Psychotherapies Without Feeling
by Dr. Arthur Janov
Posted June 2005 on primaltherapy.com
Chapter 4: Restructuring Reality with Hypnotic Pain Control
The potential to reduce pain to a manageable level is a genuine tribute to the capabilities of the human mind, and constitutes one of the most meaningful applications of therapeutic hypnosis.
Hypnotic pain control has always been viewed as a dramatic testimony to hypnosis as a special, altered state. My intent is to show the opposite. The use of hypnosis for pain control illustrates my thesis that hypnosis works because the "trance state" of neurosis is already established. Hypnotic pain control actually involves a conscious and circumscribed activation of an imprinted neurotic process which is composed of physical, chemical, and neurological alterations in functioning. It thus: (1) arises out of the pre-established mechanisms of defense which are integral to neurosis; (2) is special only to the degree that pathology is special (i.e., different, divergent); and (3) is altered only to the degree that the pathology of neurosis has already altered one's entire physiology.
The ways in which hypnosis is used to control or alter physical pain may soon show us more about the physiological processes underlying the control (read repression) of emotional Pain. It is much simpler to investigate what goes on when a hypnotized subject sticks his hand in ice water than it is to investigate what goes on when a small child is rebuffed by his mother. Investigating ongoing human processes in a controlled and scientific manner is nearly impossible; investigating contrived situations that appear to utilize the same or similar mechanisms is not. So while hypnosis is not a special or altered state, it may end up providing us with valuable information about what must be mankind's most altered state: neurosis. Hypnotic pain control measures are of interest at this point precisely because they demonstrate the degree to which the human brain can restructure reality. According to Yapko, "The person in pain is capable of using her mind to change her perception of the pain...and this ability is amplified with hypnosis." Whether one is transforming severe abdominal cancer pain into an annoying but bearable itch on the foot, not registering the discomfort of one's hand immersed in ice water, or repressing the Pain of being left alone in an orphanage, the neurophysiological mechanisms involved in the restructuring of painful realities into endurable ones remain the same.
Experiments in hypnotic pain control demonstrate that one can become unconscious to some extent of physical pain, and also indicate how this occurs. These experiments have lead to conclusions about the capacity of consciousness to dissociate itself from the experience of physical pain – a mechanism similar to the dissociation from the emotional pain that results in neurosis. The similarity supports the theory that, in the end, the brain does not distinguish between physical and emotional pain. Hypnosis experiments therefore provide excellent models for illustrating the mechanisms through which neurosis is induced and maintained. Conversely, understanding how neurosis works will provide clues as to how hypnotic pain control is possible.
Views of Hypnotic Pain Control
In his book on pain and hypnosis, Ernest Hilgard outlines hypnotic methods and techniques now commonly used to abolish or alter the personal experience of pain. Among them are the clinical pain control techniques Erickson spent over forty years developing. More recently, Yapko describes a variety of hypnotic strategies which can facilitate analgesia. Each technique either redefines the pain or "shifts the person's awareness away from the bodily sensation(s) under consideration." For example, in the use of "direct suggestion of analgesia" for a client experiencing stomach pain, the hypnotist may offer suggestions for a lack of sensation in the relevant body area, as follows:
As you feel your arms and legs getting heavier...you can see the muscles in your abdomen loosening...relaxing...as if they were guitar strings you were unwinding...and as you see those muscles in your abdomen relax, you can feel a pleasant tingle...the tingle of comfort...and whenever you have had a part of you become numb, like an arm or leg that fell asleep...you could feel the same tingle ...like the pleasing tingle in your abdomen now...tingling more...and isn't it both interesting and soothing to discover the sensation of no sensation there? That's right...the sensation of no sensation..a tingling, pleasing comfortable feeling of numbness there...
Isn't that what parents do to children? "You're not sad. Stop with that depressive act and smile!" The child hurts his knee and the parent says, "Stop whining. It doesn't really hurt. You're making too much of it!" "Stop acting like a baby!" All phrases that change the hurt into something else. Or when a child begins to cry after falling down, the parents will do everything to distract him. "Look at this!" The child can no longer feel what he feels.
In another technique known as "glove anesthesia," the patient is given suggestions which lead her to experience anesthesia or numbness in one hand or both hands. Further suggestions then enable the patient to transfer this numbness to any other part of the body simply by touching that site with the hypnotically anesthetized hand.
If you put all of the techniques for hypnotic pain control together, you come up with a rather hefty list of methods. Pain can be numbed, transferred, suggested away, shifted, displaced, substituted for, reinterpreted, reframed, diminished, altered, relocated, converted, or substituted; the experience of it can be partially or entirely forgotten, or condensed into a few seconds duration; one's attention can be directed away from the pain via hallucination and/or age regression; or one can induce a straightforward anesthesia or analgesia.
Each particular pain control technique requires a different set of suggestions and taps into different physiological processes. For example, numbing the pain in one's chest involves different physiological processes from relocating it from the chest to the right thumb. Yet whatever the technique, it can and often does successfully provide at least some alleviation of discomfort. The various techniques share a common point of convergence: The hypnotist uses ideas in order to transform the subject's experience of pain, to dissociate it from conscious awareness.
Hilgard points out that all hypnotic pain control methods "make use of the dissociative possibilities within hypnosis." [Italics added] This could be restated such that the "dissociative possibilities of hypnosis" are really alterations in neurological functions that make use of the dissociative process, period. We are all capable of separating levels of consciousness from one another, that is, dissociation. We can all revert to different brains within our skulls. This compartmentalization was an evolutionary mechanism to keep the Pain at bay and allow us to function. So even though childhood pain churns a tempest below the third-line, we go to work and carry out our duties. We are in a sort of coma but no one notices, not even us. We are compartmentalized; a whole world of experience is going on below decks but we are focused on the mast. But however it is stated, dissociation seems to be the primary ingredient in hypnotic pain control.
Hilgard uses an excellent example:
Directing attention away from pain can be achieved in more than one way. One method is to deny the existence of the painful bodily member. We have utilized this method successfully in the laboratory following reports of its clinical use. Before his arm is stimulated by lowering it into circulating ice water the subject is told, "Think that you have no left arm. Look down and see that there is no left arm there, only an empty sleeve. An arm that does not exist does not feel anything. Your arm is gone only temporarily; you will find it amusing, not alarming, that for a while you have no left arm." The arm is then stimulated by icy water, and the subject commonly reports that he feels nothing.
Whether or not such a subject's report is genuine again raises the question of a special or altered state of consciousness. Does the subject experience no pain in the arm – indeed no arm at all – because of an altered hypnotic state? Predictably, Hilgard and Erickson thought so. Barber, by contrast, explained the phenomenon in terms of normal (non-special) psychodynamics, contending that the motivation for denying pain is present in the relationship between the doctor and the patient.
If Barber were correct, it would mean that achieving dramatic hypnotic effects would be contingent upon two simultaneous and interrelated factors: the outward presence of a hypnotist or hypnotherapist, and the subject's inward desire to please him. It would also mean that this "complaisancy motivation" involved neuro-psychophysiological mechanisms capable of mediating remarkable alterations in perception and function. If Hilgard and Erickson were correct, on the other hand, it would mean that dramatic hypnotic effects were fundamentally independent of outer factors (such as the presence of the hypnotist). Instead, a state of consciousness intrinsic to the subject would be responsible. It would also suggest a strong motivational factor which, however, would be self- rather than outer-directed.
It seems likely that Barber's viewpoint of pleasing the hypnotist could be true in laboratory-experimental situations. It is easy to imagine a subject not having anything better to do than achieve what is being asked of him. But there also appear to be far more complex factors involved when real-life situations are considered. When the stakes are high enough, it doesn't matter who is or is not present. Erickson worked with many terminally ill patients who, bedridden and racked with pain, were clearly too weak to care about helping him succeed as a hypnotherapist. In most cases such patients desperately desire the success of hypnotic relief for the purely personal reason of wanting to die in peace.
Erickson treated a 35-year-old woman five weeks prior to her death from lung cancer. She had spent the previous month "almost continuously in a narcotic stupor to counteract unbearable pain." She then requested the use of hypnosis and readied herself for it by voluntarily going without medication on the day Erickson saw her:
She was seen at 6:00 p.m., bathed in perspiration, suffering acutely from constant pain and greatly exhausted...Approximately four hours of continuous effort were required before a light trance could be induced. This light stage of hypnosis was immediately utilized to induce her to permit three things to be accomplished, all of which she had consistently refused to allow in the very intensity of her desire to be hypnotized. The first of these was the hypodermic administration of 1/8 grain of morphine sulfate, a most inadequate dosage for her physical needs, but one considered adequate for the immediate situation. The next was the serving to her of a pint of rich soup, and the third was the successful insistence upon an hour's restful physiological sleep. By 6:00 a.m. the patient, who finally proved to be an excellent somnambulistic subject, had been taught successfully everything considered to be essential to meet the needs of her situation.
Erickson describes the various hypnotic techniques the patient learned, such as positive and negative hallucinations in the modalities of vision, hearing, taste, smell, touch, deep sensation, and kinesthesia; glove and stocking anesthesias to be used over her entire body; partial analgesias for superficial and deep sensations; and body disorientation and body dissociation. After this single all-night session, Erickson did not see the patient again, although he did receive daily reports about her condition from her husband. Five weeks after the session, the woman died, "in the midst of a happy social conversation with a neighbor and a relative." Erickson writes:
During that five-week period she had been instructed to feel free to accept whatever medication she needed. Now and then she would suffer pain, but this was almost always controlled by aspirin. Sometimes a second dose of aspirin with codeine was needed, and on half a dozen occasions 1/8 grain of morphine was needed. Otherwise, except for her gradual progressive physical deterioration, the patient continued decidedly comfortable and cheerfully adjusted to the end.
