TRIBUTE TO WILLIAMS J. BRYAN JR. (1977)
WILLIAM J. BRYAN JR. M.D., (died 1977) founded the American Institute of Hypnosis and became its first president, on May 4, 1955. It was founded to be an educational body devoted to promoting all the phases of hypnosis in field of medicine and dentistry. In so doing, the Institute was founded to fill a gap that existed in that area. The Institute had member from the field of medicine, dentistry, psychology, psychiatry, theology and other professional people. Its growth was rapid and become the world's most respected educational institution devoted solely to teaching hypnosis in medicine and dentistry to physicians and dentists all over the world.
1. GORDON BOYD’S TRIBUTE TO WILLIAM J. BRYAN, JR
2. NOTES FROM RELIGIOUS ASPECTS OF HYPNOSIS: WILLIAM J. BRYAN, JR
3. HYPNOSIS AND THEOLOGY: WILLIAM J. BRYAN, JR
4. THE USE OF PARABLES IN HYPNOTHERAPY: WILLIAM J. BRYAN, JR.
5. HYPNOSIS IN ANESTHESIOLOGY: WILLIAM J. BRYAN, JR
6. HYPNOSIS IN THE TREATMENT OF BURNS: WILLIAM J. BRYAN, JR.
1. GORDON BOYD’S TRIBUTE TO WILLIAM J. BRYAN
PUBLISHER’S (GORDON BOYD) PREFACE TO THE SECOND EDITION OF RELIGIOUS ASPECTS OF HYPNOSIS BY WILLIAM J. BRYAN, JR.
This book had to be in print. I first devoured it when as a young minister I redeveloped a childhood interest in hypnosis. Then there was precious little religiously oriented therapists could find blending therapeutic trance studies with a spiritual framework. Morton Kelsey's Hypnosis and Pastoral Counseling was one happy exception. No supportive organizations such as the N.AC.H. (The National Association of Clergy Hypnotherapists) existed. Alone, seeking hypnosis training from those who sometimes disdained religion, and in a religious framework that sometimes viewed hypnosis with horror, I found Bryan's Religious Aspects of Hypnosis to be a real friend!
William Bryan, grandson of William Jennings Bryan, was a medical doctor, a minister, and an attorney. Those who had the privilege to watch his hypnoanalytic work hailed him a master. His writings reveal his grand vision of life's interconnectedness. Religion, science, law; all these were related aspects of the magnificent gift of life. Part of Bryan's genius was his appreciation for "Mind-Body" unity. His articulation of the "wholistic" approach to therapy anticipated the psychobiologists and their understandings of the "transduction" of mental-physical energies. His approach also naturally triumphed the unfortunate Cartesian difficulty permeating much contemporary epistemology. Hypnosis, in his thinking, permitted the empirical and the mysticspiritual to coexist. One could be a rigorous scientist and have a heartfelt faith. These considerations had intrigued me since my seminary days when I encountered Gilbert Ryle and Michael Polanyi. My studies in the field of hypnosis were the perfect compliment to a multidimensional model of human knowledge. Not only did Bryan confirm some of the finest thoughts in these areas - he applied them practically and powerfully in the fields of psychotherapy and hypnoanalysis.
I've been a pastor in churches of two denomination for much of my professional career. My interest in counseling stems from experiences in "Clinical Pastoral Education" at Eastern State Hospital and the Alcoholism Recovery Community in Lexington, Kentucky. When therapeutic trance became part of my pastoral counseling the results sometimes surprised me. rve seen cancer patients manage pain that drugs failed to alleviate and people crushed by life's traumas rise up to a new life. My own life has been greatly "touched by grace" through therapeutic trance. How regrettable to see the degree of superstition still existing in our churches. The couple who wrote to my denominational superior that I was "of the devil" because I used hypnosis had obviously never stood in the shoes of someone greatly helped through it. Many clergy colleagues share similar experiences. Hopefully, the republishing of Religious Aspects will shed some light where misunderstanding abounds.
Among those who may profit from Bryan's classic are religiously oriented therapists, non-religiously oriented therapist who deal with religious folks, or anyone seeking to understand a little more of the magnificent gifts of creation and the human mind. This work was important enough to me to see that it was available again. The perspectives on hypnoanalysis are valuable enough on their own to merit republication. It is an honor to follow in the footsteps of Charles Thomas Publishers who demonstrated foresight by publishing Bryan in the first place.
2. NOTES FROM RELIGIOUS ASPECTS OF HYPNOSIS: William J. Bryan, Jr. M.D. (no date) Access Books. Ann Arbor, MI):
Since in a state of hypnosis, a person's eyes are closed, the popular misconception that the subject is no more asleep in hypnosis (just because his eyes are closed) than you are asleep in church when you are standing in prayer with your eyes closed and head bowed. You are actually in the same state, a state of hypnosis, a state of monoideaism, in which your one idea and thought is (or at least should be) concentrated on God. Let me state categorically, that from the beginning of time no subject under hypnosis ever loses consciousness unless, of course, he goes to sleep, in which case he is not hypnosis.
Hypnosis is produced by the presence of two conditions: (1) a central focus of attention, and (2) surrounding areas of inhibition. The state of hypnosis, in turn, produces three things: (1) an increased concentration of the mind; (2) an increased relaxation of the body; and (3) an increased susceptibility to suggestion. (p.5)
It is important, however, for the layman to understand that hypnosis is a normal phenomenon available to all. It is neither black-magic or witchcraft; but, on the contrary, a state of extreme concentration which, when focused upon God, enables us to become close to Him and experience emotionally the great spiritual truths which we have been taught on a purely intelligent basis.... Hypnosis, however, is more than just an altered state of consciousness, just a religion is more than a state of mind. Hypnosis is a method by which we can investigate the deeper part of the mind, that part from which we normally cannot extricate memories in the waking state. (p. 6)
THE CATHOLIC FAITH: The late Pope Pius gave his approval to the use of hypnosis on several occasions. He stated that the use of hypnosis by physicians and dentist for diagnosis and treatment was permitted, but that it was not permitted for Catholics to be enter into hypnosis for entertainment purposes. In an article entitled, "Hypnosis as Anaesthesia" by Reverend Gerald Kelly, S.J., that appeared in Hospital Progress, in December, 1957 issue, he list the following quotations: The first quotation from the Vatican is from an address given to an audience of physicians on January 8, 1956, on the use of hypnosis in childbirth. Reverend Kelly summarized the Pope's three cardinal points as follows: (1) Hypnotism is a serious scientific matter, and not something to be dabbled in. (2) In its scientific use the precautions dictated by both science and morality are to be heeded. (3) Under the aspect of anaesthesia, it is governed by the same principle as any other from of anaesthesia." This is to say that the rules of good medicine apply to the use of hypnotism; and in so far as it use conforms to these rules, it is in conformity with good morality. (p. 11)
THE JEWISH FAITH: There have been no objections to the use of hypnosis in the Jewish faith to date, provided that hypnosis is used as a medical tool for the benefit of mankind. Rabbi Glassner is perhaps the most famous Jewish religious leader who has been familiar with hypnosis and hypnotic techniques and utilized them in his work. In fact, Rabbi Glassner, a doctor of education, has lectured at various seminars throughout the country on the subject of hypnosis and religion to various physicians and dentist. (p. 12)
THE PROTESTANT FAITH: There have been no objection by any of the main Protestant Church bodies, to the use of hypnosis in medicine and dentistry, and the question of healing has been left largely to the medical profession with, of course, the one principle expectations reserved by all faiths, and that is the power of prayer. (p. 12-13)
Nevertheless, there are two churches which are commonly associated with the Protestant faith, which have been opposed to the use of hypnosis in the past. One church has since modified its ideas somewhat, but the other apparently remains unalterably opposed to it.
The first group are the Seventh Day Adventists, whose Washington spokesman, R. L. Odum, stated at one time that he believed no should exercise his will to control the senses of others, since Jesus said, "Come unto me all ye that labor" (Matthew 11:28). Since that time a great deal more has been learned about hypnotism, and those persons who have been responsible for church policy and medical policy regarding the church have gained in their knowledge of hypnosis. They have realized that the complete control of the will is never attained in the hypnotic trance, and that one is free to accept or reject suggestions as he wishes.
