NOTES
I have concerns about the construction of the Diagnostic and Statistical Manual (DSM) as a whole. It was initially a research document, but it has come to dominate clinical diagnostic practice, and worse, it governs what treatment third party payers will compensate.
Dissociative Identity Disorder (DID) to replace Multiple Personality Disorder (MPD) may well change the way the condition is viewed, and we may see fewer alters in each person.
I have difficulty understanding the precise nature of dissociation–especially with its powers to produce amnesia. The dissociative disorders are part of the legacy of hysteria; though some parts of hysteria are represented in other DSM categories. The influence of environmental factors and imagination were suspected when the diagnosis was hysteria; everyone knew the picture was complicated, and subject to contagion, etc. The DSM makes little attempt to take that into account in the section on Dissociative Disorder.
Questions we must address: 1. How voluntary is clinical dissociation? To what extent can we expect the patient to claim agency for it, e.g. if it is claimed that a crime was committed by an alter? 2. To what extent does the clinical manifestation of dissociation overlap with absorption and attention? 3. How does morbid preoccupation with images differ from regression? How much is the patient the willing agent of that kind of behavior? 4. To what extent are flashbacks remembering or imaginings? 5. How do we control for contagion or imitation on the dissociative disorder inpatient units? 6. Could we be creating things to fit our theories? 7. Are other diagnoses being displaced here? The dissociative disorders being put on center stage may lead us to do disservice to the patient in dealing with their other life crisis. 8. If the shock of the trauma is associated with impaired perception, altered attention, and memory problems, how dependable are the reports that are ultimately retrieved–perhaps decades later? 9. What do we in truth understand by the word dissociation? Is it a psychological event with underlying physiology, or just a metaphor?
Psychiatry is subject to diseases rising and falling, e.g. the disappearance of hysteria itself.
1992
Vijselaar Joost; Van der Hart, Onno (1992). The first report of hypnotic treatment of traumatic grief: A brief communication. International Journal of Clinical and Experimental Hypnosis, 40 (1), 1-6.
In 1813 the Dutch physicians Wolthers, Hendriksz, De Waal, and Bakker reported the hypnotic treatment of a woman suffering from traumatic grief, in which the therapist had to deal directly with the patient’s spontaneous reenactments of the circumstances surrounding the death. This report, summarized in the present article, has historical value, as it is probably the first known precursor of the uncovering hypnotic approach. The original authors’ views on the case are discussed, and a modern view for understanding the patient’s traumatic grief and its treatment is presented.
1991
Cardena, Etzel; Spiegel, David (1991, August). Dissociative reactions following the Bay Area earthquake. [Paper] Presented at the annual meeting of the American Psychological Association, San Francisco.
This study systematically evaluates the psychological reactions of a non-clinical population to the October 1989 Bay Area earthquake. Within a week of the earthquake we administered a checklist of anxiety and dissociative symptoms and conducted a follow-up study four months afterwards. In both instances, a representative sample of close to 100 graduate students from two different institutions in the Bay Area volunteered to participate in the study. Analyses of variance for time of testing show that during or shortly after the earthquake respondents experienced significantly greater number and frequency of time distortions, alterations in cognition, memory and somatic sensation, derealization, depersonalization and, to a lesser degree, anxiety symptoms and Schneiderian first-rank symptoms. These results suggest that among non-clinical populations extreme distress significantly increases the prevalence not only of anxiety but of transient dissociative phenomena as well, a fact of considerable clinical and theoretical import particularly considering the lifetime prevalence of traumatic experiences among the general population. (ABSTRACT from Bulletin of Division 30, Psychological Hypnosis, Provided by former Editor, James Council.)
1990
Ross, Colin A.; Fast, E.; Anderson, G.; Auty, A.; Todd, J. (1990). Somatic symptoms in multiple sclerosis and MPD. Dissociation, 3, 102-106.
Fifty subjects with multiple sclerosis (MS) were compared to 50 subjects with multiple personality disorder (MPD). MS patients endorsed an average of 3.0 somatic symptoms on structured interview, and MPD subjects an average of 14.5. Somatic symptoms characteristic of neurological illness were trouble walking, paralysis, and muscle weakness, while those characteristic of psychiatric illness were genitourinary and gastrointestinal symptoms.
Bryant, Richard A.; McConkey, Kevin M. (1989). Hypnotic blindness: A behavioral and experiential analysis. Journal of Abnormal Psychology, 98, 71-77.
