Tuesday, August 9, 2011

On Hypnosis (Part 15/20)

Views of Hypnotic Pain Control

In his book on pain and hypnosis, Ernest Hilgard outlines hypnotic methods and techniques now commonly used to abolish or alter the personal experience of pain.[1] Among them are the clinical pain control techniques Erickson spent over forty years developing.[2] More recently, Yapko describes a variety of hypnotic strategies which can facilitate analgesia. Each technique either redefines the pain or "shifts the person's awareness away from the bodily sensation(s) under consideration."[3] 

 For example, in the use of "direct suggestion of analgesia" for a client experiencing stomach pain, the hypnotist may offer suggestions for a lack of sensation in the relevant body area, as follows:



As you feel your arms and legs getting heavier...you can see the muscles in your abdomen loosening...relaxing...as if they were guitar strings you were unwinding...and as you see those muscles in your abdomen relax, you can feel a pleasant tingle...the tingle of comfort...and whenever you have had a part of you become numb, like an arm or leg that fell asleep...you could feel the same tingle ...like the pleasing tingle in your abdomen now...tingling more...and isn't it both interesting and soothing to discover the sensation of no sensation there? That's right...the sensation of no sensation..a tingling, pleasing comfortable feeling of numbness there...[4]


Isn't that what parents do to children? "You're not sad. Stop with that depressive act and smile!" The child hurts his knee and the parent says, "Stop whining. It doesn't really hurt. You're making too much of it!" "Stop acting like a baby!" All phrases that change the hurt into something else. Or when a child begins to cry after falling down, the parents will do everything to distract him. "Look at this!" The child can no longer feel what he feels.

In another technique known as "glove anesthesia," the patient is given suggestions which lead her to experience anesthesia or numbness in one hand or both hands. Further suggestions then enable the patient to transfer this numbness to any other part of the body simply by touching that site with the hypnotically anesthetized hand.

If you put all of the techniques for hypnotic pain control together, you come up with a rather hefty list of methods. Pain can be numbed, transferred, suggested away, shifted, displaced, substituted for, reinterpreted, reframed, diminished, altered, relocated, converted, or substituted; the experience of it can be partially or entirely forgotten, or condensed into a few seconds duration; one's attention can be directed away from the pain via hallucination and/or age regression; or one can induce a straightforward anesthesia or analgesia.

Each particular pain control technique requires a different set of suggestions and taps into different physiological processes. For example, numbing the pain in one's chest involves different physiological processes from relocating it from the chest to the right thumb. Yet whatever the technique, it can and often does successfully provide at least some alleviation of discomfort. The various techniques share a common point of convergence: The hypnotist uses ideas in order to transform the subject's experience of pain, to dissociate it from conscious awareness.

Hilgard points out that all hypnotic pain control methods "make use of the dissociative possibilities within hypnosis."[5] [Italics added] This could be restated such that the "dissociative possibilities of hypnosis" are really alterations in neurological functions that make use of the dissociative process, period. We are all capable of separating levels of consciousness from one another, that is, dissociation. We can all revert to different brains within our skulls. This compartmentalization was an evolutionary mechanism to keep the Pain at bay and allow us to function. So even though childhood pain churns a tempest below the third-line, we go to work and carry out our duties. We are in a sort of coma but no one notices, not even us. We are compartmentalized; a whole world of experience is going on below decks but we are focused on the mast. But however it is stated, dissociation seems to be the primary ingredient in hypnotic pain control.

Hilgard uses an excellent example:

Directing attention away from pain can be achieved in more than one way. One method is to deny the existence of the painful bodily member. We have utilized this method successfully in the laboratory following reports of its clinical use. Before his arm is stimulated by lowering it into circulating ice water the subject is told, "Think that you have no left arm. Look down and see that there is no left arm there, only an empty sleeve. An arm that does not exist does not feel anything. Your arm is gone only temporarily; you will find it amusing, not alarming, that for a while you have no left arm." The arm is then stimulated by icy water, and the subject commonly reports that he feels nothing.[6]

Whether or not such a subject's report is genuine again raises the question of a special or altered state of consciousness. Does the subject experience no pain in the arm – indeed no arm at all – because of an altered hypnotic state? Predictably, Hilgard and Erickson thought so. Barber, by contrast, explained the phenomenon in terms of normal (non-special) psychodynamics, contending that the motivation for denying pain is present in the relationship between the doctor and the patient.

