The Witch in the Waiting Room: A Physician Investigates Paranormal Phenomena in Medicine

by Robert S. Bobrow M. D. M. D.

  There are some who think that one of the main purposes of sleep is to allow dreams, and REM (rapid eye movement) periods, like sleep itself, also appear to be a physiological mandate. Just about all mammals exhibit REM sleep cycles, and humans and animals deprived of REM sleep (by being awakened at the moment the REM begins) will enter this phase sooner the following night. REM and dreaming are considered "concomitant phenomena," and most observers use REM cycles as evidence of dreaming. We spend about 25 percent of our sleep time in REM; newborns spend 50 percent, the elderly about 18 percent. So why do we dream?

  The meaning of the dreams themselves has fascinated us since the beginnings of civilization. In ancient Egyptian and Judeo-Christian cultures, dream scenarios were often believed to have resulted from divine intervention. The Bible contains about seventy dream references. Meanwhile, in Asia, dreaming was seen as an opportunity for the soul to leave the body and roam free. This was also believed in primitive tribal societies, with the additional caveat that the floating soul could visit other sleepers as well. The ancient Greeks straddled both theories, accepting at times a wandering, telepathic soul as well as a divinely implanted message.

  A new epoch began in 1900, with the publication of Sigmund Freud's The Interpretatuhn o f Dreamrks. This now-famous book sold only 351 copies in its first six years (new ideas plod along slowly). And the idea that dream images might have some meaning of their own, open to interpretation, was in contrast to the ancients' philosophies. Now Freud was saying that dreams were windows to an unconscious mind-itself a new concept-mixing snippets of the day ("day residue") with symbols representing a person's inner conflicts created by what he called "primary process." Dreams could now be seen as fulfillment of wishes, conscious or unconscious, and could be used in a psychotherapeutic process.

  Freud's revolutionary way of looking at dreams did not entirely exclude telepathy. New York psychiatrist David Shainberg published a paper in the American Journal of Psychotherapy in 1976, "Telepathy in Psychoanalysis: An Instance." Before describing his own experience with a patient, Shainberg cites two Freudian references to telepathy in dreams and psychoanalysis. In one, Freud allows for the possibility that some "occult phenomena" may be real; in the other, he wonders if telepathy may have been "the original archaic method by which individuals understood each other."

  A Telepathic Dream

  Shainberg's case, involving a patient of his referred to as Martin G., in psychoanalysis for the past four years, unfolded as follows: Dr. Shainberg had just received a call that his own father, who lived some distance away, had been taken to the hospital with symptoms of a possible stroke. The next day, Martin G. came in for a session. While his father's illness was on Shainberg's mind, he did not, of course, mention this to his patient. That night the doctor received several more phone calls, regarding the worsening of his father's condition and the necessity for a test known as an angiogram, which requires the injection of a dye into an artery in the neck. This test disclosed an abnormality in Shainberg Senior, necessitating surgery.

  When Martin presented for analysis the next day, he volunteered details of a dream he had had the previous night. It involved a man who needed an operation. Shainberg was present in the dream; something had to be injected into the man's head; blood vessels were exposed; afterward, an urgent surgery was needed. There was also, according to Martin, an unusual quality of emotion in this dream.

  Shainberg considered Martin G.'s dream to have been telepathic regarding the events developing at the time with his own father. He cited several references in his paper of similar occurrences between patient and doctor during psychoanalysis. He states that "Many investigators have noted that telepathic communication is common when there is sickness or death in the family of the analyst." While the emotion-charge in the doctor might be perceivable, the details causing it would not; so this phenomenon, if it exists, would be unexplained.

  The Dream Machine

  Also unexplained is why we need to dream. We seem designed for it. Sleep allows dream cycles-usually five per night, each lasting roughly twenty minutes (some can span an hour), with the cycles lengthening toward morning. During these cycles of mental activity, the body's muscles are paralyzed by the brain so we don't literally act out our dream scenes. (Nature thinks of everything.) Occasionally this "sleep paralysis" persists into the zone between sleep and wakefulness, giving one a brief, frightening feeling of lying in bed, being unable to move.

