Book Reviews

Behavior and Adaptation

Life is change. For most of history, change was transmitted only through birth. Looking at the natural world, then, Darwin and his followers upheld the survival of our genes as the compulsion that drives our every behavior. In the mental health world, Freud also flirted with that view (everything is about sex).

But humanity has subdued the natural world with our ideas. Corn, cows and cars wouldn’t exist if ideas weren’t transmissible from person to person after birth. That exchange of ideas is also an adaptive process, but it’s not Darwinian. It’s closer to the evolution proposed by Lamarck, which is thousands of times faster than Darwin’s evolution through gene transmission.

As human beings, then, we are a combination of Darwinian (sexual) impulses and Lamarckian (intellectual) impulses. Sadly, just as our relationship with the natural world is out-of-balance, the tension between genes and ideas also drives us out of balance in our relationship with the self. Our mind changes far faster than our body. Worse, improving the mind occurs through experiences that often limit the body (and visce-versa). To keep this competition under control, the mind divides into two: the conscious mind that learns and adapts to a changing world, and the subconscious mind that manages our well-being and “automatic” behaviors.

Hypnotherapy is helpful in maintaining or restoring balance between the conscious and subconscious parts of our mind. Often that means negotiating alternatives to genetically inherited behaviors – most commonly the “fight or flight” response, but also lowered mood (sadness or depression) or pain. It’s important to understand those foundations of the personality as the basis for our work.

It was this need that stimulated my interest in Randolph Nesse’s new work “Good Reasons for Bad Feelings.” Nesse is an advocate of Evolutionary Psychiatry – a discipline that holds that we can understand the cause of mental disease as imbalances or extreme cases of behaviors that ensure that our genes are passed on. Explicit in the Nesse’s framing of the issue is that those genes cause defects in our brains that predispose us to the disease.

The book considers, chapter by chapter, our major mental health problems. In each case, Nesse proposes explanations for why more primitive species would have benefited from the behavior. The fear response triggers fight or flight, which in the right balance ensures that we mate as frequently as possible. Depression pushes us to abandon unattainable goals. Altruistic behaviors imply loyalty to sexual partners that depend upon that loyalty to ensure the survival of children over the decade preceding self-sufficiency. These are all plausible explanations for why genes that code for those traits would continue to be passed on, despite making us susceptible (respectively) to irrational phobias, suicide, and sexual manipulation.

As documented in detail by Nesse (I have to admire his integrity), the defect in this proposition is that no study has been able to identify consistent genetic differences between those that suffer from mental illness and those that don’t. The doubt generated by this observation is reinforced by clinical studies that demonstrate the importance of individual life experience in determining who suffers from mental illness. Unfortunately, the administration of determinative assessments takes hours – far more than is possible in a busy clinical setting.

Of course, life experience is not predictable. As with medicine, the preventative utility of genomic markers is seductive, perhaps leading Nesse to flog a proposition that appears to have a limited future.

In specific sections of the book, the blurry boundary between genomics and culture is evident. Child rearing doesn’t require a commitment from the male – in fact some feminist authors assert that agriculture was invented by women in part because they stayed in camp to share those duties while the men went out to hunt. So Nesse’s explanation for cooperation is arguably cultural. A more direct descent from genomics might be grooming to remove pests, which is manifested even among fish.

Nesse sets his observations against the backdrop of his clinical and professional development. All are set as heroic outcomes – illustrations of clinical innovations, or transformative insights that puncture professional myopia. As a hypnotherapist, however, some of the clinical innovations seem barbaric – exposure therapy for those suffering severe phobias is one illustration. And the primacy of evolutionary psychiatry seems overblown when outcomes depend upon life experience.

Both matters are dealt with more elegantly in practices (such as hypnotherapy) that recognize the division of the mind between conscious and subconscious realms. I was surprised when I encountered psychologists that disputed that division, and Nesse is defensive in the sections in which he recognizes its importance. His hesitancy indicates that the dispute is more widely entrenched than I knew.