If Barber were correct, it would mean that achieving dramatic hypnotic effects would be contingent upon two simultaneous and interrelated factors: the outward presence of a hypnotist or hypnotherapist, and the subject's inward desire to please him. It would also mean that this "complaisancy motivation" involved neuro-psychophysiological mechanisms capable of mediating remarkable alterations in perception and function. If Hilgard and Erickson were correct, on the other hand, it would mean that dramatic hypnotic effects were fundamentally independent of outer factors (such as the presence of the hypnotist). Instead, a state of consciousness intrinsic to the subject would be responsible. It would also suggest a strong motivational factor which, however, would be self- rather than outer-directed.

It seems likely that Barber's viewpoint of pleasing the hypnotist could be true in laboratory-experimental situations. It is easy to imagine a subject not having anything better to do than achieve what is being asked of him. But there also appear to be far more complex factors involved when real-life situations are considered. When the stakes are high enough, it doesn't matter who is or is not present. Erickson worked with many terminally ill patients who, bedridden and racked with pain, were clearly too weak to care about helping him succeed as a hypnotherapist. In most cases such patients desperately desire the success of hypnotic relief for the purely personal reason of wanting to die in peace.

Erickson treated a 35-year-old woman five weeks prior to her death from lung cancer9. She had spent the previous month "almost continuously in a narcotic stupor to counteract unbearable pain." She then requested the use of hypnosis and readied herself for it by voluntarily going without medication on the day Erickson saw her:

She was seen at 6:00 p.m., bathed in perspiration, suffering acutely from constant pain and greatly exhausted...Approximately four hours of continuous effort were required before a light trance could be induced. This light stage of hypnosis was immediately utilized to induce her to permit three things to be accomplished, all of which she had consistently refused to allow in the very intensity of her desire to be hypnotized. The first of these was the hypodermic administration of 1/8 grain of morphine sulfate, a most inadequate dosage for her physical needs, but one considered adequate for the immediate situation. The next was the serving to her of a pint of rich soup, and the third was the successful insistence upon an hour's restful physiological sleep. By 6:00 a.m. the patient, who finally proved to be an excellent somnambulistic subject, had been taught successfully everything considered to be essential to meet the needs of her situation.

Erickson describes the various hypnotic techniques the patient learned, such as positive and negative hallucinations in the modalities of vision, hearing, taste, smell, touch, deep sensation, and kinesthesia; glove and stocking anesthesias to be used over her entire body; partial analgesias for superficial and deep sensations; and body disorientation and body dissociation. After this single all-night session, Erickson did not see the patient again, although he did receive daily reports about her condition from her husband. Five weeks after the session, the woman died, "in the midst of a happy social conversation with a neighbor and a relative." Erickson writes:

During that five-week period she had been instructed to feel free to accept whatever medication she needed. Now and then she would suffer pain, but this was almost always controlled by aspirin. Sometimes a second dose of aspirin with codeine was needed, and on half a dozen occasions 1/8 grain of morphine was needed. Otherwise, except for her gradual progressive physical deterioration, the patient continued decidedly comfortable and cheerfully adjusted to the end.

Erickson's own account of the efficacy of his own work is part of an extensive literature on the success of hypnotic pain control. If we accept it as accurate, the next question to ask is this: If the patient is able to successfully dissociate from previously "unbearable pain," where does the pain go? I believe it goes where it has always been: shunted away from the structures that could relay it to third-level consciousness, and back down to the physical system. It is processed as it has always been processed, with one exception: the conscious appreciation of it.

One can sometimes change the blood pressure with hypnosis, biofeedback, and other procedures, but we must never imagine that one can erase a pain that is imprinted into every cell of the body. The pain may be focused here and there, and with various techniques refocused elsewhere, but the pain remains and remains and remains.



