Introduction
The mental state of hypnosis was misnamed
"hypnosis" during the mid 1800s. Hypnosis is the Greek word meaning
"sleep." Hypnosis is not sleep. There are two schools of thought
as to what is considered to be the hypnotic phenomena. One group,
nonstate theorists, believe that hypnosis does not involve an altered state
of consciousness but can be experienced while awake. The other group,
special or altered state theorists, believe that hypnosis involves an altered
state of consciousness. I believe that a portion of both perspectives
is accurate and I concur with Ernest Rossi's comments.
The state theorists would be correct in part with the validation that there are real alterations in a broad range of psychophysiological processes relevant for experiencing what has been traditionally called "hypnosis". The nonstate theorists would be correct in part with the validation that there is nothing really unique about the "hypnotic state": it does not have a separate and discrete reality outside the normal range of psychophysiological fluctuations in ultradian rhythms we all experience throughout the 24-hour day. Hypnosis does not exist as a mysterious special state. Rather, the experience we have traditionally called "hypnosis" is a ritually induced way of enhancing and vivifying certain naturally occurring ultradian behaviors. (Rossi, 105-106)
Charles Walker (1973) theorized that hypnosis is a redistribution of attention which may result in a deeper level of concentration on selected stimuli which results in the readiness of an individual to act on a suggestion or idea concurrently or post hypnotically. According to Watkins & Watkins (1986), hypnosis has historically been considered an altered state of consciousness which is often called a trance. When the altered state is achieved then various therapeutic measures, such as guided imagery, can be performed effectively. (p. 133)
An effective use of hypnosis in working with the terminally ill is to use it for relaxation, meditation, pain control, and guided imagery. It can also be used to prepare the individual for his/her death by helping him/her to be able to clearly concentrate on issues that are important to him/her. Guided imagery can be used to slow or arrest some terminal illnesses. Guided imagery can be enhanced using hypnosis to create a more vivid awareness of suggested situations and activities. In order to fight a terminal disease, the individual might be asked to image the healthy cells attacking the diseased cells and ridding the body of the disease. If the terminally ill individual is having difficulty coping with his/her situation, guided imagery can be used to help him/her to imagine being in another place or time that is more pleasant. Stanley Krippner (1990) states, the use of psychodynamic suggestions and imagery is now commonly applied in the psychodynamic tradition, including a range of specific techniques such as guided affective imagery (GAI), active imaging, eidetics, and behavioral modification and modeling of the so-called "covert processes" of imagination. (p. 42)
Hypnosis has been a subject of considerable controversy since its discovery. It has been part of ancient social and religious practices and has been used as a form of psychological treatment. In western cultures, its use and practice have been debated by social, scientific, and legal professionals and lay people for centuries. In this paper I will give a brief analysis of various researchers' impressions of what hypnosis is and its uses. I will also state my paradigm of hypnosis and describe the effective use of hypnosis and guided imagery with the terminally ill person.
What Is Hypnosis?
Hypnosis is an altered state of consciousness that may result in heightened concentration, awareness, and openness to suggestibility in an individual. It is not sleep, a loss of personal will, an unusual or abnormal experience, a state where the individual will tell all of his/her secrets, or a state where the individual is under the hypnotist's power. If the hypnotist suggests something the subject does not want to do, he/she can refuse to perform the suggestion.
The hypnotic state has been considered, by some, to be an altered state of consciousness often called a "trance." (Watkins & Watkins, 1986) According to Pattison, Kahan, and Hurd (1986), trance states are a mode of consciousness in which the person is conscious, but seemingly unaware or unresponsive to usual external and internal stimuli. (p. 286) The hypnotic state can be induced by the focusing the attention of the individual. It can be spontaneously induced by concentrating on highway driving, listening to a moving speech or religious service, by focusing on reading or watching television, or listening to music.
