Controversies Surrounding The Use Of Hypnosis With The Dissociative Disorders

Many controversies currently surround the use of hypnosis with the dissociative disorders. Although they constitute an area of considerable interest, limitations of space preclude their extensive discussion here. The interested reader is referred to more thorough explorations elsewhere (Kluft, 1995b,c, 1997a).

Arguments for the efficacy of hypnosis in the treatment of the dissociative disorders have been countered by concerns that hypnosis has the capacity to play a role in the formation of pseudomemories or confabulations, that the recovery of memories of childhood traumatisations may not be possible, and that hypnosis may play a role in the iatrogenesis or worsening of dissociative identity disorder. Furthermore, it has been argued that trauma may not be at the root of many of these disorders, so that hypnotic searching for antecedents may generate confabulations with far-reaching consequences. At this moment in time, it is clear to those who are not dominated by ideological concerns and/or political agendas that no single polarised argument has succeeding in driving its opponent from the field. Although some evidence is more supportive of one stance than another, all perspectives have contributions to make to this complex area of study, and a rational view of the subject precludes the complete or peremptory discounting of either perspective. Scholars and clinicians who take into account all available data (e.g., Alpert, 1995a; Brown, 1995a,b; Brown, Scheflin & Hammond, 1997; Hammond, Garver, Mutter et al., 1995; Kluft, 1984, 1995b; Nash, 1994; Schacter, 1996; Schooler,

1994; Spiegel & Scheflin, 1994; van der Kolk, 1995; van der Kolk & Fisler, 1995), acknowledge from the first that once unavailable memories can be retrieved in some instances, and that there are occasions when pseudomemories may be encountered; they are disinclined to be peremptorily dismissive or to take extreme polarised positions.

With regard to the dissociative disorders, there are many expressions of opinion, but few relevant published studies. Numerous studies demonstrate that Dissociative Identity Disorder patients generally have experienced genuine trauma (Bliss, 1984; Coons 1994; Coons & Milstein, 1986; Hornstein & Putnam, 1992; Kluft 1995b), even if materials that they produce in therapy may not always have genuine historical antecedents (Kluft, 1996). Without making efforts that violated the frame of therapy, Kluft (1995b) was able to corroborate memories of abuse in 56% of 34 patients with dissociative identity disorder. