Most psychotherapy, as it is practiced in 2021, is either the supportive or conversational kind. These forms of therapy can be quite helpful, but do not aim for fundamental psychological change or full resolution of the presenting psychiatric problem or complaint. They simply help the patient manage life, but generally do not succeed in helping the patient achieve a cure or wellness. The concept of a cure in psychiatry is generally not much discussed and does not rank highly in treatment goals. The reason for that is that a cure is generally not considered possible as it might be in internal medicineor general surgery, for instance.
It is about 120 years ago that an important discovery was made. The discoverer was Freud. He found that if he assisted a patient, through the use of age regression while deep in hypnosis, to recover the original traumatic experience in full historical detail and to also experience the associated feelings, patients recovered from their problems. The reliving of the original trauma was often accompanied by the discharge of intense feelings, though not always. Freud called it “catharsis”, derived from Greek and meaning cleansing and purification. The ensuing recovery was often dramatic and complete.
This remarkable discovery by Freud is now largely forgotten, and its beneficial effects in patient care are only very rarely exploited in general medicine and psychiatry. The bulk of clinical practice is now devoted to medication management with psychotherapy taking a very secondary role. There is a handful of psychiatrists, some of whom are members of the American Society for Clinical Hypnosis, who are aware of this phenomenon and make use of it in their clinical practices.
Implementing this methodology is technically not particularly difficult. It does, however, require specialized training on the part of a psychiatrist, as well as motivation and the necessary training in hypnosis on the part of the patient who needs to demonstrate the ability to enter the hypnotic state predictably and at sufficient depth. Potentially, more patients than not should be able to utilize this technique.
We all can have sudden insights and understandings in the ordinary waking state, even in the absence of hypnotic relaxation. The hypnotic state is a vehicle that facilitates the process of recall, presumably by reducing the defensiveness on the part of the conscious mind. We know that conscious and subconscious naturally and regularly communicate with each other in dreams when conscious defenses are lowered. In the state of hypnotic relaxation, the conscious mind tends to be more willing to accept information from the subconscious than in normal day-to-day conscious functioning. Thus, hypnosis facilitates the same processes that are in place in dreaming.
Patients will often worry about whether, in fact, they can enter into hypnosis. They are reassured when it is pointed out to them that they have been hypnosis many times before, the last time being when they fell asleep the night before. In order to fall asleep we have to pass through a phase of relaxation that is akin to or the same as hypnosis and that helps us move from consciousness to sleep. Everyone is familiar with what happens when one does not go through that phase of relaxation, namely insomnia. This explanation helps patients realize that hypnosis is part of normal everyday psychophysiological functioning.
In the treatment setting, the steps that the patient takes in order to make use of resolution by age regression start with giving the patient some technical explanations that focus on the idea that our subconscious is a huge database that contains all our memories, including especially memories of traumatic experiences. Another important piece of information is the concept of post traumatic amnesia with which the mind protects itself by making itself unaware of some or all of the details of past trauma. That way life can continue as well as it can with as good a functioning as possible under the circumstances. This unknowing does come at some cost, one of which is anxiety. The third item is to explain that hypnotic relaxation that develops in training is intended to reduce the stress of the recall and the reliving of the traumatic experience so that that experience will be reframed along more positive and less stressful lines. As a result the traumatic experience loses its power and the patient is be able to think about it with objective detachment.
Once the patient has learned to enter hypnosis reliably and predictably, treatment can start when the patient has declared himself to be ready. The following vignette, one of many other similar instances, is a summary of a case in treatment.
A female patient, aged 52, returns to the office. She has been in therapy working on resolving issues of anxiety and depression as well as a several stress-induced medical conditions such as chronic migraine headaches and irritable bowel syndrome. She had not been seen for a month and, on this visit, comes in wheezing, coughing and gasping for air. She has been suffering from these respiratory symptoms for about three weeks, since she was exposed to cigar smoke while she was in a cafeteria. She has had this asthma-like syndrome in the past and always in response to exposure to tobacco. The usual medications had not been successful in resolving the symptoms this time. Since she was known to be a very competent and well trained hypnotic subject and since the history and presentation of her symptoms seem to fit the pattern of a Pavlovian conditioned reflex, it was suggested that she might find it beneficial to recover the details of the original formative experience.
She was able to enter a deeply relaxed hypnotic state and was asked to go back in time to whatever it was that had set up this conditioned response, the formative traumatic event, in other words.. While she was so engaged, her respirations began to ease until they were normal. At that point she returned from hypnosis to regular conscious functioning and was able to report the following experience after regressing to age 4. She saw herself sitting on the side of the sink in the family bathroom. Her mother had lit a cigarette and was urging her repeatedly to “suck on it like a bottle”. She recalled how she had begun to experience choking, vomiting and gasping for breath.
This therapeutic experience had two effects. One was that she had almost immediate relief from the acute respiratory symptoms and the other was that since that session she has been able to be in environments where there was tobacco smoke without suffering ill effects.
Several conclusions can be drawn from this vignette. One is that Freud’s discovery of 120 years ago is still valid and could have wide application in today’s clinical practice. Another conclusion would be that no other known medical treatment could produce such a result.
The fact is that when a patient is given the opportunity to review past trauma in a calm and composed mind, healing can begin.