[1]Ernest R. Hilgard and Josephine R. Hilgard, Hypnosis in the Relief of Pain (Los Altos, Calif.: William Kaufmann, 1975, pp. 63-82.
[2]See Milton H. Erickson and Ernest L. Rossi, Hypnotherapy: An Exploratory Casebook (New York: Irvington, 1979, pp. 94-142.
[3]Yapko, Trancework, pp. 276-281.
[4]Yapko, p. 277.
[5]Hilgard, Hypnosis in the Relief of Pain, p. 66.
[6]Hilgard, Hypnosis in the Relief of Pain, p. 66.


17 comments:

  1. Quote: Isn't that what parents do to children? "You're not sad. Stop with that depressive act and smile!"

    That is so true. You see it everywhere. Parents are always trying to dissociate their kids from what they feel.

    It's like us neurotics are just hell bent on selling on to others our own defence system.
    And psychoanalysts do the same thing: "Don't listen to yourself. Don't feel. Just lock yourself into my ideational mindset. Come join me in my dead empty world".

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  2. Quote: "We can all revert to different brains within our skulls".

    I think that expression gives us the true hallmark of the neurotic event. And yes as you have said it's fundamentally the same as hypnosis. Only with neurosis the dissociation is locked down. You can't "wake up" into the rest of your brain on a mere suggestion because of, of course, the incredible pain contained within those other brain zones.

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  3. Art: said simply I think we could state that pain has a purpose and that eliminating it, (by whatever means) eliminates it's purpose. Shunting pain into the subconscious where we have no access to it or even awareness of it is;- NEUROSIS. I remember years ago you stating that hypnosis was just neurosis under another name. The greatest example in this piece was a parent telling (suggesting) to the child that it was not a pain and it should stop whining. I remember clearly when that happened to me as a child. My re-action was; "Oh! I am doing something wrong; I should take notice of mammy and do something different". In hindsight what I did was stop whining (expressing my feeling) and as time went by became very adept at it. In therapy I have had to learn to reverse that process.

    Throughout this whole blog on hypnosis I have wondered about the very reverse of blocking pain and considering if it was possible to get a patient into their early feelings (re-living). My off the cuff feeling is that you'd have to be a very, very experienced therapist to know just exactly when and where to take a patient. Near impossible, I feel. Art; have you any comments on just this.

    Jack

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  4. Art >>This compartmentalization was an evolutionary mechanism to keep the Pain at bay and allow us to function. So even though childhood pain churns a tempest below the third-line, we go to work and carry out our duties.

    This also relates to what I say. To function! To reason! To Analyze! To construct! To dismantle! We need to be able to do these to survive. Not immediate survival such as stranded in the winter or wilderness. But long term survival in society filled with pits and traps. Can we find a way to get past the pain to get a clear accurate understanding of the world? I say yes. Art says no but then says compartmentalization. That says yes even though he says no.

    While pain is a serious matter, consider the pilots in WWII coming back to their carriers, unaware that they had been seriously injured by gun fire. But as they near the landing strip on the ship, suddenly a burst of pain comes forth and they have trouble landing and crash. The mind held off the pain cause there was a more urgent need at the time, fighting to stay alive and functioning well to fight. As soon as the “sub-conscious” had determined that the urgency was gone, it allowed the pain to be felt. Seeing the ship near made them relax and feel relieved. So the pressure of fighting was gone, that pressure holding down the pain.

    We are confronted, whether we know it or not, with very dangerous times and circumstances. Though what goes on in politics seems to not concern us, nothing could be further from the truth. The long term survival of our family line, our nation, and maybe our race is at stake. While internal pain is an important priority, there could be circumstances which merit more attention at a given time. Like the pilots were in. So what is the purpose of Law, Courts, Justice, and Science?

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  5. Paul G. pointed out how his thinking changes as he feels more. This would be normal. But each of us tends to allow our pain to dictate what we think. We all do it to some degree. No shame there. But maybe no long term advantage, either. What if, instead of using the intellect to justify our pain and needs, our inner self, motivated by pain, could appreciate how important it was to let the intellect pursue an objective analysis instead of a biased one to defend our ego, you might say. Let the intellect find the truth, even if it brutalizes our ego.

