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82. Adrenalin (epinephrine)
fixes memories
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This is so true that Weinberger et al. (1984) were able to do Pavlovian conditioning of rats under general anesthesia by injecting epinephrine at the time of a sound and electric shock stimulus.
In the waking state subjects showed aversive behavior on hearing the sound, while controls that were injected with saline did not.
Fear is our most powerful emotion, and trauma releases adrenalin. The instinct for self-preservation leads us to imprint dangerous memories and be alert to avoid similar incidents. Post-traumatic stress disorder is the strongest imprint of all.
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83. No need for rapport
in an emergency
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No need for rapport in an emergency, just credentials. We all know the imperative need for rapport when doing psychotherapy. This need disappears in an acute emergency situation, and hypnotic techniques are effective even when used by a complete stranger. The first law of nature is self-preservation, and when there is an explosion, rape, dislocated shoulder, baby crowning, and so on, the patient’s mind is focused on fear and survival, and a hypnoidal state occurs. Fear overrides all logic and the victim turns to anyone with believable credentials for help.
My only induction with these patients is “I’m Dr. Ewin, I can help you. Will you do what I say?” With a “yes” answer to that, I can say “Fine, you’re safe now. Close your eyes, take a deep breath, and turn this over to me. You can let your thoughts and feelings go off to your laughing place while I do what’s necessary to get you well.” I ask for an ideomotor signal when they find the “laughing place,” and then I can relocate a dislocated shoulder, suture a laceration, or set a fracture. Since the patient’s comfort is the issue, not proving how great hypnosis is, I don’t hesitate to add some local anesthetic if it’s handy.
James Esdaile recognized this principle when doing surgery in India in 1850. He wrote “In subjecting my patients to the sanative influence of Mesmerism for bodily complaints, no mental rapport has ever been thought of. … In the management of mental disease, it will probably be required” (Esdaile 1850).
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84. Easiest suggestion is “Keep
doing what you’re doing now.”
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It seems logical that as the autonomic nervous system is controlling body functions, it surely knows what it is doing right now. Our bad ideas come without effort and our good ones should come the same way. If what is happening is desirable, then a suggestion to keep doing what you’re doing right now should be easy to accept without effort.
With acutely burned patients the standard initial emergency room protocol is to give a shot of analgesic and cover the burned area with iced towels. So by the time I get to the ER the analgesic is taking effect, the burned area is iced, and all I need to say is “Notice how all the involved area is cool and comfortable. When you are aware of this, signal by raising this finger (I touch an index finger).” When I get that signal, I say “Fine, keep it that way until it’s healed.”
I had a colleague who did acupuncture for pain. He told me he had several patients with reflex sympathetic dystrophy who would get pain relief from acupuncture lasting for twelve to forty-eight hours, and then have recurrence of pain. Studies have shown that acupuncture relieves pain by releasing encephalins (natural opiates), and is inhibited by the opiate antagonist naloxone. Hypnotic pain relief uses a different path and is not inhibited by naloxone. We treated five patients who had undergone six weekly acupuncture treatments with only temporary relief. While they were pain free, I did hypnosis with a suggestion to “Notice how comfortable it feels, and that your body can keep it that way.” Three of them got complete relief in one combined treatment. One got more than 50 percent relief, and one was no better. My colleague has moved to another city and university, and we have not continued the experiment.
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85. Best suggestions are
ten words or less
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Even though we’re treating people with words, we talk too much in trance. After I’ve done my explaining in the waking state, and given suggestions in trance, it helps to summarize the message into about ten words or less, and repeat it three times or more to make it stick. For instance when I give Levitan’s pre-op suggestion (Thing 54), I summarize “Less than helpful – Chinese,” and repeat it at least three times.
Historically, the very inclusive self-hypnosis suggestion of Emile Coué (1905) resulted in many remarkable cures. He had patients repeat twenty times, twice daily, “Every day, in every way, I’m getting better and better.” Ten words.
Good political slogans are short and repeated often. I can still recall from high school history sixty years ago that “Tippecanoe and Tyler too” helped elect William Henry Harrison as our ninth president. “I like Ike” did it for Eisenhower, and “Yes, we can” worked for Obama. A suggestion should stick in the mind like a slogan.
When I first saw Monet’s Impression, Sunrise (the painting that gave its name to the impressionist movement in art), I realized that even though one could write pages about the scene with its colors, focus, contrasts, and so on, just the two words in the title sufficed to fix it all in my memory.