Erickson's own account of the efficacy of his own work is part of an extensive literature on the success of hypnotic pain control. If we accept it as accurate, the next question to ask is this: If the patient is able to successfully dissociate from previously "unbearable pain," where does the pain go? I believe it goes where it has always been: shunted away from the structures that could relay it to third-level consciousness, and back down to the physical system. It is processed as it has always been processed, with one exception: the conscious appreciation of it.
One can sometimes change the blood pressure with hypnosis, biofeedback, and other procedures, but we must never imagine that one can erase a pain that is imprinted into every cell of the body. The pain may be focused here and there, and with various techniques refocused elsewhere, but the pain remains and remains and remains.
Research: The “Hidden Observer” Discovery
Erickson often pointed out the naturalistic basis of hypnotic pain control. In everyday life, pain can be temporarily abolished simply by the intervention of more compelling concerns. The young mother suffering a severe burn pain will instantly become oblivious to it when her baby falls out of the crib and screams in pain. Football players can finish a ballgame with broken limbs while barely noticing the pain. Watching a suspenseful movie can make us temporarily forget that we have the flu, a sprained back, or an ulcer. Whatever the particular circumstances, consciousness is diverted from registering pain.
Research indicates that while one's apperception of pain may be altered by hypnosis, its physical reality in the body is not. This is no different from neurosis where one feels wonderful but has migraines and high blood pressure and considers them aberrations from this wonderful mental state.
A number of experiments have shown that hypnosis does not block the actual sensory messages of pain on their way into the brain along the peripheral nervous system. This finding suggests that hypnotic pain control takes place at the cortical or cognitive level of the central nervous system – that is, at the third level of consciousness. Other research in the field indicates that although felt pain may be reduced, involuntary physiologic indicators of it continue to register: blood pressure, pulse rate, and temperature are all up. This suggests that oblivion to pain is only "in the head" (literally, in the cortical area of the brain) while the body continues to be affected. More interestingly, it turns out that this cortical oblivion is even incomplete. That is, conscious awareness of pain is not totally eradicated in hypnosis, contrary to what was traditionally assumed. The discovery of this came as quite a surprise to researcher Ernest Hilgard while he was conducting a classroom demonstration, in response to a serendipitous question on hypnotic deafness. He recounts the incident as follows:
The subject of the demonstration was a blind student, experienced in hypnosis, who had volunteered to serve; his blindness was not related to the demonstration, except that any visual cues were eliminated. After induction of hypnosis, he was given the suggestion that, at the count of three, he would become completely deaf to all sounds. His hearing would be restored to normal when the instructor's hand was placed on his right shoulder. To be both blind and deaf would have been a frightening experience for the subject, had he not known that his deafness was quite temporary.
Loud sounds were then made close to the subject's head by banging together some large wooden blocks. There was no sign of reaction whatsoever; none was expected, because the subject had, in a previous demonstration, shown lack of responsiveness to the shots of a starter's pistol. He was completely indifferent to any questions asked of him while hypnotically deaf.
One student in the class questioned whether "some part" of the subject might be aware of what was going on. After all, there was nothing wrong with his ears. The instructor agreed to test this by a method rebated to interrogation practices used by clinical hypnotists. He addressed the hypnotically deaf subject in a quiet voice.
"As you know, there are parts of our nervous system
that carry on activities that occur out of awareness, of which control of the
circulation of the blood, or the digestive processes, are the most familiar.
However, there may be intellectual processes also of which we are unaware, such
as those that find expression in night
To the surprise of the instructor, as well as the class, the finger rose! The subject immediately said, "Please restore my hearing so you can tell me what you did. I felt my finger rise in a way that was not a spontaneous twitch, so you must have done something to make it rise, and I want to know what you did."
Hilgard then began experiments to see if the "hidden observer" phenomenon also occurred in hypnotic pain control. He used "automatic writing" (also "automatic talking") as a tool to "split" the subject's awareness. The subject was told that one arm would be put in ice water while the other would be put "out of awareness." She was then asked to report verbally on how much pain she was feeling in the icy hand, while simultaneously writing a response with the hand that was "out of awareness." It turned out that as she verbally reported no pain in the icy hand, the out-of-awareness hand reported increasing degrees of pain. Another subject, who had his hypnotically-dissociated arm pricked several times with a hypodermic needle, reportedly wrote "Ouch, damn it, you're hurting me." Meanwhile, this subject himself remained oblivious to what was happening, asking when the experiment would begin a few minutes after it had already ended. In other words, the "hidden observer" in each subject reported feeling normal pain while the hypnotized part felt little or not pain. According to Hilgard, such experiments indicate that:
A hypnotized subject who is out of contact with a source of stimulation...may nevertheless register information regarding what is occurring. Further, he may be understanding it so that, under appropriate circumstances, what was unknown to the hypnotized part of him can be uncovered and talked about...It should be noted that the "hidden observer" is a metaphor for something occurring at an intellectual level but not available to the consciousness of the hypnotized person. It does not mean that there is some sort of secondary personality with a life of its own – a kind of homunculus lurking in the shadows of the conscious person. [Italics added]
Following are statements by some of Hilgard's subjects describing their experience of the hidden observer experiments:
It's as though two things were happening simultaneously. I have two separate memories as if two things could have happened to two different people.