NOTES
This research examined the influence of visual information on a decision task that subjects were administered during hypnotically suggested blindness. Real, hypnotizable subjects and simulating, unhypnotizable subjects were tested in two experiments. Experiment 1 focused on behavioral responses, and Exper. 2 focused on experiential reactions. In both experiments, the findings indicated that the behavioral responses of reals were influenced by visual info. despite their reported blindness. The behavioral responses of reals and simulators were essentially similar. The experiential data in Experiment 2 provided information about the phenomenal nature of subjects’ reported blindness. The experiential reactions of reals and simulators were essentially different. The research is discussed in terms of the issues that need to be considered in the development of a model of hypnotic blindness” (p. 71).
1989
Bryant, Richard A.; McConkey, Kevin M. (1989). Visual conversion disorder: A case analysis of the influence of visual information. Journal of Abnormal Psychology, 98, 326-329.
NOTES:
Examined the influence of visual information on a decision task that was administered to an individual with monocular visual conversion disorder. Findings indicated that his performance was influenced by the visual information and by motivation instructions. The findings are discussed in terms of a model of hysterical blindness that recognizes the interplay of cognitive and motivational processes” (p. 326).
Ross, Colin A.; Heber, S.; Norton, G. R.; Anderson, D.; Anderson, G.; Barchet, P. (1989). The Dissociative Disorders Interview Schedule: A structured interview. Dissociation, 2, 169-189.
The Dissociative Disorders Interview Schedule (DDIS), a structured interview, has been developed to make DSM-III diagnoses of the dissociative disorders, somatization disorder, major depressive episode, and borderline personality disorder. Additional items provide information about substance abuse, childhood physical and sexual abuse, and secondary features of multiple personality disorder. These items provide information useful in the differential diagnosis of dissociative disorders. The DDIS is published in this article. It has an overall interrater reliability of 0.68. For the Diagnosis of MPD it has a specificity and a sensitivity of 90%.
Wickramasekera, Ian (1989). Enabling the somatizing patient to exit the somatic closet: A high-risk model. Psychotherapy: Theory, Research and Practice, 26 (4), 530-544.
Problems in establishing a therapeutic alliance make somatizing patients poor candidates for psychotherapy. A logical analysis is presented of the conspiracy of silence between the somatizing patient, the medical doctor, and the health insurance industry regarding the psychosocial factors contributing to somatization. Alternatives are sought to repeated biomedical tests and therapies that are clinically unproductive and iatrogenic. Two psychophysiological pathways are proposed that are promising to reduce the distance between the medical doctors’ and the psychologists’ procedures. The new profile of illness has produced a paradigm shift with implications for an expansion of the definition of the word “physician”.
1988
Pettinati, Helen M. (1988). Hypnosis and memory. New York and London: Guilford Press.
NOTES
From a review in British Journal of Experimental and Clinical Hypnosis, 7, 175- 178, by Vernon H. Gregg]:
Book has 5 sections: 1. method, theory 2. mechanisms of memory enhancement 3. hypnotic and other forms of reversible amnesia 4. clinical uses of hypnosis for increasing accessibility of memories and fantasies 5. Summary
The chapter by Martin Orne et al presents a comprehensive review. Perry, Lawrence, d’Eon and Tallant contribute a lively assessment of age regression procedures in the elicitation of inaccessible memories. They provide a description of procedures, a brief historical review, and discuss problems of confabulation and creation of pseudomemories. Their account is illustrated by clinical and forensic examples and gives an interesting account of belief in reincarnation in terms of source amnesia.
Section 3 has Hollander’s chapter on hysteria and memory, which illustrates the concept of reversibility of amnesia with two types of hysterical conditions: one of these types, the dissociative disorders, has the potential for amnesia to be reversed but the other, histrionic personality disorders, is characterized by no reversibility.
In the section on clinical studies of memory enhancement Frankel and Kolb both accept that uncovering repressed memories and fantasies is therapeutically beneficial and that the faithfulness of recovered memories is often not important for therapeutic success. Frankel illustrates the usefulness of hypnosis with several case studies. But he thinks that clinical issues are dealt with too briefly in this book. In her summary chapter Pettinati points to the dearth of systematic research into the effectiveness of hypnosis in clinical settings.
1985
Bliss, Eugene L.; Larson, Esther M. (1985). Sexual criminality and hypnotizability. Journal of Nervous and Mental Disease, 173, 522-526.