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86. ETKTM
(Every Test Known To Man)
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An ETKTM comes for hypnosis as a last resort. He/she has seen numerous specialists and been through at least one prestigious clinic, had every test known to man (except one), and has been told that all the tests are normal and basically there’s nothing wrong with you. But the question remains, “Why do I keep having headaches, feel tired all the time, cry easily, forget things, sleep poorly, and (a list of other disorders of the nervous system)?” When I started listening to these patients in depth, I realized that in general most of them were what I call “normally neurotic.” They weren’t nuts. There was something wrong with their health. I found it in Hans Selye’s research on 15,000 lab animals. He called it the General Adaptation Syndrome (Selye 1946), describing the physiological changes that occur with chronic stress of any kind.
The chronically stressed individual goes through three stages: alarm, resistance, and exhaustion. Chronic stress exhausts the adrenal cortex and the thymus (immune T-cells), and patients get functional hypoglycemia and autoimmune disorders. The entire nervous system is supplied with diminished fuel (glucose) and malfunctions. The test that wasn’t done is a five hour glucose tolerance test (GTT). The Hypoglycemia Support Foundation http://www.hypoglycemia.org has a useful questionnaire that I use to prompt me to order a five hour GTT if the score is over 20. Note that the usual three hour GTT is useless for making this diagnosis, as is a single blood sugar determination at the time of the worst symptoms. When the blood sugar drops more than 20 mg/dl below the fasting level on the five hour GTT, the test is positive and warrants a trial of diet change. The patient needs to be on a six feeding, low refined sugar, low refined starch, and no alcohol or caffeine diet, along with hypnosis for relief of the chronic stress (Thing 75).
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87. “Don’t let your
failures go to your head”
– William Kroger, MD
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This is an amusing way to give good advice to new students of hypnosis. Too often a novice is unsure of the technique, communicates this to the patient (Thing 78), gets a poor result, and then abandons hypnosis.
When I did my first induction, as soon as I got eye closure I opened the book and read the script to the patient. It worked, and very soon I could say it in my own words without reading. Accepting the fear of failure inhibits initiative and is picked up by the patient (Things 27 and 78).
Tom Edison said that in his lab he’d never had an experiment that failed,
but he’d learned ninety-nine things that don’t work.
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88. Burns have two parts
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It is not widely recognized that a burn has two separate components – the external heat injury to the skin and the internal inflammatory response to the injury (Thing 31). Anyone who has been sunburned knows that when leaving the sun there is some pain, but the heat injury is over. Then after several hours the blisters, fever, pain, and swelling occur. The initial pain is the body’s alarm system saying “do something, there’s danger,” but the subsequent pain is inflammatory (the cardinal signs of inflammation are calor, dolor, rubor, and tumor (heat, pain, redness, and swelling)). Initial pain is transitory, inflammation is long lasting. The bradykinins (enzymes) that induce inflammation are released in the first two hours, and if the patient can be hypnotized in those two hours (even the first four hours), and can hallucinate that the involved area is “cool and comfortable,” it cannot also be hot and painful, and no inflammatory enzymes are released. When the inflammatory part of a burn is thus aborted, the burn does not progress from first to second degree, or second to third degree, and there is minimal pain during healing.
Just as one can have the external burn stimulus with no response, one can have an internal inflammatory response without a physical stimulus. Using a cold coin on the patient’s forearm, Dr. Chertok’s film (1982) shows a blister developing after he suggests “It will cause a blister, as though it were hot.”
The Indian firewalkers go through a week of fasting, sexual abstinence, and mental preparation ritual, then dedicate the firewalk to the Gods. Occidentals who participate in this (hypnoidal) ritual can do it too. The Fiji firewalkers believe that the volcano goddess gave their tribe a gift of being immune from being burned. They need no ritual.
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89. Surgical analogy
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I like the analogy of hypnosis to surgery. If a person has appendicitis, we start with an anesthetic. This facilitates the surgery, but does not cure. Recover from the anesthetic without surgery and the patient still has appendicitis.
Trance induction works like the anesthetic – it facilitates treatment, but if there is only induction and alerting, the patient is still sick.
In surgery, it’s the operation that cures the patient. But it has to be the right operation – an appendectomy. A cholecystectomy or hysterectomy won’t do it.
In hypnosis, it’s the suggestion that cures, but it must be the right suggestion.
Our analytical skills lead us to find the right suggestion. In surgery, the patient still has to finish healing. If he gets an appendiceal stump abscess and it ruptures, he’s no better off than if he’d never had an operation.
In hypnosis, the patient has to accept the suggestion or he will not improve.