Both parts (of me) were concentrating on what you said – not to feel pain. The water bothered the hidden part a little because it felt a little but the hypnotized part was not thinking of my arm at all.
The hidden part knew that my hand was in the water and it hurt just as much as it did the other day (in the waking control session). The hypnotized part would vaguely be aware of feeling pain – that's why I would have to concentrate really hard.
The hidden part knows the pain is there but I'm not sure it feels it. The hypnotized part doesn't feel it but I ' m not sure that the hypnotized part may have known it was there but didn't say it. The hypnotized part really makes an effort. [Original italics]
Here we see the split clearly described in the subjects' own words. We see the knowing about pain dissociated from the feeling of it. Hilgard points out that even though there was a high level of sensory pain in these hypnotic subjects, there was no distress or suffering accompanying it. When the hypnotic state was lifted, the subjects could remember feeling pain but they did not feel the suffering. In other words, they remembered the feeling but they did not feel it.
Let's take an example of how the countless ways this split occurs outside of experimental situations. A scientist who is a rigid procedurist, never wavering from correct methods, believes in the Moonies and is a devotee (a case I know of). Here the intellect is split in a seamless unity where one part of the intellect sees reality in her science, and the other part is attending to the Pain below by developing belief systems. The Pain seeps into a part of the intellect and forces it to deal with it while keeping the person unconscious of her motivation. Another part has all of its critical faculties intact. It is easy to split the intellect. That is why one can be a crazy paranoid with weird ideas and still work and talk intelligently and rationally. So long as one doesn't touch the Pain, one can deal with the person.
How to explain hypnotic pain control? How to explain the overt and covert levels of reporting in the hidden observer phenomenon? Hilgard proposes a concept of "divided cognitive control systems" which we can shift in and out of via hypnosis. According to Yapko, dissociation from pain "involves the capacity to divide one's attentional and behavioral abilities" and "causes the subjective experience of feeling separated from all or part of one's body, and thus the pain."
As illustrated in Figure 1 below, in the normal waking state, we have an open communication channel between cognition and response mechanisms so that the sensation of pain is communicated voluntarily through face and body expressions, and involuntarily through vital sign indicators.
Figure 1 [Figures omitted in web version]
Hypnosis and suggestion can then be used, in Hilgard's terms, to restructure communication between cognition and response. He's not sure how, but in some way hypnosis results in the erection of two separate communication barriers. One barrier (running vertically in the diagram) splits cognition into two disconnected compartments and similarly splits voluntary and involuntary responses to pain, as shown in Figure 2.
Figure 2 [Figures omitted in web version]
Now what we have – at least diagrammatically – is a brain split in half. On the left side all channels of communication in the overt hypnotic reality of no pain are open and consistent; the subject registers no felt pain consciously, expresses no felt pain bodily, and communicates no felt pain verbally. On the right side we have an additional barrier (running horizontally) between cognition and communication so that the felt pain is not communicated unless a technique such as automatic writing or talking is introduced into the hypnotic situation. So in the covert hypnotic reality of felt pain, the subject registers pain unconsciously and expresses it involuntarily through vital sign indicators, but cannot or does not communicate it. Hilgard believes this model explains how a person can feel neither pain nor suffering at the conscious level within hypnosis, yet still register the physiological signs of pain unconsciously.
Pain and Awareness
As yet, there is no scientific definition of pain. It can be described and its components listed, but investigators have been "unable to come up with a definition that (catches) the single 'essence' of pain, beyond the common sense notion that we are dealing with what hurts." It seems we have made little progress since Aristotle's day, when he himself omitted the sense of pain from his list of man's five senses. It was not until the nineteenth century that the sensory component of pain was recognized as a physiological and psychological reality. Before that, pain was linked to its maiden-opposite of pleasure, and both were viewed as "passions of the soul" rather than as provinces of science.
The "hidden observer" has enormous implications for psychology. It means that while we have the capacity for concealing, repressing, denying, and dissociating from pain, we are not actually getting rid of it. We may be able to remove it from awareness, but it still exists in the lower levels of consciousness. This is the crux of neurosis: while we may split off from Primal Pain, it remains within us, exerting a real force and producing all manner of symptoms. Now we have corroboration that out of mind is not out of body. Hypnotic pain control techniques can temporarily relieve us of physical pain, just as our absorption in a certain task or spectacle may allow us to forget about physical pain for a time, but sooner or later we again become aware of it. Similarly, to repress emotional pain does not eliminate it nor alleviate the symptoms it produces.