Investigated 33 17-35 yr old sexual offenders, 18 of whom had been convicted of rape, 9 of pedophilia, and 6 of incest. Ss completed a questionnaire containing a list of 15 factors that might have contributed to their crime, a self-report containing 305 items that are symptoms characteristic of 11 major psychiatric syndromes, and the Stanford Hypnotic Susceptibility Scale. Controls for the self-report were 48 individuals taken from a church group, nurses, technicians, and graduate students. Controls for the hypnotizability scale were cigarette smokers who smoked 1 1/2 pack/day and S data taken from the literature. Results show that two-thirds of the Ss had histories of spontaneous self-hypnotic experiences (dissociations); 7 of these were DSM-III multiples and 6 were probable multiples. This group had very high hypnotizability scores. The other one-third without histories of spontaneous self-hypnosis had normal scores. It is concluded that spontaneous self-hypnosis contributed to the perpetration of the crimes in many of tehse cases, although other factors also directed the antisocial behaviors. (22 ref).
Hoffman, William (1985). Hypnosis as a diagnostic tool. American Journal of Psychiatry, 142 (2), 272-273.
Discusses the case of a 22-yr-old Swedish female who became withdrawn and depressed and developed suicidal ideation and paranoid and grandiose delusions. S was also disoriented to time and place and displayed poor memory, insight, and judgment. After a diagnosis of brief reactive psychosis, S was placed on a regimen of oral haloperidol (2 mg, 4 times/day), but she remained confused and disoriented. After induction into a trance state, S coherently recollected the events leading to hospitalization, after which medication was discontinued. It is suggested that trance induction be attempted before treatment in individuals with symptoms of hysterical psychosis.
Steingard, Sandra; Frankel, Fred H. (1985). Dissociation and psychotic symptoms. American Journal of Psychiatry, 142 (8), 953-5.
The literature on hysterical or brief reactive psychosis reflects great diversity both in clinical description and theoretical formulation. The authors describe the case of a 17-year-old girl who presented with a diagnosis of bipolar affective disorder, rapid cycling type, but who, in fact, was experiencing dissociative episodes manifested as psychotic states. The patient’s successful treatment with hypnosis is described, along with the clinical and theoretical implications of the case.
Bliss, Eugene L. (1984). Hysteria and hypnosis. Journal of Nervous and Mental Disease, 172 (4), 203-206.
Studied 33 female patients with Briquet’s syndrome to investigate the possibility that severe hysteria might be a spontaneous self-hypnotic disorder. Excellent hypnotic Ss were defined clinically as those who entered a trance rapidly, experienced lid closure and arm and elbow elevation, perceived hypnotic events with realism, could regress to early experiences, and usually had amnestic capabilities. Ss were administered the Stanford Hypnotic Susceptibility Scale, Form C. 17 of the 33 Ss were clinically tested for hypnotizability. 14 were found to be excellent hypnotic Ss, 2 were found to be good, and 1 was found to be a poor hypnotic S. 14 of the 33 Ss met the DSM-III criteria for multiple personalities. It is concluded that patients suffering from Briquet’s syndrome are usually good or excellent hypnotic Ss with few exceptions, and many have multiple personalities. Evidence is also discussed that patients with major conversion symptoms are excellent hypnotic Ss. (39 ref).
Jensen, Peter S. (1984). Case report of conversion catatonia: Indication for hypnosis. American Journal of Psychotherapy, 38 (4), 566-570.
Describes the successful hypnotic treatment of a 25-yr-old Black male who displayed symptoms of suicidal ideation, insomnia, and feelings of depression alternating with emptiness and boredom that led to an acute catatonic reaction. S met DSM-III criteria for borderline personality disorder. It is contended that since conversion mechanisms may underlie some presentations of catatonia, hypnosis may assist clinicians in the differential diagnosis of acute catatonic conditions.
Suryani, L. K. (1984). Culture and mental disorder: The case of bebainan in Bali. In Culture, medicine and psychiatry. D. Reidel Publishing Company
NOTES
Bebainan is a form of dissociation which is culturally associated with Bali. Thought to be caused by sorcery, a bebainan attack lasts up to an hour and is manifested by confusion, crying, screaming, and shouting, with inability to control one’s actions. However, it seems most victims maintain awareness of their own behavior and are not amnesic for it afterwards.
