President-Elect Address

Academyof Psychosomatic
Medicine
28thAnnualMeeting

Hypnosis in psychiatry
and psychosomatic medicine
BERNICE C. SACHS, M.D.

Hypnosis is one of the oldest forms of psychological chotherapeutic procedure proved inescapable.
healing. From time immemorial, the induction of The past three decades have seen more research in
trance has been part of the mythical and occult prac clinical applications of hypnosis in all branches of
tices of shamans, medicine men, and witch doctors. medicine than any other period of history. Thanks to
What is now designated as hypnosis began in Western serious research and creative application by a growing
medicine 200 years ago with Mesmer, who was the first number of professionals, hypnosis has emerged as a
to attempt to explain the phenomenon. Mesmer be powerful treatment modality, and has been endorsed
lieved, alas, that health and sickness depended on the by medical, dental, psychiatric, and psychological asso
balance ofa universal invisible fluid in the human body ciations here and abroad. A 1978 survey showed that
and could be controlled by the use of magnets and one third ofAmerican medical and dental schools were
something he called “¿animalmagnetism.― His fame offering courses in hypnosis, twice as many as in 1974.
spread quickly, but only among the lay public. Approximately 10,000 physicians, psychologists, and
In 1784, a commission of the French Academy of dentists in North America use hypnosis in combination
Medicine proclaimed there was no such thing as “¿an with more traditional forms oftreatment. Hypnosis has
imal magnetism.― Mesmer was discredited and “¿hyp proved particularly valuable as a weapon against prob
notism―fell into disrepute in medical circles. lems that resist more conventional forms of treatment.
Thereafter, interest in hypnosis alternately waxed
and waned. Then World War II brought about the Nature of hypnosis
merger of hypnotic techniques with psychiatry to meet The hypnotic trance is now recognized as a fundamen
the need for rapid treatment of war neuroses. When tal ability of the human mind that can be attained to
hypnosis was combined with dynamic psychotherapy, one degree or another by the vast majority of people.
treatment time was substantially shortened. Hypnosis The patient enters an altered state of consciousness,
made it possible to cut incisively to the core of psycho characterized by extreme relaxation, in which there is
somatic disorders and its value as an adjunctive psy diminished peripheral awareness and intense focal
concentration—a state of alertness in which the mind
screens out extraneous matters and focuses on particu
Read as the address of the President-Elect at the 28th Annual
Meeting of the A cademy of Psychosomatic Medicine, No
lar details.
vember 2, 1981, Dallas. Dr. Sachs is staff psychiatrist and past Susceptibility to suggestion is increased. The hyp
chief of the mental health service at the Group Health Cooper notic trance allows patients to suspend logical reason
ative of Puget Sound in Seattle. Reprint requests to her there, ing and to abandon executive control to a more or less
200 15th Ave E, Seattle, WA 98112. - regressed, dissociative state. Hypnosis allows patients to

