On Hypnosis (Part 21/26)

(There are 6 more articles to come on Hypnosis...)

We view hypnotherapy as a process whereby we help people utilize their own mental associations, memories, and life potentials to achieve their own therapeutic goals. Hypnotic suggestions can facilitate the utilization of abilities and potentials that already exist within a person but that remain unused or underdeveloped because of a lack of training or understanding.[1]

In Erickson's terms, trance is a time during which "the limitations of one's usual frames of references and beliefs are temporarily altered so one can be receptive to other patterns of association and modes of mental functioning that are conducive to problem-solving."[2] Hypnotherapy, then, is a "learning process for the patient, a procedure for re-education.[3] [Emphasis added] Erickson's approach deals with the casualties of neurosis (the "learned limitations"). He believed that it was his role to actively change patients -- to use hypnosis and post-hypnotic amnesia to help them restructure their thinking. He viewed hypnotherapy as process for/of restructuring thinking.
Prominent psychotherapist and researcher Jay Haley studied Erickson extensively. The titles of two of his books on Erickson -- Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. (1973), and Ordeal Therapy (1984) -- suggest the idiosyncratic nature of Erickson's techniques. For example, Erickson had a propensity to employ sexist language, verbal assaults, and other bullying approaches when treating women.[4] He was also an authoritarian therapist, as seen in the terms he dictated to a "plump," unhappy, unkempt, and unloved 35-year-old woman who had come to him for treatment:

These terms are absolute, full, and complete obedience in relation to every instruction I give you regardless of what I order or demand...You will be told what to do, and you will do it. That's it. If I tell you to resign your position, you will resign. If I tell you to eat fresh garlic cloves for breakfast, you will eat them...I want action and response -- not words, ideas, theories, concepts...Once you come, you are committed to therapy, and your bank account belongs to me as does the registration certificate for your car...I will tell you what to do and how to do it, and you are to be a most obedient patient.[5]

To "re-educate" this patient, from whom he had demanded complete obedience, Erickson induced a trance and then said to her:

"You are five feet three inches tall, and you weigh about 130 pounds; you have trim ankles, an excellent figure, a beautiful mouth and beautiful eyes..." Then, in a tone of voice of utter intensity, in the manner of conveying a vitally important message, she was asked the following question: "Ann, did you know that you have a pretty patch of fur between your legs?" For some minutes Ann stood staring at the author, blushing deeply and continuously, apparently too cataleptic to close her eyes or to move in any way. "You really have, Ann, and it is definitely darker than the hair on your head. Now at least an hour before bedtime, let us say at nine o'clock tonight, after you take your shower, stand in the nude before the full length mirror in your bedroom. Carefully, systematically, thoroughly examine your body from the waist down...Try to realize how much you would like to have the right man caress your pretty pubic hair and your softly rounded belly. Think of how you would like to have him caress your thighs and hips..."[6] Erickson's idiosyncracies - example {tt203}

Erickson's theories and techniques notwithstanding, a person's self-image does not remain poor, nor do her abilities remain undeveloped, because of limited "frames of reference" or "a lack of training or understanding." Adult neurosis is not the result of cognitive distortions; it is the product of correct cognition which is out of context. Childhood trauma alters one's perceptions to accommodate the Pain. When one's perception is altered, one sees hurt as an adult where none exists. "Can I help you?" becomes, "You think I'm helpless, don't you?" Furthermore, spontaneity and free feeling are not something we "learn"; children simply are spontaneous and free feeling until deprivation and injury intervene. A child whose father is too busy to notice him does not have "learned limitations"; he has the raw feeling of neglect. The child who is physically or sexually abused does not have "learned limitations"; she has the brutal pain of assault and violation. Her underlying fear and therefore distorted perceptions later on reflect an original situation that engendered lifelong fear. To be afraid of airplanes is to have fear from the past placed out of context in the present. ( adult neurosis is the product of correct cognition which is out of context {tt204} )
Learned limitations are the last outcrops of the neurotic process. They represent what Freud called the Superego. They are the acquired inhibitions impressed into the child's brain by parents when at last she has sufficient intellect to register and code inhibition. A stern look by a parent every time the child cries is an example. She "learns" not to cry on an emotional level without any words being spoken. The implicit factor here is fear of loss of love of the parents. If there is no real contact between parent and child, there will be little learned inhibition. Love has already been lost.
To assume that changing one's beliefs about oneself involves reeducation, training, or problem-solving is to assume incorrectly that beliefs, particularly about oneself, are rooted solely in cognition. Beliefs are the product of our experiences, and the source of "limiting beliefs" is a childhood with inculcated prohibitions about everything from how one eats to how one holds one's jaw.

A great deal of Erickson's hypnotherapy centered around the development of indirect suggestions that would "bypass" the conscious mind and lodge squarely and educationally in the unconscious mind. Since intellectual language is the province of the cortical mind, using language to bypass it requires some very clever wording. Erickson's skill at devising these clever linguistic loopholes, termed indirect suggestions, was unparalleled. Moreover, his use of indirect suggestions to bypass consciousness has become a model for much of the hypnotherapeutic community. This is the cognitive approach taken to its limit: there are suggestions called "double dissociation double binds" and those termed "conscious-unconscious double binds" -- not to mention compound, contingent, and associational suggestions. All in all, Rossi organized Erickson's indirect forms of suggestion into some 30 different categories, which he arrived at by simply analyzing the linguistic structure of the suggestion.
Erickson fully believed that suggestions which could not be understood by the conscious mind would be understood and acted upon by the benevolent unconscious mind. Indeed his trust in the unconscious was almost childlike:

You don't have to listen to me because your unconscious is here and can hear what it needs to, to respond in just the right way. And it really doesn't matter what your conscious mind does, because you don't have to listen to me because your unconscious is here and can hear what it needs to, to respond in just the right way. And it really doesn't matter what your conscious mind does, because your unconscious can find the right means of coping with that pain.[7]

Somehow the unconscious would then understand the message of a follow-up suggestion such as, "You can as a person awaken, but you do not need awaken as a body"[8] -- even as the conscious mind puzzled and fretted over its cryptic meaning. For Erickson, indirect suggestion was a cognitive means of bypassing cognition en route to a more beneficent unconscious which could hear, comprehend, decipher, solve, and heal all that consciousness could not. The problem with this viewpoint is that it is contradictory. On one hand, Erickson believed that consciousness could be bypassed by using intricate linguistic devices (ambiguities, metaphors, paradoxes, etc.) in the form of indirect suggestions which the conscious mind could not decipher. On the other hand, he assumed that the unconscious mind would be able to magically sift out the hidden meaning that had so eluded consciousness. The first contradiction is that he attempted to reach the non-verbal levels of the unconscious by using complex verbal techniques. The second contradiction is that in bypassing conscious-awareness, he was bypassing the one level of consciousness that contains the cognitive skills to actually comprehend his suggestions. And in bypassing consciousness he was bypassing exactly the element needed to stimulate the processes of healing and repair
None of this matters much to a person in Pain, and Erickson's viewpoint certainly spoke to the pained child in any adult. However simplistic or contradictory it might have seemed upon close intellectual scrutiny, his notion of the unconscious was comforting and promising. Indeed, it was made even more comforting (and believable) by virtue of Erickson's own personality and history.
In the last three decades of his life, Erickson was a living picture of the wise and comforting grandfather -- white-haired, penetrating, jocular, kindly, and crippled. Of far greater impact was the fact that he had lived out in a very poignant way the archetype of the wounded physician who learns to heal others by first learning to heal himself. At the age of 17, Erickson had almost died from an attack of polio that left his entire body paralyzed. As a teenage farm boy with nothing more than a rural education behind him, who was now still able to speak and see but unable to move any part of his body, he managed to find ways to use his mind to rejuvenate his muscular and motor abilities. Within a year-and-a-half of his attack he was able to walk unaided. Soon thereafter he entered medical school. Then at the age of 52 he experienced the rare medical tragedy of a second attack of polio, which robbed him of his upper-body strength and left him permanently confined to a wheelchair. He lived in constant pain and discomfort in the last decade of his life, but he continued to create ways to deal hypnotically with his disability and the physical pain it caused him. Patients knew this, and few remained untouched or uninfluenced by it.
The great poignancy in Erickson's history and physical presence must be taken into consideration in evaluating both his viewpoints and his impact. It would indeed be unfortunate if the course of psychotherapy as a field veered off into hypnotic realms in the hope of duplicating the often unprecedented results Erickson achieved professionally after coping with his own personal afflictions. His simplistic view of the unconscious has tended to be accepted uncritically, for example, by virtue of the results he achieved (by his own accounts) in applying it clinically. The question remains as to whether patients were responding to an intrinsic principle of consciousness rightly perceived and utilized by Erickson, or were they responding to the influence of an inspiring and seminal personality
{tt210}
Part of the trouble with Erickson's approach to therapy lies in his assuming the role of an omniscient, infallible figure. Jay Haley describes Erickson as "the first major clinician to concentrate on how to change people...influencing people with hypnosis, persuasion, or directives, Erickson...seems to have been the first major therapist to expect clinicians to innovate ways to solve a wide range of problems and to say that the responsibility for therapeutic change lies with the therapist, rather than with the patient."[9] Should a psychotherapist really be so concerned with "influencing" and "changing" his patients? When you combine this attitude with the needs of a patient, you have a formula for continued repression.