Realizing that accepting suggestions necessary for pain relief is both beneficial and worthy contributions to medical science, the Seventh Day Adventist's medical school in Los Angeles, commonly known as the College of Medical Evangelists, has instituted "relaxation therapy" in some of their outpatient clinics, and it has been used by a number of Seventh Day Adventist physicians in the administration of anaesthesia, although it is seldom called by the name "hypnosis." It would seem that as greater knowledge of the subject is uncovered, it should gain greater and greater acceptance among those of the Seventh Day Adventist faith. I deeply question the basic premise of Mr. Odum on the grounds that Jesus never said, "Come only onto me"; and there many references where Jesus himself employed other to utilize his techniques for the benefit of the sick. One such example if His use of the Centurion (Matthew 8:1) (p. 13)
The Christian Science church is the only church, to my knowledge, which still remains unalterably opposed to the use of hypnosis; although occasionally some articles denouncing hypnosis has appeared in the Watch Tower, which is a publication of the Jehovah's Witnesses. It should be said that Jehovah's Witnesses is a denomination in which the members are unalterably opposed to blood transfusions, on the basis of a direct quotation from the Bible which they believe prohibits its use. Nevertheless, there are a good many Jehovah's Witnesses who have experienced the benefits of hypnotism and who praise its use. Despite the fact that some are against it, there is nevertheless no national policy of the Jehovah's Witnesses barring hypnosis in medical treatment. (p. 13-14)
Returning to the problem of the Christian Science church, one may perhaps understand their point of view if we examine, carefully, the origin of their religious beliefs. Mary Baker Eddy, who founded the Christian Science faith, obtained many of her ideas from Phineas Quimby, who was a stage hypnotist of that era. Phineas Quimby, himself, was a very interesting and unusual personage, who not only give Mary Baker Eddy most of her ideas for founding the Christian Science religion, but also founded a number of other faiths of his own, including the Unity Movement.
Being sickly most of her life, she consulted a Dr. Phineas Quimby, who had acquired some local fame for his cures through the use of hypnotism. In October of 1862, she went to his office, a rather pitiful figure. Three weeks later, in a letter published to the Portland Courier, she declared that by virtue of the great principles discovered by Dr. Quimby, "who speaks as never a man has spoken and heals as never a man has healed since Christ," she was on he way to complete health. She returned to her sister's home a confirmed disciple of Quimby.
In 1866, Quimby died, but, continuing his work, she taught and wrote regarding "the science of the Mind." Her first students paid her $100 for their lessons (a tidy sum in those days). She later raised the fee to $300 for twelve lessons, dropped Quimby's name, and used her own exclusively in writing and expounding the metaphysical theories which were to become the doctrine of the Christian Science Church. (p. 15)
It is my personal belief, therefore, that in her zeal to gain acceptance for her new religion, Mary Baker Eddy found it necessary to divorce herself entirely from the mysticism which had grown to surround hypnotism as used on the stage during that particular period. Without doing that she would have been unable to gain the support of other members dedicated to her faith. Therefore, even though she herself recognized that many of the techniques used the Christian Science Church itself were actually the same as those used then by many stage hypnotist, and that by various methods of concentration one was expected to bring about changes in mental and physical health (which is the exact method of using hypnosis in medicine today), she nevertheless had to denounce the very thing which she was advocating in order to gain acceptance for her particular faith.
OTHER FAITHS: Many of the faiths of the Far East have not only approved the use of hypnotic techniques, but actually depend upon them to a great degree; both in the training of their priest and in the maintenance of control over their congregations. Buddhist and Moslems have no laws against the use of hypnosis.(p. 16-17)
Many element of hypnosis remain in our religion today. The chanting, testimonials, the flickering candles and the cross as a fixation point for our vision; the relaxation of the rest of our body; the bowing of our heads in supplication, the silence in the Friend's meeting; Kavanah in Jewish mysticism; the preparation for prayer; the rotation of the body in the synagogue, and the effect of prayer on those who offer it, are all examples of hypnotic techniques which have been accepted as part of our worship. (p. 25)
3. HYPNOSIS AND THEOLOGY: WILLIAM J. BRYAN: JOURNAL OF THE AMERICAN INSTITUTE OF HYPNOSIS: 1968:
From time to time, special issues of the Journal of the American Institute of Hypnosis have appeared. The first special issue was on the history of hypnosis and other subjects have from time to time been of such import that we felt a special issue was warranted to call to the reader's attention the importance in value of some particular perspective or viewpoint of the field of hypnotism.
Actually, the origin of both ancient and modern therapeutic usage of hypnotism is theological. The first doctors were actually priests, and in the most primitive societies today, the priest or witch doctor performs both the services of a theologian and a physician. This is clearly evident in the first writings about the phenomena of hypnotism which appeared on the Ebers papyrus in 3,000 B.C. The Egyptian sleep temples, which existed primarily to cure physical illnesses, were run by priests. It was only with the increase of scientific knowledge and medical exploration that specialization began to occur, and the specialists in healing the spirit became known as ministers and the specialists in healing the body became known as physicians. The area of the mind was left largely to the spiritualist except when some anatomical reason could be ascertained for the symptoms ( such as a brain tumor) Here the neurologists eventually exerted their influence to claim this specialty.
When Freud, the neurologist, began to invade the study of the mind, ministers, who had already been at work for thousands of years, were forced to relinquish a certain portion of their specialty, but the medical profession was still not accepting a scientific investigation of the energy of the brain even though the anatomy of its mass had been well known for years. Many ministers, on the other hand, fought the intrusion of scientific investigation into matters they considered to be strictly theological.
Yet, it was Father Gassner, a Catholic priest living in a small Swiss village near what is now called Kloisters, who was the predecessor and teacher of Mesmer and who convinced him that there was indeed a subconscious force in the mind of tremendous proportions which could be harnessed for the patient's benefit. The priest called it God; Mesmer called it magnetism; Braid renamed it hypnotism, and modern theologians call it Faith.
A few years back, at my suggestion, the American Institute of Theology and Hypnosis was formed and fellows of this organization printed the appropriate initials behind their names, which spell out the word FAITH. These individuals include such brilliant men as the Most Rev. Dr. L. D. Canon Gottschall, Bishop of the Episcopal Church; Bishop Basil, a Doctor of Philosophy and a Bishop of the Greek Orthodox Church; Dr. Paul Adams, Doctor of Philosophy and Divinity and Pastor of the largest Baptist church in the Detroit area, author of "The New Self-Hypnosis, " and director of a hypnosis guidance clinic; Rev. John Whitehead, eminent pastor in Florida, the first man to record the Holy Bible in its entirety and present it on long-playing records, author of numerous articles on hypnosis; and many others.
These brilliant men have formed a nucleus around which other theologians may very well gather in the scientific exploration of the deepest part of man's subconscious, at the very foundation of which lies man's creator. Both medical and theological researchers in hypnosis have proved that while man's behavior must invariably in part be sinful due to his "fallen past," his composition brought about by his creator is good.
By concentrating on our composition rather than our behavior, we are thus able to bring forth the noblest works of man because these works do not represent man's behavior but represent the work of God acting through a man who has so hypnotized himself as to make his body available to the spirit of his creator.
Freud has postulated that the only way that psychiatric treatment could ever be available to the masses of people would be through the use of medical hypnotism. I believe that the only way in which large masses of people can ever be brought back to God is by means of theological hypnotism. This is what Christ meant when he suggested to his audiences that one could reach the Father only through him. He did not mean that only those people who lived during his lifetime on earth would be saved. He meant that through the methods which he used, We would use also, and he predicted that greater works than he did, We would do. These works can only be accomplished by the hypnotic techniques of laying on of hands, concentrating the mind, and believing, for the just shall not live by the law nor under it, but by faith, and salvation is not accomplished by good deeds but by belief- belief brought about by faith, that faith which worketh by love publishing Bryan in the first place.
