Tag: psychiatry

Basics

Clinical Hypnosis is not Hypnotherapy

Brian Balke

When our health is threatened, we take extreme measures to protect and restore it. Staying alive, after all, is necessary to anything else. For this reason, when sick or injured we are vulnerable to deception and self-serving by those claiming to restore us to wellness.

To the extent that wellness exists in the body, the methods of science have much to offer those that need healing.

In the medical field, the precepts of science are easy to fulfill. We can diagnose the patient’s condition using objective observations. We can stage clinical trials that compare the efficacy and side-effects of various treatments. And we can apply the methods of engineering to standardize therapies and minimize cost.

Recognizing these benefits, states adopted licensing laws to ensure that medical practitioners adhered to sound scientific practices.

In the 1800s, those caring for the mentally ill encountered diseases that seemed to fit the medical model. Foremost of these was syphilitic meningitis (in which the syphilis bacteria attacks the brain). For this reason, psychiatry was made part of the medical world. Various alternative forms of therapy were grandfathered in, including hypnosis and psychoanalysis.

Psychiatry and psychotherapy were thus granted the imprimatur of science, and states eventually interceded to license their practice. Unfortunately, as generation after generation of therapeutic methods was applied and disproven, it became clear that mental illness was far more difficult to characterize than illness in the body. Schizophrenia, depression, and neurosis were split and blended until with the DSM-V (Diagnostic and Statistical Manual v. 5) there are more than 200 recognized conditions, most of which are recognized as covering a spectrum of severity.

Now this seems wonderfully scientific, but there’s a catch: who among us doesn’t have a psychiatric condition at the low end of the spectrum? This is not idle speculation. Under licensing laws, only a licensed clinician can treat psychiatric conditions.

In California, the methods identified by use for clinicians include interviewing, counseling, drugs, and hypnosis. When the licensing law was proposed, other professions took exception to reservation of those methods. Among those granted specific exceptions were attorneys, religious leaders, and hypnotherapists.

Now hypnotherapy and psychotherapy are often both seen as “mental health” disciplines, but the legal definition of hypnotherapy defies that: it says that hypnotherapists may utilize hypnosis for “vocational and avocational self-improvement.” This is an essential distinction. What it says is that the hypnotherapist’s client knows what changes they want in their behavior, and seeks assistance in accomplishing those changes. Through experience, a hypnotherapist may offer additional guidance, but at every step it is the client who chooses what is inserted into the subconscious mind.

Conversely the psychiatric patient has a generalized malaise and doesn’t know how to change. A psychiatrist is thus allowed to change the patient’s mind with prescribed medication or therapy.

Considering the application of hypnosis, how does clinical practice differ from hypnotherapy? An excellent example is found in the introduction to Erickson’s “My Voice Will Follow You.” Erickson was visited by a woman who was systematically sexually abused by her father until leaving the house at 17. The woman described her painful fear of an erect penis. Erickson’s therapy was to call her “stupid” as she didn’t realize that her vagina could “render any penis soft.” With that established, he suggested that she enjoy “vicious pleasure” in exercising that power.

How is this a hypnotic approach? In calling her “stupid,” Erickson validated her worst fears to achieve a shock induction (kind of like throwing her in front of a bus). He then gave the subconscious a strong image of personal power (the effect of her vagina) before encouraging her to enjoy the exercise of that power.

I don’t know whether he considered the impact on her subsequent sexual victim. At least, given the summary, I hope that there was only one, as that was the plan she had upon leaving the clinic.

Obviously Erickson is skating on the edge of disaster here, and only as a highly experienced clinician should he ever have exercised that authority. If the wheels came off the bus (so to speak) during the shock induction he had the authority to prescribe medication and commit the patient for observation. The problem is that this bravado is typical of clinical hypnotists. As evidenced in the continuation of the introduction, at least some of Erickson’s proteges revel in demonstrations of that kind of power – seemingly magical cures achieved with just a few words.

But this is not what I do as a hypnotherapist. Having heard that this woman suffered childhood sexual abuse, I would have recognized that she was suffering from a mental wound and referred her to a licensed clinician. If she came in complaining only of frigidity, I would have asked her to explain the imagery she associated with intercourse, and helped her develop alternatives that might release her anxiety. All of this would be done in conversation before hypnosis was induced to associate the new imagery with intercourse – and followed by referral to her medical doctor to verify that no health issue existed.

Obviously there is an ambiguous line here: in the first case, the clinician heals the client; in the second, the hypnotherapist helps her strengthen her personality. Is that “strengthening” also a healing? That’s hard to tell. But the question is whether a client wishing to strengthen her personality should be denied the opportunity to have a hypnotherapist facilitate that process.

