The Therapeutic Value Of Hypnotism
( Originally Published 1908 )
WE have now reached the most important part of our subject, and that is, the therapeutic use of hypnotic suggestion. Janet says (Lowell Lectures) that "there is no physiological function which is exempt from modification by hypnotic influence, if not complete control by it." This is true only within certain limits, for hypnosis must not be looked upon as a panacea for all the physical and psychical ills that flesh is heir to. While its field of action is limited, yet within that field it is absolute master. Since it has been found that hypnosis is practically only effective in those diseases designated as functional as distinguished from the organic type, the first perquisite is a thorough and careful examination of the patient by a competent medical man. This examination should comprise a minute study of the disease, its origin and symptoms; it should be determined if the disease is organic or functional, and if the latter, are there any organic complications into which physical therapy must enter? These are facts of the highest importance, for without these a serious and even a fatal mistake might be made if we attempted to treat an organic disease by hypnosis where it would require surgery or some specific drug. It is into these errors that the various irregular sects and practitioners of suggestive therapeutics, mind cure, and mental healing have fallen. They disregard the physical and mental examination and look upon disease as purely imaginary, as an error of mortal mind. What surgery was in the hands of the barber surgeons of the Middle Ages, so to-day psychotherapy in the hands of the mind curists occupies an analogous position. Their errors fill our hospitals and clinics and add to the number of obituary notices. We only hear of their few successes; of their many mistakes they preserve a wise silence. But with a proper medical examination such errors are reduced to a minimum, and although it narrows the field of hypnotic therapy, yet it greatly increases its efficiency. This examination is just as important for the patient as for the physician. Now in what functional diseases has hypnosis been most effective and what are its results? To this we will briefly turn.
The medical aspects of hypnotism are of great practical importance and, as previously stated, the basis of all hypnotic therapy is found in the increased suggestibility of the hypnotic state and in the phenomena of post-hypnotic suggestion. Hypnosis is most efficacious in the so-called functional nervous diseases. Hysteria with its manifold symptoms is very amenable to hypnotic treatment. Hysterical symptoms all tend to disappear in the hypnotic sleep, a fact which speaks emphatically for the soundness of the modern theories of hysteria. By this we mean that hysteria is a mental disease whose symptoms are due to a dissociation or splitting of the personality. In the hypnotic state the splitting disappears and the hysteric individual remains well while in this condition. On being awakened the symptoms tend to recur, but by repeated hypnotizing there is established a psychic re-education through the suggestions, and ultimately a cure results. Hysterical paralysis and convulsions, losses of sensation (anaesthesia) or of memory (amnesia), losses of the voice (aphonia), the various digestive and motor disturbances of hysteria, yield to hypnotic treat-ment. Many of the sudden recoveries of persons who have been paralyzed for years are cases of pure hysteria. If the paralysis were of an organic nature, that is, caused by a hemorrhage or softening of the brain or spinal cord, such a recovery could not occur. In one case of hysteria with convulsions the attacks disappeared under hypnotic suggestion; in another case of hysteria with peculiar wandering acts, and a complete loss of memory for the same, these memories were recovered in the hypnotic state and remained permanent on awakening. In still another case of hysterical paralysis of an arm, suggestion brought about a rapid recovery. As hysteria with all its symptoms is due to a dissociation of the personality, so hypnotic suggestion can synthetize this dissociation and bring about a cure.
Another field where hypnosis yields brilliant results is in the various sexual aberrations. There is perhaps nothing in the whole range of nervous diseases which tends to make the individual so miserable, as the unfortunate victims of these aberrations are usually persons of high intelligence and culture. In these cases hypnosis must be repeated a great many times until the abnormal state is firmly and perfectly replaced by healthier associations and habits of thought. As a rule, most of these patients are difficult to hypnotize.
