The use of
hypnotism to treat medical problems is increasing, but how it works still
baffles scientists. Sally Appleton reports for the Daily Telegraph...
(September 2004)
Some
doctors use it to treat insomnia, asthma and eczema. Others to calm
migraines and irritable bowels, and to reduce anxiety. Yet, even though
the use of hypnosis is on the increase across the medical profession, no
one understands how it works. Some experts even believe the "trance"
induced by hypnosis can happen to us all when we are daydreaming,
engrossed in a bestseller or commuting to work. Mind games: health
professionals are being trained to use hypnosis, which can help in the
treatment of problems such as insomnia and migraines The ways that doctors
are willing to use hypnosis are expanding in number and range. Some use it
to relieve the chronic pain of arthritis, the acute pain of dental
surgery, reduce the side effects of cancer treatments and help people stop
smoking or lose weight. It is even used to make food taste better for
cancer patients whose taste buds have been damaged by radiotherapy.
Hypnosis is now one of the most commonly used complementary therapies,
with an estimated 353,000 consumers every year in England. To meet this
demand, more and more health professionals are being trained in its use.
General practices in 12 per cent of primary care groups in England offer
hypnosis to patients. This results in nearly one-and-a-half million
private and NHS appointments with hypnotherapists every year, at a cost to
private users of £34 million and to the NHS of more than £5 million.
Despite this increase in medical use and a boom in hypnosis research,
experts still don't agree how it works and such understanding could make
it even more effective. Scientists at the British Association's Festival
of Science in Exeter will continue the long-running debate on the subject
tomorrow.
Hypnosis attempts to direct a person's thoughts, feelings and behaviour by
"suggestions" that instruct him or her to concentrate on particular images
or ideas. This can be achieved with the help of a hypnotist or through
self-hypnosis. For example, a "suggestion" to reduce the pain of having a
tooth extracted might invoke an image of pain being controlled like the
volume on a television set. So if the dial is turned down, the pain can be
reduced. Likewise, the image of lying on a beach in the sun can help some
people to experience less pain.
People usually need a series of hypnosis sessions, starting with a
"hypnotic induction", which increases relaxation and allows people to
become absorbed in their inner thoughts. During hypnosis, subjects are
usually aware of their environment, can remember most of what happens and
cannot be made to do things against their will.
Scientists agree that there is a pattern or "orchestra" of brain activity
during hypnosis that some refer to as a trance. A trance can be described
as a state of mind in which a person's attention is focused, he or she is
absorbed in a specific activity and is switched off from what is going on
around them. This brain activity depends on the type of "suggestion" that
the patient is given and can occur in a number of parts of the brain,
including the cortex that controls the "higher" brain functions such as
perception, sensation, thought and memory and the lower parts that control
unconscious processes such as breathing, heart rate and muscle movement.
One view suggests that the brain achieves an altered state of
consciousness, a unique trance, during hypnosis.
Prof Helen Crawford, of Virginia Polytechnic Institute and State
University in Blacksburg, Virginia, an expert in the neurophysiology of
pain relief through hypnosis, says she has concrete physiological evidence
to show that the brain achieves a state of focused attention during
hypnosis. She says there is something "dramatically different" about the
brain activity in people during hypnosis, for pain relief, compared with
when they are not hypnotised. She describes a change in the pattern of
brain activity during hypnosis, characterised by a significant increase in
theta waves of about 5-7Hz recorded by electroencephalograph (EEG)
monitors. However, support among experts for an alternative explanation
appears to be growing. Although proponents of this rival theory do not
dispute that research has reliably shown physiological changes in the
brain during hypnosis, they do not believe these changes are confined to
hypnosis. They propose that the pattern of brain activity seen during
hypnosis can be found during everyday experiences when attention is
focused: for example, being absorbed in a piece of music or driving a long
distance. This explanation makes the brain activity seen during hypnosis
seem less special, since it suggests this can happen to us all.