So what is the trance-like state of hypnosis that is neither sleep nor unconsciousness? One theory states that it is a concentration of the mind, a form of attention "far greater than that which is possible in the ordinary waking state." A normal mind, so this theory claims, is a hurly-burly of thoughts, from then and now, past event, future possibility, current happening. Any suggestion made by a friend, for example, has to compete with counter-suggestion from one's own mind, with present mind, with present mood, with other thought and odd-remembered happenings. So much is occurring that concentration is always difficult. Hence the theory that less is happening in hypnosis: a cutting down has been achieved and the patient can therefore listen as never before. Be that as it may the hypnosis state is yet another form of consciousness. (Smith, 1984, p.141)
Some assert that hypnosis is an altered state of consciousness in which the person goes into a trance. This is often thought to give the entranced person some special power to draw on the subconscious, or to alter brain chemistry and functioning. (Walker, 1975, p.95)
In support of the nonstate theories of hypnosis, T.X. Barber (1969, 1979), maintains that "hypnosis" is simply a form of "task motivation", and the concept of an altered state is neither necessary nor sufficient to account for the hypnotic phenomena. (Watkins & Watkins, 1986, p.134) Hypnosis has been described by Gill and Brenman (1959) as a form of "aggression in the service of the ego." Some psychoanalytic writers have noted a close relationship of hypnosis and the concept of transference. Researcher P. Janet (1907) was one of the first researchers to consider the dissociative aspect of hypnosis. Dissociation is considered, in psychology, to be the process in which a set of mental activities break away from the main stream of consciousness and function as a separate unit of consciousness. (Webster, 1983) Possible support of the dissociative theory of the hypnotic state can be demonstrated in the parallel processing of the human brain. The parallel processing [in the dissociated state of hypnosis] is illustrated by the emergence, in creative individuals, of full-blown and completed compositions, writings, and inventions. Prior to the moment of its emergence the creative person apparently is not aware of working on the creation; but at some covert or unconscious level much cognitive processing must take place for the product that emerges to consciousness to be so completely constructed. (Wolman, 1986, p.139)
Personal Paradigm of Hypnosis
The hypnotic trance is an altered state of consciousness which can be induced through the focusing of attention of the individual on a specific point, object or activity or can happen spontaneously. The hypnotic state can be achieved through self-hypnotic induction or with the guidance of a hypnotist. It can also be induced by a redundancy of stimuli, such as, highway driving, a persuasive speaker - as in a religious setting, or by a pleasant sound - such as music or a meditation mantra. In my opinion, the state of hypnosis is an altered state of consciousness in which the individual is seemingly unaware or unresponsive to external and internal stimuli but is susceptible to suggestions and actions by the individual, through self-hypnosis, or the hypnotist. Individuals that use hypnosis to alter responses are task motivated to make a change in his/her behavior and/or thinking. Hypnosis is a dissociated mental state in which the individual is processing separate activities on different levels of consciousness. During deep levels of hypnosis, the individual may experience positive or negative hallucination.
Dissociative aspects of hypnosis relate to the emphasis being placed on the discreteness of hypnotic phenomena and the degree to which irrational behavior can be induced, which seems to be untouched by the usual censoring processes of the individual. The fact that a highly hypnotized individual can perceive a hallucinated person while at the same time seeing the real person seated nearby demonstrate the extent to which true perception and rational cognition are "dissociated" from the suggested hallucination." (Watkins & Watkins, 1986, p. 138)
The altered state of consciousness, being in a trance and in a dissociative state, is associated with all the levels of the hypnotic consciousness. Scales of hypnotic depth and susceptibility have been developed. There are six levels of depth and susceptibility, as identified by Harry Arons, a hypnotherapist with the Ethical Hypnosis Training Center in New Jersey. During the first three levels of hypnosis, the subject is aware of most activity around him/her but is focusing primarily on the hypnotic induction and suggestions. The physical activities of the subject are affected by various levels of catalepsy and suggestibility. The remaining three levels of hypnotic depth are amnesic, in which the subject has limited or no recall of the hypnotic session and suggestions but is responsive to the hypnotist's suggestions. The individual is susceptible to both positive and negative hallucinations. He/she may or may not see or hear things that are within his/her surroundings.