Today it is recognized that pain contains both a sensory component and a suffering component. The presence of one does not necessarily mean the presence of the other. We can be in physical pain without feeling badly emotionally, and we can feel badly emotionally without being in any sensory pain. For most of us, however, the two go hand-in-hand: being physically ill is emotionally upsetting and being emotionally upset is physically painful.
The distinction between the sensory and suffering components of pain has many significant medical and psychotherapeutic ramifications. This was demonstrated several years ago, when an experimental operation was performed on a group of patients who were suffering from intractable pain. The operation involved a pre-frontal lobotomy, which means that a group of connecting fibers between lower and higher (cortical) brain centers were severed. After the operation the patients reported that they could still feel the sensation of pain but that it did not bother them. In other words, the suffering component of the pain was alleviated surgically while the sensory component remained.
This is also the situation in neurosis.–– A neurotic may feel neither pain nor suffering, depending upon the degree of defense, or "gating" of pain between levels of consciousness. The neurotic's face may show a good deal of misery while he remains unaware of feeling miserable; his body may be stiff with tension, yet he doesn't know why. He can talk about his deprived childhood with complete detachment. No feeling of suffering or distress reaches his awareness.
Thus, in all three conditions – neurosis, hypnosis, and lobotomy – awareness and recall on the cognitive level are effectively disconnected from the emotional components of what is remembered.
There is obvious value in using hypnosis to remove the suffering component from organic pain when it cannot be alleviated in any other way. No one benefits from unbearable pain related to terminal cancer, constant back pain caused by a genetic spinal problem, or from constant residual pain after a serious car accident.
The numerous techniques for removing the awareness of pain and the everyday distractions that achieve the same thing show us the dramatic abilities of consciousness to alter its own perceptions. And we certainly need hypnosis to achieve this. In everyday life, we are very adept at keeping ourselves distracted from what is going on inside. A busy, even hectic lifestyle is probably the main defense today. Phone calls, letters, business deals, discussions, movies, television, are all part of the hypnotic process. It seems that half the people watching TV are indeed mesmerized – as if half the population is in a coma after six p.m. One lets in the message, particularly the commercial message, without any critical capacity, whatsoever. One is simply the passive recipient. The next day, as if in a posthypnotic suggestive state, one goes to the store and buys Crest and Kellogg’s Corn Flakes, just as one has been programmed to do.
Hypnotic pain techniques demonstrate how far cognition can go in structuring a false reality. But how is this possible? By what physiological mechanism is it achieved?
The Endorphin System
I have already discussed the plasticity of the third level of consciousness and its role in susceptibility to hypnosis. There are additional, more specific neurological factors which help make dissociation possible. One is the left brain-right brain dichotomy referred to by Hilgard to illustrate his "hidden observer" discovery. Another is the system of "gating" which exists between levels of consciousness to inhibit or facilitate the flow of information. Still another is the body's capacity to produce morphine-like substances called endorphins. And the neuroinhibitor, serotonin. These chemicals block the message of pain from crossing the cleft between nerve cells, the synapse, in effect gating the message from reaching higher brain centers.
The neuroinhibitors function as the biochemicals of repression and its twin, dissociation. They are produced to quell both physical and emotional pain. Although the body does not differentiate between the two types of pain in qualitative terms, it does respond differentially in quantitative terms. As I pointed out in Prisoners of Pain:
The Swedish pharmacologist Lars Terenius has discovered that patients suffering from emotional Pain produce more endorphins than those suffering from physical pain. Emotional Pain is real and often physically more intense than "physical pain." Those with emotional or psychological Pain in Terenius' studies had less tolerance to physical pain. Their bodies were hyperactive, producing more Pain suppressants.
When the amount of pain assaulting the system can no longer be integrated, endorphins are mobilized to repress the experience and the memory of the event. These endorphins can be many hundreds of times more powerful than commercially produced morphine. They keep events out of full consciousness by interfering in the connection between feeling and the realization of feeling, between injury and reaction to it, between sensation and cognition. Nonetheless the trauma remains in the system, full and intact.
Through the production of endorphins, the person may be able to dissociate from the pain of his hand submerged in icy water, but the icy water nonetheless causes his vasomotor system to contract in pain. Similarly a child may be able to dissociate from the Pain of losing his mother, but that Pain is still causing his system to siphon off its impact in some way – be it through acting-out behavior, compulsive eating, chronic depression, or whatever. The child may simply "numb-out." He is no longer emotionally reactive. He's inert, immobile, and emotionally "dead". He no longer suffers the horrendous pain of losing his mother. He goes on with life in a very "dead" fashion. Nonetheless, there is always some physical manifestation of the presence of pain in the system, regardless of what one is consciously experiencing.
Where is Reality?