[1]Milton H. Erickson and Ernest L. Rossi, Hypnotherapy: An Exploratory Casebook (New York: Irvington), 1979, p. 1.
[2]Ibid., p. 3.
[3]Ibid., p. 9.
[4]See Masson, J., Against Therapy: Emotional Tyranny and the Myth of Psychological Healing. New York: Atheneum, 1988, 224-234.
[5]Innovative Hypnotherapy: The Collected Papers of Milton H. Erickson on Hypnosis, vol. 4, ed. by Ernest L. Rossi (New York: Irvington, 1980), 482-90.
[6]Innovative Hypnotherapy, 482-490.
[7]Erickson and Rossi, Hypnotherapy..., p. 45.
[8]Ibid., p. 47.
[9]Jay Haley, ed. Conversations with Milton H. Erickson, M.D., vol. 1, Changing Individuals (New York: Triangle Press, 1985), vii.

On Hypnosis (Part 20/20)

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."[1]

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.[2] Since then, hypnosis has become one of the most oft-used forms of therapy in pain management and psychotherapy .[3]
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.[4]

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."


[1]Yapko, Trancework, p. 276.
[2]_American Medical Association: Medical use of hypnosis. Journal of the Medical Association 1958, 168: 186-189.
[3]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.
[4]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.

Origins of ADD and Leaky Gates (Part 1/4)

Hello,
Dr. France Janov has been working on a legacy project for several years: THE ART AND SCIENCE OF PRIMAL THERAPY. It has many videos of our training and sessions showing how we work. This is a transcript of a one training session about attention deficit disorder (ADD) that I thought we should show you because it has so many insights. AJ

ORIGINS OF ADD AND LEAKY GATES

BY DR. Arthur JANOV

Transcribed by Frank Robinette

___________________________________________

INTRODUCTION: This is a discussion about the effects of ADD, what causes it, what drives it, the cause and effect of leaky gates, feelings of failure, panic, procrastination, and how a person copes with it. Also discussed are the effects of Primal Therapy on those who present with ADD. The conversation begins with Dr. Arthur Janov (Dr. AJ) introducing David who reads a segment from Dr. AJ’s blog, Janov’s Reflections (Published on December 15, 2010): 

 _________________________________________________ 

I would let this go, except that last night there was a one hour special on PBS about ADD, with four major specialists in the subject. The diagnoses they came up with is what I think is the problem with the whole field of psychotherapy, psychology and psychiatry.

Not once in the hour did I hear what the origins of ADD might be and why it occurs. Most of the time, it was spelling out how to cope with it. So we also might add how to deal with phobias, obsessions, migraines, high blood pressure and on and on. It is tantamount to saying that the illnesses stay but how we deal with them changes. It is all about our attitude. So you still have the allergies and you avoid this and that to cope with your allergy. Or you have a chaotic mind, try to avoid clutter.

The first point they made is that diagnosis is essential. And they list ten things that make you an ADDer. You need to be impulsive, not able to focus and concentrate, unable to pay attention, hyperactive, unable to sit still (I am adding here), low self esteem, learning disorders, can’t listen, needs to talk constantly, cannot wait, no long-term goals, lose temper easily, act without thinking, very impatient, a bad memory, an underachiever, etc. I added here some from a list of the Brown Scale for ADD. It pretty well covers it. But you have to be suffering from this for six months or more, they claim.

What the experts concluded was that a diagnosis was critical. Once you are aware, they claim, you are half-way there, because you know what to do; which includes: making future plans, making your environment work for you, find a calm partner and a job that suits you, making an effort not to lose patience, and above all, they claim that the therapy for this is success. Once you have a success you can build on it. And you will have a higher self-esteem and won’t be an underachiever.

So let me see: you tell the doctor that you are impulsive, impatient, cannot wait, cannot concentrate nor sit still, and she says to you that you have ADD. Ok there is the diagnosis, now what? She has told you what you just told her in more simple terms. Have we made progress? Is that what a diagnosis is? Saying things in esoteric language? The doctors have then many suggestions: don’t do too many chores at once, stay in a calm environment, jog to work off tension but do not over-talk. Don’t work amid chaos. I say to the doctor that I cannot stand crowded restaurants and he tells me to avoid them. And he adds “do not take so many risks in your life”, yet he adds it is the risk takers who invent and innovate and tend to be more creative. Now I am confused.

Not once did I hear in one hour the word, why? Where does it come from and what I can I do about it. What is the generating source of all that? So now you will read my opinion about it. It is an educated opinion since I have treated many cases. What happens is that cognitive/behavioral approaches have taken hold so that the psychiatric diagnostic manual indicates all these behaviors, and it is assumed that to treat it all, we need to change behaviors, hence, behavioral therapy.

Let’s go back to womb-life; there is a good deal of evidence that a mother’s hyperactivity, the drugs she takes, such as cocaine can leave an imprint or a residue that affects the offspring for a lifetime. If the mother is “hyper” the child may also be. Just that can set up a child who is revved up from the start. An Israeli study found that the children of holocaust survivors, very anxious people gave birth to anxious children. At first they thought it was because the parents told horrible stories to the children but then they discovered that the anxiety came down through the genetic chain; that is, it was descended from the mother’s physiology—epigenetics. (Laura Spinney, 2,Dec. 2010. Internet) Then there is the trauma of birth and infancy where the child may be left for days without warm cuddling. And then harsh parents who fill the child with feelings of rejection and abandonment. All this sets up imprints down low in the neuraxis. This is then transmitted to higher centers (as they develop and evolve) where the child is filled with input from inside that frazzles his brain; that feeds constant and varied input to the neo-cortex, no different from listening to ten people at once all talking at you. Except...,except that this information is constant from inside not outside. It competes with stimuli from outside but it all gets to be too much. It is paying attention to too much input which is normal, not an aberration. The disease, if it exists at all, is stimulating information that floods the cortex with electrical input just the same as being flooded with shock therapy.

