Clinical Accounts

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The Marquis de Puysegar in 1784 expressed concerns about the potential adverse effects of hypnosis when he created 'accidental somnambulism' (Conn, 1981). By the middle of the nineteenth century, frequent concerns were being raised about the use of hypnosis, although in the first instance these related to the manipulation of patients to act against their will or to their seduction (Conn, 1981; Reiter, 1958).

Clinical accounts of complications arising from hypnosis appeared sporadically and in his landmark text on fact and fiction in hypnosis, Marcuse (1959) highlighted 11 major areas of concern. These related to the psychological well-being of the subject involved; suggested physiological sequelae; acute distress reaching hysterical proportions; and hypnotically suggested mutism, blindness, or disturbances of memory. These generally resulted from the inexperience of the clinician involved and complications in the suggestions or metaphors used, rather than the hypnosis itself.

In the first half of this century numerous reports appeared concerning the sequelae of hypnosis. Hilgard, Hilgard, and Newman (1961) reviewed this literature in which it was claimed that headaches, tremor, neurotic and psychotic symptoms could arise from the clinical application of hypnosis. They noted 15 cases of hypnosis related to the development of psychotic symptoms in the previous 50 years and argued that, in most cases, these adverse effects occurred in subjects who had a long history of pre-existing disturbance.

Meldman (1960) reported a case of 'personality decompensation' following hypnotically based treatment for a flying phobia. Rosen (1960) warned against the ineffective management of abreactions and unspecified psychological sequelae. Meares (1961) expressed concerns about the application of hypnosis with the overly dependent personality type; the pre-psychotic schizophrenic patient; the schizoid personality type; and the depressed patient. He highlighted problems that might arise in dealing with acute panic reactions, abreactions, the incomplete removal of non-therapeutic suggestions, difficulties in terminating 'trance' and symptom substitution. Similarly, Haberman (1987) reported a deterioration in psychological functioning when a non-professional practitioner used hypnosis with a patient with pre-existing psychotic difficulties.

Concerns about the potential for the use of hypnosis to encourage the acting out of suicidal ideas in the depressed patient have been expressed by many clinicians and researchers. Cheek and Le Cron (1968) warned against the use of hypnosis with depressed patients. Similarly, Spiegel and Spiegel (1978), Miller (1979), Burrows (1980), Crasilneck and Hall (1985) and Watkins (1987) expressed the same concerns about the potential for hypnotically based treatments encouraging patients to act on suicidal ideation. Such views are not universally accepted, particularly by those who use indirect techniques (Gilligan, 1987; Yapko, 1992), but even here there is the caution about the care needed in selecting appropriate techniques.

In a dental setting, Kleinhauz and Eli (1987) reported four cases of anxiety, depression, post-hypnotic confusion, and cognitive impairment after the clinical use of hypnosis.

Kleinhauz and Beran (1981) reported on a case where 'stage hypnosis' appeared to precipitate a severe psychological reaction which resulted in threats to the sufferer's physical health and resulted in several hospital admissions. Kleinhauz, Dreyfuss, Beran and Azikri (1984) also reported a case of 'stage hypnosis' being implicated in a participant's psychological distress including anxiety, depression and 'episodic psychotic decompensation' in a subject with pre-existing traumatic experiences. Kleinhauz and Beran (1984) described two further cases where hypnosis appeared to precipitate depression and antisocial behavior respectively. Similarly Allen (1995) reported on an the apparent precipitation of a 'schizophreniform psychosis' following involvement in hypnosis in the setting of 'entertainment'.

Page and Handley (1990) reported two cases of adverse effects in a research setting.

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