This is an omission that I find indefensible. The tension between biological and social imperatives explains so much regarding our behavior – and mental vulnerabilities.  Even more, those insights inform powerful therapeutic strategies that are known to be gentler and more efficacious than the alternatives described by Nesse.

To conclude, “Good Reasons for Bad Feelings” is an excellent survey of mental health issues, and in relating those pathologies to behavioral benefits, Nesse reduces the stigma that burdens sufferers. I am concerned, however, that his focus on genetics will delay recognition that the genome specifies an architecture for the brain that is vulnerable to cultural pathologies. In both the formation of synapses and the allocation of blood flow, the brain is wonderfully plastic. That faculty facilitates the spread of ideas, but also the insinuation of contradictions that manifest as pathological behavior. Evolutionary psychiatry only sets the table – it doesn’t determine the contents of life’s meal.

Mind Management

“Gateway” Drugs

I’ve had two people point me at Michael Pollan’s new book “How to Change Your Mind.” It’s the latest celebration of drugs as a gateway to psychological balance and spiritual experience. Predecessors include the writings of Aldous Huxley, Timothy Leary and Sam Harris.

What few remember is that the same thing was said about cocaine in the ’70s – doctors considered it a mild addiction, and users celebrated the clarity that it brought to their mental process.

But the fact is that a drug elevates your mind in an unsustainable manner, and in spiritual affairs every gate opens both ways. When the high comes down and it slams shut, you no longer are able to manage the demons that have taken up residence in your psyche, and they slowly begin to amplify your weaknesses as they take over your motivations.

I raised my children with the precept that “Love is the Anti-Drug.” Drugs are merely a way of creating the state that is achieved when you are in a committed, loving relationship. If you have to take a drug to achieve that state, then the real problem is that you are resistant to that kind of intimacy.

The benefits of submitting to the discipline of commitment to another are immense. They see aspects of you that you can’t see yourself because your consciousness resides at the surface of your psyche. This is why Shamballa Buddhists celebrate tantric sex – it’s not just a physical experience, but a bearing of witness that is a powerful aid to achieving spiritual clarity and connection.

But just as with gateway drugs, the Shamballah tradition does not see tantric sex as a foundation of spiritual development. It’s a refinement intended for mature practitioners.

If you’re not ready to open yourself to the spiritual winds but want to prepare yourself for that engagement, please contact me. If you look at my blogs (everdeepening.com and love-returns.org) you’ll see that I’ve been refining my capacity to express love unconditionally for a long time. I’ll bear witness to your journey, and ensure that what comes through the gate serves only your best interests. All for a fee that does little more than ensure that I’ll be there next week for the next step – and the next, until you’re ready to fly on your own.

Basics

Hypnowars: Team Kappas vs. Erickson Camp

When choosing a hypnotherapist, clients should understand that we do not all use the same techniques. This post will compare the two most important bodies of techniques: those developed by Milton Erickson and John Kappas.

Our methods are always the same: attain depth and change thinking. As depth increases:

  • the regulatory activity of the conscious mind decreases, and
  • the elements of the subconscious mind operate more independently (they disassociate).

When the right depth is attained, behavior at that depth is changed through suggestions. These suggestions must match the expectations of the conscious mind, which must still interpret them for the subconscious mind that regulates the body and motivations.

Prior to Erickson and Kappas, many hypnotherapists worked at shallow depth and used scripted suggestions. This limited both the pool of clients and the types of behaviors that could be changed. Both Erickson and Kappas used systematic studies to create techniques that made it possible to attain any depth and address almost any behavior.

While they shared the same goals, Erickson and Kappas worked in entirely different contexts.

Milton Erickson

Erickson was a practicing psychotherapist in an academic setting. Many of his published papers recount experimental sessions where he attempted to teach the curious how to do “hypnotic work.” This “work” included (among others) catalepsy (muscle rigidity), analgesia (pain suppression), amnesia (lose memories) and age regression (revisit old memories). These skills were also important in therapeutic settings but are rarely emphasized in his reports.