Of course, he is hyperactive, he is being prodded all of the time from below so that any new input is overwhelming and he starts to crumble. He cannot manage complex instructions; you go to the right two blocks and then one block to the left and then go straight to the roundabout and then………we have already lost him because the internal input is crowding out the information. And of course, he cannot sit still because there is information that needs connection and resolution, the integration. That cannot happen so long as he has no access to his early imprinted memories. The information is constantly climbing upwards and forwards for that connection so that the system can function better.

And then he cannot get down to things, quickly start a paper, a project or an article because there is so much going on in his brain for him to focus on just one thing. So others get impatient because he did not turn in his paper on time. He was so busy, doing this or that, as his moods dictate because he is being twisted and turned here and there internally with little cerebral control.

Let's Go Over This Again: Why is Connection Important?

We have a triune brain—3 brains in one, with each one having a different evolution, different function and a different survival system. The reason that this is important is that when we begin our evolution our brain is not fully developed. So when there is a trauma while we are being carried or at birth it is imprinted in the lowest brain level, and therefore, we can only react with that level which is the most developed brain system at the time. This is important because it is in this deep brain system that terror exists, and we can react to terrible events with terror; which is how we know where and when something is imprinted, and where that anxiety can come from, and can only come from. When a person with chronic anxiety comes into our clinic we know where we have to go eventually, and that if we do not go there the person will always have a tendency to anxiety.

In the same way when we have a migraine patient we know that its origin may well be at birth or before when the blood circulation and oxygen level is inadequate (mostly during the birth trauma). So an upset at the age of thirty that leads to a migraine means there is a deeper level substrate that is set off; if not, there is no migraine. There may be severe upset but not deep enough to elicit a terrible headache. So there are levels we deal with that are precise and contribute in their own way to trauma. Let’s put it another way: when there is a migraine it means that there is a very early imprint involved that involved the oxygen supply. And when the person has deep internal access and there is no longer the migraine it means it has been resolved; or perhaps that deep level trauma never existed. But if she always had migraines chances are that level imprint has always been there. Thus, the kind of symptom points to when the imprint was registered, and more important, the resolution of that symptom means the person now has deep access. And by implication, with that kind of access one may well live much longer because the pain is no longer aggravating the system. Deep catastrophic imprints often lead to catastrophic symptoms, which is one way we know what level of imprint we are dealing with. Thus when we have deep mid-line trauma resulting in sex problems, either frigidity or premature ejaculation, we know where we must for resolution. And we know about the nature of the imprint—-sympathetic nervous system and premature ejaculation, or parasympathetic nervous system and lack of sexuality.

An overload of anesthetic at birth can lead to parasympathetic dominance, and the opposite when there was a struggle and success at birth.

When there is a life-and-death struggle at birth due to lack of oxygen (anoxia), for example, the existing reactive system is activated (impeded oxygen circulation), but because it cannot fully respond due to the complete load of pain (to feel it completely would be to die, or at least to lose consciousness), it reacts partially within its biologic limits and then puts the excess part of the terror away for good keeping; it houses it until our system is strong enough to feel and resolve it. It lives behind our repressive gates. And when triggered will lead to a migraine; that migraine tells a story of our history; of how it all happened and how we reacted originally, perhaps decades ago. And now we see how ahistorical therapy cannot resolve the migraine problem and why, therefore, the great push for migraine pills: a failure of psychotherapy.

However, we continually respond to this stored terror with chronically high stress hormone levels, a compromised immune system, misperceptions, strange ideas, nightmares, and chronic malaise: all the contributions from the different levels of consciousness; from different parts of the triune brain.

During a primal therapy session, when a person has access to feelings and the connection is finally made there is first great hurt and then great relief. In a primal experience (reliving an early lack of love completely), there is such a rush of pain that the defense system is temporarily overwhelmed, gating is weakened, and symptoms appear. These are often deep-brain originated and lead to life-threatening symptoms, because it was originally life-threatening at the time of the imprint. Symptoms mean a non-connected state. And clearly, it is connection that resolves the symptom. That is why connection has to be the goal of therapy, and not simply the release of tension.

On Hypnosis (Part 19/20)

More and more evidence indicates that the thalamus plays a key role in human awareness.[1] The thalamus has a relay function to the cortex, but it also serves as a switching station which handles most sensory input and delivers it to the cortex. When it is overwhelmed it cannot do that; the message gets blocked and rerouted. Those in a coma often have damage to the thalamus; what happens is that messages never arrive to consciousness. It would seem that in hypnosis, as in coma, there is a functional "lobotomy" between cortex and thalamus, so that the higher level (cortex), doesn't know what the lower level (thalamus) does or feels.

I often call a Primal a "conscious coma" because the patient is (re)living on a lower level of consciousness during the session but "knows" what is going on as well. That is, the patient has retrieved a memory stored on a lower level and is feeling it on that level while bringing it to consciousness. Whereas hypnosis depends on the split and guards it, in Primal Therapy we mend it. That is why you cannot get cured with hypnosis. The split is the source of the problem, not the solution.


Pain Control and the Neurotic Split in Consciousness

Let's take another look at the statements made by Hilgard's subjects (HS) in the hidden observer experiments, followed by rephrasing of what the subject is describing from a Primal viewpoint (PV):

HS: It's as though two things were happening simultaneously. I have two separate memories as if two things could have happened to two different people.

PV: In neurosis the adult recalls the Pain of the child as if he and that child were two separate people. He can talk about it in a detached way, dissociated from its suffering component. This is precisely the neurotic split in consciousness: the Pain is merely repressed and concealed, not eliminated.

HS: Both parts (of me) were concentrating on what you said – not to feel pain. The water bothered the hidden part a little because it felt a little but the hypnotized part was not thinking of my arm at all.

PV: In neurosis the child is told "not to feel pain" in some direct and many indirect ways. "Why such a sad face today?" "What have you got to feel bad about?" "Stop whining and sniveling or I'll give you something to cry about." "It can't hurt that much." etc. As a consequence, he grows into an adult who is well able to not think of the Pain he is in. It may "bother the hidden part a little," but the "hypnotized part" – the part that is neurotically split off – does not think of the Pain at all. It thinks of telephone calls, things to do, places to go, projects....all to keep from feeling the emptiness and solitude inside.

HS: The hidden part knew that my hand was in the water and it hurt just as much as it did the other day (in the waking control session). The hypnotized part would vaguely be aware of feeling pain – that's why I would have to concentrate really hard. 

PV: The hidden part of the neurotic feels how much Pain he is in so that he also has "to concentrate really hard" to ignore it: "I can take it like a man."

HS: The hidden part knows the pain is there but can't feel it. The hypnotized part doesn't feel it but may know it's there.

PV: It is possible to observe this process of dissociation taking place in the hypnotic subject. If we could photograph a neurotic with time-lapse photography over years, we could probably see a similar (neurotic) process taking place. The main difference is that neurosis is a long-term, lifetime event. The important similarity in hypnosis and neurosis is that while a false reality is imposed upon the system via ideas and suggestions, the ideas and suggestions cannot remove the pain actually experienced in childhood.

In both hypnotic pain control and childhood trauma, the lower levels of consciousness continue to register the pain. Recall the hypnotic subject's description that "the hypnotized part really makes an effort." Why does it have to make such an effort? Because the truth of reality is just beneath the surface. In hypnosis the hypnotist simply repeats the suggestions whenever the person starts to feel pain – when the "effort" of the hypnotized part begins to lag. In neurosis the lower levels of consciousness produce manic activity, for example, a constant effort to distract oneself from the Pain. In either case, we see the reality of pain pushing toward the surface, necessitating efforts to push it back down. One can either take a cigarette (in neurosis) or take a suggestion (in hypnosis) to push it down.

