Hypnosis can be an adjunct to psychotherapy for certain types of spasmodic torticollis, hysterical contractures, backache due to “vertebral neuroses,” pain relief in traumatic emergencies, and the setting of fractures where analgesia or anesthesia are unavailable. It also can help to reduce neurogenic shock in debilitated or elderly individuals requiring extensive surgical procedures such as the nailing of hip fractures and spinal fusion. Rheumatism, fibrositis, and certain types of arthritis which have a psychogenic component are amenable to a combination of hypnotherapy and medical procedures.
TORTICOLLIS
Spasmodic torticollis or wry neck is due to a hysterical conversion reaction; the torsion often symbolizes deep-seated anxieties which are too difficult to face. This condition is extremely resistant to physical therapy and often requires resection of muscles and nerves. Hypnosis has proven effective in numerous cases of recent origin.1,7,10
Often hypnosis dramatically removes the torticollis in a single session, but invariably it returns; this indicates its functional significance. A case of torticollis cured by ideomotor finger signaling to ascertain the underlying psychodynamics has been described.5 Using the concept of “organ language,” guilty fears were elicited over an illicit relationship which caused a “turning away” from the problem. If the condition is of long enough duration and accompanied by muscle hypertrophy and scoliosis, the prognosis is well-nigh hopeless. Where no anatomic involvement exists, there is a better response to hypnosis.
A 33-year-old male was seen with a torticollis of 14 months' duration. No gross anatomic changes were observable. Eight months before the onset of the torticollis, he had fainted while receiving an injection. Two months later he saw his mother fatally burned. Following this latter episode, he developed dizzy spells, and always “needed more air.” One month later his wife suffered a nervous collapse which required shock therapy. Soon after, his neck started turning to the left. However, the torsion was relieved whenever he held a pencil in the right side of his mouth or whenever he touched the top of his head. Posthypnotic suggestions were directed toward increasing utilization of these two mechanisms, which inhibited the turning of the head. Through sensory-imagery conditioning, he imagined these acts to be associated with a normal alignment of his head and neck. The more he actually put the pencil in his mouth and touched the top of his head, the longer the torticollis disappeared, often for several hours. Posthypnotic suggestions were given that he could, if he wished, increase the intensity of the torsion. It was further explained that whenever one could increase the severity of a symptom, one could deliberately decrease it! An uncovering type of psychotherapy revealed considerable resentment over his wife's sexual coldness. He related that he had had considerable hostility toward his mother, “who was always cold and distant.” After his wife had a “nervous breakdown,” he was unable to look directly at the customers of his smalltown drugstore because of his strong guilt feelings. Alleviation of his anxiety and feeling of guilt, together with hypnotic manipulation of the symptom, as described above, and a cathartic type of psychotherapy altered his attitudes toward his wife's sexual problems. These, together with the sensory-imagery conditioning, ultimately resulted in dissolution of the spasm and tic.
In another case, a 44-year-old woman developed a spasmodic torticollis, more marked when she had to talk before groups. Particularly significant in her history was her husband's demand for intercourse almost every night of their 25 years of marriage. She acquiesced in the act merely as a wifely duty. After having a mechanical-like coitus, her husband would fall asleep promptly. An interview with the husband revealed strong fears of impotence. Since the patient was Catholic, she was referred to her priest for consultation on the moral aspects of the intolerable situation. He advised psychotherapy for the husband, which was refused. Autohypnosis and the use of sensory-imagery conditioning directed toward imagining that she was speaking before groups without anxiety afforded some relief of the torticollis. However, she generally relapsed within several days. Posthypnotic suggestions to twitch the forefinger of the right hand helped to decrease the intensity of the spasm. She was advised to face and discuss the sexual situation with her husband, who finally agreed to decrease his inordinate demands. Soon after, the spasmodic tic of the neck cleared up. However, on a follow-up 6 months after the author had left the area, it was discovered that she had relapsed. Further psychotherapy for the husband, who eventually reverted to his former demands for intercourse, was strongly recommended.
HYSTERICAL CONTRACTURES
Recent hysterical contractures can be relieved in a few sessions by hypnosis. If active participation of the patient is enlisted by autohypnosis, the results are more permanent than when direct symptom removal is used. The hypnotherapeutic approach is similar to that described for the torticollis cases. When chronic joint fixation or fibrosynovitis are marked, the outlook is poor.
VERTEBRAL NEUROSES
Spasm of the neck and back muscles, and their etiology, differential diagnosis, and psychotherapeutic approach have been reviewed in detail by Kroger and Freed.9 Backache may be a conversion reaction to the commonly observed physiologic expression of emotional tensions. They state:
It seems clear to us that “low back pain” in the neurotic personality may very well be a conversion reaction to (1) emotional insecurity, as an excessive need for attention and sympathy; (2) strong dependency attitudes, as inability to make decisions and pronounced inclination to lean on others; (3) antisocial feelings, resulting from a marked reaction to poverty or an intense opposition to existing social or moral codes; (4) deep-seated guilt, as “pangs of conscience” because of expressed or unexpressed hostility which was unacceptable to the patient.
When situations arise that are demanding, the physical complaints are aggravated, especially when the patients feel threatened by feelings of deep humiliation and worthlessness.