Erickson’s methods are powerful but require great care. Depth cannot be created willy-nilly but must be done as a spelunker enters a cave, with markers and lights left in place to ensure that the patient can be brought out if something ugly is encountered. For this reason, the American Clinical Hypnosis Society he founded requires that all members be licensed psychologists.

Erickson’s ethics were impeccable. In his favorite paper (“Deep Hypnosis and Its Induction”) he offers the following principles.

A subject needs to be protected at all times as a personality possessed of rights, privileges, and privacies and recognized as being placed in a seemingly vulnerable position in the hypnotic situation. …

This protection should properly be given the subject in both the waking and the trance states. …

There should be a constant minimization of the role of the hypnotist and a constant enlargement of the subject’s role.

These principles came to full expression in his paper “The Burden of Responsibility in Effective Psychotherapy.” In the three cases reported, each cure was achieved as the patient slowly and laboriously explained his condition and described the behavior that would resolve it. Erickson did nothing more than suggest a powerful compulsion to do as the patient himself said.

Erickson was not followed by an intellectual heir. In part this reflected his choice of cases. Personal fondness or intellectual challenge seemed to play a large influence. When writing of patients (rather than volunteers) Erickson focused on complex cases often involving medical or psychological disorders. Many of his patients were referred to him as a “last resort” following ineffective surgical or drug treatment.

For less acute treatments, Erickson’s desire to guard the integrity of the patient’s autonomy led him to use images and metaphors familiar to them – again increasing the flavor of his therapy.

Given the diversity of his cases, it was unlikely that a formal manual of Ericksonian technique would arise. That does not mean that others have not built upon his legacy. Neural-Linguistic Programming (NLP) offers a model of information processing (although Hammond, in Hypnotic Suggestions and Metaphors, disputes its efficacy). Erickson’s use of implication in suggestions is a hallmark of a certain therapeutic style. Zeig and others focus on hypnotic disassociation as the key to effective therapy.

John Kappas

Kappas learned hypnosis at a young age, using it informally with family and friends. He polished his skills at a school for professional stage hypnotists. Although a terrible performer, Kappas was recognized for his hypnotic technique. He was picked by a pair of TV producers to represent the profession in a never-aired series.

In contrast to Erickson, Kappas was directive in his style. However, he recognized the need to utilize natural processes in allowing the mind to seek balance and health. To facilitate this, he devoted years to developing a theory of mind that – while psychologically sound – was understood by people from all walks of life.

Four pillars formed the basis of most Kappasinian therapy. The Theory of Mind was extended with Eric Erikson’s Stages of Development. The tendency of the mind to shift emotional pain to physical pain is explained in a basic theory of body syndromes. The Institute recognized the importance of dream process – both as relates to developing new behaviors and releasing obsessions and trauma.

Most importantly Kappas developed a fundamental theory of relationships (the Emotional / Physical dichotomy known here as Protector / Adventurer). While harder to explain than the Theory of Mind, E&P accounts for many of the most serious conflicts we face in our relationships, giving clients hope that they can work their way to a resolution. In this process, Kappas (as Erickson) was protective of the client’s goals and preferences, passing no moral judgment on behaviors that many would consider deviant.

We might expect that Kappas as a therapist was focused on the nuts-and-bolts of everyday living. Indeed, his recorded cases histories are dominated by commonplace issues, including fears and phobias, neurotic behavior (especially obsessive/compulsive personalities), marital disputes, and inexplicable pains, tics, and allergies.

As he aged, Kappas became more sympathetic to Erickson’s ethic, guiding the development of Cheryl O’Neil’s therapeutic imagery program. In this technique, the client constructs resources before venturing out into their subconscious landscape. The therapeutic imagery comes from the client’s own words.

From these elements, Kappas and his team at the Hypnosis Motivation Institute constructed an accredited hypnotherapy training program. Successful students have been applying those methods for fifty years.

What should be appreciated, however, is that Kappas designed a sandbox that minimized the chance that a therapist could upset the mental balance of the client. Age regression is almost never used – rather hidden trauma clears through the dream process. A limited set of therapeutic practices is employed. Recommended session length is one hour at weekly intervals.

