101 Things I Wish I'd Known When I Started Using Hypnosis

by Dabney M Ewin

  53. Always add an endpoint

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  Always add an endpoint to a suggestion that would cause a problem if it continued indefinitely. Analgesia should last only “until it’s healed” or post-op “as long as you need it.”

  I was asked to see a patient with a broken neck who had been in traction for six weeks and had bony healing, but could not sit up in a neck brace. Every time she sat up she got excruciating pain and had to lie back down immediately. Reviewing her treatment in trance revealed that on admission, when she was put in cervical traction the orthopedic resident had told her “Whatever you do, don’t take off this traction and sit up, because you could be paralyzed for life.” She was in a traumatic hypnoidal state at the time, and took it literally like a post-hypnotic suggestion. All I had to do was add an endpoint by saying “It was a good idea at the time, but now that it’s healed it is safe to sit up comfortably.” If the resident had added an endpoint such as “Don’t sit up until we tell you to,” there would have been no problem.

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  54. Pre-hospitalization suggestion

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  In a hospital all kinds of things are said that have unintended consequences. I may go to the recovery room and hear a nurse saying “Wake up Mr. Jones, it’s all over.” If he’s frightened and interprets that pessimistically (see Thing 64), it’s not what he should hear. I go and tell that patient “Joe, this is Dr. Ewin. Your operation is completed and you’re OK.” We must be precise in our language.

  Alexander Levitan, MD taught me to suggest “If anybody says anything that’s less than helpful, let it be as though they said it in Chinese (or any language they don’t understand), and it will have no effect at all.”

  I gave this suggestion pre-operatively to a member of my family who had a simple release of a DeQuervain’s tenosynovitis of the wrist, and the anesthetist had said

  “My uncle had that operation, and they ended up having to amputate his thumb.” Fortunately, she just smiled and immediately translated the comment into unintelligible Chinese.

  It’s a common thing for people (called “Job’s comforters”) to think it’s reassuring to say “You sure are lucky … (you didn’t get killed, lose a leg, etc.).” It doesn’t make anyone feel lucky – it simply implants an additional catastrophic thought at a time when the patient most needs reassurance. It should be heard in Chinese.

  A negative expectation (nocebo) tends to be accepted without testing (instinctive self-protection), and it trumps a placebo, which first requires some education for positive expectation to be accepted (Colloca et al. 2008).

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  55. A specific question often acts as

  an indirect suggestion

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  There is danger of implanting a false memory with a leading question.

  Martin Orne demonstrated this in the BBC documentary on hypnosis (Orne 1982).

  All questions in hypnosis should be open and non-specific: “What’s happening?” “And then …?” and so on.

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  56. Avoid delayed response to a

  suggestion by using a broad

  alerting suggestion

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  Delayed response is a well documented phenomenon, and is one of the dangers of not removing undesirable suggestions given during trance. The lack of an immediate response to a post-hypnotic suggestion does not mean that it had no effect. André Weitzenhoffer (1957) reports in his book the case of a student who took the Stanford Scale test with no apparent effect but woke up the next morning with a partial paralysis. I have a published letter to the Editor of the American Journal of Clinical Hypnosis describing three cases of delayed effects (Ewin 1989). This has led me to an all encompassing wipeout alerting suggestion, saying “When I say three, you will open your eyes and come back fully alert, sound in mind, sound in body, and in control of your feelings. One (pause), rousing up slowly, two (pause), three.” An increase in tone and volume on “three” helps effect a change to full alertness. Richard Kluft (2007) has stressed the importance of fully terminating trance, and the dangers of neglecting it.

  My premise is that if the patient is suggestible enough to accept one suggestion in trance, he/she is also suggestible enough to be sound in mind (not goofy), sound in body (no unwanted motor or sensory aberration), and in control of feelings (not an emotional disaster).

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  Miscellaneous

  Pearls of Wisdom

  In medical school we used to classify keen insights and clever or astute discernments as “Pearls of Wisdom,” or just Pearls. Sometimes they were simply philosophical thoughts, and often they could not be easily classified, but were worthy of recollection. In this section I have included some random observations, insights, and thoughts that have impinged on my experiences in life as a doctor who uses hypnotic concepts in daily practice. Perhaps this section should just be labeled “Pearls.”

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  57. Nobel Prize for

  left–right brain function

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  Roger Sperry, PhD won the 1981 Nobel Prize for his studies of the difference in function of the two cerebral hemispheres. Clinical experience demonstrates that in a good trance the left brain functions are progressively shut down. Speech is a left brain function, and a subject in trance will not ordinarily initiate speech (but will answer and talk when so instructed), ordinary logic is abandoned in favor of trance logic, timekeeping sense is lost, and the analytical step-by-step sense is switched to global, metaphoric, and intuitive (right brain) processing of information.