Pain of any kind is an affront to the system and, as one of Hilgard's experiments suggests, denial of that pain may constitute a kind of double-barrelled assault. Attempting to differentiate between pain and anxiety in hypnotic analgesia, Hilgard found that hypnotic pain reduction techniques may actually increase the amount of anxiety felt by the person while he is in the process of supposedly reducing his pain. Hilgard wrote:

Maintaining hypnotic analgesia requires some effort by the subject, even though he knows he is going to be successful in reducing pain. This effort is accompanied by physiological signs of anticipatory excitement when the subject knows he must soon fight off painful stimulation. These signs may be interpreted as a form of anxiety, perhaps deriving from a latent fear that this time control may be lacking. In any case...both heart rate and blood pressure increase more when pain is to be reduced by hypnotic analgesia than when it is to be felt normally at full value.[2] [Italics added]

In neurosis, of course, it is typical to see both blood pressure and high heart rate chronically high. Hilgard's description illustrates the conflict between Pain and repression continually waged in every neurotic, a conflict which often results in anxiety. Anxiety is the global symptom which arises when Primal Pain threatens to overwhelm inhibition and make itself fully conscious. Every pre-Primal state, where patients are about to enter into an old feeling, can be considered an anxiety state.

There is no anxiety without repression; anxiety is a sign of faltering repression. Without repression, one simply gets terror in context. When my patients feel their terror in the ancient context there is no more anxiety. Thus it is both a symptom and a signal.

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."[3]


[1]See Science News, July 2, 1994, pp. 10-11.
[2]Hilgard, Hypnosis in the Relief of Pain, p. 78.
[3]Yapko, Trancework, p. 276.

On Hypnosis (Part 18/20)

Where is Reality?

It is certain that the serotonin/endorphin system will not turn out to be the sole mechanism by which hypnotic dissociation occurs. There is a key central brain inhibitor known as glutamate. But we do know that hypnotic suggestion can catalyze inhibitory or repressive chemical production. The suggestion (or idea) given by the hypnotist is transformed into electrochemical activity that somehow blocks pain. More specifically, the suggestion takes on a meaning on the third or cognitive level of consciousness and is then transformed into electrochemical processes which inhibit perception of physical experience. Think of it! A bit of air in the form of certain sounds (words) breathed out to another produces biochemical changes in her which alter her perceptions and block pain.

The subject in Hilgard's ice water experiment was no longer responding to the reality of the ice water. Instead, she was responding to ideas about it, even when those ideas were in complete contradiction to events actually taking place. This transformation of meaning that occurs in hypnosis is not unlike the transformation of meaning that makes neurosis possible. In both, the perception or meaning of the event is altered on one level of consciousness while its intrinsic meaning is registered accurately on the other levels. This leads to the sixty-four dollar question: WHERE IS REALITY?

If I say to a hypnotic subject, "I'm going to put a hot piece of metal on the back of your hand," and then put a cold quarter on it, and the hand then blisters as if a hot metal were placed there (an effect that has been demonstrated in hypnosis), what is real? The metal, the response, the idea, the suggestion? Is there no objective reality? Objective reality dictates that the psychophysiology responds to a cold quarter. Yet the idea in the mind is that it is a hot one and the physiology follows that idea. Clearly, reality is in the perception; that is, intellectual reality. That reality dictates bodily reactions. This is the true meaning of “psychosomatic.” Here the mind innervates and alters bodily reactions; so if we wonder how it is that a child who obeys his parents absolutely has allergies or asthma we see it encapsulated in the hypnosis experiments. The parental dictates change the immune system of the child, for example.

If I perceive an elevator to be terrifying, even though it clearly isn't, and I'm dizzy, fainting, etc., in plain terror, it is my perception that is real for me. But that perception is based on a history. The newly-perceived reality has an historical basis. There are levels of reality that lay on different levels of consciousness. The hypnotist who pricks you states that you will not hurt, and there is no perception of hurt; yet the blood pressure and heart rate mount. The lower level knows reality on its level. That is why when you are in touch with the lower levels of consciousness you are not so easily fooled, lulled or hypnotized. The physiological processes inform the cortex of what is reality.

What Hitler did in Germany was an effective job of hypnosis. He suggested with emotional force, "You are superior to all other races! You need liebensraum!" (more space and freedom). For those who felt inferior and downtrodden, it was a perfect message. And Hitler got the German people to do almost anything, including killing millions of "inferior" individuals. Even those who realistically did not need any more living space responded to his message. What was inserted into their minds supplanted reality. And they acted exactly as if they had been hypnotized. They could kill without feeling anything because any appreciation of the meaning of their acts had been wiped away. Meanwhile, those who wanted and needed peace, an obvious choice, were known as "defeatists" and were punished. Hitler's control became absolute; the "mesmerized" (dissociated) populace went on fighting and dying for a dying cause that had nothing to do with their everyday lives. Not so different today in Iraq where any talk of a peaceful solution is considered by the administration as defeatest and sending the wrong message to our troops. Jingoism then becomes the only topic admissible.

How did Hitler do it? He tapped into the people's basic needs and into their split consciousness. He capitalized on their already existing dissociation and on the ideas that duty was all, and that how you felt was unimportant. He used their feeling of being a defeated nation to suggest that they were conquerors. He turned reality upside down. In short, he suppressed their Pain just as a hypnotist does, and he infused and inculcated another reality – his. Hitler was so skilled (and his subjects so prepared) that he could do it on a mass level.

This whole notion of the nature of reality is critical to an understanding of psychotherapy, for if we assume that reality is what the patient tells us it us (“I feel wonderful. Therapy has been a great success”)we will be led astray. We have neglected an important internal reality, something that can only be achieved by “talking” to the body; that is, measuring it to see what secrets it holds. It may tell a very different story. So then were is reality? Is it what the patients says it is. In short, the nature of reality splits the field of psychotherapy into those who think it is cognitive and those who think it is cognitive-somatic.

When there is dissociation, either in neurosis or hypnosis, the information takes a detour and the person is unconscious of certain facts or states. One of the structures to help in this detour is the thalamus.

Another Hot New Gadget

We love new gadgets, especially when it has the word ‘”new” attached to it. Even if it is the same-old, same-old ad nauseum approach throughout history. These new-fangled therapies become viral very quickly and a whole new group of specialized therapist spring into action. This new one is called mindfulness or mindfulness meditation. So what is new about it? Nothing.

What does it claim to do? And how come it gets such huge space in scientific journals?

So here is a quote from a scientific journal (New Scientist): “Training allows us to transform the mind, to overcome destructive emotions and to dispel suffering.” (New Scientist, “Everybody say OM”. 8, Jan. 2011). Where have we heard that before? EST perhaps, Cognitive Behavioral, trans blah blah, EMDR and so on.

And so what is the basis for all this? Enthusiasm and perseverance, (their words). But they quickly add, “What does science say about all this?” Using MRI”s they measured the brain of experienced meditators. And they believe that the time you spend investigating the nature of your mind is well spent.

The researchers spent three months following the 60 acolytes at a retreat in Colorado. What the subjects did was concentrate on their breathing, tactile sensations and to the sensation of breathing itself. As time went on they became more skilled on judging a line that was shorter than the others; a measure of attention span and reaction time. The clicked a mouse when they noticed a shorter line. That’s it folks! You wanted something more substantial? Not here. You see, science is really about the criteria you use to measure you notion of progress. And so here you have a so-called “objective” measure. Here again we are faced with statistical truths. There are variations on this theme. Another study had subjects pick out different tones to see how well they perceive and have sustained concentration.