    If the inner self can be persuaded that its best long term interests are bound up with discovering the absolute objective truth, then it can allow the intellect to seek out without bias and deception that protect and defend our egos.

    This is the purpose of courts and scientific methods and rules. They try to weed out bad processes, bias, personal prejudice, poor thinking, corruption, etc. Courts and their procedures attempt to make rules such as not tampering with the jury or witnesses, not with-holding evidence, handling evidence with proper care, allowing each side a chance to examine and cross examine witnesses. To be confronted by your accuser and on and on. These help to protect the process from contamination. But too often today, politics and corruption deliberately ignore these good concepts. Ignore the concepts and justice will be perverted. Politics and power then take over.

    Science also seeks clear steps where data is not forged, withheld, or picked selectively, and challenges are based on evidence and not personal feeling apart from evidence. It must be independently verifiable or it is not valid. There are possible conflicts of interest as well. Pharmaceutical companies carefully select certain researchers to do their research. There is no independent verification in many cases.

    But both disciplines, of Law and Science, have procedures and rules to weed out the nasty tendencies of human nature and arrive at a conclusion that is fairly free of bias and self interests. In other words, to separate what is rational, from what is irrational, superstitious, unreasonable, or of impure motive.

    So when Jack faults world leaders, perhaps, and scientists, what he is rally faulting is the lack of applied standards created for those professions. He has not been able to separate the result from the corruption of the process, in my opinion.

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  6. A thought about how it would work if thoughts and feelings worked around a single task (feel what we say and say what we feel). Why would we have two parts of brain for the same task? The thinking brain develops under circumstances of meaning to be handling feelings… feelings of pain. If there was no pain… then the thinking brain should not develop… as the need of “love” at the time was much to grate.

    The thinking brain should not be of any difference than the feeling… if they work for the same task. Why should we analyze what we feel and feel what we analyze ... what is the point? The reason is… we live in two rooms of our self… one of pain and the other to handle it… pain that threatening the whole system.

    There is only one reason for this… and that is… somewhere down the road of evolution something has gone wrong. To think about what we feel and feel about what we think is not of a fundamental sense… except to being of planning. We must know that since planning started we have been out of the feeling sense.
    That we do think… is consistency to a defense needed for physiological surviving. Life-threatening pain we could no longer endured… something that must be kept away... with no less than narrowing… that is the cause of how we developed the thinking brain

    Nature is not always considerate of the content ... the survival of the species are more important. Being "smart" for survival belongs only to the world of thought for survival. We works grate emotionally for physical survival ... that shows all the other species to be the case.

    Planning for survival does not show otherwise ... than we have not yet discovered that we are destroying our world.

    frank

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  7. Jack. I wish it were not so but it takes many years to train a really competent therapist. art janov

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  8. Apollo, you often talk about corruption and the need for new standards in politics and science. You are right. We need humane politicians. Humane scientists. Feeling people.

    Unfeeling people can be very clever. They can build cost-effective nuclear power stations which are designed to supply electricity to your kitchen so you can feed your hungry children. On the surface, it looks like a beautiful idea.

    But without feelings, these scientists and politicians have a tendency to overlook the things that matter most. They have no humane sense of priority. No right brain to keep everything in perspective. For them, everything is just a game. Scientists often say "If we hold back a new technology simply because it is unproven, we will never make any progress."

    PROGRESS. What is progress? That is a huge intellectual debate. Scientists and politicians can never agree. Their arguments are endless and have no real direction. They are not guided by feelings.

    Feeling people find it easy to agree with each other. They learn quickly from each other without any stupid arguments. They all feel the same needs. Their answers come quickly and naturally. They are not hippies. They are not the Green Party. They are realists.

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  9. The way I see it is that we did not go wrong in evolution.From information from Smithsonian Museum we were in a constant adrenaline rush back then because of wild animals hunting us,WE were the hunted.And there was hardly enough food.(The human line all most got extinct twice in history)
    So in that sense there is much progress.
    That we now come to the limits to what the planet can bare is a problem that we can only solve (if possible) with an inventive mind I guess.

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  10. Panl.