In this study, the author interviewed 27 people, mostly female, most of whom experienced their first attack between 16-30 years of age. The author concluded that the attacks permitted release of feelings of frustration and anger without stigma. Author concluded it is not a form of psychosis, is not organic, and is not a neurosis.
Wilson, Ian (1984). Jesus–The evidence. London England: Weidenfeld and Nicolson.
NOTES
Miracles of Jesus are attributed to hypnosis, in a culture that had already experienced faith healers. Many of those healed had diseases that today might fall into the ‘hysteria’ or ‘psychosomatic’ categories (paralysis, lameness, fever, catalepsy, haemorrhage, skin disease, mental disorder), which diseases are frequently responsive to hypnosis. Further, Jesus’ reputation preceded him, and the fact that his cure rate was low in his home town is evidence of both the veridicality of the written record (Mark 6: 1-6) and the expectancy factor. “The significance of this episode is that Jesus failed precisely where as a hypnotist we would most expect him to fail, among those who knew him best, those who had seen him grow up as an ordinary child. Largely responsibble for any hypnotist’s success are the awe and mystery with which he surrounds himself, and these essential factors would have been entirely lacking in Jesus’ home town” (pp. 111-112). The author also assigns other miracles (his transfiguration into dazzling light before three disciples; turning water into wine) to hypnosis [which other writers might ascribe to suggestion].
1979
Spanos, Nicholas P.; Gottlieb, Jack (1979). Demonic possession, Mesmerism, and hysteria: A social psychological perspective on their historical interrelations. Journal of Abnormal Psychology, 88 (5), 527-546.
Provides a social psychological interpretation of the interrelations among demonic possession, mesmerism, and hysteria. It is argued that the reciprocal role relationship of mesmerist and magnetized S in the 18th and 19th centuries involved the secularization of the role relation that had existed between exorcist and demonically possessed. The commonalities between these 2 sets of social roles are delineated, some of the variables leading an individual to learn and enact the posessed role are outlined, and several lines of historical evidence pertaining to the influence of the exorcist-demoniac relationship on the mesmeric relationship are outlined. The influence of the possessed role in shaping the role of the hysterical patient is also discussed. The use of hysteria as a modern explanatory concept in histories of possession and mesmerism, however, is criticized. (198 ref).
1978
Nichols, Michael P.; Bierenbaum, Howard (1978). Success of cathartic therapy as a function of patient variables. Journal of Clinical Psychology, 34 (3), 726-8.
Treated sample of 42 patients with cathartic psychotherapy and evaluated differential effectiveness on types of patients. Patients without mental disorders experienced more emotional catharsis than all others, and those with obsessive compulsive personality disorders improved more than all others as a result of emotive treatment. Contrary to popular notions, neither women nor hysterics experienced more catharsis or improved more in cathartic therapy. Although women and hysterics may cry more easily in daily life, obsessives are apparently more able to maintain focus on unhappy experiences and are therefore able to express more emotion in cathartic therapy. Furthermore, it seems that cathartic treatment is beneficial by disrupting long-standing defenses against emotional experience, rather than by releasing stored-up affects.
1972
Cedercrentz, C. (1972). The big mistakes: A note. International Journal of Clinical and Experimental Hypnosis, 20, 15-16.
In his book, A System of Medical Hypnosis, Ainslie Meares writes, “Most books on hypnosis, from Bernheim to the present time, devote a great deal of space to the description of successful and dramatic cures. These accounts may be of prestige value to the author, and may do something to inform the profession of the potential value of hypnosis in medicine, but these success stories are really of little help to those who would learn the technique of hypnotherapy because the emphasis is always on the success of the treatment rather than on anlysis of the psychodynamic mechanisms which brought it abauot. As in everything else, we learn most from a study of our failures [p. 3].” These comments remain as true today as they were ten years ago. With the notable exception of Meares, few colleagues have been willing to share their errors, allowing us to profit from their experience. Thus, when Dr. Cedercreutz sent along a note describing his experience with one of his patients, I was struck by his generosity, and it seemed most appropriate for all of us to share his experience by way of the Journal. Hopefully, this may encourage other colleagues to share their failures as well as their successes so that all of us may learn to be more effective therapists and better scientists. M.T.O. [Martin Orne]
NOTES
The case reported involves a patient who had migraine headache removed with hypnosis, but later developed gastrointestinal symptoms that were operated surgically with absence of positive (physical) pathology noted. Subsequent investigation of the psychological component of the problem with hypnosis revealed an early trauma (seeing a soldier killed with a bayonette) that led to migraine-like pain in the head and vomiting.