And how does focusing on your breath every day help focusing? They say it adds to working memory. Anyway let me repeat ad infinitum: we are historical beings. What happens to us, our dreams, symptoms, behavior and concentration is a result of OUR HISTORY. All of this doesn’t suddenly spring up to show itself in how badly we concentrate; nor does a real change suddenly spring up and show itself to the world. How can we ignore hjstory and make progress? When that history has to do with whether there is progress or not. We have found that early trauma can stimulate the system, overexcite it so that there is a continuous massive input from inside; from the early imprint, that overwhelms the ability to focus and concentrate. And when we take the force/pain out of the system there is enhanced concentration. How can we neglect these historical forces and help anyone? We can if we are satisfied with temporary help but no here-and-now therapy which treats in a non-historical way can produce permanent serious changes. If we believe they can then we cannot believe in the memory imprint that guides our behavior and helps produce symptoms, whether of migraine or high blood pressure. Or we believe that we can circumvent history and find a way around it. I have never found a way. Ahistoric therapies have found ways to make you feel better or ways to convince yourself that you feel good but that at best is a chimera. Tricks of the mind. Not only can we be deceived by others but more importantly we can be deceived by ourselves; and that is the greatest deception because we believe the self that is alienated from the real being, the feeling self. That self believes in lies because it has no feeling base to help it judge things. Mindfulness is another mindf----; an apotheosis of mental gyrations that is akin to evangelicals who do not believe in remote history. And if I say that ADD is partially caused by memories occasioned during birth and gestation, that remote, I will not be believed. Mindfulness is, in short, psychoevangelicalism. “We live in the near present and that is that.”

So here is where we get down to the nitty-gritty. “Meditation does not remove the sensation of pain so much as teach sufferers to control their emotional reaction to it, there reducing the stress response. In bried—denial. And it is the job of the prefrontal cortex to suppress emotions. Here there is a recognition that it cannot do its job properly without help. So a whole industry has grown up with no knowledge of the brain and how it works; an Industry of denial, suppression and ignorance of the truth. Of course this can help cognitive performance as they claim but can it improve emotional access? That is the key question. We are feeling beings, not just thinking animals. Only academics can see it backwards, apotheosizing mental cognition to the neglect of emotions. ayayay

The Case For and Against Antidepressants

There is polemic going on in the magazines about the use of antidepressant medication. It seems like the case against them is gaining ground. The Week magazine (July 29/11) seems to feel that they are useless. Worse, no one knows how they work or where in the brain. And in some studies they are about equal to placebos.

It all gets confusing, more so when there is no real understanding about what depression is. So allow me to enter the fray. Depression is repression elevated to great heights due to the onslaught of very early trauma and is a counterpart repression. The deeper the depression the more likely it emanates from our life before birth at even at birth. It is, in effect, massive global repression. And what happens is that catastrophic imprinted pain has to be repressed continuously; and in the service of repression there is an exhaustion of serotonin (and other inhibitors) supplies. Thus, it may be possible during life in the womb that our set-points for serotonin are very low and remain so throughout our lives. Naturally, then we grow up needing outside help to boost our supplies of key inhibitory medication. We may take any one of the SSRI’s to enhance serotonin. Those repressors lighten the burden of a system overloaded with pain. They help ease the load and lend a shoulder to the gating system. So do they do any good? Of course, if we are simply helping normalize supplies; all of these key mental medications do is mimic what the brain normally does all of the time. But when the system is overloaded the brain cannot function normally. Then we need outside help.

So how is it that placebos do almost as good as SSRIs? Because thru suggestion we produce the very same painkilling chemicals that we do with real medication. That is why it is so easy to sell hope. The dispensers of booga booga nearly always get rich because their ideas, now inculcated into us, cause the dispensation of pain- killing chemicals. And we think that the phony product really works. It isn’t the product it is the vendor. It isn’t that phony and neutral medications work as well as real ones; it is that the suggestion or implication that accompanies giving the placebo works in the brain to manufacture neuroinhibitors which enhance gating. So it is hope again, sold in the form of implication, “This ought to do the job.” That is why cults and religion works so well; that dispense hope; the dispenser is the cult and the leader. He actually controls the pain of the worshiper. He tells us he is making a better world for us but meanwhile we are obliged to make a better world for him (and it is most often males) by giving him our money and possessions.

So now there is the assumption that we are dealing with a chemical imbalance; and if we are satisfied to deal with only surface appearances then it is true. There is an imbalance which is only part of the story. What causes it is what is not obvious and what is not seen or even imagined. If a theory doesn’t allow for deeper events then it will never be seen. And here again we have cognitive therapy dealing only with what is current and obvious, but not really true.

Without a proper theory and a bit of science, to boot, one can give into the notion that these drugs do help only slightly. If we don’t know how deep the pain lies, and if we don’t know that ideas produce painkillers, and if we don’t know that ideas that contain hope work the same way in the brain as true medications, then we will never understand how to deal with depression. Too often we just address each new medication de novo, as something new and unrelated and we do not place it into a gestalt context (meaning an overview). There are those who swear that anti-depressive medication has helped them. And it does by normalizing the balance that the system should do on its own. Overload of pain prevents it. Helping the system produce enough to make us feel better is all it is about.

Transforming Feelings Through Resonance

How do we transform sadness into depression? Anger into rage? Fear into terror? RESONANCE. The deeper we go in the nervous system the more unreasoned, out of control, impulsive feelings/sensations there are. For good reason. The deeper we go, down into the brainstem the more survival, animalistic, immediate reactions are elicited. Rage and terror are there to help us react quickly to save our lives. Also there is deep hopelessness (the basis for severe depression). It is all there and can be triggered off in the present through resonance. It seems to me that all basic feelings are held together through specific frequencies which unite such feelings as anger and rage. Rage and terror are the first line components of feelings that are triggered off, resonate, with/by current feelings which are far less severe. Nothing in the present is ordinarily meant to be terrorizing. Yet giving a speech can be just that. Why? Because when one’s childhood is ridden by constant lack of love and neglect and often hatred by parents, the defense system is weakened and resonance can go deeper without impediment because of weakened or leaky gates. Those early traumas when early and severe damage our ability to develop a good gating system.

So giving a speech elicits terror, which actually has nothing to do with what is going on in the present. But what is resonated with is real and tells us a lot about what lies down there in that primitive salamander brain. Is there an immediate life-threatening event? Often yes. A mother smoking or drinking or taking drugs. A pre-psychotic mother can do it due to her high levels of mobilizing chemicals. The excessive vital signs speak to us in the language of the body, and they tell us how severe the early event was. This is particularly true in psychotics. I treated a young man who was born on a marine base to parents who were divorcing. The mother abandoned him and he was reared thereafter by a father who was nearly always absent, sent to war zones. There was trauma after trauma, meaning no love.

The problem is that we often do not recognize the resonance factor and treat the top level as the problem. In cognitive/insight therapy the patient is convinced that there is nothing to be afraid of. Ay ay ay. There is a lot to be afraid of only we cannot see it. It is like anger management. We treat rage through top level cortical pleadings when the real rage lies sleepily but stealthily down deep ready to pounce. Here is where words are but a weak, weak weapon for dealing with it. We must understand resonance, for that is what we must treat. We must attack what we cannot see; the imprint that has been there for decades, something that will eventually give us cancer or a heart attack, and we will wonder why?

How can we be sure about all this? One way is through vital signs. We systematically measure all patients’ sessions before and after. As the resonance factor kicks in, we find that the deeper we go in the brain the greater the vital sign measures. So down in the brainstem where much of our birth trauma and prenatal trauma is registered is where we find the long slow-wave brain signatures in our patients as they approach the deeper levels. It is where we see blood pressure of 200 over 110, and of resting heart rate of over 100.

Thus, the terrific impact these very early imprints have is demonstrated every day in almost every session. A patient comes in very hopeless and depressed and her blood pressure is very low. Another comes in with great anger and his heart rate is exceedingly high. It is of a piece, and we literally see the contribution of each level of consciousness during the session. We rarely if ever find a patient down on the brainstem level without resonance. This alone should guide us in the therapy of those who are ridden by out-of-control impulsiveness.

