In a brief introductory note to the topic above, it seems appropriate to put it into context, for which reason the next two sub-chapters precede the actual topic.
a) General issues
Contrary to some beliefs, and despite the root of the word (Hypnos, sleep), hypnosis is neither sleep nor dream. Hypnosis is an altered state of consciousness regarding wakefulness, characterised by attentive and receptive focusing, during which an individual does not think about the context he is in by means of a suggested attention focusing, in which partial absence of critique occurs. Very simply, it can be compared to the state of drowsiness one goes through everyday when we wake up or fall asleep, of variable duration.
This state does not have specific clinical or neuropsychological changes, which, for some authors, means it does not really exist, or that it represents a “social agreement” between the two parts. However, recent studies resorting to the most current imaging techniques (fMRI) clearly differentiate between imagination under the state of wakefulness from imagination under hypnosis, which indicates it is a different/altered state of consciousness compared to the normal state of wakefulness.
Several doctors were involved in developing hypnosis as a therapy instrument, of whom the following stand out: Mesmer, who advanced the theory of animal magnetism (supporting the theory of the existence of a special magnetism, both in animals and in humans); Charcot and Freud, one of his students at Salpêtrière, used hypnosis to treat patients suffering from hysteria. It was through his observation of the phenomenology of hypnosis that Freud later theorised about the unconscious and, later on, about psychoanalysis.
Portuguese scientist Abade Faria, about whom Egas Moniz wrote a book, also played an important role in the history of hypnosis, given that he was the first to believe that the state of hypnosis always corresponds to a state of self-suggestion.
Milton Erikson, a North American psychiatrist, is considered to be the father of modern hypnosis. This hypnosis is not-directed, is naturalist, forms part of the context of the interview, appeals to the imagination of the patient and of the therapist, makes plenty of use of metaphors and, above all, it grants the therapist the role of mere facilitator, conferring an active role to the patient (as co-therapist) in his own therapy.
Despite its long history, which goes back to the Greek and Egyptian sleep temples, and its recent history of scientific study, hypnosis has been cast aside, perhaps due to the strangeness of its phenomenology and the bad image transmitted by entertainment hypnosis. This means that only those who are more interested in it currently use it, and continue to explore its therapeutic potential and as a means to study the mind.
Currently, hypnosis is still met with some scepticism and mistrust, both by society in general and by some doctors. This image was brought about by a strand of hypnosis performed on stage, hypnosis of entertainment as opposed to clinical hypnosis, which is a form of therapy. What distinguishes them is not the induction methods and phenomenology, as they are similar, but content, and what actually happens during the hypnosis. In other words, the distinguishing factor is the intent (to entertain or to heal), and the distinct theoretical and practical training of the hypnotist (artist or therapist).
b) Therapeutic mechanism
The way therapy under hypnosis acts in the body is still being subject to scientific research. Besides the physiological effects of a state of relaxation, other effects come up as a result of suggestions given to the patient, which practically simulate the entire psychological and psychopathological phenomenology and, in some circumstances, one of a (psycho) somatic psychopathological nature. In a very simply way, yet confirmed by the latest research, one can affirm that, for the brain, to imagine is the same as to do. This is attested by functional brain endoscopic imaging, psychoneuroendocrinology and psychoimmunology, all of them changeable by the suggestion of something to imagine when one is in a state of hypnosis.
These alterations are not always permanent, for which reason, as with vaccination, booster sessions must be carried out, and the patient must be taught how to maintain them by means of self-hypnosis. It can equally be said that the state of hypnosis depends more on the effort and capacity of the subject than on the capacities of the therapist. The degree of hypnotisability is relatively constant in each individual.
c) Current indications
Accounts of attempts to cure through hypnotic methods go back to classical antiquity, and were mentioned in the activity of sleep temples. Patients and therapists at that time had a common understanding (not an explanation!) of the cause of the illness, as well as a common intention to cure it. This was coupled by the trust relationship between patient and therapist, which acted as a single force field and a ritual (standardised actions) in the therapeutic setting to foster cure. In fact, this is what happens today, mutatis mutandi, in a hospital/surgery environment, perhaps with less “magic” involved. Without these assumptions, even outside the hypnotic context, any “indication” to cure does not resort to somehow unspecific factors, but which prove their strength in the placebo effect. In some psychiatric studies, this explains around 38% improvement of conditions.
It is precisely in the disorders that are the object of psychiatry that clinical hypnosis finds some of its main indications. These include anxiety disorders (phobias – social, specific, and resulting from panic disorders), circumstantial and pre-surgery anticipatory anxiety (to optimise performances), some obsessive phenomenology (coping training and relaxation), post-traumatic stress disorder, dissociative identity disorder, somatoform and conversion disorders, some obesity components, anorexia nervosa, and smoking addiction.
In the range of indications, according to medical specialisations, in second place come those associated with anaesthesiology and its correlates, such as chronic pain and the reduction of anaesthetic medication in distinct contexts (surgeries, balneotherapy of burned patients, invasive medical procedures, such as gastroenterological endoscopy, dental extraction, and pain-free birth).
In a broader sense, hypnosis can also be used in any medical specialty when there are non-explained symptoms following exhaustive or persistent study (atypical pain, cephaleas), or in pathologies with a strong psychological component in precipitating, aggravating and maintenance of symptoms, to foster or speed up effects in symptomatic remission or cure (for instance, in oncology), and in sports medicine to improve performance.
Naturally, hypnosis is, in itself, equally considered to be an experimental model for the study of the mind’s functioning.
In conclusion, it must be stated that before deciding to use hypnosis as a therapeutic aid, therapists must question themselves about the benefits of this therapeutic procedure, which is time consuming and requires some continuity. One should also be watchful of patients’ unrealistic expectations, so that, following a long trail of therapies in search of a miracle cure, they do not say: “I have tried out hypnosis, and not even that worked”!
Mário Simões. Professor Agregado de Psiquiatria
University Psychiatric Clinic
Faculty of Medicine of Lisbon
noonauta@gmail.com
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References
Handbook of Clinical Hypnosis (2nd ed.)
Steven Lynn, Judith Rhue, Irving Kirsch
American Psychological Association
Washington. 2010
