Publisher: Los Angeles Times
Doctors find recovery is aided by helping patients into healing trances.
Hypnosis transports some people beyond serenity and absorption to a state of pure silliness. A solemn voice whispering to relax, breathe deeply and imagine a waterfall can bring to mind high school séances, Ouija boards, and Woody Allen routines.
Yet the very same technique, the same voice, can move others to climb mountains. After a fall on a climbing expedition that mangled her ankles, Priscilla Morton, a 48-year-old New Orleans social worker and mountaineer, discovered that she was afraid to step off the curb and onto the street, much less climb again.
Using a program of hypnosis, she was able to ascend to the 19,347-foot summit of Mt. Cotopaxi in Ecuador. "Self-hypnosis was the only way I could deal with the fear, the cold, the steepness, the exhaustion," Morton said.
Once mainly the province of entertainers, mystics and New Age healers, hypnosis is now gaining a foothold in mainstream medicine. At teaching hospitals such as those at Mount Sinai School of Medicine in New York and Harvard Medical School, hypnotists work with some surgical patients to help speed recovery. Many of the country's 1,000 or so certified hypnotherapists now get referrals from physicians on cases ranging from irritable bowel syndrome and heart disease to managing the pain of childbirth and cancer. In some studies, 50% to 70% of people who have tried it say hypnosis has helped them to feel better or heal faster. Such reports have encouraged its use for everything from weight loss to smoking cessation, with varying results.
But is the evidence strong enough to justify sessions that can cost $100? Most doctors are skeptical. For every person who learns to manage chronic pain, they say, several others manage only a yawn or a shrug. To earn widespread respect, hypnotherapists are going to have to reach more people, more consistently. "At this point, the therapy is certainly not well accepted by most physicians and surgeons," said Guy Montgomery, an assistant professor of biobehavioral medicine at the Mount Sinai School of Medicine.
The answer may be to teach hypnotizability, or suggestibility, as it's sometimes called. In more than a dozen studies over the last decade, men and women of various ages demonstrated they could learn to fall into a hypnotic trance more easily and deeply.
"Now the idea is to find what is most effective in getting them there, from a low level of suggestibility to a higher one," said Steven Lynn, a psychologist at the State University of New York at Binghamton who's conducting a large federally funded study on the subject. "You do that and you not only increase the number of people who would benefit but also widen the range of its applications."
Researchers long thought that suggestibility was a stable trait, like a person's IQ or leaping ability, that couldn't be improved on much. Yet there's little evidence that it's related to innate gullibility or a person's imaginative powers. Personality isn't a deciding factor either; researchers have found no strong relationships between hypnotic suggestibility and traits such as neuroticism, extroversion or intellectual curiosity.
Attitude does seem to matter - in particular, skepticism - and for good reason. Since an Austrian physician named Franz Mesmer first popularized the use of trance-like states as a method of treating anxiety and hysteria in the 18th century, the technique has appealed to all variety of charlatans and healers, as well as to Hollywood scriptwriters, who've had fun using it to brainwash, possess and otherwise manipulate characters and plot. Movies such as "Whirlpool" (1949), "The Manchurian Candidate" (1962) and almost any Dracula film have defined hypnosis in the public imagination as a form of demonic mind control, and that image itself may undermine people's hypnotizability.
So psychologists trying to teach hypnotic suggestibility often start with a simple explanation of what hypnosis is and what it's not. Being hypnotized does not turn a person into an automaton or a puppet, for instance; almost always it's a mundane experience, as familiar as a daydream.
The therapist might have a person simply stare at a spot on the wall, for instance, then gradually relax, feeling his or her arms getting lighter and lighter, as if the bones were hollow, say, as if connected to helium balloons. Highly hypnotizable people often are best at demystifying the trance. "You're not losing control, like in the movies," said climber Morton, who described her experiences in a recent issue of the American Journal of Clinical Hypnosis. "It's more like you drift off a little. You're temporarily distracted by a particular image or lost in thought, like when you drive home from work and arrive without remembering how you got there. It's a very natural state, the kind we go into all the time, and it helps to think of it that way."
In several studies, research psychologists have found that a straightforward description of the sensations and images that occur during hypnosis can also help skeptics and other trance resistors become more suggestible.
In his ongoing project, Lynn shows volunteers a videotape of highly hypnotizable people explaining their sensations and what they thought about while in a trance. On one video clip, a hypnotist has a subject clasp his hands together and then imagine they're welded together. The hypnotized man suddenly cannot separate his hands; they're stuck. "If I stopped imagining and admitted to myself that they could come apart, then of course I could have made them come apart," he explains afterward on the tape. "But I figured that's not the point of the suggestion. The point is to get involved in the make-believe, no matter what. So, I just kept imagining that my hands were welded blocks of steel and did this until the suggestion was over."
Using imaging technology, neuroscientists have taken pictures of people's brains during hypnosis. The snapshots show a decrease of arousal in the cortex, the brain's manager and planner, and an increase of activity in areas involved in focusing attention. This makes some sense to psychologists who practice and study hypnosis.