Someone comes to a doctor with chronically very high blood pressure and they immediately give blood pressure medication. And they should offer medication. It must be controlled. In our therapy, we have an idea already of where the origins lie because we are a therapy of genesis, of genotypes, not phenotypes. In fact the phenotype (appearances) is one way to arrive at the genotype. If we suppress the phenotype with medication we can almost be sure the patient will not get well. We know very little of the minute details of a malady but we know a great deal about genesis. This tells us a great deal about the status of the gates, how leaky they are, how solid and impenetrable or refractory they are. As soon as the patient comes in her body is sending out information. If she is awash in first line input we know where we have to go in therapy. Either help her into the imprint or perhaps helping with the gating system through the temporary use of tranquilizers.

A new patient with very low blood pressure and body temperature already signifies parasympathetic excess. We may have to boost her vital functions for a time with energy boosters. We may have to offer something that enhances stress hormone output. As I have pointed out, in our therapy we attack the conductor of it all, not the individual players such as blood pressure or heart rate. And that is the difference between what we do and what other therapies do. We have an overview. We know the music and it often has no lyrics.

On Hypnosis (Part 17/20)

Hypnosis and suggestion can then be used, in Hilgard's terms, to restructure communication between cognition and response. He's not sure how, but in some way hypnosis results in the erection of two separate communication barriers. One barrier (running vertically in the diagram) splits cognition into two disconnected compartments and similarly splits voluntary and involuntary responses to pain.

Now what we have – at least diagrammatically – is a brain split in half. On the left side all channels of communication in the overt hypnotic reality of no pain are open and consistent; the subject registers no felt pain consciously, expresses no felt pain bodily, and communicates no felt pain verbally. On the right side we have an additional barrier (running horizontally) between cognition and communication so that the felt pain is not communicated unless a technique such as automatic writing or talking is introduced into the hypnotic situation. So in the covert hypnotic reality of felt pain, the subject registers pain unconsciously and expresses it involuntarily through vital sign indicators, but cannot or does not communicate it. Hilgard believes this model explains how a person can feel neither pain nor suffering at the conscious level within hypnosis, yet still register the physiological signs of pain unconsciously.


Pain and Awareness

As yet, there is no scientific definition of pain. It can be described and its components listed, but investigators have been "unable to come up with a definition that (catches) the single 'essence' of pain, beyond the common sense notion that we are dealing with what hurts."[2] It seems we have made little progress since Aristotle's day, when he himself omitted the sense of pain from his list of man's five senses. It was not until the nineteenth century that the sensory component of pain was recognized as a physiological and psychological reality. Before that, pain was linked to its maiden-opposite of pleasure, and both were viewed as "passions of the soul" rather than as provinces of science.

The "hidden observer" has enormous implications for psychology. It means that while we have the capacity for concealing, repressing, denying, and dissociating from pain, we are not actually getting rid of it. We may be able to remove it from awareness, but it still exists in the lower levels of consciousness. This is the crux of neurosis: while we may split off from Primal Pain, it remains within us, exerting a real force and producing all manner of symptoms. Now we have corroboration that out of mind is not out of body. Hypnotic pain control techniques can temporarily relieve us of physical pain, just as our absorption in a certain task or spectacle may allow us to forget about physical pain for a time, but sooner or later we again become aware of it. Similarly, to repress emotional pain does not eliminate it nor alleviate the symptoms it produces.

Today it is recognized that pain contains both a sensory component and a suffering component. The presence of one does not necessarily mean the presence of the other. We can be in physical pain without feeling badly emotionally, and we can feel badly emotionally without being in any sensory pain. For most of us, however, the two go hand-in-hand: being physically ill is emotionally upsetting and being emotionally upset is physically painful.

The distinction between the sensory and suffering components of pain has many significant medical and psychotherapeutic ramifications. This was demonstrated several years ago, when an experimental operation was performed on a group of patients who were suffering from intractable pain. The operation involved a pre-frontal lobotomy, which means that a group of connecting fibers between lower and higher (cortical) brain centers were severed. After the operation the patients reported that they could still feel the sensation of pain but that it did not bother them. In other words, the suffering component of the pain was alleviated surgically while the sensory component remained.[3]

This is also the situation in neurosis.–– A neurotic may feel neither pain nor suffering, depending upon the degree of defense, or "gating" of pain between levels of consciousness. The neurotic's face may show a good deal of misery while he remains unaware of feeling miserable; his body may be stiff with tension, yet he doesn't know why. He can talk about his deprived childhood with complete detachment. No feeling of suffering or distress reaches his awareness.

Thus, in all three conditions – neurosis, hypnosis, and lobotomy – awareness and recall on the cognitive level are effectively disconnected from the emotional components of what is remembered.

There is obvious value in using hypnosis to remove the suffering component from organic pain when it cannot be alleviated in any other way. No one benefits from unbearable pain related to terminal cancer, constant back pain caused by a genetic spinal problem, or from constant residual pain after a serious car accident.

The numerous techniques for removing the awareness of pain and the everyday distractions that achieve the same thing show us the dramatic abilities of consciousness to alter its own perceptions. And we certainly need hypnosis to achieve this. In everyday life, we are very adept at keeping ourselves distracted from what is going on inside. A busy, even hectic lifestyle is probably the main defense today. Phone calls, letters, business deals, discussions, movies, television, are all part of the hypnotic process. It seems that half the people watching TV are indeed mesmerized – as if half the population is in a coma after six p.m. One lets in the message, particularly the commercial message, without any critical capacity, whatsoever. One is simply the passive recipient. The next day, as if in a posthypnotic suggestive state, one goes to the store and buys Crest and Kellogg’s Corn Flakes, just as one has been programmed to do.

Hypnotic pain techniques demonstrate how far cognition can go in structuring a false reality. But how is this possible? By what physiological mechanism is it achieved?


The Endorphin System

I have already discussed the plasticity of the third level of consciousness and its role in susceptibility to hypnosis. There are additional, more specific neurological factors which help make dissociation possible. One is the left brain-right brain dichotomy referred to by Hilgard to illustrate his "hidden observer" discovery. Another is the system of "gating" which exists between levels of consciousness to inhibit or facilitate the flow of information.[4] Still another is the body's capacity to produce morphine-like substances called endorphins. And the neuroinhibitor, serotonin. These chemicals block the message of pain from crossing the cleft between nerve cells, the synapse, in effect gating the message from reaching higher brain centers.
The neuroinhibitors function as the biochemicals of repression and its twin, dissociation. They are produced to quell both physical and emotional pain. Although the body does not differentiate between the two types of pain in qualitative terms, it does respond differentially in quantitative terms. As I pointed out in Prisoners of Pain:

The Swedish pharmacologist Lars Terenius has discovered that patients suffering from emotional Pain produce more endorphins than those suffering from physical pain. Emotional Pain is real and often physically more intense than "physical pain." Those with emotional or psychological Pain in Terenius' studies had less tolerance to physical pain. Their bodies were hyperactive, producing more Pain suppressants.[5]

When the amount of pain assaulting the system can no longer be integrated, endorphins are mobilized to repress the experience and the memory of the event. These endorphins can be many hundreds of times more powerful than commercially produced morphine. They keep events out of full consciousness by interfering in the connection between feeling and the realization of feeling, between injury and reaction to it, between sensation and cognition. Nonetheless the trauma remains in the system, full and intact.