Arluck, Edward WIltcher (1964). Hypnoanalysis, a case study. New York: Random House.
NOTES
Details transcripts (90 pages) and comments of a 28 session hypnoanalysis (Jungian) of a World War II soldier with traumatic war neurosis in a military setting shortly after the end of the war, for a conversion reaction with onset just prior to return to the States. Author cautions he found this amount of success in only about 15 of more than 70 individually treated cases. Emphasizes giving suggestions to dream about his condition/problem and utilizing dream interpretation. 53 references.
1964
Moskowitz, Arnold E. (1964). A clinical and experimental approach to the evaluation and treatment of a conversion reaction with hypnosis. International Journal of Clinical and Experimental Hypnosis, 12 (4), 218-227.
A combination of hypnotherapeutic techniques within a clinical and experimental context provided a method of understanding, evaluating, and predicting the course of a conversion reaction. During waking and hypnotic conditions, 5 trials of dynamometer presses were obtained from a patient having primary symptoms of paralysis of his left arm. Difference scores between the left and right hands during waking and hypnotic conditions were evaluated. Findings were: (a) At the beginning of treatment, significant differences were found between the waking and hypnotic conditions (b) The largest differences between the waking and hypnotic conditions occurred during the early stages of treatment, while the smallest differences occurred on the final day of treatment. (c) With a complete remission of the patient”s symptoms, no significant differences between the waking and hypnotic conditions were found. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
1963
Slater, Roger C.; Flores, Louis S. (1963). Hypnosis in organic symptom removal: A temporary removal of an organic paralysis by hypnosis. American Journal of Clinical Hypnosis, 5 (4), 248-255.
NOTES
Summary and Conclusions. A detailed case study is reported on the use of hypnosis with beneficial results in an instance of eventually proved organic brain disease. Three other confirmatory case reports of organic disease definitely benefitted by the use of hypnosis are briefly cited.
” The first patient had been adequately studied repeatedly for organic brain disease. Because the studies led to an uncertain indefinite unconfirmed suspicion of psychogenic epilepsy, the patient was returned with a recommendation for continued treatment and observation by the author, a general practitioner. Hence, she was, after still further study for organic disease, treated symptomatically by hypnosis with beneficial results. This led to the erroneous conclusion that the patient’s disability was probably functional. A sudden fatal outcome of the actual but unrecognized brain disease led to a correct but post- mortem diagnosis of astrocytoma of the brain, Grade IV.
“This report and those given to supplement it raise significant questions about the importance and value of hypnosis in organic disease. These include the challenging question of the extent to which the use of hypnosis can potentiate the natural corrective forces of the body; the need to recognize the value of hypnosis in effecting beneficial results in organic disease; the need to qualify the reliability of hypnosis as a differential diagnostic procedure in relation to psychogenic and organic disability; and the possibility and extent of the amelioration or actual correction of known organic illness” (p. 254).
1962
Moss, C. Scott; Thompson, M. M.; Nolte, J. (1962). An additional study in hysteria: The case of Alice M.. International Journal of Clinical and Experimental Hypnosis, 10, 54-74. (Abstracted in Index Medicus, 62, 1425)
Detailed account of the psychotherapy of one female hysteric–a treatment failure–is the stimulant for discussion of the genetics and dynamics of this nosology. Hypnosis revealed the experimental basis for the symptoms and associated adjustment difficulties. The dynamics bear a remarkable resemblance to those advanced by Freud, though issue is taken with several psychoanalytic concepts. The discussion deals largely with the phenomenology of the female hysteric. (PsycINFO Database Record (c) 2002 APA, all rights reserved)
1961
Levendula, Dezso (1961). Two case presentations: Treatment of central pain with reconstruction of the body-image — hypnoanalysis of a travel phobia. International Journal of Clinical and Experimental Hypnosis, 9, 283-289.
NOTES
Uses analogy of phantom limb (hallucinated pain which is a central pain) with a multiple sclerosis patient who had ”excruciating” pain between her thighs despite paralysis from waist down due to multiple sclerosis. She valued her sex life though she couldn”t feel sexual response, and felt that she ”didn”t have any legs” and her husband ”had to carry her.”