  REM sleep seems to have some function in consolidation of memories, and in learning and coping, but there are no consistent data on this. What's more, there are patients with brain injuries or on certain medications who no longer have REM sleep, and they seem quite capable of functioning and learning. While dreaming is usually the province of REM sleep, some dreaming occurs in non-REM periods, and not all REM awakenings are associated with dreams.

  There are differences in the brain physiology of REM sleep and dreaming. Mark Solms, professor in neuropsychology at the University of Cape Town, wrote a paper, "Dreaming and REM Sleep are Controlled by Different Mechanisms," in which he notes that the parts of the brain responsible for each state are different and able to function independently of each other. Thus, dreaming can occur without REM, and vice versa. Dreaming is subjective, and, as Solms points out, "there is no generally accepted definition of dreaming." I wonder if some dream-inhibiting brain lesions could sever the capacity to ascertain whether one has been dreaming, rather than removing the dreaming itself. Are rapid eye movements associated with a dream akin to watching a movie, so that REM might indicate observation of the dream, rather than the existence of dreaming itself'?

  Apropos, in a 1962 paper in the Archive., of General Psychurtry, "Dream Imagery: Relationship to Rapid Eye Movements of Sleep," patients were awakened immediately by one researcher upon noting any distinct pattern of eye movement. A second researcher, not told of the specific REM pattern, then asked the patient what they were dreaming about. In one example, a dream of climbing stairs and looking at each step corresponded to upand-down eye movements of the sleeper. The authors, Columbia University psychiatrist Howard Roffwarg and colleagues, summarize by noting that the dreamer "is almost totally immersed in his dreaming consciousness." They find that emotional stress in the dream translates into quickening of pulse and respiration, while the dreamer's eyes flit about following the action. The paper includes a quote from Lewis Carroll: "We often dream without the least suspicion of unreality."

  Solms does conclude that "the biological function of dreaming remains unknown." At a 2003 meeting, he responded to a question about whether dreams were meaningless with the answer "probably not." In a recent (2005) review, "Physiology and Psychology of Dreams," University of Michigan psychologist Alan Eiser reviews many of the "impressive advances" we've made in understanding brain function, but points out that "there are widely differing views concerning how dreams should be seen."

  Am I Dreaming?

  In the last chapter, I quoted a study, "When Dreams Become Reality," where subjects confused words from their reported dreams with non-dream words selected at random. In a further blurring of the distinction between dreaming and real life (as noted by Solms and Eiser), lesions located in certain parts of the brain cause vivid and frequent dreaming as well as a breakdown of the patient's ability to separate the real from the dreamt. While the mental illness schizophrenia cannot be traced to a specific brain lesion, there is a line of research suggesting that dream processes in these patients can "leak through" into waking life. Their hallucinations can thus be seen as "dreaming while awake." Other research has noted that the more severe is the schizophrenia, the less is the time spent in REM sleep, as if the patients' dreamlike, hallucinatory waking hours somehow satisfy their brains' physiologic need for REM periods.

  The dreams of schizophrenics are often quite bizarre. There can be dreams of incest. A twenty-six-year-old schizophrenic woman had a dream in which she gave birth to her younger sister. One might wonder whethe
r members of the Ingram family (in the preceding chapter) had dream-versus-reality issues (remember that a lot of schizophrenics, even with treatment, never come to understand that they are hallucinating). Put another way, "when hallucinations become reality" describes the schizophrenic consciousness.

  What has been called the "REM intrusion" theory of schizophrenia postulates that dream activity can erupt into real life. Support for this theory came from the finding that a type of electrical activity around the eyes associated with REM sleep could be found in awake, hallucinating schizophrenics. Another avenue of study finds "florid refractory schizophrenias" that are "treatable variants ... of narcolepsy." Narcolepsy is an uncommon condition where people can sleep. And sleep. And sleep. It is often genetic, and requires high doses of stimulants to prevent inopportune snoozing. In a 1991 paper, psychiatrist Alan Douglass and colleagues describe five schizophrenic patients who also suffered from narcolepsy; their mental illness improved when their narcolepsy was treated with stimulant drugs. Schizophrenia would not itself be helped by these medications, and the premise was that narcoleptic "sleep intrusion" resembled the delusional world of mental illness. Yet this could be successfully treated as a wake/sleep abnormality rather than as a psychosis. While Douglass's patients would only be a small (up to 7 percent) proportion of currently diagnosed schizophrenics, the concept of overlap of narcolepsy, a sleep disorder, and schizophrenia, a thought disorder, is interesting.