Through the production of endorphins, the person may be able to dissociate from the pain of his hand submerged in icy water, but the icy water nonetheless causes his vasomotor system to contract in pain. Similarly a child may be able to dissociate from the Pain of losing his mother, but that Pain is still causing his system to siphon off its impact in some way – be it through acting-out behavior, compulsive eating, chronic depression, or whatever. The child may simply "numb-out." He is no longer emotionally reactive. He's inert, immobile, and emotionally "dead". He no longer suffers the horrendous pain of losing his mother. He goes on with life in a very "dead" fashion. Nonetheless, there is always some physical manifestation of the presence of pain in the system, regardless of what one is consciously experiencing.



[1]See Hilgard, p. 48, Figure 15, right diagram.
[2]Hilgard, Hypnosis in the Relief of Pain, p. 29
[3]The same effects can be achieved with marijuana, morphine, and other drugs that suppress the suffering aspect of pain more than the actual sensation of pain. Aspirin, on the other hand, does just the opposite: it reduces localized sensory pain but does not reduce anxiety or suffering. Localized sensory pain has a specific physical location in the body; anxiety, by contrast, is a non-specific and diffused state of being.
[4]For a brief discussion of "gating," see "The Gated Mind" in my book Prisoners of Pain (New York: Doubleday, 1980) pp. 111-114. For a more technical discussion see "The Gating of Pain" in Primal Man (New York: Thomas Crowell Co., 1975 ), pp. 126-134.
[5]Arthur Janov, Prisoners of Pain, p. 85.

On Hypnosis (Part 16/20)

Research: The “Hidden Observer” Discovery

Erickson often pointed out the naturalistic basis of hypnotic pain control. In everyday life, pain can be temporarily abolished simply by the intervention of more compelling concerns. The young mother suffering a severe burn pain will instantly become oblivious to it when her baby falls out of the crib and screams in pain. Football players can finish a ballgame with broken limbs while barely noticing the pain. Watching a suspenseful movie can make us temporarily forget that we have the flu, a sprained back, or an ulcer. Whatever the particular circumstances, consciousness is diverted from registering pain.

Research indicates that while one's apperception of pain may be altered by hypnosis, its physical reality in the body is not. This is no different from neurosis where one feels wonderful but has migraines and high blood pressure and considers them aberrations from this wonderful mental state.

A number of experiments have shown that hypnosis does not block the actual sensory messages of pain on their way into the brain along the peripheral nervous system. This finding suggests that hypnotic pain control takes place at the cortical or cognitive level of the central nervous system – that is, at the third level of consciousness. Other research in the field indicates that although felt pain may be reduced, involuntary physiologic indicators of it continue to register: blood pressure, pulse rate, and temperature are all up. This suggests that oblivion to pain is only "in the head" (literally, in the cortical area of the brain) while the body continues to be affected. More interestingly, it turns out that this cortical oblivion is even incomplete. That is, conscious awareness of pain is not totally eradicated in hypnosis, contrary to what was traditionally assumed. The discovery of this came as quite a surprise to researcher Ernest Hilgard while he was conducting a classroom demonstration, in response to a serendipitous question on hypnotic deafness. He recounts the incident as follows:

The subject of the demonstration was a blind student, experienced in hypnosis, who had volunteered to serve; his blindness was not related to the demonstration, except that any visual cues were eliminated. After induction of hypnosis, he was given the suggestion that, at the count of three, he would become completely deaf to all sounds. His hearing would be restored to normal when the instructor's hand was placed on his right shoulder. To be both blind and deaf would have been a frightening experience for the subject, had he not known that his deafness was quite temporary. 

Loud sounds were then made close to the subject's head by banging together some large wooden blocks. There was no sign of reaction whatsoever; none was expected, because the subject had, in a previous demonstration, shown lack of responsiveness to the shots of a starter's pistol. He was completely indifferent to any questions asked of him while hypnotically deaf.

One student in the class questioned whether "some part" of the subject might be aware of what was going on. After all, there was nothing wrong with his ears. The instructor agreed to test this by a method rebated to interrogation practices used by clinical hypnotists. He addressed the hypnotically deaf subject in a quiet voice.

"As you know, there are parts of our nervous system that carry on activities that occur out of awareness, of which control of the circulation of the blood, or the digestive processes, are the most familiar. However, there may be intellectual processes also of which we are unaware, such as those that find expression in night dreams. Although you are hypnotically deaf, perhaps there is some part of you that is hearing my voice and processing the information. If there is, I should like the index finger of your right hand to rise as a sign that this is the case."

To the surprise of the instructor, as well as the class, the finger rose! The subject immediately said, "Please restore my hearing so you can tell me what you did. I felt my finger rise in a way that was not a spontaneous twitch, so you must have done something to make it rise, and I want to know what you did."[1]

Hilgard then began experiments to see if the "hidden observer" phenomenon also occurred in hypnotic pain control. He used "automatic writing" (also "automatic talking") as a tool to "split" the subject's awareness. The subject was told that one arm would be put in ice water while the other would be put "out of awareness." She was then asked to report verbally on how much pain she was feeling in the icy hand, while simultaneously writing a response with the hand that was "out of awareness." It turned out that as she verbally reported no pain in the icy hand, the out-of-awareness hand reported increasing degrees of pain. Another subject, who had his hypnotically-dissociated arm pricked several times with a hypodermic needle, reportedly wrote "Ouch, damn it, you're hurting me." Meanwhile, this subject himself remained oblivious to what was happening, asking when the experiment would begin a few minutes after it had already ended. In other words, the "hidden observer" in each subject reported feeling normal pain while the hypnotized part felt little or not pain. According to Hilgard, such experiments indicate that:

A hypnotized subject who is out of contact with a source of stimulation...may nevertheless register information regarding what is occurring. Further, he may be understanding it so that, under appropriate circumstances, what was unknown to the hypnotized part of him can be uncovered and talked about...It should be noted that the "hidden observer" is a metaphor for something occurring at an intellectual level but not available to the consciousness of the hypnotized person. It does not mean that there is some sort of secondary personality with a life of its own – a kind of homunculus lurking in the shadows of the conscious person.[2] [Italics added]

Following are statements by some of Hilgard's subjects describing their experience of the hidden observer experiments:

It's as though two things were happening simultaneously. I have two separate memories as if two things could have happened to two different people.

Both parts (of me) were concentrating on what you said – not to feel pain. The water bothered the hidden part a little because it felt a little but the hypnotized part was not thinking of my arm at all.

The hidden part knew that my hand was in the water and it hurt just as much as it did the other day (in the waking control session). The hypnotized part would vaguely be aware of feeling pain – that's why I would have to concentrate really hard.

The hidden part knows the pain is there but I'm not sure it feels it. The hypnotized part doesn't feel it but I ' m not sure that the hypnotized part may have known it was there but didn't say it. The hypnotized part really makes an effort.[3] [Original Italics]

Here we see the split clearly described in the subjects' own words. We see the knowing about pain dissociated from the feeling of it. Hilgard points out that even though there was a high level of sensory pain in these hypnotic subjects, there was no distress or suffering accompanying it. When the hypnotic state was lifted, the subjects could remember feeling pain but they did not feel the suffering. In other words, they remembered the feeling but they did not feel it.

Let's take an example of how the countless ways this split occurs outside of experimental situations. A scientist who is a rigid procedurist, never wavering from correct methods, believes in the Moonies and is a devotee (a case I know of). Here the intellect is split in a seamless unity where one part of the intellect sees reality in her science, and the other part is attending to the Pain below by developing belief systems. The Pain seeps into a part of the intellect and forces it to deal with it while keeping the person unconscious of her motivation. Another part has all of its critical faculties intact. It is easy to split the intellect. That is why one can be a crazy paranoid with weird ideas and still work and talk intelligently and rationally. So long as one doesn't touch the Pain, one can deal with the person.