It is certain that the serotonin/endorphin system will not turn out to be the sole mechanism by which hypnotic dissociation occurs. There is a key central brain inhibitor known as glutamate. But we do know that hypnotic suggestion can catalyze inhibitory or repressive chemical production. The suggestion (or idea) given by the hypnotist is transformed into electrochemical activity that somehow blocks pain. More specifically, the suggestion takes on a meaning on the third or cognitive level of consciousness and is then transformed into electrochemical processes which inhibit perception of physical experience. Think of it! A bit of air in the form of certain sounds (words) breathed out to another produces biochemical changes in her which alter her perceptions and block pain.
The subject in Hilgard's ice water experiment was no longer responding to the reality of the ice water. Instead, she was responding to ideas about it, even when those ideas were in complete contradiction to events actually taking place. This transformation of meaning that occurs in hypnosis is not unlike the transformation of meaning that makes neurosis possible. In both, the perception or meaning of the event is altered on one level of consciousness while its intrinsic meaning is registered accurately on the other levels. This leads to the sixty-four dollar question: WHERE IS REALITY?
If I say to a hypnotic subject, "I'm going to put a hot piece of metal on the back of your hand," and then put a cold quarter on it, and the hand then blisters as if a hot metal were placed there (an effect that has been demonstrated in hypnosis), what is real? The metal, the response, the idea, the suggestion? Is there no objective reality? Objective reality dictates that the psychophysiology responds to a cold quarter. Yet the idea in the mind is that it is a hot one and the physiology follows that idea. Clearly, reality is in the perception; that is, intellectual reality. That reality dictates bodily reactions. This is the true meaning of “psychosomatic.” Here the mind innervates and alters bodily reactions; so if we wonder how it is that a child who obeys his parents absolutely has allergies or asthma we see it encapsulated in the hypnosis experiments. The parental dictates change the immune system of the child, for example.
If I perceive an elevator to be terrifying, even though it clearly isn't, and I'm dizzy, fainting, etc., in plain terror, it is my perception that is real for me. But that perception is based on a history. The newly-perceived reality has an historical basis. There are levels of reality that lay on different levels of consciousness. The hypnotist who pricks you states that you will not hurt, and there is no perception of hurt; yet the blood pressure and heart rate mount. The lower level knows reality on its level. That is why when you are in touch with the lower levels of consciousness you are not so easily fooled, lulled or hypnotized. The physiological processes inform the cortex of what is reality.
What Hitler did in Germany was an effective job of hypnosis. He suggested with emotional force, "You are superior to all other races! You need liebensraum!" (more space and freedom). For those who felt inferior and downtrodden, it was a perfect message. And Hitler got the German people to do almost anything, including killing millions of "inferior" individuals. Even those who realistically did not need any more living space responded to his message. What was inserted into their minds supplanted reality. And they acted exactly as if they had been hypnotized. They could kill without feeling anything because any appreciation of the meaning of their acts had been wiped away. Meanwhile, those who wanted and needed peace, an obvious choice, were known as "defeatists" and were punished. Hitler's control became absolute; the "mesmerized" (dissociated) populace went on fighting and dying for a dying cause that had nothing to do with their everyday lives. Not so different today in Iraq where any talk of a peaceful solution is considered by the administration as defeatest and sending the wrong message to our troops. Jingoism then becomes the only topic admissible.
How did Hitler do it? He tapped into the people's basic needs and into their split consciousness. He capitalized on their already existing dissociation and on the ideas that duty was all, and that how you felt was unimportant. He used their feeling of being a defeated nation to suggest that they were conquerors. He turned reality upside down. In short, he suppressed their Pain just as a hypnotist does, and he infused and inculcated another reality – his. Hitler was so skilled (and his subjects so prepared) that he could do it on a mass level.
This whole notion of the nature of reality is critical to an understanding of psychotherapy, for if we assume that reality is what the patient tells us it us (“I feel wonderful. Therapy has been a great success”)we will be led astray. We have neglected an important internal reality, something that can only be achieved by “talking” to the body; that is, measuring it to see what secrets it holds. It may tell a very different story. So then were is reality? Is it what the patients says it is. In short, the nature of reality splits the field of psychotherapy into those who think it is cognitive and those who think it is cognitive-somatic.
When there is dissociation, either in neurosis or hypnosis, the information takes a detour and the person is unconscious of certain facts or states. One of the structures to help in this detour is the thalamus.
Figure 3 [Figures omitted in web version]
More and more evidence indicates that the thalamus plays a key role in human awareness. The thalamus has a relay function to the cortex, but it also serves as a switching station which handles most sensory input and delivers it to the cortex. When it is overwhelmed it cannot do that; the message gets blocked and rerouted. Those in a coma often have damage to the thalamus; what happens is that messages never arrive to consciousness. It would seem that in hypnosis, as in coma, there is a functional "lobotomy" between cortex and thalamus, so that the higher level (cortex), doesn't know what the lower level (thalamus) does or feels.
I often call a Primal a "conscious coma" because the patient is (re)living on a lower level of consciousness during the session but "knows" what is going on as well. That is, the patient has retrieved a memory stored on a lower level and is feeling it on that level while bringing it to consciousness. Whereas hypnosis depends on the split and guards it, in Primal Therapy we mend it. That is why you cannot get cured with hypnosis. The split is the source of the problem, not the solution.