These sexual aberrations or psychopathies are very wide in their range and of great medical and forensic interest. They comprise such vices as masturbation, the condition known as sexual neurasthenia, sexual hyper-excitability, the various acts of active or passive cruelty or violence with lust (masochism and sadism), the association of sexual ideas with certain portions of the female person or with certain articles of female attire (fetichism), and finally the development of a homosexual tendency and a contrary sexual instinct. Sometimes these unfortunate individuals are led to crime, such as lust-murder, or the larceny of articles of female attire. Many of the petty thievings of women's gloves or handkerchiefs, or the so-called "hair clippers" which sporadically create excitement in our large cities, are in reality sexual psychopaths. Krafft-Ebing has given us a masterly description of these sexual aberrations, while Schrenck-Notzing has shown how much suggestive therapeutics in the form of hypnosis can do for these diseases. Our own observations on the value of hypnotic therapy in the sexual psychopathies have been in harmony with the authorities cited above.
The most prevalent nervous disease of modern times is neurasthenia or nervous exhaustion. This disease, more than any other, taxes all the patience and ingenuity of the physician. Most of the unfortunate victims of this disease are chronic sufferers. Perhaps no human malady has had so many lines of treatment suggested for its cure. Rest and isolation seem to have been the most successful; drug treatment has been weighed in the balance and found wanting; electricity has but a limited value.
Neurasthenia like hysteria has many symptoms, but the principal complaints of the patient are the rapid exhaustion, the sleeplessness, the various fleeting pains, gastric distress, palpitation of the heart, headache, and dizziness. One or several or all of these may be present, in various grades of intensity. Many chemical and physical theories have been proposed to explain neurasthenia, but the latest researches seem to show that we are dealing with a disease of the subconscious, a dissociation of the personality. Much can be accomplished in the way of treatment by waking suggestion and a system of psychic re-education, which comprises persuasion and a rational explanation of the symptoms to the patient. In fact, surprising results have been secured by these psychotherapeutic conversations, within recent years. If we approach neurasthenia from the sound, psychological standpoint, much can be accomplished by hypnotic suggestion. The fatigue can be made to disappear, the cardiac symptoms to vanish, and by this system of psychic re-education, the patient can be taught to pay less attention to himself, to become less introspective. Continual mental analysis is the worst thing that can befall a neurasthenic, and once this demon of analysis has taken possession of the mind it can plunge one into the lowest depths of psychic misery and torture. This is why neurasthenics are so miserable; they are too self-analytical and introspective. This self-analysis can lead to something else, namely, the condition known as hypochondriasis, wherein the patient is continually examining his fleeting bodily pains and finally comes to believe that he is suffering from a severe organic disease. He does not for a moment consider that they are purely functional. Palpitation to him means heart disease; headache, brain tumor; gastric symptoms, an incurable affection of the stomach. Hypnosis can overcome this self-analysis, the bane of all neurasthenics, perhaps the most important thing that accounts for the chronic nature of the disease. It can direct the thought to healthier channels; it can force the patient to stop thinking of himself, and when this is accomplished, the physical symptoms tend to disappear and the patient is on the road to recovery. Many of the much vaunted and advertised cures of the mental healers, who claim to have successfully treated organic diseases, are merely cases of neurasthenia that have become hypochondriacal, that believed they were ill in body when in reality they were merely sick in mind. Of course, many cases of neurasthenia are associated with poor blood states (anæmia), loss in weight, and other purely somatic disorders. Under these conditions, it becomes necessary to combine rational, medical treat-ment with the purely psychic procedures.
What is known as psychasthenia, which is really a name for the complex mental state accompanying fixed ideas and obsessions, is rather more difficult to treat by hypnosis. Many of the symptoms resemble neurasthenia, but the fixed ideas predominate, the mental torture is greater, crises of intense anxiety may arise and there is often a feeling of unreality. Like neurasthenia and hysteria, its basis is purely psychic, what is known as a disturbance in the mental level, a lowering of the psychological tension. By persistence, however, these obsessions or fixed ideas which torture the mind of the patient, by reason of his appreciation of their absurdity, can be finally annihilated. For instance, one psychasthenic was tortured by the fear of stammering, another was possessed of the fixed idea that his throat was closing up and therefore he must continually swallow to keep the passage open. Both of these practically recovered under hypnotic treatment.