4. THE USE OF PARABLES IN HYPNOTHERAPY: WILLIAM J. BRYAN, JR. JOURNAL OF PSYCHOPHYSICAL SCIENCES AND HYPNOSIS: 1969:
I. Introduction: Parables have been in existence for thousands of years, indeed almost as long as man has been able to talk. Jesus taught in parables because he realized that the individual might have such a block to his own situation that he would clam-up and you would find yourself as an analyst with a brick wall in front of yourself. On the other hand, if the patient can be taught by a means of a parable, he can see the situation and how it applies to himself and can more readily accept it. The purpose of this paper is to bring to your attention some parables which, if utilized correctly, will bring excellent results in obstreperous patients who are either showing no progress or having a great deal of difficulty with their problem.
II. When are parables better to use than plain language. Some times parables are clouded in flowery language. This may need to be done in order to conceal from the patient the true nature of the parable giving him time to work itself out, but this is not the better or more frequent use of parables.
III. When is it better to use the plain language. The "plain language" that one uses is the language of the patient and, therefore, is most easily understood by the patient even though, of course, as Kovzibsky and Hiakawa have pointed out, your idea of a thing can never be exactly like anybody else's idea of a thing because of the
IV. Utilizing the word "you" and utilizing the word "I" and which is appropriate when. Sometimes you may need, in order to achieve the results (and I have always been pragmatic), to use the word "you," and sometimes it is better to use the word "1." This is particularly true when one is relating a story about themselves in an effort to influence the patient to emulate the behavior of the doctor.
V. The Story:
A. How to tell it: It is important to realize that if the story is to be accepted by the patient, it must be told with absolute sincerity. If there is any doubt about this, all you have to do is look up the technique of the "con-men " who have been jailed for the misuse of "the story. " They weave around a story and are able to make old ladies give up millions, to influence minds to do things that in their right mind they would never do, and many other despicable things. The story has a positive side to it. You can actually talk a person into getting well, and it is to this end that we address ourselves.
B. Length of time:
I. Long: Sometimes a long story is necessary, especially if you want to weave in and come in slowly by bringing up a subject that has absolutely nothing to do with the patient's history. It sort of puts the patient at ease; and you weave from that subject closer and closer into the analysis of the patient, and then you inform him that you haven't been just sitting there talking all this time for nothing, that this really applies to him, and don't you realize it? By that time he will say, "yes, I do, Doctor."
2. Short: Sometimes just a quick short story will make all the difference in the world between success or failure in hypnosis. Sometimes a quick command of only one word will bring about the desired result, and the patient will perform as he should perform, adequately and efficiently just by one simple word or act.
An example of this was a case of a man who had asthma for a long time; in fact, ever since he left a particular clinic. He had a small skin cancer removed at that clinic, and he was given the card that if he had any recurrence, he was to call that clinic back. I asked him about his illness, realizing that he was simply wheezing to make sure he was still alive. I pointed out to him that it had been ten years since his original visit to the cancer clinic, and he had no more cancer and did not need the doctor's card. I took out the doctor's card and ripped it into little pieces before his eyes and threw it in the waste basket. I said, "now that is the end of it, you've given up worrying about cancer, and consequently you've given up your other symptoms as well" and the patient was cured .
C. Examples of stories:
1. The "I had it" story In the "1 had it" star the doctor weaves around a story which he explains to the patient that he actually had suffered fro the same disease, and really it makes no difference what that disease is or whether you had it or not but merely that you convince the patient that you had it, and, of course, there are some things yo just cannot use. For example, if you were a male physician, you cannot tell the patient that you've had trouble with your periods like she has because the credibility gap would be just too great, to say the least. Frequently you can say "You know, when I was a boy I had that problem, too, and here how I overcame it, and I'm not saying that you can overcome it in the exact same way, but it doesn't hurt any to give it a try, so why not? It worked for me, and maybe it will work for you."
2. The next story is the "I had it worse" story. This is a situation in which the doctor not only had the patient's problem, but he had complications far worse than the patient; and he recovered. Therefore, the patient should quit crying about his own predicament and get to work and do something about it. It's like the man who cried because he had no shoes until he saw a man who had no feet, and it works very well on occasion.
3. The "others have had it" story: This story is the story that you tell and is really part of No.9 "all the patient's I've seen" story, but not quite because it's "all the others that have been cured that had it" story and there's no reason to suspect that you can't do as well as they have. The others got well, and you can, too. I frequently use a little parable saying that "1 cannot guarantee you a cure, but if I know you have appendicitis, and I remove the appendix, I know that you're going to get well unless you've had some rare allergy to the anesthetic or unless some other complications occur, so it's that kind of a chance that you have, Mr. Patient," so you see, you have drawn a parable between physical surgery and the mental surgery because you see, we know what is wrong in your mind, we know it is these negative, subconscious thoughts you have and they act just like that diseased appendix. We're not going to give you morphine for the appendicitis, we're going to take it out, and, likewise, if you have a mental diseased thought, you do not give tranquilizers, but on the contrary, you take out the voltage or power behind that mental incident, behind that diseased thought so that it can no longer trouble you again.
4. "The others worse" story: This is similar to the "I had it worse" story only what I usually do is tell the patient of the many cases that I have seen similar to the patient's case but which in fact were much worse than the patient's case and these others all recovered, so with you it should be a cinch; and while I cannot guarantee it, I see no obstacles to it. If I did, I would not be taking you as a patient right now.
5. "The facing death" story: This is one of the most difficult stories to tell a patient to get them prepared to face death, when it is obvious that they are suffering from a terminal disease and nothing can help them. Nevertheless, with every such case I think it is better to give that person hope right up until the end rather than to tell the patient that yes, he is going to die and nothing can help him because I know if I heard a doctor tell me that, I would immediately search for another doctor. There are things that can be done, you know. There are always those miracle cases, one in a million shots, and yours could be it. I advise the patient to pray a great deal, and I give them positive suggestions under hypnosis. I tell them of other persons who faced death and did so in such away that they brought everlasting credit to themselves. Think of Nathan Hale facing certain death at the hands of the British, who said "my only regret is that I have but one life to give for my country." Now, that's something. You may still, before your death, reach your highest height ; and it is important that you don't lie down and accept death, but that you live to the fullest whatever time is remaining, follow the doctor's orders and get involved in helping others in the same situation for such a patient can be a great asset to those people. Hypnosis plays a great part in those terminal cases by alleviating pain, increasing appetite and making the patient feel euphoric and well right up until the last minute.
6. The "making your greatest fault into your greatest asset" story: Many people come to me suffering from stage fright, inability to get up in front of groups, things of this nature. They just cannot be effective in their work. One of the best stories you can tell them is that you're not only going to be a normal public speaker, but we're going to make you into a great public speaker, we're shooting really high. After all, look at the story of Barbara Ann Scott who had polio and was told she could never walk again. She took up ice-skating and became the world's Olympic champion ice-skater! Regard Annette Kellerman, another victim of polio who was told she could never walk again. She became one of the world's greatest swimmers appearing at the old New York Hippodrome many years ago. And so is the story of Glen Cunningham, the famous runner who at one time was told he would never walk. You too, can turn your greatest fault into your greatest asset and think how happy you would be in doing just that. But the goal must not be just to "walk" but rather if you can't walk, run."
7 . The "broken leg and bruised leg" story: Frequently a patient will come in and tell me that he is very sick and just simply cannot get well. When we examine his symptoms he says, "Oh, those first two symptoms that I thought were so big, they're all cured up; but these other symptoms are much worse." This is the time for the broken leg and bruised leg story. You tell the patient you once knew a man who had both a broken leg and a bruised leg. The broken leg was so painful that he didn't pay attention to the bruised leg; but once the broken leg was put in a cast and immobilized there was no further pain from that area, and then the pain began to come from the bruised leg and he began to take notice of how terrible that was. In fact, the patient will say (and did say) that "I'm sure that this leg must be broken too because it hurts worse than the other one you put in the cast." So you take an X-ray and you show the patient that the leg is not broken (and it was not), but it was badly bruised and once the pain was taken away from the broken leg, the bruised leg just naturally felt more painful.