How to explain hypnotic pain control? How to explain the overt and covert levels of reporting in the hidden observer phenomenon? Hilgard proposes a concept of "divided cognitive control systems" which we can shift in and out of via hypnosis. According to Yapko, dissociation from pain "involves the capacity to divide one's attentional and behavioral abilities" and "causes the subjective experience of feeling separated from all or part of one's body, and thus the pain."[4]
In the normal waking state, we have an open communication channel between cognition and response mechanisms so that the sensation of pain is communicated voluntarily through face and body expressions, and involuntarily through vital sign indicators.



[1]Hilgard, Hypnosis in the Relief of Pain, pp. 166-167.
[2]Hilgard, Hypnosis in the Relief of Pain, pp. 168-69.
[3]Ibid., p. 173.
[4]Yapko, Trancework, p. 279.

On Charlie Parker, Saxophonist

I had come back from the European theater of war. I landed in New York and heard about a new guy playing something none of us ever heard before…bebop. We went down to 42nd street to hear him, and it blew us away. His name was Charlie Parker. Years later he was found wandering the streets naked. And showed all the signs of severe psychosis. Now what has psychosis to do with bebop? A lot.
Just a smidgen of neuroscience: late research shows that inventive jazz playing (and I include bebop)is largely right brain, just the place where very, very early trauma is imprinted, where our key feelings reside, and where we need access in order to invent in music and get well in life. Wow! What a tall order. Alas, it is also the place that pain can break through and disrupt our functioning. It happened to poor Charlie who was run by his right brain, happily and unhappily. It helped him invent and go crazy. He did not have enough left brain to integrate his feelings and suppress those too cumbersome. He did not have enough left brain to stifle his inventiveness.

Charlie’s music was wild, florid, unconstrained, liberated, unpredictable, unexpected and flourishing. It went off in many directions at once, which is why we all had such a hard time learning it. It was the beginning of a very new music, thanks to a pre-psychotic who could not contain his feelings. Like Dali, it made him the most creative and also very close to madness.

Why We Remember for Such a Long Time

You know the brain is one of the rare places in the human system where there is a very small turnover of cells. The blood, bone and muscle cells turn over fairly rapidly so we get new cells every few weeks or months. No so with the brain whose cells last us a lifetime, which is why what happened to us during gestation and infancy has such a long lifespan. Yes, there are a few places, such as the hippocampus, where we get new cells perhaps for a lifetime but that is the exception.

So trauma while we are being carried is imprinted into the very rapidly developing neurons and does its damage forevermore. Those long-lasting imprints are designed for survival; to warn us over and again about how to react in the case of similar adversity or threats later on. Those traumas stimulate the production of stress hormones affecting the nerve cells and change memory and learning. They form the “epigenetic mass” which changes how the genes are expressed. We learn how to react from all that. It is adaptive, not an aberration. That is, deviation, neurosis, in my terms, help survival. The early traumas enhance some parts of memory and help them endure; that is one function of the stress hormones. They change the structure and function of some nerve cells. Think of this as a lesson in evolution and how and why it takes place: Experience produces the kinds of cells that are needed to react to that experience. Experience changes us neuro-biologially. Our whole system changes in order to adapt to life. And when that life is traumatic and loveless we change accordingly; we become neurotic (what I call that change). We deviate physically and emotionally in order to adapt and survive. Neurosis is adaptive, which is why we should not mess with it, our compulsions and obsessions until we understand the basis of it all. It is the feeling centers, such as the hippocampus that seals in those critical early memories and makes them last. One role of the stress hormones is to produce a kind of consolidation of key memories so that they remain in place to guide us and help us adapt, even in neurotic ways. We may do it to feel loved and to survive. This enhanced memory also takes place in the key feeling structure, now well explored, called the amygdala, which seems to swell a bit under the load of feeling.

We may have become intellectual to please parents who needed smart kids so that they would look good. And the kid’s physique suffers and changes in deference to the parents needs. The feeling centers diminish and there is less emotion to call on. The kid now lives in his head. Smart but emotionless. Not good.

The Role of Evolution in Psychotherapy

This article was first published on October 26, 2010. I just want to run it again, as it is so important.

I have been thinking about evolution in regard to psychotherapy. Last night there was a program on evolution; scientists from several countries convened to discuss the possible evolution of dinosaurs. There were many explanations, none satisfying. One, however, seemed credible. The question was which came first dinosaurs or birds?, since fossils were found of dinosaurs with feathers. They studied birds found near the site that had similar appendages as dinosaurs and filmed them. They found that these birds were born knowing only how to run; as their personal evolution continued they began to fly. This seemingly added evidence to the notion that birds came second, not first; that birds evolved out of dinosaurs, not the reverse. It is still a moot question but it led me to think about our own therapy; observing a primal session explained so much about evolution. Specifically, about the primacy of thoughts over feelings.


In a reliving, feelings come before thoughts, as they did in evolution; and indeed, as feelings become preponderant they nudge thoughts and beliefs into action. Those thoughts evolve out the feelings—being suffocated during birth—leading to, “he suffocates me.” “There is no space for me,” etc. What resolves this is not a change in attitude or thoughts but feelings; the imprint, the generating source needs to be addressed and relived because it was not fully relived originally. It was at best partially experienced when it happened and then shut off due to its load of pain. It needs to be fully lived, connected and resolved.

When we look at the session we are exploring evolution; observing both phylogeny and ontogeny. It is my position that unless the system is allowed to follow evolution exactly there will only be abreaction and not a connected, resolved feeling; that is the reason to pay attention to evolution. During a reliving of birth where we find skyrocketing vital signs there can be no crying like a two year old, no radical movements of the legs and arms and no words whatsoever. All these come later in personal evolution (ontogeny). To do all this now is to defy evolution, which violates biology and how it progresses.
We cannot get ahead of ourselves in therapy. Evolution is not to be fooled with. If we do not believe in it then all is lost and therapy is a useless exercise.

The minute a patient who is reliving something in early childhood uses words like entertaining, satisfaction, disappointed, we know she is not in the feeling brain and it is not a real experience. A five year does not normally use those words. In other words, evolution is a check on the reality of what the patient is undergoing. If we don’t know how the brain develops, at least minimally, then we might err in therapy; worse, we might push the patient beyond her tolerance level, beyond where evolution allows her to go for the moment. We might push her back into her history where massive pain lies; and all that will accomplish is overload and then symbolic acting out or acting in. Example: a patient was coming close to a feeling of a sexual seduction by her father. The therapist was pushing for her to get there. She reached the lip of the feeling and then sat up and said, “I’ve been saved! Saved by the Lord.” She was saved by the thought of the lord as the feeling nudged the thinking/believing centers into action to protect against feelings. Here evolution rushed in to save the situation and it did so in orderly fashion.

So when we observe progress during a session we are seeing how the brain works; what functions it uses to protect us, how it recruits thoughts to make us safe and neurotic, at the same time. We see how neurosis can take place. Most of all, we learn how to do the therapy; what biologic laws not to violate. What we also learn is how impossible it is to fulfill needs that are long past their due-date.

When we look at the evolution of babies we learn the laws of fetal and infancy evolution; what are the key needs and, above all, when they can be fulfilled. That critical window of need cannot be violated. After the window is closed there is no fulfillment possible, only amelioration. We cannot love neurosis away. Pain is stronger than that.

Once we begin to understand all this we know that we cannot use a later-developing mechanism, thoughts, to bring about change in neurosis. Thoughts then become a cover for feelings, not a resolving process. One reason this is not Primal Scream Therapy is that screams come after grunts in evolution. On the way out of the womb but not as yet out, there seem to be no screams. If we force screams we are wrong. If we try to make something dramatic happen to prove how smart and effective we are the patient will suffer. If we are patient and trust evolution we are on the right tract.

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.