MAY l982@VOL23'NO5 523

 Hypnosis
draw on psychological strengths they do not normally
command voluntarily. It is a state of intense and sensi
tive interpersonal relationship between patient and
hypnotherapist. However, it does not involve relin
quishing one's will or being controlled by someone. The
capacity to experience hypnosis is inherent in the pa
tient: the hypnotherapist only provides the setting.
Use in psychiatric disorders
Psychotherapy has seen by far the widest and most
extensive application of hypnosis. The term “¿hypno
therapy― is used here to denote the use of hypnosis in
psychotherapy.
The use ofsuggestion techniques for the treatment of
mental illness was in vogue before the introduction of
psychoanalysis. Freud himself used hypnosis for a
while, but becoming dissatisfied with his results, he
sought other methods of treatment and developed
psychoanalysis.
Hypnosis is a clinical tool—not a method of treat
ment. Hypnotherapy is also active and dynamic, rather
than passive. It deals in a direct way with the subcon
scious part of the mind.
For change to be possible, the patient must experi
ence within himselfthe need to change. Susceptibility is
definitely enhanced by motivation. If rapport is es
tablished quickly, there is greater motivation. A healthy
rapport is necessary to secure the patient's cooperation
and to establish the hypnotic state. Hypnotherapy is an
art of interpersonal relationships; it increases the ca
p pacity ofthe patient to respond to ideas; it ideally lends
itself to the type of psychotherapy that involves guid
ance, reassurance, and persuasion in an atmosphere of
genuine interest and enthusiasm.
Goals of hypnotherapy are to relieve or to remove
symptoms, to help the patient make more realistic
adjustments to conditions that cannot be changed, to
effect a change in behavior that is acceptable to the
individual and to a social and cultural environment,
and to aid the patient in understanding, evaluating, and
handling his problems.
Hypnosis enables a psychiatrist to focus the patient's
intense concentration on certain areas with the purpose
of relieving major conflicts and debilitating symptoms.
The desired information can be reached more directly
through hypnosis than through the psychiatrist's de
pendence on the patient's free association with its mass
of resistances, irrelevant information, and conscious
censure. When the patient's intensified transference
and attention are focused on the treatment situation, an
524
atmosphere of receptivity enhances the capacity for
exploration and change.
Hypnotic techniques can be incorporated into any
psychotherapeutic approach. The choice depends on
the nature and duration of the therapy and the experi
ence of the therapist. In long-term therapy, hypnosis
can be effective in uncovering repressed material by
abreaction and explorative uncovering ofpast events. It
provides an effective means of overcoming blocks that
are encountered during lengthy and intense basic re
constructive psychotherapy. Hypnosis accelerates the
uncovering process. However, highly complex hyp
noanalytic procedures should be attempted only by the
well-trained hypnotherapist. Indeed, the applications
of hypnosis depend on the extent of the therapist's
training and ability to understand the needs and values
of the patient's symptoms.
While hypnotherapy may not help any more patients
than other forms of psychotherapy, it is less cumber
some and more rapid than most. Hypnosis is not
appropriate for all persons and all kinds ofproblems; it
takes a well-trained specialist to know when and how to
use it properly.
A knowledge of hypnotic techniques alone does not
form the basis for good clinical practice. These tech
niques must be meaningfully integrated into clinical
practice with emphasis on the basic psychodynamics of
human behavior and the patient-physician relation
ship. This relationship should be one of confidence,
trust, and cooperation on the part of the patient, and a
sympathetic, permissive attitude on the part of the
therapist. What is important is not the depth of the
trance, but the degree of rapport and emotional partic
ipation by the patient in the therapeutic process. The
therapist only “¿sets
the stage,―but ultimately it is the
patient who permits the hypnotic relationship to de
velop by selective attention. The important factors are
motivation, belief, expectation, imagination, and sub
sequent restructuring of the patient's reality percepts.
Use in psychosomatic disorders
Hypnosis is a uniquely effective tool for evoking deep
relaxation, thus neutralizing anxiety, fear, and tension,
and for intensifying receptivity to therapeutic sugges
tion. Relaxation induced by hypnosis is associated with
a generalized decrease in the activity of the autonomic
nervous system, thereby creating favorable physiologic
reactions.
Any clinical application of hypnosis in the practice of
medicine, by its very occurrence, is a psychosomatic
PSYCHOSOMATICS
event. It underscores a relationship between biologic
and psychological phenomena as they occur in and are
influenced by the physical and social environments.
The greatest effectiveness of hypnosis can be ex
pected in cases in which symptoms are primarily emo
tionally triggered rather than strictly physiologically
induced. Tension sponsors a host of physiologic symp
toms and interferes with the healing process in a variety
of illnesses. Those conditions that have responded fa
vorably to hypnotherapy include peptic ulcer, colitis,
anorexia nervosa, organic heart disease complicated by
fear and emotional disturbance, asthma, allergies, hy
pertension, migraine headache, and pelvic pain. There
is scarcely an ailment that is not aggravated by tension.
Teaching the patient to practice the same techniques
once or twice a day will often bring surprising health
dividends.
In addition to offering a useful technique for the
treatment of a broad spectrum of psychosomatic dis
orders, hypnosis can serve as a unique tool in the
treatment of sexual dysfunction, obesity, habit dis
orders, dermatologic disorders, and pain. A chronic
state of pain may occur in some individuals when
severe emotional stress, through psychophysiologic
mechanisms, produces skeletal muscle spasms, local
vasoconstriction, and visceral dysfunction. Hypnosis,
by producing mental and physical relaxation, can ef
fectively reduce pain or alter the patient's perception of
the pain.
It should be noted, however, that hypnosis is not as
likely to be useful against pain that seems to be pri
marily functional. If the pain does not serve a psycho
logical function, the use of hypnosis is safe and appro
MAY 1982 ‘¿VOL23 ‘¿NO5
priate. If functional, the pain may be protecting the
patient from some consequences he is seeking to avoid.
Therefore, it is first necessary to understand why the
pain is there and to treat underlying causes before
dealing with the functional pain through hypnosis.
Conclusions
The important thing about hypnosis is that it can be a
useful adjunct to conventional medical therapy.
Among its other distinct advantages is that it has
virtually no morbidity or mortality. Since it has neither
a physical nor a permanent psychological effect on the
body or mind, there is no way in which a person can
become addicted to it. Whether to undergo hypnosis is
always the free choice of the patient.
Twenty-five years after its controversial reintroduc
tion into medicine, hypnosis—that mystical art—has
turned out to be a surprisingly useful medical tool.
Hypnosis was “¿legitimized―
in 1958, when the Amen
can Medical Association stated that “¿the use of hyp
nosis has a recognized place in medicine and is a useful
technique in the the treatment of certain illnesses when
employed by qualified medical and dental personnel.
Hypnosis should be used on a highly selective basis by
such qualified individuals and should never become a
single technique used under all circumstances by the
therapist. No physician or dentist should utilize hyp
nosis for purposes that are not related to his particular
specialty.―
Hypnosis has been redeemed from its ill repute and is
here to stay. The reason that hypnosis has survived is
that it works—not with everybody, not with everything,
not always, but well enough to make it live on. D
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