Pain Control and the Neurotic Split in Consciousness
Let's take another look at the statements made by Hilgard's subjects (HS) in the hidden observer experiments, followed by rephrasing of what the subject is describing from a Primal viewpoint (PV):
HS: It's as though two things were happening simultaneously. I have two separate memories as if two things could have happened to two different people.
PV: In neurosis the adult recalls the Pain of the child as if he and that child were two separate people. He can talk about it in a detached way, dissociated from its suffering component. This is precisely the neurotic split in consciousness: the Pain is merely repressed and concealed, not eliminated.
HS: Both parts (of me) were concentrating on what you said – not to feel pain. The water bothered the hidden part a little because it felt a little but the hypnotized part was not thinking of my arm at all.
PV: In neurosis the child is told "not to feel pain" in some direct and many indirect ways. "Why such a sad face today?" "What have you got to feel bad about?" "Stop whining and sniveling or I'll give you something to cry about." "It can't hurt that much." etc. As a consequence, he grows into an adult who is well able to not think of the Pain he is in. It may "bother the hidden part a little," but the "hypnotized part" – the part that is neurotically split off – does not think of the Pain at all. It thinks of telephone calls, things to do, places to go, projects....all to keep from feeling the emptiness and solitude inside.
HS: The hidden part knew that my hand was in the water and it hurt just as much as it did the other day (in the waking control session). The hypnotized part would vaguely be aware of feeling pain – that's why I would have to concentrate really hard.
PV: The hidden part of the neurotic feels how much Pain he is in so that he also has "to concentrate really hard" to ignore it: "I can take it like a man."
HS: The hidden part knows the pain is there but can't feel it. The hypnotized part doesn't feel it but may know it's there.
PV: It is possible to observe this process of dissociation taking place in the hypnotic subject. If we could photograph a neurotic with time-lapse photography over years, we could probably see a similar (neurotic) process taking place. The main difference is that neurosis is a long-term, lifetime event. The important similarity in hypnosis and neurosis is that while a false reality is imposed upon the system via ideas and suggestions, the ideas and suggestions cannot remove the pain actually experienced in childhood.
In both hypnotic pain control and childhood trauma, the lower levels of consciousness continue to register the pain. Recall the hypnotic subject's description that "the hypnotized part really makes an effort." Why does it have to make such an effort? Because the truth of reality is just beneath the surface. In hypnosis the hypnotist simply repeats the suggestions whenever the person starts to feel pain – when the "effort" of the hypnotized part begins to lag. In neurosis the lower levels of consciousness produce manic activity, for example, a constant effort to distract oneself from the Pain. In either case, we see the reality of pain pushing toward the surface, necessitating efforts to push it back down. One can either take a cigarette (in neurosis) or take a suggestion (in hypnosis) to push it down.
Pain of any kind is an affront to the system and, as one of Hilgard's experiments suggests, denial of that pain may constitute a kind of double-barrelled assault. Attempting to differentiate between pain and anxiety in hypnotic analgesia, Hilgard found that hypnotic pain reduction techniques may actually increase the amount of anxiety felt by the person while he is in the process of supposedly reducing his pain. Hilgard wrote:
Maintaining hypnotic analgesia requires some effort by the subject, even though he knows he is going to be successful in reducing pain. This effort is accompanied by physiological signs of anticipatory excitement when the subject knows he must soon fight off painful stimulation. These signs may be interpreted as a form of anxiety, perhaps deriving from a latent fear that this time control may be lacking. In any case...both heart rate and blood pressure increase more when pain is to be reduced by hypnotic analgesia than when it is to be felt normally at full value. [Italics added]
In neurosis, of course, it is typical to see both blood pressure and high heart rate chronically high. Hilgard's description illustrates the conflict between Pain and repression continually waged in every neurotic, a conflict which often results in anxiety. Anxiety is the global symptom which arises when Primal Pain threatens to overwhelm inhibition and make itself fully conscious. Every pre-Primal state, where patients are about to enter into an old feeling, can be considered an anxiety state.
There is no anxiety without repression; anxiety is a sign of faltering repression. Without repression, one simply gets terror in context. When my patients feel their terror in the ancient context there is no more anxiety. Thus it is both a symptom and a signal.
Anxiety indicates that the defenses are under maximum strain and signals for the extra production of repressive chemistry. The system revs up to quell the Pain before control is completely lost. Anxiety is taxing enough but its suppression even more so, and the anxious person usually uses self-hypnotic techniques in order to control himself (though he may never identify them as such): "It'll be alright," "Don't worry, it'll turn out fine," "Take it easy," "Calm down," "Think positive." These are all hypnotic style suggestions. Very often they have to be repeated over and over to produce any effect, which gives us some idea of the energy needed to suppress and contain the anxiety.