  Do the arms of Morpheus sometimes reach out and touch us while we're awake? How solid is the wall between dreams and reality? Not everyone, as we've seen, can tell the difference. How could Dr. Shainberg's patient have a dream that reflected reality? And why are we constructed to dream? It can't be just for the purpose of confusing ourselves....

  Thirteen

  When I Snap My Fingers ... Hypnosis

  On the morning of Friday, February 17, 1978, in the city of Waterloo in Ontario, Canada, a dental surgeon named Victor Rausch had his gallbladder removed. What made this noteworthy was that no anesthesia was used. No drugs, no gas, no acupuncture, no bullet to bite, no whiskey to swig. Dr. Rausch merely hypnotized himself. The operation, known as a cholecystectomy, was at that time done in an "open" fashion, as opposed to the laparascopic slits that current technology offers. This meant making an eight-inch incision through the abdominal wall, entering the abdominal cavity, cutting out the gallbladder, and sewing it all back up.

  What turned out to be the most difficult part of the procedure, from Dr. Rausch's point of view, was getting the hospital and the surgical team to let him try this "insane" idea. (That's the word Rausch used when he published his experience two years later in the Aineruan Journal of Clinical Hypnosis.)

  The dental surgeon's experience with hypnosis came from a stint in the army, during which he employed it with patients for painful and traumatic dental procedures. He was impressed that these patients seemed to heal faster, and with less discomfort, than those treated conventionally.

  Rausch began his preparation for this mind-over-matter feat the night before, using relaxation and visualization of the operation itself, and focusing on confidence. Wheeled into the O.R. the next morning, the tension of everyone else-none of whom had any experience with hypnosis-was overwhelming. But the patient assured them that all would be well, and separated himself from the situation by concentrating on music playing only in his mind, specifically Chopin's Nocturne in E-flat.

  Rausch had not known the surgeon, the O.R. personnel, or the stand-by anesthetist beforehand, and met them only briefly prior to his big day. They assured him that the pain would be unbearable and all-consuming, but they could not deter him.

  Victor Rausch's blood pressure shot up as the incision was made, while he felt only "an interesting, flowing sensation throughout my entire body." The pressure returned to normal in a few minutes, and the surgery of an hour and fifteen minutes proceeded uneventfully, with the patient conscious, but feeling "as though I were an observer rather than the patient." Eye contact with the nurses seemed to strengthen him. The surgeon even asked him not to try to control his bleeding, for fear that a vessel that might open up later would be missed by the cautery.

  Dr. Rausch acknowledges that only a small percentage of the population, at best, could tolerate major abdominal surgery with nothing beyond hypnosis for anesthesia. He assumes his is the first published report, and suggests "that we keep our intuitive channels wide open and learn to expect the unexpected."

  Hypnosis Defined

  Not everyone can be hypnotized. A Google search on the percentage of the population that is hypnotizable turned up widely different numbers-from 5 percent to 95 percent! Much of this hinged on how hypnosis was defined. What, exactly, is it? Literally, the word means "sleep." But hypnotized subjects are clearly not sleeping in the usual sense. Let's review some definitions:

  • In Trances'ork: An IntroSuetum to the Practice of Clinical Hypntkoa, (2nd ed., 1990), clinical psychologist Michael Yapko begins by reviewing some past definitions. These include:

  • a natural, altered state of consciousness;

  • a relaxed, hyper-suggestible state;

  • guided daydreaming;

  • a twilight state, halfway between sleep and wakefulness.

  Yapko also practices therapeutic hypnosis, and he feels that these descriptions only see the process from the subject's point of view. Since Yapko believes hypnosis to be interactive-a series of communications between therapist and patient-he uses the term "influential communication" to define the state.