California’s Business and Professional Practices Code answers emphatically “No!”

The reason that I emphasize this at this juncture is that Psychology Today defines “hypnotherapy” as clinical hypnosis, and pointedly excludes from its recommendation graduates of accredited Colleges of Hypnotherapy (such as the Hypnosis Motivation Institute). Furthermore, psychotherapists often tell their patients that they cannot also seek the assistance of a hypnotherapist. As I see it, both the magazine and the therapist are engaged in illegal restraint of trade – and you can be certain that if I had the resources I would see them in court for it.

Hypnotherapy is a distinct discipline with its own methods, intellectual frameworks and scope of application. So long as services rendered are “vocational and avocational self-improvement,” the public has the right to engage a hypnotherapist to strengthen their personality. If clinician wishes to constrain such use, it must come with a strong written argument that the benefits sought by the client are potentially harmful to their self-interest.

Book Reviews, Mind Management

Psychiatry in Disorder

Brian Balke

Any accredited professional college must educate students on the legal requirements for their practice. In the case of hypnotherapy, in most states the law makes psychology a dominant field. I have been forced to turn away clients because their concerns might be due in part to an actual illness of the mind – something that I was unqualified to diagnose or treat. Sometimes that’s made easier because the client is actually under the care of a psychologist – I’ve learned to expect that I just need to turn them away, because I’ve never found a psychologist that was willing to work in tandem with me. They don’t even answer my e-mails.

In the gray zone are clients that have read the pop psychology press and tell me, for example, that they have “PTSD.” Given what I know about the diagnostic definition, I ask a few questions and determine that they probably have post-traumatic stress, or PTS. Now I can work with PTS, but not PTSD. Here’s the rub: I can’t tell them that they have PTS, because that would be a diagnosis that I am not qualified to offer. You can imagine how difficult this becomes with more common psychiatric designations: depression and general anxiety disorder, for example.

Against the backdrop of this frustration I now report on Anne Harrington’s “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness.” Obviously I would like to be assured that there’s a valid scientific basis for the designations offered by psychologists – and something in their treatments beyond the power of suggestion. Because if that basis is weak, then the legal pressure I am under is hurting not just me, but my potential clients.

I regret, then, that Harrington mounts a devastating critique of psychology. It is not just that psychology has no sound scientific basis – the dynamics of its development have systematically brought suffering to those it characterizes as patients.

In considering the history surveyed by Harrington, I think that it would be generous to say that, desperate for some therapeutic method, psychiatrists have systematically seized upon symptoms as causes. Each generation of psychiatrists took up tools that addressed the purported cause of the era, only to discover that the treatment tended to increase the aggregate suffering of their patients.

This generalization applies to both of the broad classes of therapeutic approaches. The first assumes that mental illness reflects a biologic imbalance in the brain that can be treated with surgery or drugs. The second sees the imbalance as a learned response to a toxic environment that can only be corrected with therapy that builds new behaviors in a supportive environment. These two approaches are known popularly as “nature or nurture.”

Harrington’s history develops as a pendulum swinging between these two approaches, driven by shifting political winds. Reflecting the stark contrasts, psychiatry’s torch-bearers tend to be absolutists.

On the medical or nature side, anatomists first treated asylum patients as laboratory specimens, extended in their second era with legislative policies of sterilization and euthanization. This was followed by the practices of electroconvulsive therapy and prefrontal lobotomy. As biochemistry advanced, drugs were sought to target the specific pathways. Manipulation of metabolism (for depression and mania) was pursued using addictive drugs, followed in the modern era with drugs that target neurotransmitter balance. Unfortunately, Harrington reveals that early drug trials did not assess serious long-term side effects of metabolic drugs, and that more rigorous tests of neurotransmitter drugs show that they are only marginally better than sugar pills. Having hidden those results while marketing directly to consumers, Big Pharma is abandoning mental health under pressure from European advertising regulations that require that any new drug must be demonstrably better than existing remedies.

On the nurture front, Freud first blamed sexual repression for all mental illness. Mental institutes abandoned treatment to function largely as warehouses of sufferers deemed to be incurable. In the aftermath of World War II those concerned with valor blamed mothers for mental illness. Seeking early intervention, psychologists formulated categories of “deviance” that were seized upon by parents and schools as justifications for anesthetizing unruly youth. Finally legal decisions forced the disbanding of mental institutions, eventually leaving the prison system to step in as de facto provider of care for those that that cannot align their behavior with our civil codes. Of course prison society is not an incubator for civil behavior, and certain practices (solitary confinement foremost among them) are known to trigger psychotic breaks. While Harrington does not reference a statement of policy that blames the mentally ill for their condition, today American society does choose to punish them.