8. The "when I was in medical school" story: This is a frequent story physicians use to point out that they saw a case similar to the patient's when they were in medical school and the favorable result that came from that case due to the team work of yourself, the resident and the attending physician. You can say I really learned a lot about that particular problem right then, I learned some little tricks that many doctors don't know; and since I know these tricks, I'm going to use them on you, and you'll see just how fabulous and rapid and thorough your recovery is going to be. An instance of this was when I served as extern working part-time for a Dr. Ponder in Chicago who had an industrial practice. Doing industrial medicine three or four times a day, patients would come in with a little flick of steel in their eye, and I would have to remove it with a von grafe knife. I started doing this with the patients sitting up, but the patients kept leaning back in a way which made the eye operation very difficult. Dr. Ponder came in and said, "look son, here's the way to do this. You lay the patient flat on the examining table, tell them to put their hands at their sides, to relax, and then put eyelid retractors in and tell the patient to stare in the position where the foreign body would be most easily visible. A couple of drops of pontocaine in each eye or sometimes just in the afflicted eye is all that is necessary. " Very soon, by learning this technique a small piece of steel could be removed from the schlera in a few minutes with a minimum of difficulty and strain on patient and doctor. Now, eyes get well fast and they get sick fast, so you must see the patient the very next day. I learned many things like this in medical school and while working on the side in practical situations, and I learned something that will be of great benefit in your case. For example, and then comes the story of how you learned something that is going to cure this particular patient and how you're going to do it.
9. The "all the patients I've seen" story: I frequently tell my patients that the average psychoanalyst sees one hundred patients in a life-time, and that I have analyzed over 22,000 patients, 22.000 analyses more than any human being living or dead, including Freud, Adler, Jung, Mesmer and all of them combined, which is true and I have the records to prove it. So even an idiot must learn something from that much experience. This true story is very reassuring to the patient.
10. The "when I hypnotized " story: This story is utilized to help make the patient realize that there isn't any blue gas that is going to come out of their ears when they're hypnotized. Most patients think that they're going to be under something, a spell, or whatever, or that they're going to be knocked unconscious, when in reality very little is felt under hypnosis yet it is very, very powerful. The mind is only concentrated, the body is relaxed and the individual is told to imagine whatever is suggested to him. He is told to get up and walk out whenever he wants; but if he does, he is just wasting his money. In fact, I was hypnotized 15 times before I knew it, so I don't expect you to know when you're hypnotized at all. One thing will convince one patient, something else will convince another. During the course of therapy somewhere you will realize you have been hypnotized; and even if you never realize it, I don't care as long as we get you well, don't you agree with that? If the patient agrees, then your problem is over.
11. This story is a continuation of a "when I was hypnotized" story: It is called the "whatever state you're in is the one I want you in anyway, and you don't have to recognize it as hypnosis" story. In other words, what I call hypnosis as a medical doctor, the patient may never wish to call hypnosis simply because he has in his mind that hypnosis is something magical, which it is not, although miracles can be performed with it. It is important that the patient should not concentrate on whether he is hypnotized or not, but listen to the sound of my voice over the earphones.
12. The "cripple children" story: This is the story I frequently use on depressive patients. I tell them that when I was in medical school I was occasionally fatigued and I was once very depressed, and what I did to lose that depression was to overcome the fatigue by rest and overcome the depression by going to a crippled children's hospital and just walk through the wards and hand out a few presents or gifts and look at the little children and see how happy they are without arms, without legs, sometimes without both, some blind, some deaf. After seeing this, it is very difficult for you to be depressed; in fact, what will usually happen is that the patient will be ashamed that he allowed himself to get into such a depression considering what a difficult life that these other children must have and the fact that they are bearing up under it so well.
13. The "fictionalized patient" story This particular story is the story you tell the patient by making up a fictionalized case history. Say, do you know a patient came to me once that had exactly the same symptoms you have and we did thus and so and thus and so, etc. and he just snapped out of it like that (snapping your fingers at the word "that"). Now, why in heaven's name can't we do the same thing with you since we've seen the results with this other patient. The answer is of course there is no reason why we can't do the same. The only thing that's holding you up is yourself.
14. The "phone call" story This is a story which is really not a story at all but it is an arranged thing so that when the patient comes into the office you arrange for the girl at the desk to buzz you on the phone, and when she buzzes you, you pick up the receiver and say oh hello Charlie, how're you getting along. Gee, that's fine, I'm so glad. Well, I thank you Charlie, thank you very much, it's so kind of you to call and tell me how well you're doing. Oh, no, you don't owe me anything, why I know that you said that you'd give your life to get rid of this problem, but I'm just happy that you're well and I got my fee and you got well and that's what you came here for. Then you keep up this fictionalized phone call to include the patient's history who is sitting in the chair. He overhears this phone call and realizes indirectly that another person is getting well of the same affliction and that there is no reason why he can't do it, too.
15. The "you’re the boss" story This story is given to an obstreperous patient who insists on analyzing himself. I frequently say, " All right, you're the boss. If you want to analyze yourself, I'll rent you some space up here and you can come up here and talk to yourself and talk it all out. It might be good for you." Chances are the patient will say, "well, what the hell good is that? I'm paying for you to analyze me," and I say, "Fine, then if you're paying for me to analyze you LET ME DO IT!"
16. The "I'm the boss" story This is very close to the next story which is the "1 can do it all" story and that in turn is very close to the next story which is the "I'm only the steering wheel to your motor" story so let us take those three stories and lump them together. "When you sit down here, Mr. Patient, you voluntarily surrender a certain portion of your will so that I can get you well. Now, you never will surrender it all. If at any time you decide you simply don't want to go along with this line of therapy, all you have to do is stop. But because you realize it is for your own good, even though it may hurt to bring some of these thoughts out, then you will bring out these diseased thoughts - bring them out from the deepest part of your subconscious, but the point is I don't want you to discuss your problems with anybody else because it's only your head that I want to deal with. I don't want to deal with someone else's head, so you just keep it to yourself and come in to me and make no permanent transactions of any kind until your therapy is complete and you know what manner of man or woman that you are. Now, you don't have to do anything. All you have to do is get the money in and get the body in, and the rest is up to me, we'll take over. Just like the surgeon and his patient, you just lay there, relax and enjoy it and allow us to remove the negative thoughts from your mind and replace them with positive thoughts, and that's the way it is, for I am only the steering wheel to your motor. I can't make you do anything, it's actually your brains that send the signals down the nerves to your muscles. It's your head that makes our suggestions work, it's actually your brain that sends the signals down the nerves to your muscles that makes them work, it's actually your brain that is changing these signals that it sends down to your various muscles all the time, and this is true whether it's an impotence case, or an overweight case or practically any other case, but you have to voluntarily relinquish the control of that brain of yours so that I can guide it along the pathway to get you well and I may not guide it exactly properly because I am only human, too, but I’ll do a much better job of guiding it than you will and you know that or you would not be here.
VI. Summary: The use of parables in the treatment of hypnosis especially in direct suggestion has been pointed out. It has also been pointed our when it is better than the plain language, the use of "you" and "I" which is appropriate in the story, and when using stories how to hell them, the length of time necessary and examples of 18 stories given. I hope these stories were given. I hope these stories will be valuable to the doctors who use them when patients become obstreperous and tend to either avoid to leave when their therapy is uncompleted.
5. HYPNOSIS IN ANESTHESIOLOGY: WILLIAM J. BRYAN: JOURNAL OF THE AMERICAN INSTITUTE OF HYPNOSIS:1962:
PART A - INTRODUCTION: The first recorded use of hypnotism in anesthesiology appears in the Holy Bible in the book of Genesis, Chapter 2 Verse 21. "And the Lord God caused a deep sleep to fall upon Adam and he slept. And He took his ribs and He closed the flesh in its place." Far from being new, hypnotism, formerly called Mesmerism, was without doubt the first anesthesia employed in surgical cases. Up until the time of Mesmer, and the Marquis de Puysegur a swig of booze and a clout on the head of this was made by Thomas Wakely, who published the following poem in the Lancet, official publication of the British Medical Associatio: "No more shall we hear the afflicted complain, Operations will give more of pleasure than pain; And ladies will smile in their Mesmerized trance As the pains of their uterine efforts advance. Then shut-up the schools, burn the Pharmacopoeia, Let us all carry out Dr. Mesmer's idea. And whilst skeptics their agonized vigils are keeping His disciples will through their afflictions be sleeping."