While in the trance, a person is usually concentrating on bringing to mind some vivid image, which could account for heightened attention. The drop in cortical arousal accompanies a decline in moment-to-moment alertness. In effect, psychologists say, the person is conscious enough to hear and understand suggestions such as "You will feel strong and healthy after surgery" or "You will feel calm and relaxed when taking the test," without applying his or her usual skepticism or irony. If the suggestions are helpful, the theory goes, they may become a part of the person's subconscious memory.
"This is all happening beneath the level of consciousness, so the suggestions are not something the person has to think about or remember," said Marc Schoen, a Los Angeles psychologist and assistant clinical professor at the UCLA School of Medicine who has used hypnosis for more than 20 years.
Like other therapists who specialize in hypnosis, Schoen has treated everything from social anxiety to pain from cancer and cancer treatment. Typically, he works with people once a week for six to eight weeks. When effective, the therapy blunts emotional over-reactions to a particular person, situation or drug side effect, say, that normally would intensify pain, interrupt sleep or otherwise trigger anxiety. With practice, many people learn to do this on their own. In effect, they adapt the therapist's methods to put themselves into a brief trance, reinforcing suggestions or thoughts they've found helpful during a session - self-hypnosis.
Schoen may also use traditional cognitive therapy, in which people learn to consciously identify these same emotional triggers, then avoid them altogether (if possible) or calm themselves before getting upset. But when hypnosis is successful, he said, no conscious mental effort is necessary to short-circuit a painful emotional reaction. "It just doesn't happen; you don't feel the same fear, the same apprehension," he said. "In that sense, it's a form of desensitization."
Henry Polic II, a movie and TV actor in his 50s best known for his work in the 1980s series "Webster," got a referral to Schoen last summer during treatment for malignant skin cancer. Polic was on a drug and radiation regimen that caused a paralyzing nausea, plus swelling blisters in his mouth so severe that he had trouble speaking and swallowing. While hypnotized, the actor imagined himself in Key West, Fla., at sunset, as he remembered it from a vacation years ago. Meanwhile, Schoen was informing him that the water washing on the sand was clearing his body of illness and relaxing his tissues. It took a few sessions, but the swelling dropped by about half, Polic estimated, and the blisters near the back of his throat disappeared. "Gone, and I mean gone; I could swallow again," he said. "I have no idea how that happened, but it did."
Nor does anyone else know. Distraction may play an important role, some doctors say. It's well known, for instance, that the brain can virtually shut down pain signals when preoccupied; many athletes and soldiers have known the surprise of suddenly discovering a cut or wound once the fray is over, well after suffering the injury. If nothing else, those who respond to hypnosis have learned to escape into their imaginations for a time. But there's more going on, and many psychologists argue that it has to do with the placebo effect, the self-fulfilling belief that a condition has been treated.
In 1995, a team of researchers from the University of Connecticut reviewed six weight-loss studies that compared the effect of cognitive therapy - identifying eating triggers and defusing them - with and without hypnosis. About 70% of the overweight people who got hypnosis lost more weight and kept it off longer than those who got only talk therapy.
In a 2002 look at 20 studies on hypnosis and surgical pain, Mount Sinai researchers found that adding hypnosis to standard post-surgical care sped recovery almost 90% of the time, in terms of levels of pain, anxiety and the need for painkillers.
"The hypnosis seems to change expectations, in the same way that a placebo does," said Montgomery, an author on both studies, "and this change appears to have a strong effect on what people actually experience."
Montgomery, like other psychologists, is now running a study of hypnosis on people undergoing surgery, in this case breast cancer patients. On the day before surgery, a trained hypnotist puts the patients into a trance for about 15 minutes, telling them that they'll feel "healthy, full of energy, strong," after their operations.
There's reason to believe that even a very short - i.e. relatively inexpensive - approach could lessen a patient's pain and drug use after surgery, psychologists say. For whatever their personal views of hypnosis, people awaiting surgery have one thing going for them that many others don't: motivation. It doesn't take a psychologist to explain why people going under the knife have tremendous anxiety, not only about the success of the operation but also about complications and recovery. They long for hypnosis to work.
"You have to really want to do what the hypnotist is suggesting you do, for obvious reasons," said psychologist Lynn. His preliminary results suggest that most people on the low end of the suggestibility scale can learn to be two to three times more hypnotizable than before, once they overcome skepticism and resistance to imagining and they establish a rapport with the therapist.
For cancer patient Polic, hypnosis has helped make the difference between living in misery and leading an active life, with the luxury of being able to laugh now and then. He doesn't feel like a million bucks, but his skin isn't burning and he's not crippled with nausea. Using CDs of recorded hypnotism sessions, he has learned to put himself into a brief trance when needed, when side effects flare.
"I was never a skeptic of hypnosis, but I'm amazed so far at what a difference it has made," he said. He is due for another round of drug therapy today. On Thursday, he's scheduled for another hypnosis session. "I'm headed back to Key West."
© 2004, The Los Angeles Times