In giving her history the patient noted an increasing numbness and weakness in her legs five years earlier. At that time she also entered menopause and developed severe vaginitis. She became depressed when she became increasingly unable control her excretory functions. As the pain in the genital region increased, her ability to feel pleasant vaginal sensations diminished. Ultimately the pain was continually present.
The therapist attributed her problem to a faulty body image because she “denied the existence of her legs which were actually physically present, although, she could neither feel, nor see, nor move them” (p. 285). Secondly, it was most necessary for her to hold on to the myth [sic], that her vagina existed, because it made her feel wanted and needed by her husband. She was unconsciously afraid that by giving up her vagina she would lose the most important bond between herself and her husband” (p. 285).
The therapist speculated that “the pain, which was the last sensation perceived before the total sensory loss occurred, was fixated centrally. This ”pain-image” served to maintain the pretense, unconsciously of course, that there was still feeling in the vagina even though it was only pain and not pleasure. The pain permitted her to avoid facing reality, just as in the case of an amputee who develops the fantasy of a phantom limb, because he cannot readjust his pre-existing body-image to the acceptance of mutilation” (p. 285). He offered the patient “the rather simple explanation… that because she really did not feel where her lower body ended or began, the pain served her need to know where the body halves were separated. If she could learn to imagine and to accept herself as a full, whole person, the pain probably would leave her. This theory seemed very logical and acceptable to the patient” (p. 285).
“Hypnosis was extensively utilized in the following sessions to regress the patient toward her youth. She went again for long walks with her boyfriend, now her husband. It was fun to re-experience the feeling of walking in her father”s apple orchard and stretch up for a red apple. Autohypnosis was taught and [he] told her to exercise ”walking” while hypnotized twice daily” (p. 285-286). He also tapped on the soles of her feet repeatedly, until she could localize the vibrations. “She finally learned that she did have legs and also that other sensations besides pain could originate below the waist…. Gradually with the acceptance of her ”wholeness and tallness” the pain became less and less. She was able to ”forget” the pain for a longer period of time. … Occasionally she does call. She tells [the therapist] that in a stressful situation, such as moving into a new house and not knowing where things are, the pain comes back temporarily, but it is much less and after [they] talk an hour she is relieved” (p. 287). The patient had a total of 20 visits.
The author describes a second case, which is not described in these notes.
1959
Hodge, James R. (1959). The management of dissociative reactions with hypnosis. International Journal of Clinical and Experimental Hypnosis, 7 (4), 217-221. (Abstracted in Psychological Abstracts 61:920)
A case report is given of an unusual type of dissociative reaction, and treatment by a variety of hypnotic techniques is described. A distinction is made between the emergency and long term asects of treatment by hypnosis, and emphasis is laid upon understanding the symptom and avoiding a too rapid challenge of the symptom. Special mention is made of the technique of predicting the future of the symptom” (p. 221).
“The patient was a 19 year old white Marine who became subject to hysterical seizures in which he acted the part of his own dog which had died several years before. The attacks occurred at irregular intervals; but when the patient was first seen they were occurring about twice weekly. During these seizures, which came on without warning, the patient would get down on all fours, bark and growl like a dog, attack ward personnel, paw at the floor, and respond to simple commands like those given to a dog such as ‘Down, boy’ or ‘Play dead’. He would become motorically hyperactive and sometimes pound his head against the floor or walls. The really dangerous act which he performed, however, was to attempt to gouge out his own eyes with his hands; and for this reason cuff restraints had to be applied during each attack. There were no methods, until hypnosis was tried, which could control or terminate these attacks, which usually lasted from 30 to 60 minutes” (p. 217).
Platonov, K. I. (1959). The word as a physiological and therapeutic factor: The theory and practice of psychotherapy according to I. P. Pavlov. ( 2nd). Moscow: Foreign Languages Publishing House.
NOTES
On pp. 75-76 the author discusses conditioning in hypnosis. Most of the theoretical material is in the first part of the book; the rest consists of case studies. He presents the position that the activity of the cortex and subcortex are different during states of waking and suggested sleep.
Note: Much of the Russian research done during “suggested sleep” involves subjects who are hypnotized for a long period of time–sometimes hours. Routinely, in treatment, they would give corrective suggestions and then tell the person to “sleep” and would leave them in the “sleep” for an hour or longer.