PSYCHOGENIC RHEUMATISM
Most cases of psychogenic rheumatism are conversion symptoms, usually hysterical in nature, in which the emotional conflict symbolically expresses itself in musculoskeletal disorders. Functional camptocormia, in which the patient assumes a position of extreme kyphosis after trauma, falls into this category. These patients are not malingerers but, rather, are exploiting the symptom for secondary gain purposes. Establishing the need for the symptom can be accomplished by hypnosis. This enables such individuals to face their life situations more realistically. Autohypnosis, glove anesthesia and sensory-imagery conditioning can be utilized to implement psychotherapy.
In infectious arthritis, traumatic synovitis, gout and rheumatoid arthritis, hypnosis potentiates medical and physical therapy. The clinical applications have been discussed in Chapter 33.
MISCELLANEOUS APPLICATIONS
Hypnosis helps to reduce the excruciating pain of traumatic emergency cases encountered in military and civilian settings. Although it is usually difficult to induce, hypnosis can relax an injured person and ease the discomfort when drugs are unavailable. Before attempting induction in such situations, the therapist must develop a rapid rapport. He can remark, “I know that you are in great discomfort, but if you wish to relax and have less discomfort, then follow my instructions.” A direct authoritative approach is more effective in such instances.
Hypnoanesthesia minimizes neurogenic shock in amputations, in the setting of fractures, and in cases requiring extensive major surgery, such as spinal fusion and hip-pinning in elderly individuals. Hypnosis is particularly indicated for the setting of fractures and orthopedic surgery in children, as psychic trauma is minimized. Children from 3 to 8 years of age respond to nursery tales, cartoons and popular TV shows and to suggestions such as “You are very tired,” accompanied by prodigious yawns on the part of the anesthesiologist. As has been mentioned, television provides almost inexhaustible material for hallucinatory or sensory-imagery conditioning in the 8- to 14-year-old group. These youngsters will even recite commercials along with the story plot when they imagine that they are watching their favorite show. Orthodox eye-fixation technics can be used on those over 14 years of age.
Bachet and Weiss used group hypnosis for pain relief in a series of patients who had undergone amputation of limbs.2 They cured more than 80 per cent. Opiates and sedatives were drastically reduced. Phantom limb pain, spasm, and clonus were alleviated in many instances by hypnotic inhibition.
The author is frequently called in consultation for many bizarre types of pain syndromes associated with orthopedic conditions.
HICCOUGHS
Persistent hiccoughs are included in this section because the orthopedic specialist is often called in to respect the neck muscles and the nerves. Hiccoughs are due to involuntary spasms, which are caused by reflex action, and are usually unilateral. They occur with a wide variety of physiologic and functional disorders. The entire subject has been reviewed.6 The usual therapy consists of interrupting the reflex action by pharmacologic measures and surgical intervention. From 1 to 10 hypnotic treatments were required to relieve 14 of 18 patients who had not responded to other therapeutic procedures.6 Hypnosis induced complete relaxation and relieved the spasm.
My experiences are similar to those reported by Dorcus and Kirkner6—about 75 per cent of the patients can be helped by a permissive hypnotic approach. Often a single session dramatically and permanently alleviates the most intractable cases. Psychological probing is seldom indicated because of the time factor. It is also of considerable interest that direct symptom suppression does not result in other symptom equivalents taking the place of hiccoughs.
Other investigators have employed hypnosis for relief of intractable hiccoughs.4,8,11,12 As was cited earlier, the author reported a case of intractable hiccoughs stopped in a single session of “telephone hypnosis.”8 The subject, who was unknown to the author, was entirely relieved within minutes. The induction was a life-saving procedure as the patient, a physician, was moribund.
REFERENCES
1. Ampato, J.L.: Hypnosis: a cure for torticollis. Am. J. Clin. Hypn., 18:60, 1975.
2. Bachet, M., and Weiss, C.: Treatment of disorders of amputated subjects by hypnotic inhibitions. Br. J. Med. Hypn., 4:15, 1952.
3. Bendersky, G., and Baren, M.: Hypnosis in the termination of hiccups unresponsive to conventional treatment. Arch. Intern. Med., 104:417, 1959.
4. Bizzi, B.: On two cases of hysteric hiccough and hysterical sneezing treated with hypnosis. Rass. Stud. Psychiat., 53:60, 1966.
5. Cheek, D.B., and Le Cron, L.M.: Clinical Hypnotherapy. New York, Grune & Stratton, 1968.
6. Dorcus, R.M., and Kirkner, F.J.: The control of hiccoughs by hypnotic treatment. J. Clin. Exp. Hypn., 3:104, 1955.
7. Friedman, H.: Brief clinical report: hypnosis in the treatment of a case of torticollis. Am. J. Clin. Hypn., 8:139, 1965.
8. Kroger, W.S.: Hypnotherapy for intractable postsurgical hiccups. Am. J. Clin. Hypn., 12:1, 1969.
9. Kroger, W.S., and Freed, S.C.: Psychosomatic Gynecology, Including Problems of Obstetrical Care. Philadelphia, W.B. Saunders, 1951.
10. Le Hew, J.L.: Use of hypnosis in the treatment of long standing spastic torticollis. Am. J. Clin. Hypn., 14:124, 1971.
11. Smedley, W.P., and Barnes, W.T.: Postoperative use of hypnosis on a cardiovascular service: termination of persistent hiccups in a patient with an aortorenal graft. J.A.M.A., 197:371, 1966.
12. Theohar, C., and McKegney, F.P.: Hiccups of psychogenic origin: a case report and review of the literature. Compr. Psychiatry, 11:377, 1970.