Ether and chloroform, however, were soon introduced as chemical methods of producing anesthesia and because of this, the use of hypnosis for this purpose took a downhill course. This was despite the fact that many great medical men such as Braid, Elliotson, Liebeault, Bernheim, and others pointed to the fact that in no instance has a fatal result ensued from the use of Mesmerism or hypnotism, but that in many cases ether and chloroform have produced instant death or induced symptoms which have not disappeared for days or months. Somehow the value of hypnosis in anesthesiology was lost to the medical profession who busied themselves primarily with narcosis by chemical means. Another unhappy aspect to this was that, while chemical anesthesia frequently produced the absence of pain, it did not produce the absence of fear and those patients operated under mesmeric trance or under hypnosis both today, as in the 1800's, experienced remarkable recoveries due to the absence of fear, while many persons under chemical anesthesia while, nevertheless, pain-free, were still frequently literally "scared to death." Both Van Pelt' and Marmer" have pointed out the tremendous importance of fear in producing bodily changes of such profound intensity that they are sufficient to destroy the organism. The patient may be asleep, but still suffering intensely from anxiety. Proper management of preanesthetic apprehension calls for calm and authoritative reassurance; and the use of hypnosis as a routine measure for pre-operative sedation and for the giving of post-operative suggestions pre-operatively is recommended in every case.
PART B: USES IN ANESTHESIOLOGY: Marmer lists four indications for the use of hypnosis in anesthesiology. He states: 1. To overcome fear, apprehension and anxiety, thereby reducing the tension associated with the anticipated anesthesia in surgery. It is useful as a means of sedation either in conjunction with or as a substitute for drug pre-medication. It. will aid in increasing patient cooperation and help bring peace of mind. 2. To aid in post-anesthetic and post-operative recovery, making for a more pleasant and more comfortable reaction from anesthesia. It permits the use of post-hypnotic suggestions to aid in the post-operative course. It can be used to produce operative amnesia, to improve post-operative morale and motivate the patient toward getting well. 3. To raise the pain threshold and reduce the need for or eliminate the use of post-operative narcotics. It may be helpful in diminishing post-operative nausea and vomiting and may be useful in decreasing the incidence of post-operative pulmonary complications by encouraging the patient to breathe more deeply and cough up sputum more effectively. Patients can also be induced to earlier fluid intake and to easier voiding. 4. To induce analgesia and anesthesia, thereby reducing the total amount of chemical anesthesia or replacing it entirely. Marmer goes on to say, "The mere writing of an order for a barbiturate or other sedative medication does not necessarily insure the patient a restful night's sleep. It is better to spend five minutes talking to a patient, than to give him some questionable drugs.
When a patient is severely anxious and disturbed, he will be restless and uncooperative despite his medication."
One of the main uses of hypnosis in anesthesia is to ascertain the particular fears and anxieties of the patient while in the state of hypnosis. Under hypnosis, the patient feels more free to discuss these anxieties and, hence, they can be removed before surgery begins. The value of this approach cannot be overestimated. The use of hypnosis in aged persons and bad-risk cases must also be considered. One of the first surgical uses of hypnosis was by Jules Cloquet who removed the breast of a Madame Plantin, who was 64 years old at the time. The operation took approximately 12 minutes and the doctor talked with his patient during the entire operation, performed with the patient in a sitting position! The operation was a success and the patient felt no pain, discomfort, or apprehension.
This was repeated only last year by Dr. Lester Millikin in St. Louis when he removed the breast of a 90-year-old woman suffering from carcinoma. The operation was performed under hypnosis, was a success, and was preserved for posterity through the medium of motion picture film. The following preoperative verbalization is suggested by the author:
The giving of post-operative suggestions pre-operatively is perhaps the most important use of hypnosis in anesthesiology. I have adopted the following verbalization which is given under hypnosis to each patient the night preceding surgery. It is, of course, modified to the patient's individual needs: "You will relax and sleep soundly tonight. You will feel rel4xed and comfortable in every way for the surgery tomorrow. During the surgery you will feel secure and perfectly safe. The anesthetic will be administered carefully and safely, and the operation will be performed skillfully. When you awaken after surgery, you will awaken quietly and comfortably as though awakening from a long, peaceful, health-restoring sleep. You will have prompt and regular bowel movements and prompt and regular urination. You will feel pleasantly hungry, vigorous, full of life, pep and vitality. You will have a dry wound, heal rapidly, and be up and around very soon. You will first awaken in the Recovery Room, the safest place for you to be. You will awaken rested and unconcerned and will ignore all other patients who may be there. You will concentrate on being wide awake, full of life, pep and vitality, and when fully awake, you will be taken back to your own room. You will be relaxed and rested at all times and will find this experience to be very interesting, fascinating and rewarding.
"As you rest peacefully and calmly, you will know that God constantly watches over you and you are able to place your trust in His infinite goodness. Now, you will sleep soundly and sleep well and wake up sound in body, sound in mind, sound in spirit and sound in health.
The forgoing was my own verbalization give to a patient pre-operatively. In addition to this, other personal suggestions of comfort to the individual patient, depending upon his problems, should be included. Obviously, anesthesia for obstetrics will be a great deal different than anesthesia for a stapes mobilization operation, and suggestions peculiar to the type of operation being done, should be given as far in advance of surgery as it is possible. These suggestions should then be reinforced on the day of the surgery.
PART C THE TIME FACTOR: Many physicians who have a poor understanding of hypnosis have criticized it because they believe that hypnosis takes such a long time to induce that it is impractical. Nothing could be further from the truth. While certain mental patients may be difficult subjects and take thirty minutes to an hour to perform the initial induction, the vast majority of patients may be easily induced within five minutes. Many can be induced by the "Oriental pressure point method," developed by myself and described in a previous issue of the Journal, in a matter of 2/5ths of one second. This is the fastest induction ever recorded and was recently demonstrated by myself on a movie actress, Miss Francine York, whom I had never seen before she entered my office, for the production of the anesthesia. Accompanying photographs illustrating the induction by means of the "Oriental pressure point method" and anesthesia production all were taken within a few minutes. The entire period of time, including induction, production of anesthesia, testing of anesthesia with a needle, control of blood supply, testing of blood supply control by removing the needle, and the wake up procedure, took less than one minute! (See accompanying illustrations) The statement that hypnosis is time-consuming, either for anesthetic or other purposes, is totally unjustified. Indeed, hypnosis is time-saving as it both prevents a great many post-operative complications and a good many anesthetic deaths.
A number of items have been published in the Journal of the American Institute of Hypnosis under "Hypnosis in the News" testifying as to the decreased hospital costs to the patient when hypnosis is employed in their surgical procedure. Insurance companies should make themselves aware of the fact that thousands of dollars of hospital expenses could be saved if more patients underwent hypnosis either in place of or as an adjunct to their chemical anesthesia for surgery .
PART D PRODUCTION OF ANESTHESIA: The various methods of inducing hypnosis will not be discussed here as they are covered adequately elsewhere. The major methods of producing anesthesia, however, are by 1. Direct suggestion. 2.Modified direct suggestion. 3. Visualization. and 4. Dissociation. The method of Direct Suggestion producing glove anesthesia first and then transferring it to other portions of the body is illustrated pictographically here by first inducing the patient with the Chinese pressure point method or by some other method of induction, then secondly creating rigidity in the arm and merely giving the patient the direct suggestion that her hand and arm from the shoulders to the finger-tips are getting cold and numb. Cold and numb, cold and numb, colder and more numb with every breath you take. As you give this verbalization, you stroke the arm and hand so that the patient "feels" something and can associate this with becoming cold and numb.
Later on the verbalization extends to include "you will feel only pressure, pressure only, and the only other feeling you have is cold and numb." We do not mention the word pain or discomfort anymore than is absolutely necessary. An negative suggestions are generally undesirable and the more opens his eyes and visualizes the needle through his hand. In most cases, the patient has felt nothing. Consequently, he is surprised at his ability to produce the anesthesia. The patient should then be complimented at once and quickly be put back into a deep hypnotic trance. After this, the transference of anesthesia is accomplished from the hand to the other portion of the body which is to be anesthetized.