    ”WE were the hunted”… there is where it went wrong ?
    Other animals do it... and make it still today… they are hunted almost all of the time… they are still perfect of their purpose… purpose of surviving with all of the senses needed for surviving… they can fly. The difference is… they don’t have mad parenting.
    Were parenting gone wrong can be of the reason you say... but why has not the thinking brain become useful for survival ... survival for the purpose of love.
    In the end of this meaning... the thinking brain is of no good... that is what we should put focus on. Can or would it be of something good in the future... survival at any price to die for?
    The big question... our brains don't work in harmony... primal therapy do something about it... the thinking brain has seeing its last days. We got no need for the thinking brain… what so ever… that “need” is only to block the pain… pain that can led to schizophrenic reactions… reactions that are the child in us... that’s way so frightening.
    Listen we only got some years to live… we got no use of technological solutions... this is the cause of the tanking brain.

    Frank

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  11. A facebook comment: "I like his voice, or dr.Erickson.. "You have a conscious mind and an unconscious mind and your conscious mind has ways of understanding, and you unconscious mind has ways of understanding you conscious understandings. But then time and time again, there are misunderstandings... and you can consciously misunderstand your unconscious understandings or you can unconsciously understand your unconscious misunderstandings But the kind of conscious misunderstandings that you unconsciously understand are different from the kind of the unconscious misunderstandings that you consciously understand But you can really understand until you... take a deep breath, close your eyes and really go inside"

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  12. For Frank
    Frank said:
    >>The thinking brain should not be of any difference than the feeling… if they work for the same task. Why should we analyze what we feel and feel what we analyze ... what is the point?<<

    To analyze our feelings causes us to recognize, if we dare, that something is amiss and out of whack. Our reactions do not match the present circumstances. If we follow this mystery, we soon end up discovering Primal Theory-Therapy. We should be curious about the world and our inside self, too. It is that curiosity that often gets strangled by primal trauma. But we need that curiosity so that when we come to a puzzle, we go after it rather than run from it. Make sense?

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  13. As Nancy Reagan could have said, Just Feel it! That is a bit too simplistic but I have said why many times. It is almost an insult to repeat a poorly thought out mantra. We hate religious people for doing this but many here are also guilty of those things. Maybe we ought to hate ourselves as well or give more thought to statements we make.

    Some take right to therapy, PT that is. but many others have struggled, perhaps cause of therapists missing things but more likely, in my opinion, that the patient might have been harmed quite a bit and there might be limits on what can be done. Unless Arthur can split the Red Sea and raise people from the dead, we can not or should not expect miracles.

    Getting healed is not always easy or full of results. Lets not create false hopes and be too optimistic. there is much that can make it more challenging. If some healed fast and easy, that is great. but not all can or do. What works for one many not work for another. Bearing pain is no easy matter for anyone.

    Listen, I have and still do often deal with judgmental types in Christianity. And if you think I am mean or pushy here, you have seen nothing. But there are PT fundamentalists among us here as well. How sad. Can't we learn from the mistakes of others? It worked for me. Mercy and compassion are not such bad things, are they?

    Let he who is sinless, cast the first stone.

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  14. Frank I know how much your are interested in all this but you must get help with your english; otherwise it is hard to understand. art janov

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  15. An email comment:
    "I have always and still today believe that Primal Therapy is the only true method that will help people to understand themselves and their emotions.Our best way forward is to except our feelings because feelings can destroy us or build us as we progress through life.I also believe that every day of life is a learning experience and you never stop.As to all things in life,relationships i.e. marriage,friendship and how we feel about the broader society even spiritual beliefs are only built by self examination!As Kahil Gibran wrote it is true we are as weak as our weakest link but it is also true we are as strong as our strongest link but we need to nurture ourselves constantly,stay true to the belief that our life is evolving constantly,then we will understand our place in this wonderful life and grow stronger and wiser.Every person knows the truth,to often we get lost in the details of everyday life,lose our sense of self and the broader picture.Often I have to tell myself,stop!think, take a breath!and then a little voice inside says....smell life..... taste life......feel life..and a wonderful sense of calm wipes away the moment of confusion and I feel strong again and in control again of my situation.Most people just need to see that others also have pain and doubt for themselves to be able to down play their own struggle and through empathy find their harmony again.To often this world puts to much emphasis that we need to be better than then rest..drive a certain model of car or have a certain nice house or own that big job..and this all is in contrast to our true human nature..which is to see each other as equals!what else can we be! All experiences are shared, who wants to be bigger stronger or richer than the other!All we are to become will come naturally.So with this,society enforced delusion, all problems are created..thank God for Primal Therapy! certainly changed my life and made me human again..I did not even attend the therapy, it was just the knowledge that I was not alone that saved my health,may you prosper in what you do always,kind regards,"