In grappling with these outcomes, psychiatry has recognized that therapies cannot be evaluated effectively until mental illness can be diagnosed accurately. Thus was born the institution of the Diagnostic and Statistical Manual. At this time it recognizes over two hundred conditions. Perhaps because of this complexity, Harrington reports that two clinical evaluations are likely to disagree roughly 70% of the time – and thus that treatment will follow different paths. Harrington does not report any studies that elucidate the discrepancies, but I am familiar with reports that suggest that overlap of criteria means that the diagnosis is often biased by clinical predisposition. If a psychiatrist has had success treating schizophrenia, they may look for schizoid symptoms and thus bias towards that diagnosis.

Harrington concludes her survey with the admission that the scientific foundations of psychiatry are vague, and calls for clinicians to return to basics. Should they fail, she foresees that they will surrender therapeutic initiative to those that lack prescribing authority: counselors, therapists and social workers.

I have deeper concerns. Hypnotherapists understand that the brain is not the mind – and this is a view shared by followers of Jung, who split with Freud over the matter. Through personal experience, I believe that the human brain is best understood as a multi-channel radio receiver, and that most of our thinking is done in the soul. This undermines biological investigation for the causes of mental illness. There may be correlations between diseases of the soul and brain biology, but attempts to change only the biology will be ineffective in treating the disease.

As a hypnotherapist, my response to Harrington’s indictment of her discipline was angry. Given that “science” was the justification for preferential licensing, it now appears that in fact the regulators were snookered by a chest-thumpers seeking to engage in restraint of trade. I plan on promoting Harrington’s revelations, and will be far more aggressive in seeking to help clients that have been disempowered by the industry.

For that is where the real answers are to be found: empowering self-care. After more than a century, the evidence is in, and the human mind is beyond biological understanding. Psychology should recognize that it is largely a philosophical discipline – which in the best sense serves to provide citizens with understanding to manage their minds and relationships. The obfuscating complexity of psychiatric terminology must be removed from public dialog, and replaced with something with greater utility. Perhaps the Kappasinian Theory of Mind?

Basics

Personal Development: Part 10

Brian Balke

Imagination

Our journey of personal development has reached its end-point. Thus far, the journey has been incremental, each step building upon prior progress. In a broad sense, we can see that in the first three stages (survival, sex and exchange) the goal is to explore opportunities for personal expression. The second three stages (healing/trust, truth and creativity) shift to collaboration and social responsibility.

Hewing to the priorities of the hypnotherapist, our focus has been on changes in behavior. That growth may bring conflict with the self or others. Each segment has surveyed the tools hypnotherapists may offer to support those struggling with a transition.

Psychiatry offers some detailed insights. The brain also changes as we mature. When learning to survive, the brain is designed to capture as much experience as possible. Neurons form dense webs of interconnection. During adolescence and early adulthood (sex and exchange), the brain sheds many of those connections, focusing its energy toward identifying and amplifying social advantages.

Along with those gross changes, the brain develops new structures. Reason and relationships are our highest cognitive functions, and as we learn neurons are recruited to their service. Each new node requires the services of its predecessors. The highest relationship function – altruism – often develops only in our mid-twenties (in the region called the posterior superior temporal sulcus).

From these insights, however, we have no reason to expect that the basic model of behavior development might begin to break down. Remember how this goes: due to the complexity of social existence, around eight years of age the brain divides into the conscious and subconscious, with exchange mediated by the critical mind. Could it be possible that as we age, the more powerful subconscious might come to trust our abilities to survive in society, and come back into the light?

Such a change is not incremental. It completely upends our concept of self.

This is the nature of the final stage of personal development, the stage of imagination.

The dissolution of the critical mind begins in dreaming. Dreams are the forum in which the subconscious invents new behaviors, free from the prejudices of the conscious mind. But the process is inefficient at best and often obscure. Many remembered dreams are vague if not incoherent. But if through dream analysis we cultivate a dialog, the subconscious learns to be more precise. And when that dialog is pursued gently and respectfully, it eventually begins to call upon the conscious mind during sleep, allowing it to help resolve choices. This is called lucid dreaming.

Dream researchers and enthusiasts have developed methods to cultivate lucid dreaming. The first wanted accurate descriptions of the content of dreams and later discovered that it could be used to overcome trauma. The second enjoyed the thrill of the dream. It is important to remember, however, that unstructured dreaming is a critical part of behavior development. My recommendation is to allow the subconscious to open the door naturally, according to its own understanding of the benefits of greater conscious participation.