Many functional aches and pains, sleeplessness, the recurrence of distressing dreams, drug habits, such as chronic alcoholism, stammering, constipation, irregular menstruation without organic complications, the various pernicious habits of childhood such as bed-wetting, yield brilliant results by hypnosis. Many forms of sleeplessness or insomnia are caused by the patient acquiring a fixed idea that he cannot sleep. This fixed idea usually reaches its greatest intensity at bedtime and so keeps the patient awake. Hypnotism destroys this fixed idea and sleep follows, without the danger of acquiring a drug habit. When the insomnia is purely symptomatic, however, as occurs in many forms of mental diseases, a different line of treatment is indicated, — baths, drugs, rest in bed, etc. In one patient this fixed idea that he would be unable to sleep brought on an intense insomnia and caused several months of severe mental torture. Light hypnosis after a short time effected complete recovery.
The dangers of prolonged insomnia are manifold. It can lead to intense psychic pain, to despair bordering on suicide, to loss in weight, extreme restlessness, sense deceptions, and finally even mental diseases (exhaustion psychoses) may arise. An interesting research on the experimental effects of loss of sleep has been carried out by Prof. G. T. W. Patrick and Dr. J. Allen Gilbert.' Subjects were kept awake for about ninety hours and at six-hour intervals a series of pyschological tests were made. In one subject, the experiments were discontinued, as hallucinations of sight arose; he saw innumerable insects running on the floor and ceiling of the laboratory.
The hypnotic treatment of cocainism and morphinism has not been very successful. Such cases are best isolated in a sanatorium and the drug gradually withdrawn. The absolute unreliability of the cocaine or morphine habitué, the intense craving for the drug, the fearful de-pression, pains, restlessness, hallucinations, weakness and often collapse which accompanies its withdrawal, show how important is careful nursing and constant watchfulness on the part of the physician. These can only be secured in an institution, where the patient is placed in a new environment and carefully protected from securing the drug surreptitiously. In fact the deceit practised by these patients, which is due to the moral obliquity caused by the drug itself, is almost incredible.
Hypnotism has yielded good results in chronic alcoholism. The patient can remain at his work or business, can live with his family and prolonged sanatorium residence becomes unnecessary. Hypnosis strengthens the will power of the chronic alcoholic and creates a pro-found distaste for liquor. These two factors exert the strongest influence in preventing a recurrence of the habit. Medical and physical treatment, however, may be necessary in conjunction with the hypnotism, as chronic alcoholic indulgence has a particularly pernicious influence on the nervous system, the arteries, and the digestive organs. On the nervous system, there may result de-generation of the nerves (polyneuritis), various forms of alcoholic insanity (delirium tremens, paranoia, a state resembling general paralysis, alcoholic dementia) ; thickening of the arteries (arterio sclerosis) may take place and lead to apoplexy or degeneration of the heart muscle, and finally Bright's disease, chronic affections of the stomach, and cirrhosis of the liver. Of course, the effects on the nervous system are the most severe, degeneration of the peripheral nerves, diseases of the brain and spinal cord, insanity, peculiar disorders of memory (alcoholic amnesia). The specific effect of alcohol on the nerve cell itself has already been discussed. The effect of even moderate doses of alcohol is very unfavorable; the attention is lowered, the mental aptitude, especially for arithmetical calculations, is considerably reduced, and association time becomes lengthened. These effects can last for more than twenty-four hours after the last dose. On physical exercise, contrary to the popular opinion, heavy work is not made lighter and fatigue more rapidly supervenes. It is true that alcohol increases the facilitation of muscular movements at first, but there is a decided lessening of the power of muscular work and of the quantity of work performed, on account of this rapid fatigue. Kraepelin, who has conducted exhaustive experiments on the psychical action of alcohol, concludes that it cannot be classed among the harmless condiments.
Alcoholism or inebriety is a disease, and the chief factors in its production are heredity and environment. Alcohol is used for its effect upon the nervous system and seldom for the taste of liquor alone. The numerous advertised specifics for alcoholism are useless as each patient and each case is a law unto itself and requires individual study and treatment.