In the Modified Direct Suggestion, some visualization is employed. This is especially useful with patients who do not understand what an anesthetic is and who have never experienced novocaine or other local anesthetic. My particular verbalization for this is as follows: "1 want you to visualize in your mind's eye a bank of colored lights. They can be any particular color you wish, red, green, blue, yellow, orange, magenta,-and when you have completely visualized this bank of electric lights, you can let me know by raising slightly your right index finger ." The operator then waits for the sign from the patient that the electric lights are visible. At this point, the hypnotist proceeds as follows: "You will now visualize a bank of switches, one switch under each electric light, and you will connect that switch to the electric light in your mind's eye. As soon as you have done this, you will indicate to me by raising the right index finger ." When this portion is visualized, the patient will again indicate it to the hypnotist and he will proceed again as follows: "Now you have a bank of colored lights and a bank of switches beneath them, each light having one switch connected to it. Now you will choose one particular colored light to attach to the back of your right hand. Which color do you wish?" If the patient is reticent to choose, the hypnotist should say "You can talk, or if you would rather not talk, you can lift your left index finger and I will then read off the colors to you and you can raise your right index finger on the color you prefer." It has been my experience that a hypnotist should not choose the particular color for the patient for invariably, for some reason which I have been unable to uncover, the subject will reject the hypnotist's choice of a colored light. When this obstacle has been hurdled, the hypnotist then merely asks the patient to turn out the particular colored light attached to the right hand and the anesthesia is produced. It is important that the hypnotist not even mention the word anesthesia or what he is doing for the patient already understands that he is there to have anesthesia produced through the means of hypnosis and generally speaking, any verbalization that "When the light is out, I am sure your hand will be completely anesthetized," merely serves to indicate to the patient that the hypnotist is unsure as to whether the anesthesia is going to work or not. This feeling is absolutely deadly and is to be avoided at all cost. The hypnotist is to be constantly sure of himself, quiet, calm, and display a manner of complete confidence at all times. Anything less is unacceptable. Upon testing the right hand, if the patient should wince or display any sign that indicates the anesthesia is not present or is not working as fully as it should, the hypnotist should take note of this in a positive fashion as follows: "Take a look at that green light again. It appears that the light is now on once more." The patient will most probably respond, "Yes, it is on." The hypnotist then says, "You see, the only reason you are feeling pain is because you have failed to turn out the green light properly. Now, this is all your fault, because you have been using bad switches. There is only one thing to do. Turn off the green light again and then take a roll of friction tape and tape the switch shirt so that it cannot go on. This will then keep your hand anesthetized." What the patient does not realize is that if he accepts the negative suggestion that the only reason his hand perceives pain is because the green light is on, then obviously when the green light is off, he is also accepting the suggestion that he will be pain-free. This negative-to-positive suggestion is very useful in the field of anesthesia and brings success where other techniques fail. Physicians whose percentage of successes with hypnoanesthesia is continually low, find it generally due to the fact that they ignore the many finer points of technique which have been developed in the last few years and taught through the many Institute courses. This percentage will grow higher and higher among properly trained medical hypnotists. In this particular case, the hypnotist still has one more ace-in-the-hole. Should the patient suddenly say, "I'm sorry, Doctor, but I still feel pain in my right hand." Then the doctor still may say, "Well, your friction tape is no better than your switches. There is only one thing left to do." The patient will invariably question, "What's that ?" At which time, the physician will reply, "Unscrew the bulb." It is obvious even to an idiot that the green light cannot go on when the bulb is unscrewed. The patient relaxes and anesthesia is a proven fact in another case.
In a pure visualization method without the suggestion, we turn to the corridor method which asks the patient to visualize in his mind's eye a long corridor down which he is walking and then at the end of the corridor, he will see a bucket from which steam is rising. He is very curious as to the contents of the bucket and does not know the temperature therein. The hypnotist assures him that the bucket contains water heated to a high temperature, but not high enough to damage his hand should he plunge it into the water. Upon arriving at the bucket, the patient becomes so curious as to the temperature of the water that he plunges his right hand down into the water and immediately withdraws it, feeling it burning and tingling, burning and tingling, burning and tingling. This creation of hyper-anesthesia creates a desire for and motivation toward the production of anesthesia. The second advantage is that it also creates a difference between a normal hand on the left, and one that is hyper-aesthetic on the right. The physician-hypnotist then removes his fountain pen or pencil from his pocket and with the blunt end touches t4e patient on the back of his hand stating that he is now injecting a local anesthetic that will freeze the hand, make it cold, numb, and comfortable, and that the patient can feel the introduction of the local anesthetic and he will be very interested to learn exactly which finger becomes completely numb first. Notice the power of such a suggestion. In the first place, the patient is already familiar with local anesthetic and its actions, and upon feeling the pressure of the pen together with the motivation to get rid of the burning and tingling feeling, the patient is almost sure to accept the suggestion of anesthesia. Coupled with this, we use the principle of seeming to give the patient a choice when we really do not. We say, "Which finger will be anesthetized first?" We do not say, "We wonder whether your hand will or will not be anesthetized ?" The same trick is used in advertising. The Ford Motor Company has utilized this device to great advantage by planting in the minds of the public "Which Ford will it be? It's as simple as 1 - 2 - 3." The person is given a choice of buying one Ford or the other, but no other choice is really offered. The same is true of anesthesia. We give the patient a choice of which finger will become numb first.
Consequently, he believes he has a choice when actually he has no choice at all. Then, when he makes a choice that the middle finger is becoming numb first, the middle finger is already anesthetized and he has already accepted the idea that the other fingers are going to follow suit. Once anesthesia is complete, the left hand may be immersed in the imaginary bucket of hot water in order to broaden the difference in feeling between the two hands for testing purposes.
The Dissociation Method of producing anesthesia is one of the most valuable when utilized with operations on portions of the body which the patient cannot see. One of the big fears which all of us possess is not to be able to see what's being done to us. Witness the child who constantly wants to look at the arm which is receiving the shot. In some manner or other he feels safer if he can see what is happening to him. In this same way, we, as adults, have carried over from childhood this fear of being unable to see what is happening to us. Hence, operations on the eyes, throat, rectum, and ears, carry with them a fear greater than of other types of surgery. In the stapes mobilization operation, an operation which lends itself particularly well to hypno-anesthesia, because the ear testing which needs to be done, can then be done in the waking state without the influence of barbiturates and, furthermore, the small working area does not need to be distorted through the use of local anesthetics. An additional important factor is the control of blood supply and bleeding in the area of operation which is also better handled through the use of hypnosis than with other anesthetics.
In the case of the stapes mobilization operation, dissociation is a production method of choice. We merely ask the patient in his mind's eye to unscrew the ear and place it on the shelf across the room.
In this manner, all connections with pain have been removed and the patient can watch the physician as he operates on the ear. This same dissociation method is good for dental work too and one can hang the jaw up here and take a good look at it while it's being worked on. In the similar manner, other areas of the body may be unscrewed, or detached in the mind's eye and placed in a position of vantage so the patient may, through his own imagination, view the surgery calmly, dispassionately, and objectively as though it were being done on another person.
Occasionally, a patient who has so dissociated a part of his body, may become fearful at the dissociation and produce pain in order to prove to himself that the member is still attached to his body. Alleviation of this type of fear should be done by the hypnotist in advance so that the patient realizes he can "screw the part of the body back on anytime he so desires." And that it will be, "perfectly normal in every respect when it is replaced." In fact, it can be compared to, "just like fixing the automobile."
If a patient does complain of pain when the anesthetic has been produced by means of dissociation, one of the best ways to reproduce the anesthesia is by stating, " Are you sure you feel pain now or are you just remembering it?" The patient may jump on this and say, "Well, maybe I'm just remembering it." If he does, then the obvious answer by the hypnotist is, "That's fine, forget it." Whereupon the patient does forget it and anesthesia is re-established. This, however, will be covered later under Part F - Maintenance of Anesthesia.
