Reflections on Hypnotizability and Its Impact on Successful Surgical Hypnosis: A Sole Anesthetic for Septoplasty

American Journal of Clinical Hypnosis,  Apr 2004  by Wain, Harold J

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While hypnosis has been a significant medical tool through the ages, its use has been, at best, capricious. After the development and widespread use of ether, hypnosis has been mostly relegated to the role of an adjunct to chemical anesthesia. The present paper describes a case where hypnosis was used as the sole anesthetic for a septoplasty. The chronology of the surgery, hypnotic suggestion and strategies used as well as the clinician's responses are described. The paper highlights relevant clinical issues such as the hypnotic capacity of the patient, associated hypnotic phenomena, enhancing trance, and maximizing the hypnotic capacity by "meeting them where they are."

Keywords: Hypnoanesthesia, hypnosedation, hypnosis, surgery

Introduction

The introduction of ether in 1846 and chloroform in 1847 minimized the impact hypnoanesthesia could have had in the history of anesthesiology. In his book, Mesmerism in India, Esdaile (1902) described over 300 major surgeries that were accomplished with hypnosis as the only anesthetic. The interaction between mind and body, and the authority that one's brain can have over one's soma, is most appreciably demonstrated with the use of hypnosis as the sole anesthetic in surgery.

Peebles-Kleiger (2000) explained that hypnosis could be effective in surgery in three ways: Hypnosis potentiates the effects of analgesics and anesthesia; it facilitates postoperative healing; and it helps maintain stability of vital signs. A fourth way is the use of hypnosis as a sole anesthetic for surgery (Crasilneck & Hall, 1985).

Some past surgical uses of hypnosis include: Hemorrhoidectomy (Werbel, 1967); anorectoal surgery (Day, 1965); surgical removal of pedicle attachments (Wiggins & Brown, 1968); heart surgery (Gruen, 1972); gastrectomy (Bonello, Doberneck, Papermaster, Griffin, & Wangensteen, 1960); pulmonary infection (Jenkins & Crasilneck, 1959); neurosurgery (Crasilneck, McCranie, & Jenkins, 1956); surgical treatment of burn patients (Crasilneck, Stirman, McCranie, McCrainie, & Fogelman, 1955); and chemical peel (Wain, 1990). In most of the papers reviewed, hypnosis and similar therapeutic techniques had a positive impact on the surgery to include reduced postoperative nausea and vomiting; decreased anxiety during the procedure; fewer postoperative side effects; and quicker recovery lime.

In the past 10 years, several reports have shown that hypnosis is useful for a variety of surgical techniques, including dental surgery, breast surgery, coronary-artery-bypass surgery, endocrine cervical surgery, hernia repair, gynecological procedures, and exploratory surgery. Herod (2000) described a case that involved a woman using self-induced hypnosis instead of anesthesia during a tooth extraction. The woman remained calm throughout the procedure, and the tooth was removed without resistance or interference. Following the surgery, the woman reported feeling comfortable and confident throughout the procedure. Another paper described the effects of hypnosis during third molar extraction (Ghoneim, Block, Sarasin, Davis, & Marchman, 2000).

Williams, Hind, Sweeney, and Fisher (1994) studied the effects of positive intraoperative suggestion during major gynecological procedures. Several significant results were found in favor of the group receiving intraopcrativc suggestion compared to the group receiving no suggestion. The experimental group experienced significantly less vomiting and nausea (32% for the experimental group compared to 69% for the control group, p

Defechereux et al. (1999) found several significant advantages to using hypnosis during endocrine cervical surgery. Patients using hypnosis had significantly less days in the hospital, and less postoperative pain and analgesic consumption than did patients using general anesthesia. The group using hypnosis also reported experiencing an altered time perception during the surgery and the surgeons reported that the hypnotized patients were easier to perform surgery on. There was a significant diminishing of postoperative fatigue syndrome and surgical convalescence in the hypnotized patients. The hypnotized group also returned to work and social activities more quickly than the control group.

Another study (Lebovits, Twersky, & McEwan, 1999) compared a group using intraoperative suggestion tapes to a control group listening to a neutral tape during hernia repair surgery. Patients in the experimental group experienced significantly fewer episodes of vomiting compared to the control group in the first 90 minutes postsurgery (15% for control group vs. 4% for the experimental group, p

Meurisse et al. (1999) studied a group of patients who chose to use hypnosedation as an adjunct to a local anesthetic for bilateral neck exploratory surgery. These patients reported high levels of comfort in their recovery from surgery when using a visual analog scale.

Chronological Perspective Leading to Septoplasty with Hypnosis

The patient approached the author who was also staff at the hospital and related that because of his own anxiety he had postponed surgery for a deviated septum for several years. However, because his breathing was becoming more difficult he recognized that surgery was necessary. Initially, he inquired as to whether a desensitization approach could help decrease his anxiety relevant to the surgery. A consultation was scheduled, the patient was evaluated, and his hypnotic potential assessed. The patient was screened hypnotically by using a modified version of the Hypnotic Induction Profile (HIP; Wain, 1979). The patient was a high hypnotic subject scoring in the range of 4 out of 5. he had both a high eye-roll and immediate arm levitation. During the history-taking the patient related he had been deeply religious as a child, a high achiever throughout his schooling, and had no previous psychiatric history. The mental status exam was normal. he had postponed the surgery for several years out of fear of being out of control because of the anesthesia. The patient is a physician and his response was based on his experiences during his residency. His wife and parents were also in the medical field, and they had discouraged him from using hypnoanesthesia.