It has been generally conceded that, of all methods of treatment, for chronic alcoholism, without organic complication or severe mental disease, hypnotic suggestion is the most successful. The alcoholic as a rule is easily hypnotized, except when the subject is intoxicated, on account of the exciting effect of alcohol on the brain. The desire for drink should be totally destroyed, the will power strengthened, and new associations built up. There should be no tapering down; total abstinence from the start is the key-note of success. This procedure is without danger, although some medical or physical treatment may be necessary in the beginning in addition to the hypnosis. The length of time that liquor has been used is no contra-indication to treatment by hypnotic suggestion. In fact several of our cases were alcoholics of years standing, and yet all completely recovered by hypnosis.
By many, chronic alcoholism and dipsomania are believed to be identical, but from a medical standpoint there is a distinct difference. The chronic alcoholic is the steady tippler, the man who consumes a certain number of glasses of liquor daily, with perhaps an occasional spree. In dipsomania, however, the tendency to drink to excess is periodic. The individual for months remains a total abstainer, in fact he may have a positive disgust for liquor and a keen appreciation of the moral degradation of the drunkard. Then suddenly he begins to be restless and depressed, may be troubled with dizziness, leaves his home and business, wanders around to various low resorts for days or weeks, all the time drinking all kinds of liquor in a perfectly bestial manner. Rather suddenly he ceases drinking, the restlessness and depression disappear, and he returns to his work with a sense of shame, and usually with either a very hazy memory or a complete amnesia for his behavior and wanderings. Then he remains sober until the next attack. The peculiar periodicity of the disease and the associated mental condition has led many to consider dipsomania as a form of epilepsy.
We have secured good results by hypnosis in the bed-wetting and habit spasms of children when all other treatment had failed. Here the hypnosis was combined with a psychic or motor re-education of the child. One case of bed-wetting which had existed for a number of years, and another of facial habit spasm from which the patient suffered since a small child, yielded to these methods. Of course we must be careful to see that organic complications are absent. Hypnotism has also been used to some extent as a part of suggestive pedagogy, in the training of incorrigible children and of their vicious habits.
The conditions and diseases mentioned are only a few in which hypnotic suggestion is indicated. An enumeration of all the diseases to which hypnotic therapy has been applied by various investigators would make a formidable list. But they have all one characteristic in common. None of these possess any anatomical basis so far as known. We are dealing with purely functional disturbances, the tissue itself as tissue being unaffected. Most of these diseases are of a chronic nature, but patience and perseverance will enable one to succeed. Prolonged treatment is usually necessary, although of course a shorter time is required for the more acute conditions. The patient's nervous system must be remolded, as it were, along new lines, and this takes time. The use of hypnosis in disease may well be designated as a system of psychic re-education or training.
However, there are a few other important points which we wish especially to emphasize. Even in the purely functional nervous diseases hypnotic suggestion some-times fails, either because of the chronic nature of the disease and the formation of new habits of thought, or perhaps because of our ignorance of certain fundamental psychological laws. Hypnotic suggestion is but one of the many methods of psychotherapy. It is not applicable to or indicated in all functional nervous diseases, for psychotherapeutic methods must vary with the disease and with the individual. In any method of psychotherapy or psychic re-education, other lines of treatment are frequently necessary in conjunction with the purely psychic procedures — drugs, baths, systematic exercises, motor re-education, diet, etc.
Hypnosis has but a limited value in insanity. Before the organic brain diseases, such as senile dementia or general paralysis, it is helpless. Here, other lines of treatment are necessary. In the mild depressions and slight delusional states, however, psychotherapeutic conversations, without going to the depth of hypnotic sleep, are sometimes beneficial. Delirium due to drugs or fever requires, of course, appropriate medical treatment. Krafft-Ebing says: "Successful treatment by hypnotic suggestion can only be expected in functional psychoses, and, too, in patients who are aware that they are sick and who lend themselves to hypnosis." Of course, the entire subject has its theoretical and practical limitations. A person may suffer from a mental disease of a mild type or a severe nervous disease with mental symptoms, without the necessity of going to an insane hospital. It is in these milder affections that hypnotic suggestion is useful.