In 1846, Scottish physician James Esdaile published his book, "Hypnosis in Medicine and Surgery," which documented his experience with 345 patients in India. His use of hypnosis to perform painless surgery in this group of Hindu convicts resulted in a remarkably low mortality rate of five percent during an era when mortality rates were over 50 percent. That year happened to coincide with the introduction of the first ether anesthesia, and unfortunately surgical hypnosis was soon forgotten. Had chemical anesthesia not been discovered for another 100 years, we might now be evaluating halothane as a possible alternative to conventional surgical hypnosis.
For a long time, the benefits of surgical hypnosis have been overlooked, although the art is still commonly practiced in dentistry. It is now beginning to make a comeback in modern medicine, and dental hypnotherapists will sometimes use their skills for surgical procedures in situations where there is concern about the use of conventional anesthesia. Holly Forester-Miller, Counselor Education Program Director at North Carolina Central University, trained with the hypnotherapists at the University of Pittsburgh Dental School and has used hypnosis as the only form of anesthesia for several of her own personal surgeries.
Last summer she gave a presentation at the Mind-Body Medicine Study Group featuring a videotape that she had made of the repair of her abdominal hernia under hypnosis, a procedure that would ordinarily require general anesthesia. She had had difficulty with conventional anesthesia during a prior surgery and managed to find a surgeon who was willing to do the operation under hypnosis with an anesthesiologist standing by. He asked her if she could make it through a whole hour without any medication, and she said not to worry that it wouldn't take that long.
She gave herself the suggestion that she would become numb from the chest to the knees when she was rolled into the operating room and made herself an audiotape to reinforce the suggestion. She also added the suggestion that the blood in her abdomen would leave the operative site and go elsewhere in her body where it was needed rather than spilling into the open wound during surgery. The videotape shows her awake and alert during the bloodless procedure which was completed in less than half the usual time. The surgeon later commented that he never realized how much time he spent during surgery cauterizing vessels and sponging up blood.
Dr. Forester-Miller has also been able to teach other patients to use self-hypnosis for similar purposes. More commonly, however, hypnosis is used as an adjunct to conventional anesthesia to relieve preoperative anxiety and speed postoperative recovery. In fact, there are several dozen nurses, technologists and physicians at the Medical Center trained in Anodyne Imagery, a new approach to communicating with patients derived from hypnosis and neurolinguistic programming. Research by Dr. Henry Bennett of Hershey Medical Center has demonstrated that positive preoperative suggestions delivered from a similar frame of reference can reduce blood loss, recovery time and postoperative pain.
The importance of the skillful use of language in the medical environment is often overlooked, particularly in the operating room where it is incorrectly assumed that because patients are unconscious they are also unaware. In fact, there is some evidence that patients can recall comments made under anesthesia and that suggestions made intraoperatively have an effect on postoperative outcome. Audiotapes of positive suggestions made for use during surgery have been shown to be beneficial and also assist in blocking out any negative language used in the operating room.
With the institution of the Pain Management Initiative at the Medical Center, non-pharmacological methods have assumed their appropriate place alongside pharmacological methods in pain-treatment regimens, and an excellent example of this approach is recorded by Reynolds Price in "A Whole New Life." After surgery for his spinal cord tumor, he suffered from unrelenting, debilitating pain until discovering that hypnosis could provide the relief necessary to allow him to resume his writing career. His case illustrates what pioneer hypnotherapist Milton Erickson describes as the purpose of hypnosis, "to get the patient to utilize the competencies that exist within him at both a psychological and a physiological level."
Erickson defines hypnosis as "an altered state wherein subjects experience an intense but more narrowly focused attention," so it is fair to say that most of us go into a state of "white coat trance" upon entering a hospital as a patient. Since every doctor-patient interaction is loaded with suggestions, the skillful use of language can help physicians empower patients to mobilize their inner resources for the purpose of healing. In an essay on "Human Unity," priest/scientist Pierre Teilhard de Chardin reminds us that it is these healing relationships that "help us realize what... formidable power and joy and capacity for action still slumber in the human spirit."
Dr. Larry Burk is an associate professor in the Department of Radiology.