“Thus, it appears from the foregoing that the basic peculiarities of the activity of the cerebral cortex manifesting themselves in the state of suggested sleep are as follows: 1. In addition to the division of the cerebral hemispheres into sections of sleep and wakefulness typical of the hypnotic sleep of an animal, there is also a functional dissociation of the two signal systems and within the second signal system. 2. The activity of the second signal system under these conditions is not only confined to the narrow framework of the rapport zone, but is also frequently of a passive nature being directly dependent on the verbal influences of the hypnotist. Outside these influences there is no (or hardly any) activity. 3. A considerable increase in the coupling function with respect to the stimuli of the second signal system is noted at the same time in the rapport zone. This especially favours the formation of new cortical dynamic structures under the verbal influences of the hypnotist, these structures representing the physiological basis for effectuating the suggested actions and states.
“The foregoing peculiarities manifest themselves in the fact that the entire external second signal activity of the subject is reduced only to direct answers to the questions of the hypnotist with no independent reactions to any influences, including verbal, coming from other people (so-called isolated rapport). This is understandable, since the activity of the second signal system lying outside the rapport zone is inhibited” (pp. 73-74).
“As to the problem of the peculiarities of the conditioned reflex activity during suggested sleep, it will be noted that this problem has not been very extensively studied as yet. Nevertheless, the data of various authors are of indubitable interest, since they have revealed a number of specific peculiarities in the state of the higher nervous activity under these conditions.
“According to these data the conditioned reflex activity in suggested sleep undergoes certain changes. Thus, S. Levin observed in his early studies (1931) that in children under conditions of suggested sleep the motor and secretory conditioned reflexes elaborated earlier in the waking state grew very much weaker and that there was a dissociation both between the motor and secretory conditioned reflexes and between the unconditioned reflexes of salivation and mastication; he also observed the transitional (phasic) states–paradoxical, ultraparadoxical and inhibitory phases, all the way to the onset of complete sleep” (pp. 74-75).
Platonov indicates that conditioned reflexes may disappear during suggested sleep (Povorinsky & Traugott, 1936). Arousal from suggested sleep results in gradual restoration of the reflexes, with speech reactions inhibited first and restored last. Pen & Jigarov (1936) also showed that there is a weakening of conditioned reflexes, with increased latency, in suggested sleep. These authors showed that it is impossible to form new conditioned reflexes in deep states of suggested sleep, and the conditioning is difficult in lighter states.
“Y. Povorinsky’s data (1937) indicate that the conditioned reflexes elaborated in the waking state have a longer latent period during suggested sleep and in some subjects they are completely absent. Under these circumstances, the reactions to the verbal influences of the hypnotist are retained even during the deepest suggested sleep. The more complex and ontogenetically later conditioned bonds of the speech-motor analyzer are inhibited first as the subject lapses into a state of suggested sleep and are disinhibited the last as the subject awakens from this state” (p. 75).
“B. Pavlov and Y. Povorinsky observe (1953) that the conditioned bonds reinforced by the words of the hypnotist are formed during suggested sleep faster than in the waking state. In this case, during the somnambulistic phase of suggested sleep verbal reinforcements, as a rule, provoke a stronger and longer reaction with a shorter latent period than a direct first signal stimulus” (p. 76). The conditioning that occurs during suggested sleep does not manifest during waking periods unless suggestions are given during the sleep to react after wakening. The author takes this to be evidence that conditioned reflex activity can be modified by verbal suggestions.
During the somnambulistic stage of suggested sleep, subjects are less adept at performing addition. This indicates that inhibition has spread to the second signal system. However, inhibition of different sensory systems seems to vary from person to person. Krasnogorsky (1951) reported one subject did not react to light, but hearing seemed to be more sensitive than in the waking state.
“All of the above testifies to the considerable changes in the character of cortical activity regularly occurring during suggested sleep and determining, on the whole, the specific nature of higher nervous activity, the systematic study of which should be the object of further research” (p. 77).
1957
Schneck, Jerome M. (1957). An unusual conversion reaction during the induction of hypnosis. Journal of Clinical and Experimental Hypnosis, 5 (1), 39-40. (Abstracted in Psychological Abstracts 58: 1711)
NOTES
“A 27-63a4-old patient in psychiatric hypnotherapy had effectively entered a hypnotic state on initial induction with a two-stage hand levitation technique (2). At her second induction she started to enter a hypnotic state, yet her eyes did not close. She attempted voluntary closure unsuccessfully and then extricated ehrself from the procedure” (p. 39). The author opined that the interpersonal relationship of hypnosis was in this case affected by concerns about seeing or observing, or about being observed. He cites another case reported in the literature.
