Hypnosis In Mainstream Medicine - Wall Street Journal

Altered States: Hypnosis In Mainstream Medicine 

Major Hospitals Use Trances for Fractures, Cancer, Burns, Speeding Surgery Recoveries


October 7, 2003

Hypnosis, often misunderstood and almost always controversial, is increasingly being employed in mainstream medicine.

Numerous scientific studies have emerged in recent years showing that the hypnotized mind can exert a real and powerful effect on the body. The new findings are leading major hospitals to try hypnosis to help relieve pain and speed recovery in a variety of illnesses.

At the University of North Carolina, hypnosis is transforming the treatment of irritable bowel syndrome, an often-intractable gastro-intestinal disorder, by helping patients to use their mind to quiet an unruly gut. Doctors at the University of Washington's regional burn center in Seattle regularly use it to help patients alleviate excruciating pain. Several hospitals affiliated with Harvard Medical School are employing hypnosis to speed up postsurgical recovery time. In one of the most persuasive studies yet, a Harvard researcher reports that hypnosis quickened the typical healing time of bone fractures by several weeks.

"Hypnosis may sound like magic, but we are now producing evidence showing it can be significantly therapeutic," says David Spiegel, a Stanford University psychologist. "We know it works but we don't exactly know how, though there is some science beginning to figure that out, too."

Hypnosis can't help everyone, many practitioners say, and some physicians reject it entirely. Even those who are convinced of its effect say some people are more hypnotizable than others, perhaps based on an individual's willingness to suspend logic or to simply be open to the potential effectiveness of the process.

These days, legitimate hypnosis is often performed by psychiatrists and psychologists though people in other medical specialties are becoming licensed in it, too. It can involve just one session, but often it takes several -- or listening to a tape in which a therapist guides an individual into a trance-like state. Whatever the form, it is increasingly being used to help women give birth without drugs, for muting dental pain, treating phobias and severe anxieties, for helping people lose weight, stop smoking or even perform better in athletics or academic tests.

Many health-insurance plans, even some HMOs, now will pay for hypnosis when part of an accepted medical treatment. Until the last decade, many traditional science journals regularly declined to publish hypnosis studies, and research funding was scarce.

That's changing. Dr. Spiegel, for instance, is co-author of a widely referenced randomized trial involving 241 patients at several prestigious medical centers. Published several years ago in the Lancet, a respected medical journal, it found that patients hypnotized before surgery required less pain medication, sustained fewer complications and left the hospital faster than a similar group not given hypnosis.

Using new imaging and brain-wave measuring tools, Helen Crawford, an experimental psychologist at Virginia Polytechnic Institute in Blacksburg, Va., has shown that hypnosis alters brain function, activating specific regions that control a person's ability to focus attention. "The biological impact is very real and it can be quantified,"  Dr. Crawford says.

Still, proponents say they typically spend a great deal of time dispelling commonly held myths and answering skeptics. Hypnosis, they say, cannot make people do or say something against their will. Credible hypnotists don't wave a watch in front of their clients, as portrayed in many old movies. People who enter into a so-called hypnotic trance are not, generally, put to sleep. On the contrary, practitioners say, they refocus their concentration to gain greater control.

Even so, the field continues to be hurt by quacks, says Marc Oster, president of the American Society of Clinical Hypnosis. His group, along with the Society for Clinical and Experimental Hypnosis, publishes research studies, conducts educational seminars for health providers and certifies those who complete course work and meet other standards. Dr. Oster suggests that people interested in hypnosis see a health provider licensed in a medical discipline, who is also certified by one of the hypnosis societies -- someone who "uses hypnosis as an adjunct" to a principal medical practice.

Everyday Trances
Researchers say that most people unwittingly enter into hypnosis-like trances on their own in everyday life. When reading a riveting novel or watching a film or TV, many people are experiencing a trance-like state when they are so focused they become only vaguely aware of nearby noise, conversation or activity. In a dream, when someone imagines falling off a cliff and is startled awake by the sensation of falling, they are triggering the same mental machinery that in hypnosis allows the mind to influence the body, says Dabney Ewin, a psychiatrist at Tulane University Medical School.