The effect is that the client develops an understanding of their behavior and emerges with a strengthened partnership between the conscious and subconscious minds. It is that outcome that is most important to me as a therapist. Kappasinian hypnotherapy is not limited to helping the client accomplish their goals. It improves their understanding of their mind, empowering them to confront future challenges with their whole being, rather than just the part that they reason with.

And the Winner Is…

Always the Kappasinian client and the Ericksonian patient.

Neither approach is better than the other. Erickson left less in the way of organized therapeutic techniques, and those we have require greater control and discipline attained through formal psychological training. Kappas left a large and well-motivated body of techniques, constrained by models of “typical” behavior that can hinder treatment of deep psychological disorders. Ericksonian therapy has the flavor of surgery, with behaviors added or removed in various states; Kappasinian therapy tends toward overall integration of the hypnotic and waking experience under processes controlled by the client’s subconscious.

As a client seeking support, you are encouraged to understand your therapist’s approach. Appreciate that hypnosis is a tool employed in several practical styles. Don’t be afraid to explore alternatives. Your comfort with the therapeutic method is an element essential to successful change.

Basics, Mind Management

Hypnotherapy and Polyvagal Theory

In the basic Kappasinian Theory of Mind, we all need balance between adventurous (euphoria-seeking) and protective (fear-avoiding) behaviors. The goal of all therapy is to establish and maintain a healthful balance for the client. In this post, I consider how Kappasinian practices relate to Stephen Porges’ Polyvagal Theory (described wonderfully here).

As emphasized by Porges, our bodies are designed to seek homeostasis (the restful state in which we “feed and breed”). When threatened by unfamiliar or overwhelming experiences, we drop into a simple decision-making process: should we fight (“Can I eat it?”) or flee (“Can it eat me?”). If neither of those tactics resolves the conflict, we simply freeze (conserve energy until an escape presents itself). In the animal kingdom, survivors use shaking and quivering to discharge the residual energy, restoring homeostasis.

These kinds of experiences are traumatic, and if repeated drive us into protective behaviors. On the other hand, in safe social circumstances, those same kinds of experiences can evolve as play. When playing our pretend threats are accompanied with gestures and statements that reassure our partner. The classic pet behaviors are the dog crouching on its fore-paws, or the cat gnawing on our finger in between licks. During play, both euphoria and fear are at elevated levels.

The nerve that mediates our overall physical state (the vagus nerve) has an ancient (reptilian) part that manages the freeze response, and a more recent (mammalian) part that controls excitement. As these responses involve complex coordination among all the body parts, the vagus returns ten times as much information back to the brain as it sends out.

One of the challenges in overcoming traumatic experiences is that fear suppresses our ability to exchange reassuring gestures and statements. This permanently suppresses our ability to feel euphoria, leaving us at the mercy of fear. That prevents us from restoring homeostasis, leaving us in a perpetual state of self-induced stress that damages our physical and mental well-being. If the trauma occurred early in childhood (such as a difficult birth), we may be unable to remember the circumstances, and thus release the trauma.

Porges’ solution is to deal with the problem symptomatically. Exposing the sufferer to soothing sounds, sights or sensations overcomes the blocks to reassuring stimulation. When accompanied by mindful relaxation, the mind learns to tie that reassurance to homeostasis.

The classic Kappasinian therapy for fear and anxiety builds an experience that mixes these same elements – but with the amplifying factor of hypnosis (our optimal learning state).

Therapy begins with a progressive relaxation that establishes homeostasis.

If the trauma is mild, circle therapy is used to walk the client through a remembered experience. If the fear is irrational or of unknown origin, systematic desensitization is used to command the subconscious (the true source of the reaction) to produce the emotion. Ideomotor finger raising is used to control the level of anxiety. When discomfort is visible, the client is told to lower the finger and “pass it,” directing them back into homeostasis. As the process is repeated, the mind becomes confident in its ability to control the transition, and eventually chooses homeostasis.

