On Hypnosis (Part 15/20)

Views of Hypnotic Pain Control

In his book on pain and hypnosis, Ernest Hilgard outlines hypnotic methods and techniques now commonly used to abolish or alter the personal experience of pain.[1] Among them are the clinical pain control techniques Erickson spent over forty years developing.[2] More recently, Yapko describes a variety of hypnotic strategies which can facilitate analgesia. Each technique either redefines the pain or "shifts the person's awareness away from the bodily sensation(s) under consideration."[3] 
 For example, in the use of "direct suggestion of analgesia" for a client experiencing stomach pain, the hypnotist may offer suggestions for a lack of sensation in the relevant body area, as follows:

As you feel your arms and legs getting heavier...you can see the muscles in your abdomen loosening...relaxing...as if they were guitar strings you were unwinding...and as you see those muscles in your abdomen relax, you can feel a pleasant tingle...the tingle of comfort...and whenever you have had a part of you become numb, like an arm or leg that fell asleep...you could feel the same tingle ...like the pleasing tingle in your abdomen now...tingling more...and isn't it both interesting and soothing to discover the sensation of no sensation there? That's right...the sensation of no sensation..a tingling, pleasing comfortable feeling of numbness there...[4]

Isn't that what parents do to children? "You're not sad. Stop with that depressive act and smile!" The child hurts his knee and the parent says, "Stop whining. It doesn't really hurt. You're making too much of it!" "Stop acting like a baby!" All phrases that change the hurt into something else. Or when a child begins to cry after falling down, the parents will do everything to distract him. "Look at this!" The child can no longer feel what he feels.

In another technique known as "glove anesthesia," the patient is given suggestions which lead her to experience anesthesia or numbness in one hand or both hands. Further suggestions then enable the patient to transfer this numbness to any other part of the body simply by touching that site with the hypnotically anesthetized hand.

If you put all of the techniques for hypnotic pain control together, you come up with a rather hefty list of methods. Pain can be numbed, transferred, suggested away, shifted, displaced, substituted for, reinterpreted, reframed, diminished, altered, relocated, converted, or substituted; the experience of it can be partially or entirely forgotten, or condensed into a few seconds duration; one's attention can be directed away from the pain via hallucination and/or age regression; or one can induce a straightforward anesthesia or analgesia.

Each particular pain control technique requires a different set of suggestions and taps into different physiological processes. For example, numbing the pain in one's chest involves different physiological processes from relocating it from the chest to the right thumb. Yet whatever the technique, it can and often does successfully provide at least some alleviation of discomfort. The various techniques share a common point of convergence: The hypnotist uses ideas in order to transform the subject's experience of pain, to dissociate it from conscious awareness.

Hilgard points out that all hypnotic pain control methods "make use of the dissociative possibilities within hypnosis."[5] [Italics added] This could be restated such that the "dissociative possibilities of hypnosis" are really alterations in neurological functions that make use of the dissociative process, period. We are all capable of separating levels of consciousness from one another, that is, dissociation. We can all revert to different brains within our skulls. This compartmentalization was an evolutionary mechanism to keep the Pain at bay and allow us to function. So even though childhood pain churns a tempest below the third-line, we go to work and carry out our duties. We are in a sort of coma but no one notices, not even us. We are compartmentalized; a whole world of experience is going on below decks but we are focused on the mast. But however it is stated, dissociation seems to be the primary ingredient in hypnotic pain control.

Hilgard uses an excellent example:

Directing attention away from pain can be achieved in more than one way. One method is to deny the existence of the painful bodily member. We have utilized this method successfully in the laboratory following reports of its clinical use. Before his arm is stimulated by lowering it into circulating ice water the subject is told, "Think that you have no left arm. Look down and see that there is no left arm there, only an empty sleeve. An arm that does not exist does not feel anything. Your arm is gone only temporarily; you will find it amusing, not alarming, that for a while you have no left arm." The arm is then stimulated by icy water, and the subject commonly reports that he feels nothing.[6]

Whether or not such a subject's report is genuine again raises the question of a special or altered state of consciousness. Does the subject experience no pain in the arm – indeed no arm at all – because of an altered hypnotic state? Predictably, Hilgard and Erickson thought so. Barber, by contrast, explained the phenomenon in terms of normal (non-special) psychodynamics, contending that the motivation for denying pain is present in the relationship between the doctor and the patient.

