Hypnotherapy: recruiting the healing potential of the mind.

Charcot’s demonstration at Hopital La Salpetriere. 

Hypnosis is an altered state of mind, which captures the imagination and brings about changes in perception and behaviour.  We are all susceptible to hypnosis.  Brief states of hypnosis may occur spontaneously in all of us many times during the day, but more prolonged episodes may be induced by a traumatic event or by a particularly charismatic person or situation.  The phenomenon has been known for centuries.  The Delphic oracle, shamanic performances, religious ceremonies, exorcism, inspiring speech by a military leader before battle, the entreaties of a lover; these are all examples of hypnosis.  But it is only in the last 200 years that hypnotherapy has been accepted as a medical intervention.

It all started in 18 century France with Mesmerism.  Franz Anton Mesmer was a consummate showman.  For his public demonstrations, he would dress up in a cloak and pointed hat covered in moons and stars.   His patients, nearly all comely young women, would sit around a tub of water containing magnetised iron filings.  Metal rods of various shapes protruded from this container and were applied to the part of the body that was sick while the master made passes with his hands to attract the magnetic force.  His results were remarkable. Patients afflicted for years with a variety of illnesses improved, though there was more than a whiff of scandal about his methods.

Some fifty years later, the Scottish surgeon, James Braid, disproved animal magnetism by showing  how people could be encouraged to enter a receptive trance-like state by simple fixation on an object.  Later still, the famous French neurologist, Jean Martin Charcot, used hypnosis in his public demonstrations of people with the multiplicity of illness that he diagnosed as la grande hysterie.  Charcot, with his heavy brow and serious demeanour, defined rules for the illness and the patients complied with his suggestions and got better. Although Sigmund Freud attended Charcot’s demonstrations, he later abandoned hypnotherapy in favour of psychoanalysis, which replaced post hypnotic suggestion with psychoanalytic interpretation.

What is Hypnotherapy?

Hypnotherapy might be defined as a skilled verbal communication which helps direct a client’s imagination in such a way as to bring about intended alterations in sensations, perceptions, feelings, thoughts and behaviour. In the classical method, hypnotherapists induce a trance like state of relaxed and focussed attention using calming mental imagery,  progressive muscular relaxation and a slow repetitive vocal cadence.   While in this state, suggestions implanted by the therapist are used to alter bodily sensations and functions.  Hypnotherapy can slow the heart, reduce the blood pressure, alter the electrical activity of the brain, reduce pain, relax muscular tension and regulate gut function. Women have even undergone childbirth without fear or excess pain while under hypnosis. Nevertheless, hypnosis has never quite escaped its reputation for mind control, a belief no doubt fuelled by television hypnotists and films such as Svengali and The Manchurian Candidate.

There is no magic to hypnotherapy.  It is the attention, expectation, anticipation and imagination of the patient that produces the hypnotic effect.  The therapist is the catalyst. Patients just have to be open to suggestion. Hypnotherapy captures the imagination of the ill person and creates the expectation of cure.  It is said to work best if the therapist is confident and the patient can trust them.   The crucial element is motivation. Without the will to overcome the problems, hypnotherapy is not likely to be successful.

Contrary to popular belief, people are not asleep during hypnosis; they don’t even need to be in a trance; they are quite focussed and aware.  Although people often fear they will lose control,  hypnotherapists assure their clients that they cannot make them do anything they do not want to.  They also assert that it is not possible to get stuck in hypnosis. As with sleep or daydreaming, people emerge naturally from hypnosis, particularly if there is a need to do so.

Hypnotherapists treating people with IBS do not usually employed regression in order to bring past traumas back to mind.  Such techniques are unreliable and could be dangerous. Memory is malleable and subject to revision and invention. Under hypnosis, some may fabricate false memories that may seem to explain the way they are.   Moreover, exposure to previous trauma, even imagined, risks re-traumatisation.

Bowel Directed Hypnotherapy.

It was a colleague of mine, Dr Peter Whorwell, who first startled the senior members of the British Society of Gastroenterology with his demonstrations of hypnotherapy for IBS.  Peter, now a Professor of Gastroenterology at the University of South Manchester, developed the technique, he called bowel directed hypnotherapy to alter gut function, relieve pain and regulate bowel habit.  When his patients were deeply relaxed, he encouraged them to relieve their abdominal pain using the warmth of their own hand resting on the abdomen and to regulate their bowel function  using the metaphor of a river.  If his patients were constipated, he encouraged them to imagine a  highland stream where the water is clear and tumbling merrily over rocks.  If they had diarrhoea, he slowed the river down and let it meander gently though fields.  He then implanted post hypnotic suggestions like ‘whenever you feel the pain, just lie down and put your hand on your stomach, feel the warmth and it will go away’.

Bowel directed hypnotherapy works; often quite dramatically.  It is particularly useful for relieving abdominal pain and bloating and said to be more successful for IBS patients with diarrhoea than it is for constipated patients.  Whorwell does not advise it in patients with severe psychological problems. In a recent audit of a thousand people who had undergone hypnotherapy for IBS, Whorwell showed that the IBS symptom severity score substantially improved in 76% of patients and pain days fell from 18 to 9 per month.  The prevalence of anxiety and depression was also halved.  I learnt Whorwell’s technique over a training weekend for gastroenterologists in a pub near Bolton.  The first time I applied it to one of my constipated patients, he had such a merry attack of diarrhoea that he was unable to leave the house for three days.

Ericksonian Hypnotherapy

The American psychiatrist, Milton Erickson, claimed that teachers, priests, politicians and advertisers are perhaps best at getting people to act on instructions and suggestions but their coercion may encourage resistance. Erickson did not follow a prescriptive method of induction and direct suggestion. He favoured a more conversational model of hypnotherapy, making indirect comments that seemed to resonate with his patient’s experience, suggesting that they might want to do something rather than instructing them to do it.  The unconscious mind, he suggested, responds better to opportunities than orders.  Erickson encouraged therapists to develop what he called ‘artful vagueness’, using metaphors to construct gaps in meaning for people to fill with their own suggestions.  This technique, however, is somewhat demanding for the hypnotherapist and most find it easier to use the classical method.

Erickson further claimed that a trance like state does not necessarily need to be induced by the therapist.  We all tend to slip into and out of altered states of consciousness during everyday rituals, daydreams, exercise or when we are absorbed in listening to music or watching a film; anything that induces a sense of wonderment or engrossment.  The therapist may be able to use these states to the patient’s advantage    In hypnosis, it is the imagination rather than the intellect is active.  This sounds very similar to ideas of Mindfulness, as a cognitive-emotional  space where ideas may form and take root.   But such states are not always positive.  They can occur in traumatic circumstances.  When parents get angry with their children and tell them they are clumsy or stupid, they are creating a gap in their consciousness containing a descriptor that may characterise them for life.

At every age, we create different models of health according to what is in fashion.  Our current  model is evidence-based, but that has its own persuasions and limitations.