If the trauma is deep, these practices are preceded with sessions that build a safe haven in the subconscious landscape, ensuring that the learned skills take root in a context free from debilitating memories. For this purpose, today’s practitioners will often use therapeutic imagery, but even they will reinforce that work with a staple of Kappasinian therapy: a staircase deepener that projects a positive, confident self-image into the subconscious.

The final element of Kappasinian therapy is to suggest that the client begin to chuckle and smile as they come out of hypnosis. As the therapist smiles and speaks soothingly, this reinforces the ability to exchange reassuring signals. Of all the suggestions offered by Kappasinian therapists, this is the most playful.

Porges first articulated his polyvagal theory back in the early 1980’s and the therapeutic practices were not popularized until well into the new millennium. Hypnotherapists trained with Kappas’ methods have been performing these therapies since the sixties. Not only do those techniques have the same effect as those offered by Porges, but they are coupled to far broader strategies for overall behavior development.

Relationships, Specializations

Loss and Grieving

To know loss is to confront change.

People, pets, homes and jobs are not just things – they are the backdrop for our behavior. When we first acquire them, we are conscious of learning to adapt to their presence. Over time, those changes become automatic behaviors managed by the subconscious, woven together as a pattern for our life. Remove one element and the pattern vibrates. It may be a trivial disruption, such as when we lose a penny. Or it may be a near-collapse, such as when we lose a child.

When the loss is great, we may be overwhelmed and seek to avoid change. Most directly, we may deny the loss. We might imagine that the loved one will walk through the door any second, or that after the tornado we’re at the hotel on vacation. When denial becomes a permanent condition, the sufferer should be referred to a licensed mental health professional.

Another strategy is to cultivate dependency. We may expect other people to care for us, take refuge in pleasant experiences, or consume substances (food and drugs) that boost our energy and mood.

Healing begins when we discard denial and dependency to accept that we need to change our lives. Specializing in behavior change, a hypnotherapist can help with that journey.

The mind is always seeking health, and so hypnotherapy works with the mind. In planning therapy for loss, then, we should understand how the mind responds to loss. I cover two accepted frameworks for loss before offering my own perspective.

Kubler-Ross

Elizabeth Kubler-Ross broke ground with her study of how terminally ill patients dealt with loss and grief. In the popular formulation, the process follows five stages, but the middle three stages can become a whirlpool. The stages are:

  • Denial
  • Anger
  • Depression
  • Bargaining
  • Acceptance

We’ve already discussed denial and its helpmate, dependency.

Anger is the natural reaction to the realization that there is no answer to “Why?” It can be focused on the self for past misbehavior (such as cigarette smoking) or toward others (the tobacco companies). In the grief process, anger is important because it breaks down neural pathways. It is a mechanism used by the mind to get rid of behaviors that no longer serve us. In the context of a broken heart, this is clearly necessary: we need to stop acting like we did when we had a romantic partner and prepare ourselves to seek a more fulfilling relationship. In the case of a terminal illness, anger prepares us to accept that life as we knew it is going to end.

If the loss is due to illness, persistent anger also has dangerous consequences: it stimulates the sympathetic nervous system, which increases inflammation in our tissues. This can inhibit healing or even stimulate metastases.

Depression is a term in psychology used when we are unable to respond to the world. In severe cases, that manifests as avoidance. The highly depressed person can end up hiding in a darkened room. It is more severe than denial because while in denial we can at least function. What is different is that while in depression we are recovering from the mental disorder created by anger and gathering energy to create a new life.

After anger has softened our old behaviors and depression has allowed us to gather strength, we begin bargaining. This can take two forms. The less helpful is whining: “Dear God, what do I need to do to make this cancer go away?” Whining often loops back into anger and depression. The better is imagining: “If I heal from cancer, I will commit more of my time to charitable work.” Imagining builds new behaviors to replace those erased by anger.

Imagining prepares us to move forward to the last stage: acceptance. Acceptance is a great gift. It is the ability to take life one day at a time, savoring every moment and opportunity, while trying to enrich the experience for ourselves and others. Having achieved that wisdom, you will hear people say that getting divorced (or sick with cancer or arrested or…) was “the best thing that ever happened to me.”