Hypnosis can be used to help the individual to a greater depth of meditation and relaxation and at the same time enhance the ability to use imagery to fight disease and to improve the individual conscious existence.
The Use of Hypnosis With the Terminally Ill
Terminally ill individuals may seek mental health
counseling as a result of the continued stresses of normal daily living
and the additional psychic trauma of a terminal illness and impending death.
According to Kalish (1981), the dying individual may enter counseling for
several reasons.
1. Individuals who are dying continue to have the usual conflicts
and anxieties of normal life.
2. The stress of the dying process, the physical pain, losses that have occurred - such as the loss of independence, and the anticipation of losses to be experienced.
3.The will to live may be diminishing which causes the terminally ill person to decompensate more rapidly than is necessary.
4. The fear of death is causing the terminally ill person to not make good use of his/her remaining time.
The use of hypnosis can help the terminally ill individual get in better touch with his/her feelings, relax and meditate, and deal with some of the anxiety and pain associated with terminal illness. Imagery, relaxation, and counseling can make the remaining days of a terminally ill person more rewarding and fulfilling.
If the dying person can understand that the worth of a person's life is not in accomplishments, but in one's humanity and self, then not having reached the achievement goals established years earlier will seem less important, and the dying person can get on with the task of living in whatever time is left. The reduced stress and anxiety and the increased desire for inner growth may even serve to mobilize the life force and reverse the downhill path of the illness. (Kahlish, 1983, p.280)
Life-threatening disease (or accident) immediately breaks you out of the everyday ordinary reality in which most people live. It is up to you to take a positive hold of this break from (and dislocation of) your normal reality that disease presents you, instead of seeing it as an abnormality to life's flow, and hence to be feared. Utilize this "shift point" as a means to maximize your opportunity for making a quantum leap in consciousness and thereby in your experience, whether it be that of healing, or quality dying - or both - when the time comes. (Foos-Graber, 1989, p.209)
It is my opinion that through the use of hypnosis the terminally ill individual can attain a level of consciousness that provides him/her with the ability to meditate clearer and to feel as if he/she has more control over his/her body and the terminal disease attacking his/her body. According to Anya Foos-Graber (1989), if the dying individual can restructure his/her consciousness by using various techniques, such as imaging, meditation, mantras, breathing, prayer, and energy transference, often the progress of the disease can be slowed or arrested. This is based upon the theory that energy manifested in thought and matter can modify each other (p. 209).
Carl Simonton, in his book Getting Well Again, make the assumption that illness is not only a physical problem but a problem the effects the whole person.
It is our central premise that illness is not purely a physical problem but rather a problem of the whole person, that it includes not only body but mind and emotions. We believe that emotional and mental states play a significant role in susceptibility to disease, including cancer, and in recovery from all disease. (Simonton, Simonton, & Creighton, 1978, p.10)
A controversial health-treatment program that claims to be effective, especially in healing cancer patients who have been given up as terminally ill by their physicians, is the combined imagery, relaxation, and psychotherapy program developed by physician Carl Simonton. The Simonton approach requires that the cancer patient accept the responsibility for having cancer; that is, they are told that they have, perhaps unconsciously, caused their cancer, and therefore, they also have the power to get rid of the cancer. Part of the treatment is to develop visual imagery of the site of the cancer-to see it in the mind's eye in either literal or metaphoric terms-then to visualize healthy cells attacking and destroying the cancerous cells.
Simonton and his followers have claimed an extremely high rate of success-especially considering that they work primarily with patients diagnosed as having terminal cancer. (Kahlish, 1983, p.272)
In my work with Carol F., a woman who was diagnosed
with terminal cancer, we used hypnosis to enhance the guided imagery of
a healing white light and to promote the effectiveness of her personal
meditation. Carol was told that she had about 6 to 9 months to live
from the time she was diagnosed as having terminal cancer. With the
combination of her medical protocol, hypnosis, imagery, and meditation,
she lived for more than year after she was expected to die. Her final
days were peaceful and her passage from life into death was calm.
The following is an excerpt from several parts of her journal that she
kept after she learned that she was terminally ill.
