Anxiety indicates that the defenses are under maximum strain and signals for the extra production of repressive chemistry. The system revs up to quell the Pain before control is completely lost. Anxiety is taxing enough but its suppression even more so, and the anxious person usually uses self-hypnotic techniques in order to control himself (though he may never identify them as such): "It'll be alright," "Don't worry, it'll turn out fine," "Take it easy," "Calm down," "Think positive." These are all hypnotic style suggestions. Very often they have to be repeated over and over to produce any effect, which gives us some idea of the energy needed to suppress and contain the anxiety.
Hilgard's discovery regarding the link between pain and anxiety parallels what we have learned about the effort involved in maintaining dissociation: feeling the Pain in its entirety is "easier" on the system than going through the labor of dissociating from it. In fact, it is not Pain alone that produces symptoms, but Pain together with its counteracting repression. Repression is responsible for the pressure the system is under leading to symptoms. It takes great physiological effort to keep Pain out of awareness, an ongoing internal struggle which is measurable through one's vital signs. Indeed, heart rate and blood pressure tend to decrease permanently after a period of releasing Primal Pain.
The fact that emotional pain registers as a physical entity, one which is imprinted throughout the system (indicated by the physiologic changes which occur as a result of its removal), is vital to our understanding of neurosis and hypnosis. This knowledge wrests neurosis from the abstract and even metaphysical realm created for it by its definition as a mental illness, from the realm of mechanics created for it by the behaviorist viewpoint, and at last, places it where it belongs in the very real and physical organismic processes.
Pain is not often thought of as anything other than the localized sensations caused by physical injury. When it is viewed on another level it is seen as an idea: as something that can be thought away, forgotten, or in some way mentally altered by psychological gymnastics (hypnosis, biofeedback, directive daydreaming). More recently we have coined the term "problem" to describe the affliction of neurosis. It then becomes a matter of unbalanced equations, malfunctioning machinery, and unsorted puzzles. Mental solutions are sought for mental problems and behavioral solutions are sought for behavioral problems.
Pain creates problems for those who suffer from it, but to become caught up in the treatment of each problem is to lose sight of the central issue: that only by dealing with the physical reality of repressed Pain does the nature and depth of the organismic disease known as neurosis become fully treatable.
As mentioned earlier, psychological mechanisms by which hypnotic states are induced are based on the innate defensive capabilities of the brain. Even more importantly, they are based on a pre-existing pattern of behavior that has been in constant and active use throughout the subject's life. Neurosis is the ongoing post-hypnotic state which is already operating when the hypnotist goes to work. The neurotic lives in a state of permanent dissociation from his pain. Hypnotic techniques take advantage of this situation without it being recognized. The already existing defense of dissociation gets an added boost from hypnosis. When translated back into neurological terms, this means that extra endorphins pour into the system. In other words, hypnosis helps the system function even more neurotically than usual.
"Pain," writes hypnotherapist Yapko, "is a warning sign that something is wrong. The various hypnotic approaches are essentially 'band-aids,' for while they may assist the client in being more comfortable, their healing abilities remain uncertain."
As we shall see in the following chapters, the same can be said of the use of hypnotherapy as a psychotherapeutic tool. Hypnotherapy is anti-dialectic. It fails to take into account the complex interplay between imprinted Pain and repression in the development of problems such as smoking and drinking. Be it physical pain or psychological "problems," it takes the symptom as a viable force to be treated ex machina. It usually takes only one side of the dialectic process, working on the surface pain to the neglect of all else, manipulating it, changing its location, attenuating it by suggestion, but never...never... asking where it came from...and never...never...eliminating it.
Reinforcing Neurosis with Hypnotherapy
As far back as 1958, the American Medical Association recognized the use of hypnosis by physicians and psychologists as a valid therapeutic modality. Since then, hypnosis has become one of the most oft-used forms of therapy in pain management and psychotherapy .