Trujillo

Through his teaching and trauma response work, Timothy Trujillo has developed tools to aid those trying to recover from loss. Where Kubler’s focus is practical (“This is how people grieve”), Trujillo offers a metaphor for healing. Trujillo starts every therapy with the mind/body connection, establishing that it is possible to feel good.

The table elaborates the physical metaphor for psychic healing:

Stage Physical Healing Psychic Healing
Whole    
Injury    
Hemostasis Stop bleeding Separation from trauma
Inflammation Clear damage, fight infection Release old behaviors
Proliferation Repopulate with new cells Evolve new behaviors
Remodeling Cells organize as tissue Reconstruct relationships
Adaptation Compensate for lost function Deal with unexpected consequences
Recovery Return to normal

The power of this metaphor arises from the fact that often recovery from psychic trauma is impeded because the wound is projected into the body, causing discomfort to persist. In emphasizing the body’s natural healing powers, the client associates increased physical comfort with psychic healing. In effect, the conscious mind no longer interferes with the subconscious effort to restore balance and harmony.

Confronted by traumatized communities, Trujillo captured this psychological transition as a hypnotic script titled “The Five-Minute Miracle” (https://timothytrujillo.com/projects/five-minute-miracle).

Beyond Healing

If we have a wonderful relationship that falters and fails, do we want to release those cherished memories and behaviors? Or do we want to learn from the failure and expand our vision of future possibilities? Not just sexual satisfaction, for example, but also children and society?

Loss and wounding both have negative connotations. We have seen that at the end of grieving, we achieve a positive resolution – but the steps along the path are dreary, to say the least. With physical wounds, we can be awed and humbled by our natural healing powers, but in most cases after recovery we are less capable than before the injury. The metaphor suggests that the mind will also lose function during grieving. Why should we accept that?

I refer a simpler, positive model. Like Trujillo, I recognize the connection between mind and body, but would emphasize that it goes both ways. The reason we say the old lover’s name is because we remember them when our cheek is kissed. We have associations between physical sensation (the kiss) and old behaviors (saying their name).

The first step in recovery from loss, then, should be creating space within the self. This can be done many ways, but all involve intense physical exertion with focused attention. Shaking our fist at the sky is one example, as is a long, wracking cry. Other methods are possible: I use Sunday dance celebrations to create space within myself; others might go rock climbing. The point is to be aware that we are consciously creating these sensations of exhaustion within ourselves.

The next step is to rest until our energy recovers. Finally we imagine what we can do with this new awareness and energy. That inevitably collides again with loss: we would like to have dinner with lost spouse, but that’s not possible. So we return to creating space inside ourselves, resting and imagining until we have established that it is myself that needs dinner.

How is this space inside created? In my view, it is from the heart. When I weep or dance, I have the sense of something inside bearing witness to me and my loss. If I allow it, it flows from that deep inner source and enters the situation as it is to bring healing – not just to myself, but to everyone that will accept it.

A Hypnotist’s Support

How is this model facilitated by hypnotherapy? When anger (or other negative emotions) are entrenched, I start with a hand clasp induction; otherwise a simple eye fascination suffices. Complete awareness of the self is built through a long progressive relaxation starting at the feet with particular attention paid to expansion around the heart to allow the emanation of light. Gathering all the resources of the being and the represented potential, the progressive passes up the neck and over the back of the head to rest over the forehead, above the prefrontal cortex where all planning is done.

From there the therapeutic strategy depends upon the specific needs of the client. Those in deep grief often need to establish resources in the subconscious landscape through free-form therapeutic imagery. That work leads to reconstruction of their self-image. Those seeking to implement behavioral changes may have fear responses to clear using desensitization.

Between sessions, breathing meditation and mindfulness reinforce personal boundaries. Dream therapy can be used to assess the readiness to change, to release resistance, and to focus subconscious attention to find constructive solutions to specific behavioral problems.