  Doing clinical work, I have found this knowledge very helpful in my understanding of what is going on with my patients as I do nonverbal (right brain) ideomotor questioning. Since most left brain functions are learned, children don’t have a lot to turn off. They are simply not yet completely on, and children live easily in daydream and trancelike states. Animals function as though they have two right brains.

  We must of course be aware that hypnosis is much more than Sperry’s studies show, and that respected scientists disagree vigorously on details of its true nature. Nonetheless, it is a simple concept for me as a clinician working with a patient. I can drive a car without understanding all the machinery and electronics, and I can treat nearly all of the patients who come to my office. Sometimes a car has to be referred to a mechanic, and sometimes a patient must be referred to a more knowledgeable doctor.

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  58. Left and right are a

  title and a picture

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  Sperry’s studies indicate that the left brain processes information in words, and the right brain processes the same incoming information in the senses (mainly sight, sound, and action – NLP anyone?).

  The right brain visualizes the information, and the left brain puts a verbal descriptive title under it. David Pedersen, MD, of Oxford, theorizes that in trance, with the patient’s left brain function inhibited, the voice of the hypnotist becomes the substitute for the verbal input of the left brain to the right brain (Pedersen 1994). He stresses how useful this concept is in clinical work, and I agree.

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  59. Dissociation

  requires association

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  In psychology, the word dissociation was always difficult for me to understand, because no one ever said what the patient was dissociating from. You can’t dissociate without being first associated with something. When it became clear that left brain functions are shut down when a person is dissociated, I was able to make sense of the word.

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  60. Fixed idea

  (idée fixe of Pierre Janet)

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  Anyone carrying out a post-hypnotic suggestion or an imprint has his/her behavior unshakably determined by the fixed idea. A fixed idea can be violated but only at the expense of experiencin
g anxiety.

  Phobias are fixed ideas and locating their origin by a regression in hypnosis allows reframing to a better idea.

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  61. Strong emotion makes one

  vulnerable to waking suggestion

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  I had a patient with a hysterical paralysis who had lost the tip of his finger in an industrial accident. He was very upset because he was not a laborer; he was just working a part time job before beginning teaching music at a local university. The skin closure was tight and the orthopedist said “Don’t bend your finger, because you will pull out the stitches.”

  Three months after the stitches were removed he was still unable to bend the finger. In a regression to the surgery I learned what the surgeon said, removed the suggestion, and pointed out that the sutures were already out and the wound healed. He rapidly regained a full range of motion. An emotional state focuses like a trance and a statement at that time can act like a post-hypnotic suggestion.

  The strong emotion at the time of a death-bed wish affects the recipient like a post-hypnotic suggestion. It becomes a fixed idea and may be carried out at considerable inconvenience. In his famous poem “The Cremation of Sam McGee,” the poet Robert Service (1940) says “A promise made is a debt unpaid,” and it’s a long story as he is determined to carry out his friend’s dying request (Thing 62, Law iv).

  In therapy, we know that if you can put an idea in, you can remove it. Correct diagnosis requires that we identify the suggestion we want to remove. A regression to the incident and reframing that it was a good idea at the time, but it has now outlived its usefulness, will resolve a problem that started at a time of high emotion.

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  62. Coué’s Laws

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  Emile Coué was a French pharmacist who studied hypnosis in Nancy under Liébeault around 1900. He is considered the father of auto hypnosis, and gave us the classic self-suggestion “Every day, in every way, I’m getting better and better.” He also gave us five laws that have stood the test of time:

  Law of Reversed Effort (or Effect). If a person fears that he cannot do something, the harder he tries, the less he is able. In fact, he tends to do the opposite of what he wishes to do. I’ve seen this many times with insomnia, with excellent students who are failing exams, and with impotence. They all solve themselves naturally if one doesn’t try too hard.

  Law of Dominant Effect. When the will (I translate as left brain) and the imagination (I translate as right brain) are at odds, the imagination invariably wins. I see this in nearly every phobia that I treat. If someone imagines that it is very dangerous in an elevator, even though his left brain logic says it’s not, he will walk up ten flights of steps to avoid the elevator.

  Law of Concentrated Attention. An idea tends to realize itself, within the limits of possibility. Choices in daily life tend to favor the realization of the idea. I recall reading that as a boy Jimmy Carter dreamed of becoming President. He sought and obtained an appointment to Annapolis and became the only member of his family to have a college education. Then he went into politics, was Governor of Georgia, and ran as an almost unknown candidate for President, and won. His idea realized itself.