  • A Hiotory of ,ikdieal Hypn,ao1. in Psychiatric CYiines of North Anurica (1994) traces the use of' suggestion, sometimes accompanied by ritual or fanfare, as a means of improving health dating back to antiquity, adding: "However these events come to pass, they are mediated through the intimate connection between the sufferer and the healer."

  • In The Practice of Hypnotann (2nd ed., 2000), hypnotherapist Andre M. Weitzenhoffer introduces hypnosis "as the label for a peculiar state or condition that can presumably be brought about in some human beings." He sees present-day hypnosis as a "suggested effect," and its practice as both a science and an art. In a later chapter, Weitzenhoffer, who had degrees in physics, mathematics, and biology in addition to psychology, views hypnosis "as a state of consciousness characteristically associated with suggestibility."

  • A 1999 review of hypnosis in the Brita+h Medical Journal defines it as "the induction of a deeply relaxed state, with increased suggestibility and suspension of critical faculties."

  • A recent edition of a textbook of psychiatry (Synopsis of Psycb&ztry, 9th ed., 2003) presents the definitions according to three prominent practitioners:

  • a state of heightened focal concentration and receptivity;

  • a condition in which a person can respond to appropriate suggestions by experiencing altered perceptions, memory, or mood;

  • a free period in which individuality can flourish.

  The last statement is from psychiatrist Milton Erickson, perhaps the best-known and most innovative hypnotherapist of the mid- and latter twentieth century. (Erickson was famous for the creative and outrageous ways in which he could affect patients' behavior. Once, treating a couple whose problem was that they were both bedwetters, he advised them, when bedtime arrived, to get in the bed and urinate into it. Then they were to go to sleep in their sodden bedding. Very quickly, the problem resolved.)

  The textbook adds that hypnosis may involve a sense of involuntariness and automatic movements, where suggested perceptions can replace ordinary ones. Elements of trance may include an altered state of consciousness, a dissociative state, or an ability to regress. Alterations in perception, memory, and mood may be evident.

  The textbook also defines three levels of a trance state, which a properly hypnotized subject enters. Light trance brings on relaxation of muscles, a weightlessness of the arms, and a gentle, numb feeling. Medium trance involves diminished pain perception and partial or complete amnesi
a for the events during the session. And heavy trance induces deep anesthesia and hallucinations. Distortions of time, reminiscent of dreaming, occur at all levels, but are greatest in the deepest state.

  In Weitzenhofer's book, the point is made that all hypnosis is essentially trance, but not all trances are hypnotic. The difference is that true hypnosis generally requires two people (hypnotist and subject); they communicate; the hypnotist acquires the power of suggestion. While a phenomenon of selfhypnosis exists, Weitzenhoffer feels that it is vaguely defined, overlaps with positive thinking, or employs a not-physicallypresent hypnotist via imagination or tape recording.

  The gist seems to be that classical hypnosis, like sex, tea, or the tango, can be experienced alone, but is better served by the presence of another person. On the other hand, once taught self-hypnosis by a therapist, patients may continue to treat themselves.

  Going Under

  Whatever this state is, how easily can you be transported into it? In other words, how hypnotizable are you? Scales to measure hypnotic susceptibility have been in use since the nineteenth century. Many currently exist; and in medicine, when there are many ways of doing something, you can be sure that no single way is clearly superior. One commonly used instrument is the Stanford Scale (there are a number of variations of it), developed in part by Weitzenhoffer. It consists of about a dozen hypnotic parameters, and includes things as simple as whether or not the eyes close spontaneously, or as complex as whether age regression occurs. Another is the eye-roll test, which is a physical measurement. The patient is asked to look up, only with the eyes. Then, eyes upward to the max, he or she is asked to roll the eyelids downward, over the eyes. If properly accomplished, only the whites of the eyes show, ghoulishly. The textbook considers the eye-roll "a presumptive measure of biologic ability to experience dissociation." The implication is that dissociation and hypnosis, particularly in its deeper forms, have a lot in common.