Given the established nature of hypnosis as a form of controlled dissociation, question s remain : Are changes in permanent or temporary? And if it is possible to effect permanent change in symptoms with hypnotherapy, is it desirable to do so, given the physiologic stress that results from maintaining the dissociation
Whenever we consider hypnosis we must understand that however sophisticated the explanation, it is still repression that is at its core; a matter of narrowed perception; a constricted perceptual field. Just as it is possible to make a person unaware of physical pain, it is possible to dissociate him from feelings of anxiety, low self-esteem, and depression. Someone can think his emotional problems have vanished when they have not. A person can believe that his feelings of inferiority have been resolved even while he admonishes his children to be the best in everything. While the hypnotic reality constructs one world -- "I feel relaxed," "I am not compulsive anymore," "I feel worthwhile," "I want the best for my kids" -- the actual physiologically engraved reality (necessarily) constructs another world of referred tensions, substituted symptoms, and projected emotions. The first logical extension of this fact is that applying hypnosis in psychotherapy means utilizing the same dissociative conditions of consciousness that characterize neurosis. The second logical extension is that hypnotherapy reinforces rather than resolves neurosis
Utilizing key neurotic mechanisms to treat neurosis is at the very least contradictory. But before examining this hypotheses, let us take a look at how two prominent hypnotherapists apply their views of hypnotherapy to their patients.
Different Views of Hypnotherapy: The Ericksonian Approach
Despite his death in 1980, Milton H. Erickson's approaches to hypnosis have swept the field. "Ericksonian Hypnotherapy" is a recognized area of specialization for therapists, and Ericksonian training centers and foundations exist across the country. Psychotherapists from other specialties -- psychoanalysis, behaviorism, gestalt, etc. -- also draw from Ericksonian methods.
Erickson led the field in developing a vast array of techniques that were often highly innovative, and sometimes shocking and incomprehensible. Several of his colleagues spent much time and effort studying and observing his techniques, trying to find out what he did and how he did it. Foremost among them was psychologist Ernest Rossi. Rossi was with Erickson during much of the last decade of his life and wrote several books (with Erickson as co-author) that attempted to systematize and conceptualize Erickson's hypnotic approaches. The only relatively simple part of Erickson's work was his theory of the "conscious and unconscious minds," but how he applied that theory clinically with patients remained highly unusual and virtually non-reproducible. The crux of Erickson's viewpoint is the belief that the "unconscious mind" can heal the patient without the "conscious mind" ever being involved. According to Erickson, the conscious mind is often a barrier to healing, In his view, the unconscious mind and its reception of repressive suggestions can do, as h e demonstrated, is aid in the job of repression, so that symptoms are brought under control. "You will forget. You will not feel pain. You won't have migraines anymore .,"
In the hypnotic trance state, the conscious mind can be bypassed and the unconscious mind given free rein. According to Erickson, the conscious mind contains the "learned limitations" and "negative life experiences" that prevent us from enjoying ourselves and using our given potentials. The unconscious mind, on the other hand, contains the answers and untapped potentials for us. In Erickson's view, by bypassing or "depotentiating" consciousness, the unconscious is allowed to solve and heal. This does not mean that consciousness is kept out entirely, for it may be brought in at the end in a very secondary position:
The patient doesn't consciously know what the problems are, no matter how good a story he tells you, because that's a conscious story. What are the unconscious factors? You want to deal with the unconscious mind, bring about therapy at that level, and then translate it to the conscious mind...One tries to do hypnotherapy at an unconscious level, but to give the patient an opportunity to transfer that understanding and insight to the conscious mind as far as it is needed.In other words, consciousness may be included in therapy, but it need not be. It certainly is not to be trusted, since "the patient doesn't consciously know what the problems are, no matter how good a story he tells you..." Hypnotherapy is effective when it occurs on an unconscious level, and may then be brought into consciousness, but only "as far as it is needed."
Yapko, Trancework, p. 276.
_American Medical Association: Medical use of hypnosis. Journal of the Medical Association 1958, 168: 186-189.
54% of 1,000 respondents to a recent survey agreed that "hypnosis can be used to recover memories of actual events as far back as birth." 97% felt hypnosis is a worthwhile tool for psychotherapy. (Yapko, M., Suggestibility and Repressed Memory of Abuse: A Survey of Psychotherapists' Belief. American Journal of Clinical Hypnosis, 36 (3), 1/94, 163-171.
Milton H. Erickson, "Hypnotic Approaches to Therapy." In The Collected Papers of Milton H. Erickson on Hypnosis, Vol. IV, pp. 76-95. Edited by Ernest L. Rossi (NY: Irvington), 1980. Originally published in The American Journal of Clinical Hypnosis, 1977, 20, 20-35.