 Katie Miley used self-hypnosis taught to her by a Chicago-area psychologist to help her give birth "without being so anxious and without pain medication." For weeks preceding the delivery Dr. Miley, herself a psychologist, used tapes provided by the therapist to practiced slipping into a hypnotic state. During the birth, and as suggested by the therapist, she muted the pain by imagining the contractions "as a warm blanket enveloping me," she says. "It was weird," she says. "I was aware of everyone in the room and I was interacting, but mentally my focus was elsewhere and I just allowed the process to unfold."

Some of the clearest clinically measured results come from using hypnosis to mute severe and chronic pain -- as the University of Washington's regional burn-treatment center in Seattle is doing with burn patients. Patients sent there must undergo frequent therapy to sterilize their damaged skin, and get new grafts. They must be awake and alert during the treatment, and even the most powerful narcotics rarely diminish the intense pain.

David Patterson, a psychologist at the center, induces a hypnotic trance with a typical and relatively quick technique. Patients are told to close their eyes, breath deeply, and imagine they are floating. Through a variety of verbal suggestions, Dr. Patterson then helps the patient imagine themselves elsewhere, away from the treatment. "The pain is still there, of course, but patients simply don't experience it as before," he says.

While relieving physical pain is one of the more common uses of hypnotism, it is also the hardest to explain. Dr. Patterson and others report that hypnosis doesn't appear to act on the body's natural pain-killing chemicals, the way drugs do. Instead, scientists believe, through hypnosis a person can be trained to focus away from the pain, not on it as most people usually do. Many athletes often unconsciously use such a technique to play through severe pain, concentrating their attention on the game or task ahead, instead of on their injury.

Recently, Dr. Patterson added another tool to transport hypnotized patients to a "safer emotional environment." He and his colleagues created a virtual reality film; patients placed in a helmet during therapy watch a three-dimensional depiction of a snow-covered set of mountains and canyons. By interacting with the film, patients can feel they are suspended over a cool and calming world. Michael "Mac" MacAneny, one of the first burn patients to use the 3-D film, says he is certain that "it saved my life."

Early last year, Mr. MacAneny sustained deep burns over 58% of his body when building a bonfire for his sons in his backyard. A gas tank he was using suddenly exploded, enveloping him in flames. Before Dr. Patterson began treating him, the 39-year-old Mr. MacAneny says he dreaded his daily therapy, "freaking out" whenever the nurses came to get him. Hypnotized and inside the 3-D virtual world, "I knew what was going on, but I just didn't pay attention to it," he says.

Hypnosis, in some form or another, has been used for more than 200 years. It began gaining credibility as a medical tool in the early decades of the last century as psychiatry and psychoanalysis began to show how the unconscious mind often rules daily life. Its usefulness was cemented when combat physicians reported using it during World War II for the wounded.

By 1958, as more doctors described their experiences in the war, the American Medical Association certified the technique as a legitimate treatment tool. Nevertheless, few doctors employed it. But in 1996, a National Institutes of Health panel ruled hypnosis as an effective intervention for alleviating pain from cancer and other chronic conditions. These days, as many people accept that stress can exacerbate illness, the potential curative power of hypnosis is becoming more acceptable, too.

Healing the Body
 Carol Ginandes, a Harvard psychologist at McLean Hospital in Boston, is trying to prove that "through hypnosis, the mind can have a potent effect not only on mental well-being but also on the acceleration of bodily healing itself." She has co-written a study showing ankle fractures among patients receiving a hypnotic protocol healed weeks faster than usual and another study showing wound-healing benefits for hypnotized breast-cancer surgery patients. Though these studies were preliminary, Dr. Ginandes believes that hypnosis enabled her subjects to stimulate the body's own healing mechanism to work more efficiently.

Elvira Lang, director of interventional radiology at Beth Israel Deaconess Medical Center in Boston, has made similar findings. She recently reported that hypnotized patients who must remain awake during certain vascular and kidney procedures fared measurably better than similar patients who didn't undergo hypnosis. Still, says Dr. Lang, until very recently, "I didn't dare use the 'H' word around here."