PART E TRANSFERENCE OF ANESTHESIA: Regardless of the method used to produce anesthesia in the first place, after it is finally produced, it must be transferred from the back of the hand to the arm or the abdomen, perineum, jaw, or whatever place is necessary, depending upon the surgery to be performed. Usually, merely by placing the hand on the affected area and gently tapping the back of the hand, the hypnotist can see to it that the subject transfers the anesthesia by merely saying that the numbness will go out of the hand and into the breast, out of the hand and into the breast, out of the hand and into the breast, or out of the hand and into the jaw, or whatever part is involved. Sometimes the patient will wish to transfer the anesthesia on their own, and if they can do this well, this should be allowed, as the more self-determination the patient shows, the more self-confidence he will have in his own ability to produce anesthesia. Anesthesia transference is generally no problem except that there are certain pitfalls. One of the mistakes made by physicians who have not had adequate experience in hypno-anaesthesia is the fact that they do not extend the anesthesia far enough or deep enough during the initial session, and then later they find that their surgery must extend into areas which have not been anesthetized. This may especially be true in childbirth and one should always extend the area of anesthesia above the umbilicus to the end of the sternum and include both sides of the abdomen as well as the entire perineum and perianal area. When this is correctly done, there is no reason for the physician to worry that he may not have inadequately anesthetized the area. If there is any suspicion that an appendectomy to be done under hypnosis may wind up as a cholecystectomy or as an abdominal perianal resection for carcinoma, then certainly all these areas should be completely anesthetized by transferring the anesthesia from the hand to that particular area, then stiffening out the arm once more, producing more anesthesia and transferring that until the entire area is completely anesthetized
PART F MAINTENANCE OF ANESTHESIA: Although the patient should be assured before surgery that any drugs or medication which he needs will be furnished him immediately and safely, Maintenance of Anesthesia can, on occasion, become a problem. The first thing to be remembered is that anxiety leads to tenseness which leads to loss of relaxation, which leads to loss of anesthesia, which leads to pain and which in turn leads to more anxiety. This complete vicious cycle which, if started, will interrupt the deepest anesthesia which can be produced. It is important, therefore, that this cycle not be allowed to begin, and if once begun, that it be broken completely and quickly and then reversed by direct suggestion as soon as possible. If the patient complains of pain in the middle of surgery, surgery should be completely halted at the nearest possible moment and the patient told, "We have all the time in the world. Whenever you are completely relaxed again and ready for us to start, you let us know. We will rest and you may rest until you are ready for us to begin again." The very fact that the patient is reassured that there is plenty of time, no need to hurry, and that the surgery will not begin again until he is completely relaxed and ready for it, is almost always enough to stop the pain right at that moment. For when the patient's anxiety is removed, then the pain stops and there is a re-establishing of anesthesia, a re-establishing of relaxation, loss of tenseness, a loss of anxiety, a loss of pain, a re-establishing of anesthesia; and the cycle goes around, and around in the opposite direction. On extremely rare occasions during surgery, the patient may become anxious about some particular procedure that is going on or some particular unfamiliar sounds in the operating room which can be eliminated if one only knows what is causing the anxiety. The easiest approach is to ask the patient. It is amazing how few doctors have mentioned this perfectly obvious approach to the maintenance of anesthesia. By merely asking forthrightly, "What is it that is frightening you ?" The patient may come up with something of which the doctor was totally unaware. Once this is brought out into the open, the doctor may then give the patient reassurance, the anesthesia is then re-established and the operation goes on. In my experience, none of these breaks in surgery have lasted more than a minute providing proper action is taken immediately and almost never do these breaks occur more than twice in anyone operation. In the event that the patient is anxious solely about the anesthesia itself, there are rare occasions in which the patient must be given supplementary drug therapy. In this case, placebos are sometimes of value and other times not. I am reminded of one case of mine in which, after along and arduous operation, the patient, nevertheless, had to be given approximately 1cc. of local procaine anesthetic in order to finish closing the last two stitches of a 15-stitch wound. It seemed incredible that after all that surgery the patient would be unable to produce anesthesia for the last two stitches; but, this was the case and the local was given. As soon as the patient felt the local anesthetic under the skin, ever so slightly, his muscles completely relaxed and hypno-anesthesia was again established. This illustrates the importance of a very small amount of anesthetic doing a very large job when coupled with the proper suggestions under hypnosis.
PART G THE EFFECT OF HYPNOSIS ON THE PHYSICIAN: The physician who is relaxed by means of hypnotic technique is neither tired, worried, aggravated, nor hostile. If the physician has any of these negative feelings, they may very well be transferred to the patient and, coi1sequently, it is important that the physician utilizing hypnosis in his practice be relaxed himself before attempting to relax his patient. It is equally important that the physician understand any disturbing or anxiety-provoking drives within the patient and when anesthesia is being administered to a patient through hypnotic techniques, a careful history should always be taken regarding past psychiatric illness, as well as any past sessions under hypnosis.
With hypnosis being utilized more and more in the treatment of psychosomatic and psycho-neurotic illnesses, more and more patients accepted for surgery under hypnosis will have had previous hypnotic treatment by other physicians and it is important for the physician administering the anesthetic to know this and to use caution so as not to disturb any previous curative suggestions left there by another medical hypnotist. It is also important for the physician-hypnotist to know if the patient has received any post-hypnotic suggestions regarding inductions so that these can be utilized properly. Fearful patients, poor-risk patients, and allergic patients are especially good patients for the use of hypnosis in anesthesiology . It is important that the physician, utilizing hypnosis as an anesthetic, familiarize himself with the positive approach in every case. One does not talk about eliminating post-operative nausea, but rather about feeling pleasantly hungry when we wake up. One does not talk about eliminating postoperative illus., but rather about prompt and regular bowel movements. Similarly, one does not mention hemorrhage, but speaks in terms of "dry wounds." Since subjects under hypnosis are extremely literal in their interpretation of statements made and, because they respond to specific requests and commands with remarkable accuracy, suggestions should never be ambiguous or confusing. As Marmer said, "Exactness of meaning is of the utmost importance." If you tell a patient that his arm win be as numb as the last time he had Procaine, make sure that the patient had Procaine and that he knows he had it, otherwise the suggestion may be lost. Mark Twain once remarked that "The difference between the right word and the almost right word, is like the difference between lightning and a lightning bug !" and nowhere is this more true than in formulating the suggestions for hypno - anesthesia. Use words like, "peaceful, tranquil, restful, serene, still, calm and that wonderful, magical word, relax." Avoid such words as, "pain, discomfort, complications, bleeding, hemorrhage, nausea, vomiting, death and other negative expressions." Dr. Marmer, in his book "Hypnosis in Anesthesiology," has a word of warning for the physician or dentist utilizing hypnosis for anesthesiology purposes which is prudent. He states, "Be sure to remove all suggestions that prevent awakening and be certain that all previous suggestions not included in post-hypnotic suggestion are terminated. Be as careful with hypnosis as with other anesthetic procedures and it win be perfectly safe. Exercise the same good judgment with hypnosis as with chemical anesthetics and you will avoid any trouble. Withdraw from hypnosis as quickly as you would withdraw a drug when an untoward reaction occurs. Be prepared for psychological resuscitation in the same way you are prepared for physical resuscitation. Care, diligence, skill and vigilance are the watchwords of anesthesiology. They are also applicable to the newest anesthesiological tool hypnosis."
Hypnosis has a great place in anesthesiology and its principles and practice should be a required part of every anesthesiologist's training program. In my opinion, no medical doctor should ever be certified by the Board of Anesthesiology until he is also proficient in the use of hypnosis in his specialty since there are times and areas in which no other modality will work quite as well, and anyone specializing in this field should be familiar with all the modalities of his field.
6. HYPNOSIS IN THE TREATMENT OF BURNS: WILLIAM J. BRYAN, JR. MD: JOURNAL OF THE AMERICAN INSTITUTE OF HYPNOSIS: 1964:
The correct medical management of a severely burned patient often spells the difference between life and death for that individual. This is especially true for the initial management of the case, that is to say, what is done within the first eight hours. The Burn Center, at Brook Army Hospital in Texas, has perhaps lead the field in developing new and unusual methods of treating burn cases. They were the first to introduce the open treatment of burns, and they were also the first to call attention to the need for whole blood in large quantities during the first eight hour period. It was from this Institution that the "Rule of 9's" sprang into general use and it still is perhaps the quickest way of ascertaining the amount of burned surface area which is so important in predicting the prognosis of the patient.
