & Stratton, 1953.
6. Bowers, K.S., and van der Meullin S.J.: Effect of hypnotic susceptibility on creativity task performance. J. Pers. Social Psychol., 14:247, 1970.
7. Bowers, M.K., and Beckowitz, B.: Clinical observations on the effects of electroconvulsive therapy in the hypnotic state. J. Nerv. Ment. Dis., 118:355, 1953.
8. Bowers, M.K., and Brecher, S.: The emergence of multiple personalities in the course of hypnotic investigation. J. Clin. Exp. Hypn., 3:188, 1955.
9. Cheek, D.B.: Unconscious perception of meaningful sounds during surgical anesthesia as revealed under hypnosis. Am. J. Clin. Hypn., 1:101, 1959.
10. _________: Further evidence of persistence of hearing under chemoanesthesia. Am. J. Clin. Hypn., 7:55, 1964.
11. _________: The meaning of continued hearing sense under chemo-anesthesia: a progress report and report of a case. Am. J. Clin. Hypn., 8:275, 1966.
12. Cheek, D.B., and LeCron, L.M.: Clinical Hypnotherapy. New York, Grune & Stratton, 1968.
13. Cooper, L.F., and Rodgin, D.W.: Time distortion in hypnosis and non-motor learning. Science, 155:500, 1952.
14. Cooper, L.F., and Tuthill, C.H.: Time distortion in hypnosis and motor learning. J. Psychol., 34:67, 1952.
15. Crasilneck H.B., and Hall, J.A.: Clinical Hypnosis: Principles and Applications. New York, Grune & Stratton, 1975.
16. Dhanens, T.P., and Lundy, R.M.: Hypnotic and waking suggestions and recall. Int. J. Clin. Exp. Hypn., 23:68, 1975.
17. Dickson, J.T.: Effects of hypnotically-induced emotional states, difficulty of task and anxiety on psychomotor behavior. Dissert. Abstr., 15:149, 1955.
18. Donk, L.J., et al.: Toward an increase in reading efficiency utilizing specific suggestions: a preliminary approach. Int. J. Clin. Exp. Hypn., 16:101, 1968.
19. Dorcus, R.M.: Recall under hypnosis of amnestic events. Int. J. Clin. Exp. Hypn., 8:57, 1960.
20. Egan, R.M., and Egan, W.P.: The effect of hypnosis on academic performance. Am. J. Clin. Hypn., 11:30, 1968.
21. Erickson, M.H.: Hypnosis in examination panics. Am. J. Clin. Hypn., 7:356, 1965.
22. Estabrooks, G.H.: Hypnotism. New York, E. P. Dutton, 1943.
23. _________: Hypnotism. New York, E. P. Dutton, 1957.
24. Filatov, A.: Quoted in Hoskovec, J.: Hypnosis in the Soviet Union: a critical review of recent and major experiments. Int. J. Clin. Exp. Hypn., 14:308, 1966.
25. Gilbert, S.F.: Homosexuality and hypnotherapy. Br. J. Med. Hypn., 5:2, 1954.
26. Glasner, S.: Two experiments in the modification of attitude by the use of hypnotic and waking suggestion. J. Clin. Exp. Hypn., 1:71, 1953.
27. Golburgh, S.J.: Hypnotherapy, chemotherapy, and expressive directive therapy in the treatment of examination anxiety. Am. J. Clin. Hypn., 11:42, 1968.
28. Gray, W.H.: The effects of hypnosis on learning to spell. J. Educ. Psychol., 25:471, 1934.
29. Gruenwald, D.: Hypnotic techniques without hypnosis in the treatment of dual personality. J. Nerv. Ment. Dis., 1:153, 1971.
30. Hammer, E.F.: Post-hypnotic suggestion and test performance. J. Clin. Exp. Hypn., 2:178, 1954.
31. Hartman, B.J.: Parahypnosis: unconscious perception under chemoanesthesia. J. Natl. Med. Assoc., 61:246, 1969.
32. Heyer, G.R.: Psychogene Funktions-störungen des Verdauungstraktes. In Schwartz, O.: Psychogenese and Psychotherapie körperlicher Symptome. Vienna, Springer-Verlag, 1925, pp. 229-257, 464-466.
33. Hilgard, J.R., Hilgard, E.R., and Newman, M.: Sequelae to hypnotic induction with special reference to earlier chemical anesthesia. J. Nerv. Ment. Dis., 133:461, 1961.
34. Hoskovec, J.: Hypnopedia in the Soviet Union: a critical review of recent and major experiments. Int. J. Clin. Exp. Hypn., 14:308, 1966.
35. Kampman, R.: Hypnotically induced multiple personality: an experimental study. Int. J. Clin. Exp. Hypn., 24:215, 1976.
36. Knowles, F.W.: Hypnosis an amnesic states. N.Z. Med. J., 63:100, 1964.
37. Krippner, S.: The use of hypnosis with elementary and secondary school children in a summer reading clinic. Am. J. Clin. Hypn., 8:261, 1966.
38. Kroger, W.S., and Fezler, W.D.: Hypnosis and Behavior Modification: Sensory Imagery Conditioning. Philadelphia, J.B. Lippincott, 1976.
39. Kroger, W.S., and Freed, S.C.: Psychosomatic Gynecology; Including Problems of Obstetrical Care. Philadelphia, W.B. Saunders, 1951, p. 284.
40. Levin, M.: Hypnosis in the Law. Inst. Law. J., 14:97, 1964.
41. Levinson, B.W.: States of awareness during general anesthesia: preliminary communication. Br. J. Anesth., 37:544, 1965.