Schneck, Jerome M. (1957). Hypnoanalytic observations on the psychopathology of fainting. Journal of Clinical and Experimental Hypnosis, 5 (4), 167-171. (Abstracted in Psychological Abstracts 62: 3 II 67S)
NOTES
Summary
Varieties of fainting have been described as hysterical syncope, vasodepressor syncope, and carotid sinus reactions, among others. Fainting has been linked in general with personality problems, emotional instability, and immaturity. It has been called a mechanism for blocking of ego functions in its role of primitive defense against overwhelming stimuli. The present paper gives in greater detail the specific dynamics in a patient with fainting episodes. A crucial event incorporating major dynamic ingredients was an operative procedure in childhood. The psychological impact of this trauma was revivified during a spontaneous hypnotic regression. The personality matrix significant for this patient in relation to the fainting episodes consisted of passive, masochistic submission to a dominant, highly influential mother whose pressure was felt by the patient as pervasive and stifling. Circumstances associated psychologically with this feeling apparently triggered the fainting reactions. As he matured through the years and cast off increasingly this type of maternal influence, the tendency toward fainting reactions diminished” (p. 170).
Erickson, Milton H. (1954). Special techniques of brief hypnotherapy. Journal of Clinical and Experimental Hypnosis, 2, 109-129. (Abstracted in Psychological Abstracts 55: 2508)
NOTES
Author describes techniques used with patients who aren’t able, for internal or environmental reasons, to undertake comprehensive therapy, “Intentionally utilizing neurotic symptomatology to meet the unique needs of the patient” (p. 109). He provides 8 case reports.
Patient 1 was reassured, in hypnosis, that his arm paralysis was due to “inertia syndrome” which he would continue to have, but it wouldn’t interfere with his work.
Patient 2, also with arm paralysis had another comparable, non-incapacitating, symptom substituted.
Patients 3 and 4, for whome restrictions on therapy were the limits of time and situational realities, had their symptoms transformed (e.g. by introducing in hypnosis the obsessional thought or worry that he would NOT have the symptom for which he sought help).
Patients 5 and 6 were helped, through hypnosis, to symptom amelioration. (Patient 5 had an IQ of 65.)
Patient 7 “Therapy was achieved … by a deliberate correction of immediate emotional responses without rejecting them and the utilization of time to palliate and to force a correction of the problem by the intensity of the emotional reaction to its definition” (p. 121)
Patient 8 “the procedure was the deliberate development, at a near conscious level, of an immediately stronger emotion in a situation compelling an emotional response corrective, in turn, upon the actual problem” (p. 121).
1954
Malmo, Robert B.; Boag, Thomas J.; Raginsky, Bernard B. (1954). Electromyographic study of hypnotic deafness. Journal of Clinical and Experimental Hypnosis, 2 (4), 305-317.
Summary and Conclusions.
The main purpose of the present study was to investigate the question of similarities and differences between hysterical deafness, previously studied, and hypnotically induced deafness. The study was designed to repeat the objective physiological tests previously carried out with a case of ‘total hysterical deafness.’ There was also the more general aim of securing objective data to enrich our general understanding of hypnosis.
“Similarities between hysteria and hypnosis which we observed may be listed as follows: (a) Significantly reduced motor reaction (exclusive of blink) to strong auditory stimulation in the deaf state. (b) Complete hearing loss in the hysteric and in one of the hypnotic subjects, even with strong auditory stimulation (i.e., denial of any auditory sensation). (c) With elicitation of strong startle reaction to the first stimulus in the deaf state, much smaller reaction to the next stimulus than would have been predicted on the basis of habituation. (d) Suggestion of substitution of somesthetic for auditory sensations in all subjects (although this was much less definite in the hypnotic subjects than the hysteric).
“The most outstanding dissimilarity lay in the absence of emotional reaction when ‘hypnotic defense against sound’ was broken through, in contrast to marked affective reaction in the hysterical subject under these conditions.
“The qustion of inhibitory mechanisms in hysteria and hypnosis was discussed” (pp. 316-317).
COPING
2001
Yapko, Michael (2001). Treating depression with hypnosis: Integrating cognitive-behavioral and strategic approaches. New York NY: Brunner-Routledge.
NOTES