This article will neither attempt to review the current literature on handling burns cases nor even the current management for burns, but will only deal with the use of hypnosis as an adjunct to all the other things which should be and must be thought of when one is faced with a severely burned patient. Perhaps more than anyone thing that is needed is the concept of team work in treating a severely burned patient. Physicians in many specialties, nurses, and later physio-therapists and rehabilitation experts will all be called into play.
The major problems encountered in the treatment of burns in the order of their occurrence are: (1) The treatment of shock and the correct management of the body fluids. (2) Prevention of infection and correct treatment of infection when they occur. (3) The long term management of scars, skin grafting, etc. Hypnosis can be valuable in all these phases of burn treatment.
The proper use of hypnosis in the treatment of burns should include four categories, though not necessarily be limited to these categories.
( I) Hypnosis should be immediately used upon the first encounter with the patient in the emergency situation. The patient can be completely relaxed and the elimination of pain can be accomplished by hypnosis to a far greater degree than by any other means. One of the reasons for this is that frequently patients who are badly burned will have few veins through which to administer narcotic drugs and these veins will be needed for other purposes later on and should be conserved so that the task of management of the patient's body fluids will be made as easy as possible, both for the patient and the physician. Furthermore, narcotic drugs depress the patient's central nervous system and it is important in the initial examination of a badly burned patient to obtain a careful history.
To obtain a careful history without pain can be accomplished best by means of a rapid hypnosis induction together with suggestions to eliminate pain. In this state the patient's mind is concentrated and he may be questioned regarding the origin of the burns. This information may prove to be life-saving. This is especially true when the burn is a chemical burn, caused by alkali, acid, poison gas, or other toxic agents. Obviously the neutralization of the chemical agent is extremely important if the burn is an internal one. It is also important even if the burn is an external burn.
In addition to being able to obtain an adequate history under hypnosis, other advantages of hypnosis in the initial stage are that in eliminating pain and not depressing the central nervous system at the same time, the use of hypnosis will do a great deal to prevent shock and vasomotor collapse. Hypnosis has been utilized to raise blood pressure in patients who have even failed to respond to Levofed and other strong vasopressors. The use of hypnosis in order to obtain patient co-operation and to reduce anxiety and depression is becoming more and more well known. Dr. Norman R. Bernstein at Massachusetts General Hospital in Boston, recently reported three severely burned children two boys, ages 4 and 8, and an eight year old girl. All were unmanageable and hostile to the hospital staff. The girl refused to eat at all. Under hypnosis the three children were friendly and easy to manage. Their anxiety was reduced; they were more cooperative; they endured hospitalization better; their appetites, their pain tolerance, and general behavior improved as well. Because children are exceptionally good subjects and because they are also specially susceptible to accidents between the ages of land 15, hypnosis should always be utilized in the treatment of severely burned children. It is a well known fact that severely burned children often become apathetic and withdrawn. They may fear their doctors and nurses as tormentors identified with painful procedures ( especially the changing of dressings where closed burn treatment is in use). A close emotional relationship between a burned child and his doctor and nurses is imperative in order to obtain the child's cooperation. This can easily be done through the use of medical hypnotism. Even though hypnosis is extremely important in the treatment of burned children, burned adults also have a greater tolerance for pain when hypnotized. Probably the most important time to utilize hypnosis in the reduction of pain is during the changes of dressings. The extreme pain connected with the changing of dressings has often lead to shock in vasomotor collapse with even the heartiest and most stoic of patients. Hypnosis eliminates this danger effectively.
( 2) Hypnosis should be used and can be used quite effectively in order to help regulate the fluid balance of the patient. This includes suggestions regarding urination, which may be halted in an acute burn patient due to the renal shut off. Suggestions regarding nausea and bowel movements are also given. Even a suggestion can be given regarding the amount of sweat which is to be excreted, as well as effective control of the respiration, pulse, and temperature. All of these aforementioned things are under the control of the autonomic nervous system and hence are subject to control by hypnosis provided the deeper states are reached. There is really nothing new about influencing body fluids by hypnosis. As mentioned in Dr. Van Pelt's article on "Hypnosis and Longevity", "Glaser has influenced the blood calcium while Povorinskiij and Finne have controlled the blood sugar. Langheinrich has affected the biliary secretion. Delhougne and Hansen have controlled the secretion of pepsin, trypsin, lipase and diastase, while Heilig and Hoff have influenced the acid contents of the stomach. Heyer has reported cases in which he has controlled gastric secretions, and Marx has influenced the urinary output by hypnotic suggestion. "This is also extremely fascinating since every one of these medical scientists performed their research before the year 1930 and still, 35 years later, most physicians have not taken advantage of this monumental work. Primarily because it has all been done in German and for the most part has not been translated into English.
Suggestions which make it easier for the patient to drink large quantities of fluids and thereby maintain the correct fluid balance orally can be very valuable.
Naturally, all patients will not be able to maintain actual control over all of these bodily functions by hypnotic suggestion. But each of these areas should be investigated by the physician and whatever control is possible by the particular patient involved will certainly be improved through the use of medical hypnosis.
( 3) Hypnosis can be utilized in the control of infections by increasing the blood supply to the infected areas by hypnotic suggestion. Naturally it is assumed that all the other normal measures that are usually utilized in medical practice will also be used in this case for the prevention an. treatment of infection when it occurred Naturally the liberal use of the correct antibiotics is standard operating procedure, and many other medical drugs an( compounds have been utilized within the past ten years based on burn research carried on at Brook Army Medical Center.
Hypnosis can be utilized to control the autonomic nervous system so that certain blood vessels can be dilated and other blood vessels can be constricted by hypnotic suggestion. In this way the blood supply of infected areas can be increased by suggestion. What actually happens is, messages are sent down the nerves to the muscles which surround the arteries, arterials, and capillaries and these muscles constrict or dilate by producing a greater or lesser blood supply to that area. Since the veins have no muscular coating the blood supply draining a particular area can not be affected readily by hypnotic suggestion.
( 4) The Use of medical hypnosis is also extremely valuable in rehabilitating the burned patient after the burns have healed and the scars have formed. Hypnosis is then utilized to enable the patient to Use his hands and arms and outer extremities painlessly even though severely scarred. This can be a great step forward in retraining and rehabilitating a disabled patient. Subsequent surgeries may never need to be done under hypnosis due to the fact that the patient may have a scarred respiratory system which will not lend itself readily to inhalation anesthesia. Suggestions that grafts will take well and integrate themselves with the rest of the tissues of the body have even been helpful. No area should be overlooked and perhaps one of the most important aspects in the use of medical hypnosis in the treatment of burns is in rehabilitating the psychic of the patient who has been severely burned.
It may be that the patient is no longer able to continue in his occupation because of the burns, or that the young girl, scarred for life, can no longer attract the attention of the opposite sex or even manage to keep employment at her previous job, which may have been one of which depended to some extent on her appearance. In such cases, the will to live is extremely important and hypnosis can go a long way in instilling this will by positive suggestion, as well as relieving the patient of the anxieties and fears which he or she may have about what the future holds for such an incapacitated individual. Guilt feelings arising out of the accident or traumatic experience may also need to be handled and psycho-therapeutic procedures can be administered under hypnosis with a resultant saving of time to the recuperating patient.
Lastly, but ever important, is the use of hypnosis by ancillary personnel, such as the nursing staff, who can perform a real service for the physician in this regard. Because of the nurse's close proximity to the patient, especially a severely burned patient, constant positive suggestions can be instilled which will enable the patient to relax completely and enable the healing process to proceed unencumbered by restless, ineffective, and harmful movements.
The hypnotized patient can remain catatonic for long periods of time, conserving energy to a great degree and reduce the metabolic output as well as the nutritional need to a minimum. The "freezing" by hypnosis of a severely burned patient into a state similar to hibernation can so reduce the metabolic needs of that patient that the procedure itself is life-saving and this procedure should be taught to every physician who may encounter a severely burned patient.