Sunday, 12 January 2014

What is hypnosis? 3. Hypnosis: psychotherapy’s most powerful tool

Here is part three of our series of posts concentrating on hypnosis.

We have taken these posts from Chapter 4 of Ivan and Joe's book, Godhead: The Brain's Big Bang, so if you enjoy reading these posts, please pick up a copy of your own!

Part 1: Why all learning is post-hypnotic
Part 2: How we internalise knowledge 

PART THREE: Hypnosis: psychotherapy’s most powerful tool

As with any other scientific exploration, a close look at a relevant exceptional phenomenon can provide additional insights. Our field of expertise is psychotherapy, so we will start there.

In the 19th century, the major diagnostic label that was applied to neurosis was ‘hysteria’, which covered a range of psychological disturbance arising from trauma, and manifested in physical impairment, such as paralysis, blindness, deafness or anaesthesia. A physician in 1859 claimed that a quarter of all women suffered from hysteria. People who were described back then as ‘hysterical’ were those who often lost self-control due to an overwhelming feeling of fear.

Up until the 17th and 18th centuries, hysteria was thought to originate in the uterus, as its name implies (from the Greek hystera = uterus). Because of the extraordinarily varied nature of their symptoms and the suspected role of the emotions, patients suffering from hysteria and related ‘functional neuroses’ were often thought by both physicians and lay people to be experiencing merely imaginary diseases.

Gradually, however, by the 1840s and 1850s, hysteria had become a serious subject of study. A number of medical textbooks included discussions about it and highly detailed studies focusing solely on the condition were made. One of these was the Traité Clinique et Therapeutique de L’Hysterie, an 800-page tome published by Pierre Briquet, a medical doctor at the Hôpital de la Charité in Paris, in 1859. In it, Briquet presented data from studying 430 hysterical patients at the hospital over a decade. The famous French clinician Jean-Martin Charcot also became interested in hysteria and studied hundreds of patients hospitalised with the condition to try to pin down symptoms and clinical course.

All this interest in hysteria coincided with the beginning of European investigations into hypnosis. There were a number of researchers, including John Milne Bramwell, Pierre Janet and Josef Breuer, a colleague and mentor of Sigmund Freud, who demonstrated clearly that 50% of humanity are highly susceptible to hypnosis and a further 15 to 20% are capable of going easily into very deep trance states. It was further recorded that those suffering what they called ‘hysterical’ symptoms, for example hysterical blindness or paralysis as mentioned above, or multiple personalities, were only found among the subgroup of deep trance subjects. And it was discovered that if you put patients with hysterical symptoms into trance and had them recall the experience that triggered off the hysterical symptom, they would subsequently lose the symptom.
Josef Breuer’s patient, Bertha Pappenheim – ‘Anna O.’
Breuer, for example, reported this observation: “When, as a result of an accidental and spontaneous utterance ... a disturbance which had persisted for a considerable time vanished – I was greatly surprised.” Apparently a patient of his, Bertha Pappenheim, whom he referred to as “Anna O.” in his case notes, had suddenly found it impossible to drink water. But one day, under hypnosis, she recounted with anger and disgust how the little dog – “horrid creature” – of her lady companion had drunk water out of a glass in her presence. Pappenheim had said nothing at the time out of politeness, but after she expressed her feelings, including the disgust that she had held back, the symptom disappeared. Breuer and Pappenheim seized on this strategy and were able to dissolve a number of her distressing symptoms. “Each individual symptom in this complicated case was taken separately in hand; all the occasions on which it had appeared were described in reverse order ... When they had been described the symptom was permanently removed."

Freud was incredibly impressed by all of this, and thought he could perhaps build an entire psychology around it. For a while he used hypnosis with his patients and wrote a book with Breuer about their success. But Freud soon ran into problems when trying to cure people’s neurotic, phobic and trauma-induced symptoms in this way.

First, Freud wasn’t a good hypnotist, he didn’t understand that any method of focusing attention is hypnotic, so he could only get deep trance subjects into hypnosis with the crude directive methods he used such as getting patients to lie back, close their eyes and putting pressure on their forehead with his hands. Because he wasn’t getting the sort of quick cures that had occurred with Anna O., who was a deep trance subject, he became disillusioned with hypnosis as a mechanism for explaining what is going on in a human personality when problems emerge. Secondly, even when he did succeed in getting people into a degree of trance, very often his ‘one size fits all’ technique for helping forgotten memories rise to the surface again simply didn’t work. For many of his patients, whom he instructed under hypnosis to recover traumatic memories, such memories failed to readily emerge, so he couldn’t make them conscious of the origins of their symptoms and thereby effect a cure. Yet Breuer and other great experimenters with hypnosis at that time, being more skilled at inducing trance, did produce cures this way and had far more success with it than Freud ever did. Freud was, however, right in his observation that the majority of people don’t easily get into a sufficient depth of hypnosis where they can recall the experiences underlying their neurotic symptoms.

Freud gave up hypnosis, including the concept of self-hypnosis, although it is now widely appreciated that the ‘free association’ technique he developed to access and influence the unconscious was trance-inducing: “... the mechanism of hypnosis is so puzzling to me that I would rather not make use of it as an explanation.”