Hilgard's discovery regarding the link between pain and anxiety parallels what we have learned about the effort involved in maintaining dissociation: feeling the Pain in its entirety is "easier" on the system than going through the labor of dissociating from it. In fact, it is not Pain alone that produces symptoms, but Pain together with its counteracting repression. Repression is responsible for the pressure the system is under leading to symptoms. It takes great physiological effort to keep Pain out of awareness, an ongoing internal struggle which is measurable through one's vital signs. Indeed, heart rate and blood pressure tend to decrease permanently after a period of releasing Primal Pain.
The fact that emotional pain registers as a physical entity, one which is imprinted throughout the system (indicated by the physiologic changes which occur as a result of its removal), is vital to our understanding of neurosis and hypnosis. This knowledge wrests neurosis from the abstract and even metaphysical realm created for it by its definition as a mental illness, from the realm of mechanics created for it by the behaviorist viewpoint, and at last, places it where it belongs in the very real and physical organismic processes.
Pain is not often thought of as anything other than the localized sensations caused by physical injury. When it is viewed on another level it is seen as an idea: as something that can be thought away, forgotten, or in some way mentally altered by psychological gymnastics (hypnosis, biofeedback, directive daydreaming). More recently we have coined the term "problem" to describe the affliction of neurosis. It then becomes a matter of unbalanced equations, malfunctioning machinery, and unsorted puzzles. Mental solutions are sought for mental problems and behavioral solutions are sought for behavioral problems.
Pain creates problems for those who suffer from it, but to become caught up in the treatment of each problem is to lose sight of the central issue: that only by dealing with the physical reality of repressed Pain does the nature and depth of the organismic disease known as neurosis become fully treatable.
As mentioned earlier, psychological mechanisms by which hypnotic states are induced are based on the innate defensive capabilities of the brain. Even more importantly, they are based on a pre-existing pattern of behavior that has been in constant and active use throughout the subject's life. Neurosis is the ongoing post-hypnotic state which is already operating when the hypnotist goes to work. The neurotic lives in a state of permanent dissociation from his pain. Hypnotic techniques take advantage of this situation without it being recognized. The already existing defense of dissociation gets an added boost from hypnosis. When translated back into neurological terms, this means that extra endorphins pour into the system. In other words, hypnosis helps the system function even more neurotically than usual.
"Pain," writes hypnotherapist Yapko, "is a warning sign that something is wrong. The various hypnotic approaches are essentially 'band-aids,' for while they may assist the client in being more comfortable, their healing abilities remain uncertain."
As we shall see in the following chapters, the same can be said of the use of hypnotherapy as a psychotherapeutic tool. Hypnotherapy is anti-dialectic. It fails to take into account the complex interplay between imprinted Pain and repression in the development of problems such as smoking and drinking. Be it physical pain or psychological "problems," it takes the symptom as a viable force to be treated ex machina. It usually takes only one side of the dialectic process, working on the surface pain to the neglect of all else, manipulating it, changing its location, attenuating it by suggestion, but never...never... asking where it came from...and never...never...eliminating it.
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Yapko, Trancework, p. 274.
Yapko, Trancework, p. 274.
Ernest R. Hilgard and Josephine R. Hilgard, Hypnosis in the Relief of Pain (Los Altos, Calif.: William Kaufmann, 1975, pp. 63-82.
See Milton H. Erickson and Ernest L. Rossi, Hypnotherapy: An Exploratory Casebook (New York: Irvington, 1979, pp. 94-142.
Yapko, Trancework, pp. 276-281.
Yapko, p. 277.
Hilgard, Hypnosis in the Relief of Pain, p. 66.
Hilgard, Hypnosis in the Relief of Pain, p. 66.
Hilgard, Hypnosis in the Relief of Pain, pp. 166-167.
Hilgard, Hypnosis in the Relief of Pain, pp. 168-69.
Ibid., p. 173.
Yapko, Trancework, p. 279.
See Hilgard, Hypnosis in the Relief of Pain, p. 48, Figure 15, left diagram.
See Hilgard, p. 48, Figure 15, right diagram.
Hilgard, Hypnosis in the Relief of Pain, p. 29
The same effects can be achieved with marijuana, morphine, and other drugs that suppress the suffering aspect of pain more than the actual sensation of pain. Aspirin, on the other hand, does just the opposite: it reduces localized sensory pain but does not reduce anxiety or suffering. Localized sensory pain has a specific physical location in the body; anxiety, by contrast, is a non-specific and diffused state of being.
For a brief discussion of "gating," see "The Gated Mind" in my book Prisoners of Pain (New York: Doubleday, 1980) pp. 111-114. For a more technical discussion see "The Gating of Pain" in Primal Man (New York: Thomas Crowell Co., 1975 ), pp. 126-134.
Arthur Janov, Prisoners of Pain, p. 85.
See Science News, July 2, 1994, pp. 10-11.
Hilgard, Hypnosis in the Relief of Pain, p. 78.
Yapko, Trancework, p. 276.