  Law of Auxiliary Emotion. The intensity of a suggestion is proportional to the emotion that accompanies it. An idea goes into the subconscious with very little force if there is no emotion attached. When there is strong emotion, particularly terror, an idea is strongly fixed in the subconscious. Henry Beecher, MD at Harvard, studied placebos and found that the greater the stress, the more effective the placebo (Beecher 1956).

  Law of Autosuggestion. A suggestion only produces the condition to be transformed into an autosuggestion, that is to say accepted by the deepest self. The same incidents produce different effects depending on the subject who receives the suggestion. In other words, all suggestion is self-suggestion and a subject still has a choice to accept (self-suggest) or reject a new idea. This is why it is wise when doing ideomotor work to ask “Is it all right … (to regress to birth, to visit the White Light, to stop smoking now, etc.)?” A “yes” answer means the patient is open to accept what is contemplated, and a “no” means I may as well drop the subject for now, because nothing is going to happen.

  Coué maintained that he had never cured anyone: “I teach you a method, and you can cure yourself.”

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  63. Law of Pessimistic

  Interpretation

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  David Cheek said “If a statement can be interpreted optimistically or pessimistically, a frightened person will interpret it pessimistically.” This is protection against perceived danger. An antelope that sees the bushes wiggling and (pessimistically) moves away for fear it is a lion is more likely to survive (natural selection) than one that assumes it’s a wart hog and keeps on grazing. In a “haunted house” a squeaking sound could be a rusty door closing or it could be a ghost. If you’re already frightened, it’s a ghost! Many of our patients arrive frightened about their health and are inclined to interpret any imprecise statement pessimistically.

  When President Reagan was shot through the lung I saw a news item in the Los Angeles Times stating that the surgical resident said “This is it!” Reagan blanched, and unable to talk (he was intubated), he scribbled a note to the nurse “What does he mean, this is it?”

  Pity the poor frightened patient whose doctor’s advice was “You have to learn to live with it.” If he takes that literally (pessimistically), the only way to be without it is to die. I spend a good part of my therapy time removing that suggestion and replacing it with “There’s nothing wrong with living without it.” We must use precise language to avoid pessimistic interpretation by a frightened patient.

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  64. Law of Perceived Reality

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  If a patient believes something to be true, it is true for him/her. We know that in any kind of forensic work the veridical facts are what matter, and external corroboration is needed before we accept information obtained in trance. Not so in clinical work. Regardless of the reality, if a patient believes something to be true, he/she will think, feel, and act as though it were true. We need to meet the patient where he/she is, or lose rapport. If we treat an idea with respect, even though we don’t agree, we put ourselves in a position to lead.

  In treating psychosomatic disorders, I often ask a patient to regress to the first time this symptom was too important, and occasionally (rarely) he/she arrives at a past life. When this occurs, it is usually associated with the (supposed?) cause of death in the past life – a tomahawk to the head, a sword in the stomach, a suffocation, and so on. I interpret that as a protective idea (a sort of trance logic) that as long as the symptom is there, “I can’t be dead yet.” If I get an ideomotor confirmation that this thought is occurring, I can point out in trance that it really doesn’t matter anymore, because we know that you did die in that life, and you are back now in a new life. “Do you really still need this symptom to prove that you’re alive now, in a new body, at a new time, and in a new place?” An ideomotor “No” answer makes it easy to say “In that case, since you don’t need it anymore, would it be all right to just let it go and get on comfortably in this new life?” I have no idea if the patient had a previous life, but I can treat a patient who believes he/she did have one by accepting the fact that it is true for that patient.

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  65. Laws of Hypnotic Depth

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  A patient tends to go as deep as he/she needs to go to solve a problem. A patient tends to stay as light as necessary to protect him/her self.

  Just my personal observation, so it’s Ewin’s Law.

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  66. “Dreams are the royal road

  to the unconscious”

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  “Dreams are the royal road to the u
nconscious” (Freud 1900).

  I perceive imagination (daydreams) as key to hypnosis and would rewrite it as “Hypnosis is the royal road to the unconscious.” Freud started with hypnosis but gave it up early in his career. He apparently was not good at inductions and was dissatisfied with his results using only direct suggestions (Kline 1966).

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  67. First three years of life

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  The importance of the first three years of life in personality development is well documented. Regressions to preverbal memories are of inestimable value in hypnoanalysis. Even though it is rarely possible to validate what the patient expresses, it is therapeutic to treat it as real (Thing 64) because it comes from the patient. If the patient believes that it’s true, it is true for him/her, and reframing an early trauma (real or imagined) is often curative.