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  16. An Email Comment >> So with this society-enforced delusion, all problems are created..thank God for Primal Therapy! certainly changed my life and made me human again..I did not even attend the therapy, it was just the knowledge that I was not alone that saved my health, may you prosper in what you do always, kind regards,"

    So well said. Not everyone is suffering in agony. We have pain inside but our gates do pretty good. We benefitted from an understanding of Primal Therapy/theory, very much. It does help to know why, even if the pain stays. Many here can not accept that. Intolerant and insisting everyone do as they do. “You” belong in churches, with the rest of the intolerant.

    Listen, if I could come across some money or a job that did not require total corruption and evil, I’d be in CA tomorrow, well pending approval. Nothing would better prove my theories than to do the therapy so I could destroy elitist arguments of “you do not know cause you have not done.” But alas, being unemployed and a caretaker, leaves any chance out unless things change.

    Yes, knowledge of PT is a bit of pain killer. It’s a fact. What’s wrong with that? Is PT also in my imagination?

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  17. Hi Frank,

    I am not talking about that something went wrong,I am against that word,I say nothing went wrong in our evolution.
    The primary thing for survival is food.(and shelter perhaps).Like Desmond Morris said,we don´t have a natural weapon like other animals have.We don´t have claws,horns or sharp teeth or a thick skin or are very strong (Chimpanzees are 3 times stronger then humans) The weapon we have is our brain.
    Out of this you can conclude that humans had to be smart/intelligent from the start to survive.
    This brain however consumes a lot of energy which means more food,specifically proteins.
    We had to be smart to catch these proteins in the form of animals.
    Smarter means bigger brain,bigger brain means more food.And so on.An arms race between brain size and food.That is,I think,what happened.

    Panl

    ReplyDelete

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Dr. Bernard Park, MD, MPH

His new book “Life Before Birth: The Hidden Script that Rules Our Lives” shows that primal therapy, the lower-brain therapeutic method popularized in the 1970’s international bestseller “Primal Scream” and his early work with John Lennon, may help alleviate depression and anxiety disorders, normalize blood pressure and serotonin levels, and improve the functioning of the immune system.
One of the book’s most intriguing theories is that fetal imprinting, an evolutionary strategy to prepare children to cope with life, establishes a permanent set-point in a child's physiology. Baby's born to mothers highly anxious during pregnancy, whether from war, natural disasters, failed marriages, or other stressful life conditions, may thus be prone to mental illness and brain dysfunction later in life. Early traumatic events such as low oxygen at birth, painkillers and antidepressants administered to the mother during pregnancy, poor maternal nutrition, and a lack of parental affection in the first years of life may compound the effect.
In making the case for a brand-new, unified field theory of psychotherapy, Dr. Janov weaves together the evolutionary theories of Jean Baptiste Larmarck, the fetal development studies of Vivette Glover and K.J.S. Anand, and fascinating new research by the psychiatrist Elissa Epel suggesting that telomeres—a region of repetitive DNA critical in predicting life expectancy—may be significantly altered during pregnancy.
After explaining how hormonal and neurologic processes in the womb provide a blueprint for later mental illness and disease, Dr. Janov charts a revolutionary new course for psychotherapy. He provides a sharp critique of cognitive behavioral therapy, psychoanalysis, and other popular “talk therapy” models for treating addiction and mental illness, which he argues do not reach the limbic system and brainstem, where the effects of early trauma are registered in the nervous system.
“Life Before Birth: The Hidden Script that Rules Our Lives” is scheduled to be published by NTI Upstream in October 2011, and has tremendous implications for the future of modern psychology, pediatrics, pregnancy, and women’s health.
Editor