42. Lieberman, L.R., et al.: Use of tape recorded suggestions as a aid to probationary students. Am. J. Clin. Hypn., 11:35, 1968.
43. McCord, H., and Sherrell, C.I.: A note on increased ability to do calculus posthypnotically. Am. J. Clin. Hypn., 4:124, 1962.
44. Magonet, A.P.: The healing voice. Int. J. Clin. Exp. Hypn., 7:229, 1959.
45. Maholick, L.T., and Warkenton, J.: Hypnosis in electric shock treatment. Am. J. Psychiat., 105:623, 1949.
46. Milos, R: Hypnotic exploration of amnesia after cerebral injuries. Int. J. Clin. Exp. Hypn., 23:103, 1975.
47. Mordey, T.: Conditioning of appropriate behavior to anxiety producing stimuli: hypnotherapy of a stagefright case. Am. J. Clin. Hypn., 8:117, 1965.
48. Morton, J.H., and Thoma, E.: A case of multiple personality. Am. J. Clin. Hypn., 2:216, 1964.
49. Naruse, G.; The hypnotic treatment of stage fright in champion athletes. Int. J. Clin. Exp. Hypn., 13:63, 1965.
50. Odencrants, G.: Hypnosis and dissociative states. In LeCron, L.M. (ed.): Experimental Hypnosis. New York, Macmillan, 1954.
51. Oetting, E.R.: Hypnosis and concentration in study. Am. J. Clin. Hypn., 7:148, 1965.
52. Prince, M.: The Dissociation of a Personality. New York, Longmans, 1925.
53. Raikov, V.L.: The possibility of creativity in the active stage of hypnosis. Int. J. Clin. Exp. Hypn., 24:258, 1976.
54. Rosenthal, B.G.: Hypnotic recall of material learned under anxiety and non-anxiety producing conditions. J. Exp. Psychol., 34:369, 1944.
55. Salzberg, H.C.: The effects of hypnotic, post-hypnotic and waking suggestion on performance using tasks varied in complexity. Int. J. Clin. Exp. Hypn., 2:251, 259, 1960.
56. Sargent, W.: Battle for the Mind. New York, Doubleday, 1957.
57. Schafer, D.W.: As-if electroshock therapy by hypnosis. Am. J. Clin. Hypn., 2:225, 1960.
58. Schneck, J.M.: Notes on the homosexual component of the hypnotic transference. Br. J. Med. Hypn., 1:24, 1950.
59. _________: Some aspects of homosexuality in relation to hypnosis. Psychoanal. Rev., 37:351, 1950.
60. _________: Studies in Scientific Hypnosis. Baltimore, Williams & Wilkins, 1954.
61. _________: Hypnosis in Modern Medicine. Springfield, Ill., Charles C Thomas, 1959.
62. Schultz, J.H., and Naruse, G.: Autogenic Training and Self-Hypnosis. Tokyo, Seiskin, 1963.
63. Sears, A.B.: A comparison of hypnotic and waking learning of the International Morse Code. J. Clin. Exp. Hypn., 3:215, 1955.
64. Simon, L.: Quoted in Todorovic, D.D.: Hypnosis in military medical practice. Milit. Med., August 1958.
65. Simonton, O.C.: The Role of Mind in Cancer Therapy. The Dimensions of Healing: A Symposium. Los Altos, Cal., Academy of Parapsychology and Medicine, 1973, pp. 139-145.
66. Spear, J.E.: The utilization of non-drug induced altered states of consciousness in borderline recividists. Am. J. Clin. Hypn., 18:111, 1975.
67. Strickler, C.B.: A quantitative study of posthypnotic amnesia. J. Abnorm. Social Psychol., 24:108, 1929.
68. Swiercinsky, D., and Coe, W.C.: The effect of “alert” hypnosis and reading responsiveness on reading comprehension. Int. J. Clin. Exp. Hypn., 19:146, 1971.
69. Thigpen, C.H., and Cleckley, H.: Three Faces of Eve. New York, McGraw-Hill, 1957.
70. Thoheld, F.H.: Nonconvulsive electrostimulation under narcotic hypnosis. J. Clin. Exp. Hypn., 2:175, 1954.
71. Todorovic, D.D.: Hypnosis in military medical practice. Milit. Med., 23:121, 1958.
72. Uhr, L.: Learning under hypnosis: What do we know? What should we know? J. Clin. Exp. Hypn., 6:121, 1958.
73. Van Dyke, P.B.: Hypnosis in surgery. J. Abdom. Surg., 7:1, 26-29, 1965.
74. Weitzenhoffer, A.M.: Hypnotism. New York, Wiley, 1953.
75. _________: The influence of hypnosis on the learning processes. J. Clin. Exp. Hypn., 3:148, 1955.
76. _________: Unconscious or co-conscious? Reflections upon certain trends in medical hypnosis. Am. J. Clin. Hypn., 2:177, 1960.
ADDITIONAL READINGS
Das, J.P.: Learning under conditions of hypnotically induced anxiety and non-anxiety. Int. J. Clin. Exp. Hypn., 9:163, 1962.
Eitelberg, R.: Practical applications of hypnosis in space flight. Br. J. Med. Hypn., 13:22, 1962.
Fowler, W.: Hypnosis and learning. Int. J. Clin. Exp. Hypn., 9:223, 1961.
Kroger, W.S.: Psychotherapy of “port-of-last-call” patient (paper delivered at meeting of Academy of Psychosomatic Medicine, Minneapolis, November 1, 1962).
McCord, H., and Sherrill, C.I., III: A note on increased ability to do calculus post-hypnotically. Am. J. Clin. Hypn., 4:124, 1961.