Inductions are easy. Our workshops are to learn how to sort out the right suggestion and how to make it acceptable to the patient.
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90. Informed consent for surgery
* * *
Informed consent for surgery may stir the pot of the Law of Pessimistic Interpretation (Thing 63). In my state of Louisiana, in an attempt to protect surgeons from a rash of malpractice suits claiming failure of informed consent, the legislature passed a law stating that a patient who signed a standard consent form had been fully informed. The standard consent said “I understand and acknowledge that the following known risks, among others, are sometimes associated with this procedure and/or anesthesia: brain damage, disfiguring scars, paralysis, including quadriplegia and paraplegia, the loss of or loss of function of body organs, and the loss of or loss of function of any arm or leg.” This has since changed, but at the time it was a horror story that a patient should not read alone. If there are known specific common complications of a procedure, I write this down and review it individually.
Regarding the old standard form, I didn’t want my patient having right brain visions of any of the noted horrors happening, and kept the discussion in the left brain. I’d first say to the patient “You surely know that there is some danger to any major anesthetic and surgical procedure, don’t you?” “Yes.” “Well, the law says that I must inform you of the worst things that can happen to people in the course of major surgery, and get you to sign this form saying that we have discussed it. There have been cases where someone died, was paralyzed, lost a limb, etc. Any questions? Sign here.” I don’t want my patient drifting into a hypnoidal state and daydreaming any of this happening to him (Thing 63). In his mind, I want these to be things that happen to other people!
I saw a patient for treatment of a reflex sympathetic dystrophy of his left lower extremity. He had ruptured the left Achilles tendon and had a good tendon repair, but the skin scar was adherent to the tendon and movement was limited. His orthopedist referred him to a plastic surgeon to release the scar, a relatively simple procedure. The nurse handed him the above release to sign, and he read it carefully, including the clause about losing use of a limb. He signed it, said nothing, underwent the procedure, and post-op lost use of the limb. When I saw him he was on crutches with no weight bearing.
We know that all suggestion is self-suggestion (Things 62, Law 5, and 63).
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91. We experience emotions
in our bodies
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Frustration often leads to a headache, the betrayed person feels he’s been stabbed in the back, controlled anger causes a knot in the stomach, and a startle makes a heart skip a beat.
Psychosomatic medicine is best practiced when we can change the idea that evokes the symptom. The target organ identifies itself.
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92. Tapes and self-hypnosis
* * *
Many of my confreres report excellent results teaching patients self-hypnosis. I must not do it right, because I have not been able to replicate their success enough to be highly enthusiastic about it. However, I do use self-hypnosis for myself regularly.
Since our bad ideas come without effort, I believe that our good ideas should come the same way, and listening to a tape is effortless.
I make a tape with a short induction, appropriate suggestions, and an alerting set, and do the same for myself as for my patients.
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93. Post-hypnotic triad
* * *
When a deep trance subject is given a post-hypnotic suggestion, three things happen:
Compulsive carrying out of the suggestion.
Verbal amnesia (source amnesia) for the origin of the idea.
Rationalization of the behavior.
This meshes with what happens when a patient has a fixed idea (Janet’s idée fixe), and particularly when the fixed idea leads to a phobia. The idea can be resisted, but only at the expense of an anxiety attack. A person who is phobic about an elevator can force himself to get into it, but he is in a cold sweat, pulse racing, blood pressure up, and tense. He will gladly climb ten flights of stairs to avoid the anxiety attack. He cannot explain why he feels this way (source amnesia). When asked why he climbs the stairs, he may rationalize by saying that he does it for exercise.
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94. The duty of the subconscious
mind is to protect the organism
* * *
The first law of nature is self-preservation. Any creature that does not protect itself becomes extinct.
The subconscious functions to make it automatic, reflexive, and intuitive to take self-protective positions at all times. Symptoms are often irrational attempts at safety – see constant pain (Thing 32) and adrenalin fixes memories (Thing 82).
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95. Response to cortisone
or antihistamines
* * *
Response to cortisone or antihistamines often gives a hint that a medical
disorder is also amenable to hypnosis.
Asthma, hives, and most of the autoimmune disorders respond to hypnosis approximately as well as they do to cortisone, without the dangerous side effects.
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96. Hypnotizability is not an issue
with ideomotor signaling
* * *
Ideomotor just means an idea is activating a motor movement. This is a form of body language and all people normally have body language in the waking state. Both highs and lows unconsciously nod their heads when saying “Yes” and shake their heads as they say “No.”
101 Things I Wish I'd Known When I Started Using Hypnosis Page 6