Beyond lucid dreaming, however, comes lucid waking. Trust works both ways, and when the conscious mind respects the creative powers of the subconscious, it can facilitate their activation without falling asleep. This is the natural state of many artists: they switch rapidly between abstract analysis and physical sensation as they work. Hypnotherapists call this mental pattern “somnambulism,” and discovered that many neuroses are related to “hypersuggestibility”: the tendency for the subconscious to reinforce negative thought patterns. But when the conscious mind is disciplined to cultivate positive thoughts, when a new opportunity presents itself it can drop into a meditative state to ask the subconscious “Where does this lead?” A rich set of possibility are presented immediately.

As the critical mind continues to dissolve, eventually a new brain state emerges: the gamma state. Observed in dedicated meditators and religious devotees, the gamma state appears to be the most highly energized of the known brain states, operating almost 50% higher than the beta state that we entered when alarmed.

These experiences all lead to increased imaginative capacity. But there is far more open to us in the space of imagination.

To understand the richness of that experience, I must challenge the psychiatric model of thought. Observing that damage to the brain causes loss of cognitive function, psychiatrists believe that all thinking occurs in the brain. Another possibility, however, is that the brain is an interface to the soul. Damage to an interface also causes loss of function.

My experience of the space of imagination led me to that second model: the brain is a kind of multi-channel receiver that tunes into a realm of ideas. In that space, injection of noise is the worst disaster. It disrupts the coherence of ideas. To gain full access, therefore, we must learn to sublimate our concern for the physical self, guarding against the impulses of greed, anger, fear, envy, lust, etc. In fact, failure to do so activates powerful intellectual antibodies that hurt our brains.

Psychologists might recognize my “space of ideas” as Jung’s “collective unconscious.”

Now ideas obviously strive for expression, and with our complex brains, human beings are a wonderous partner in the evolution of ideas. Unfortunately, we are still in transition from the long era of biological evolution (running back almost three billion years) that was driven by competition, conflict and pain – sources of noise that degrade the coherence of ideas. Intellectual evolution took root in us only when we learned to moderate our primitive impulses. That evolution, unfortunately, is a known threat to our evolutionary predecessors – including people that were not raised into intellectual opportunity. To avoid extinction, they are suspicious of intellectual change.

Our religious avatars explore the path through this thicket of mistrust. Buddha offered the concept of “compassion for all sentient beings.” Christ went further, promising “unconditional love.” In both cases, the avatar achieved intellectual authority only by resolving to witness sorrow as an intermediary for ideas that accumulate power from the gratitude of those that receive healing. Buddha tortured himself to achieve that status; Christ surrendered himself to death at the hands of those he loved.

The ongoing work done by our avatars is a transformation of the spiritual ecology in the space of ideas. Unconditional love seeks virtue in all things, transforming eventually even our vices. Anger becomes passion; destruction becomes creative transformation. Of course, the primitive impulses resist that transformation. Their program of repression, however, is frustrated by the sacred martyr, who endures physical wounds as a method of infecting the motivating ideas with love’s virtue.

Trapped in the world of material exchange, such acts seem insane. What history teaches us, however, is that material exchange is a dead end. It creates nothing that endures. Despite all the promotion and wailing of the 20th century, the most enduring personalities in our cultures are our religious avatars. When I was a child in the 1960’s, we still hated Hitler. Now only a few remember him, and increasingly they are ridiculed as anachronisms.

The future lies in acceptance and celebration of our differences – differences that permutate in the space of ideas to build ever richer possibilities for the expression of love.

Which brings us back to sex. Sex has a biological expression in male and female forms. That expression has a parallel in the space of ideas, in principles that I call “masculine” and “feminine.” The masculine principle facilitates change and must achieve temporal and spatial isolation to accomplish that end. The feminine principle sustains continuity through temporal and spatial diffusion. Even in our age, few appreciate the transformative power of their integration: transformation under the guidance of prescient intuition. The possibilities are literally magical.

But I have drifted into speculation, and the reader, following experience, must be wondering what hypnotherapy has to offer in this process. The answer, unfortunately, is “nothing.” Hypnotherapy is necessary only to divided minds. Those operating in the space of imagination no longer suffer from that limitation.

Of course, a hypnotherapist operating in the realm of imagination is an incredibly powerful aid to personal development. John Kappas and Milton Erickson are recent examples. I am suspicious, reading the reports of his faith healings, that Jesus also deserved the title.