6/4/85
I had my appointment with David the first thing this morning. It was excellent. The meditation/hypnosis was much deeper and David narrated it with beautiful, powerful imagery. He reinforced what I already know - I need to develop patience. It has never been one of my virtues. He said I need to go with the flow and stay in harmony with nature. It is interesting that Grand Elf says the same thing to me. I know that David thinks that I am going about my healing with too zealous a manner. I need to do it that way for it to be effective. I need to align mind, body and spirit in a conscientious sincere manner.
I want my healing thoughts to be integrated and to spread out into my daily interactions in a positive loving way.
I need so much support. My morning session got me back on the right track. If I don't have the reinforcement frequently I start to feel a little down and doubts creep in. It was good.
6/21/85
We also did a very effective hypnosis session in which my body felt almost without boundaries.
6/14/85
I meditated and just tried to catch up with myself in general. My meditation seems to be changing in that it doesn't focus as much on imagery as it does more spiritual, all encompassing feelings. The light is very much a part of it. I have been reading a little book called "The Door of Everything" and it is very reinforcing and it also talks about the light. It was no accident that David chose the light as my healing vehicle.
6/18/85
My meditation session with David was great today. Sometimes I have a feeling of an inner vibration. That happened this morning and then again when I meditated after work. To me it symbolizes my immune system vibrating into action.
Another "coincidence" occurred with David. He brought the power of the mustard seed into the imagery today. Just a few days ago I called my friend David D. and asked him if he knew where I could get a mustard seed as I felt I wanted one. On a logical basis, I know I read about it in my biblical readings and David definitely knows the Bible as he quotes it often. On the other hand, there are lots of images in the Bible and it is pretty amazing that we both focused on that. Neat!
I also used hypnosis with Danny H., another terminally ill individual whose cancer pain was not being effectively controlled by his medication. At times his pain would become so intense that he could not concentrate or get comfortable. His medication was somewhat helpful but still did not allow him to relax and be able to interact with his family and friends or sleep. By using hypnosis, he was able to dissociate himself from the pain and relax. The hypnosis did not prevent him from interacting with others since the pain control was part of a post-hypnotic suggestion of, "When I feel pain, I will relax." Through the use of guided hypnosis, by me, and self-hypnosis, by him, Danny was also able to relax and become pain-free enough to sleep more soundly and peacefully.
CONCLUSION
The use of hypnosis with the terminally ill person allows the individual to have a better control of his/her life and to achieve a higher level of satisfaction with what time he/she may have left in life. It provides the dying individual with a weapon to slow or arrest the disease that is killing them. It also allows him/her to control some of the pain associated with the disease and to improve or enhance his/her concentration and meditation. C.T. Tart (1969) defined an altered state of consciousness as one in which the individual "clearly feels a qualitative shift in his pattern of mental functioning." (Watkins & Watkins, 1986, p.137)
Watkins and Watkins (1986) state that consciousness is determined by the amount or quantum of energy in a process, not the nature of that energy (p. 144). The terminally ill person must draw upon his/her inner strength and energy to retard the physical and psychological effects of the terminal illness as it attacks his/her body. Hypnosis can empower the individual with the energy and the concentration powers necessary to focus on therapeutic intervention techniques to slow down or arrest the terminal disease process and thereby provide the terminally ill person with the ability to live his/her remaining life with a higher degree of physical, emotional, and spiritual abundance.
Through the use of imagery, the terminally ill person
can envision his/her body fighting off the terminal disease by the bad
diseased cells being attacked by healthy cells. As in Carol's situation,
the white light was both killing off the cancer cells and providing a comforting
warmth. Carol and Danny used imagery to find a peaceful place, in
their mind, to go to in order to escape the pain and anxiety associated
with their terminal disease. Imagery can enhance the hypnotized individual's
conscious and unconscious life by helping him/her visualize a positive
experience and/or place which promotes positive feelings and reactions
in the parallel processing of the human mind. Hypnosis and imagery
can provide the terminally ill person with more control over his/her remaining
life.
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