If Barber were correct, it would mean that achieving dramatic hypnotic effects would be contingent upon two simultaneous and interrelated factors: the outward presence of a hypnotist or hypnotherapist, and the subject's inward desire to please him. It would also mean that this "complaisancy motivation" involved neuro-psychophysiological mechanisms capable of mediating remarkable alterations in perception and function. If Hilgard and Erickson were correct, on the other hand, it would mean that dramatic hypnotic effects were fundamentally independent of outer factors (such as the presence of the hypnotist). Instead, a state of consciousness intrinsic to the subject would be responsible. It would also suggest a strong motivational factor which, however, would be self- rather than outer-directed.

It seems likely that Barber's viewpoint of pleasing the hypnotist could be true in laboratory-experimental situations. It is easy to imagine a subject not having anything better to do than achieve what is being asked of him. But there also appear to be far more complex factors involved when real-life situations are considered. When the stakes are high enough, it doesn't matter who is or is not present. Erickson worked with many terminally ill patients who, bedridden and racked with pain, were clearly too weak to care about helping him succeed as a hypnotherapist. In most cases such patients desperately desire the success of hypnotic relief for the purely personal reason of wanting to die in peace.

Erickson treated a 35-year-old woman five weeks prior to her death from lung cancer9. She had spent the previous month "almost continuously in a narcotic stupor to counteract unbearable pain." She then requested the use of hypnosis and readied herself for it by voluntarily going without medication on the day Erickson saw her:

She was seen at 6:00 p.m., bathed in perspiration, suffering acutely from constant pain and greatly exhausted...Approximately four hours of continuous effort were required before a light trance could be induced. This light stage of hypnosis was immediately utilized to induce her to permit three things to be accomplished, all of which she had consistently refused to allow in the very intensity of her desire to be hypnotized. The first of these was the hypodermic administration of 1/8 grain of morphine sulfate, a most inadequate dosage for her physical needs, but one considered adequate for the immediate situation. The next was the serving to her of a pint of rich soup, and the third was the successful insistence upon an hour's restful physiological sleep. By 6:00 a.m. the patient, who finally proved to be an excellent somnambulistic subject, had been taught successfully everything considered to be essential to meet the needs of her situation.

Erickson describes the various hypnotic techniques the patient learned, such as positive and negative hallucinations in the modalities of vision, hearing, taste, smell, touch, deep sensation, and kinesthesia; glove and stocking anesthesias to be used over her entire body; partial analgesias for superficial and deep sensations; and body disorientation and body dissociation. After this single all-night session, Erickson did not see the patient again, although he did receive daily reports about her condition from her husband. Five weeks after the session, the woman died, "in the midst of a happy social conversation with a neighbor and a relative." Erickson writes:

During that five-week period she had been instructed to feel free to accept whatever medication she needed. Now and then she would suffer pain, but this was almost always controlled by aspirin. Sometimes a second dose of aspirin with codeine was needed, and on half a dozen occasions 1/8 grain of morphine was needed. Otherwise, except for her gradual progressive physical deterioration, the patient continued decidedly comfortable and cheerfully adjusted to the end.

Erickson's own account of the efficacy of his own work is part of an extensive literature on the success of hypnotic pain control. If we accept it as accurate, the next question to ask is this: If the patient is able to successfully dissociate from previously "unbearable pain," where does the pain go? I believe it goes where it has always been: shunted away from the structures that could relay it to third-level consciousness, and back down to the physical system. It is processed as it has always been processed, with one exception: the conscious appreciation of it.

One can sometimes change the blood pressure with hypnosis, biofeedback, and other procedures, but we must never imagine that one can erase a pain that is imprinted into every cell of the body. The pain may be focused here and there, and with various techniques refocused elsewhere, but the pain remains and remains and remains.



[1]Ernest R. Hilgard and Josephine R. Hilgard, Hypnosis in the Relief of Pain (Los Altos, Calif.: William Kaufmann, 1975, pp. 63-82.
[2]See Milton H. Erickson and Ernest L. Rossi, Hypnotherapy: An Exploratory Casebook (New York: Irvington, 1979, pp. 94-142.
[3]Yapko, Trancework, pp. 276-281.
[4]Yapko, p. 277.
[5]Hilgard, Hypnosis in the Relief of Pain, p. 66.
[6]Hilgard, Hypnosis in the Relief of Pain, p. 66.