One of the authors of a British Psychological Society report on hypnosis,
Dr Graham Wagstaff of the University of Liverpool, believes the
physiological evidence cited by some scientists to support the idea that
the brain is in a unique "trance" during hypnosis has been
over-interpreted. "If you give anybody an instruction, you will get
physiological changes in the brain," he says. "To establish that hypnosis
invokes a special physiological state of the brain, you have to show that
the person is not capable of doing that when not hypnotised." He says
current research methods are typically not able to answer that question,
despite the conclusions of the scientists involved, because they do not
enable us to separate the effect on the brain of the "suggestion" itself
from being in a hypnotic state of mind. "I have yet to come across an
experiment where they look for physiological differences between a group
of people who are given a suggestion under hypnosis, and a different group
of people, who share similar psychological characteristics, but who
receive exactly the same suggestion without hypnosis."
One reason for this lack of good controlled research, he says, is that
scientists searching for the physiological basis of hypnosis are usually
trying to show that it is something special. They might not be as
successful at securing funding for this expensive and time-consuming work
if the aim was to show that there was nothing unique about brain activity
during hypnosis. "There are question marks," acknowledges another author
of the report, Dr Michael Heap of Wathwood Hospital, Rotherham, who has
frequently used hypnosis to treat psychological conditions. Dr Heap says
the traditional idea that you are in some special state of consciousness,
a unique trance, during all forms of hypnosis is very unlikely. He
disagrees that there is a "biological marker" to show that brain activity
during hypnosis is "uniquely hypnotic". We may not know how it works, but
it certainly seems to.
Phyllis Alden, of Derbyshire Royal Infirmary, is a clinical psychologist
who has used hypnosis to treat patients for the past 20 years. She says
hypnosis can be so effective in reducing pain that patients can even stop
using conventional painkillers. She believes the hypnotic state is simply
capitalising on our natural capacity to focus our attention. "Hypnosis
involves the focusing of attention to the point where you can make what
you imagine feel real at the same time as being able to switch off from
what is real," she says. "That is what makes hypnosis work. I don't think
it is a lot more complicated than that. You don't have to formally induce
this state called hypnosis to get some of these things to happen."
Despite the mystery, experts seem to agree that hypnosis is not dangerous,
if it is carried out with a trained hypnotherapist who has a good
understanding of the patient's condition. People who do not have vivid
imaginations and those who are sceptical about its value may not benefit
from hypnosis, as imagination and expectation are important in determining
its effectiveness. Hypnosis is not regarded as the treatment of choice for
people with severe mental health problems, such as schizophrenia.
As the debate continues, it highlights how little is known about the
closely related and fundamental scientific question of human
consciousness. These complex questions are likely to continue to baffle
scientists for many more years. In the meantime, millions of people will
continue to benefit from hypnosis, even though this lack of understanding
seems to be at odds with the health service drive for evidence-based
medicine.
Hypnosis: the history
Hypnosis was first recognised by the ancient Egyptians and Greeks as a way
of inducing dreams to solve people's problems.
Franz Mesmer (1734-1815), an Austrian doctor, is regarded as the modern
"father of hypnosis". However, the medical profession rejected what was
later termed mesmerism".
James Braid (1796-1860), a Scottish doctor, coined the terms "hypnosis"
and "hypnotism" from the Greek god of sleep, Hypnos. Scientists now know
that hypnosis and sleep are two very different physiological states. A
swinging watch was commonly used in the early days of hypnotism to allow
people to fixate on an object and go into a "trance".
Scottish surgeon James Esdaile (1808-1859) used hypnotism as an
anaesthetic during countless major operations he performed in India.
However, the British medical profession rejected the use of hypnosis in
this way in favour of new anaesthetic drugs.
In 1892, the British Medical Association (BMA) . rst formally recognised
that hypnosis had therapeutic benefits. Hypnosis was used to treat the
physical and psychological effects experienced by soldiers in the two
world wars.
Although public demonstrations of hypnosis have been popular throughout
history, stage hypnotism as a form of television entertainment, was
pioneered by an American, Ormond McGill, who also wrote the "bible" of
stage hypnosis, The Encyclopedia of Stage Hypnotism, in 1947.
In 1955, the BMA first supported the teaching of hypnosis in medicine.