Because psychoanalysis didn’t seem effective, American psychologists who had been studying how to modify animal behaviour developed a school of psychotherapy based on the notion that problematic symptoms occur because they are conditioned behaviours programmed into our brain. This was behaviourism, launched on the world in 1913 by John B. Watson in an article in the Psychological Review, ‘Psychology as the behaviorist views it’. The programming, behaviourists said, was the result, primarily, of either reward or punishment, or sometimes by what they called aversive conditioning, which is when you remove yourself from an unpleasant experience – such as by running out of a supermarket because you were having a panic attack. The behaviourists found that they could often ‘decondition’ behaviours and had more success in treating people than Freud and his followers ever had.

However, leaving the behaviourists aside for now, imagine yourself in Freud’s shoes for a moment. When he found that hypnosis was not helping the majority of his patients, what was he to do? In facing this question he hit upon the idea that hypnosis wasn’t really connected to why people get neurotic symptoms. Instead, he decided, it must be because they were repressing unpleasant feelings and those feelings festered inside them in their unconscious mind. His suggestion was that neurotic symptoms came about when those festering feelings, by circuitous and devious routes, finally emerged.

It was this idea that led him to develop free association, whereby he encouraged his patients to maunder on about whatever came into their head. Every so often, the perceptive psychoanalyst, he believed, would be able to spot in some spontaneous utterance a connection to his theories – wish fulfilment, castration fears, mother-loving desires and so on. And then the psychoanalyst could feed back to the neurotic patient that this was the real cause of their problem.

Of course, as most people now know, that didn’t cure neurotic patients either. Even Freud admitted that his psychoanalysis made no difference for most clinical problems and that the best that such an approach could really aim for was perhaps to produce some measure of reduction in his patients’ suffering from “hysterical misery into common unhappiness” (a curious sort of promise to attract so many followers). We would now say, of course, that when he did seem to help someone it was more likely to be because he was simply giving them concentrated attention, which in itself is known to be therapeutic if the therapist is sincere.

Thanks to our greater knowledge about the way emotions arise, we know why Freud, and the many well-intentioned schools of psychoanalysis that followed him, were barking up the wrong tree. Despite making useful observations – about how the way children are brought up has an influence on later behaviour, for instance, and how many of our behaviours are driven by processes of which we are not conscious – psychoanalysis didn’t seem to be very efficacious, and the world still lacked an explanation for neurotic symptoms.

It was the early French hypnotherapists in the 19th century who were on the right track when they discovered that profoundly disturbing symptoms could easily be induced in the 15 to 20% or so of people who are good hypnotic subjects. These symptoms arose when they went into hypnotic states in unpleasant situations or when they perceived something happening to them as being life-threatening, resulting in the cluster of symptoms we now call post-traumatic stress disorder (PTSD). However, since the majority of people don’t appear to go into that depth of trance so easily, or far enough to summon up the feelings on which their symptoms were based, it still did not explain how the majority of people get neurotic symptoms. And, perhaps more importantly, it didn’t explain how to cure them.

Brilliant though these pioneering hypnotherapists were, we can now see what it was that stopped them from making a breakthrough with this question and thereby massively improving psychological interventions for patients in treatment. They were confusing two different things: the ability to go into deep hypnosis as their hysterical patients did, and the ability to go into spontaneous hypnosis at the occurrence of symptoms.

There are good reasons to suppose that these are two entirely independent traits. You can be a poor hypnotic subject, for example, and yet be profoundly susceptible to hypnosis in certain situations if the right fight or flight trigger is fired (due to some perceived danger) or a particular reward or punishment trigger is given. All of us are deeply susceptible to falling into hypnotic states when certain environmental conditions are present. (Think of how easily a little craving develops and saliva is generated in the mouths of millions of us simply by hearing the word ‘chocolate’!) We only differ in the degree to which we can spontaneously do this to recall the founding memories that started the symptoms off in the first place.

In other words, everybody has a storehouse of memory patterns hypnotically programmed into us that impacts on our daily lives. Deep trance subjects just find it easier to access these than the rest of us. Hence, when Breuer and his colleagues put people into trance and told them to ‘remember such and such an experience’, most of them couldn’t. But this does not prove that the hypnotic store where salient memories are programmed deep inside our brain does not exist. It most certainly does, in all of us.

Nature evolved our memory system as a protection, a survival mechanism, because anything that gives rise to the fight or flight response is potentially significant and memories associated with a pattern-match might be life-saving. So lots of times when we get angry, hyper-vigilant or frightened, the pattern-match is perfect. Our ordinary life experiences teach us that there are times when we should get angry or anxious, or at least become very, very careful. However, it is also clear that a lot of patterns that were coded in when we were young, or when our emotional brain misunderstood a situation, will later make unhelpful pattern-matches. When this happens, the pattern-match is too crude to match closely to later circumstances; but the emotional brain misunderstands the situation and, instead of conjuring up appropriate reactions, produces neurotic ones.

In treatment for neurotic symptoms with patients who are not good hypnotic subjects therefore, we can’t do what the early hypnotherapists had hoped would work and just say to a person, “Your reaction to this stimulus is excessive. Go back to the memory that caused it.” Although a patient can go into a relatively light trance state, that in itself doesn’t automatically open up the hypnotic memory store. That can only be done with deep trance subjects who are easy to hypnotise.


Next post: Conditioning


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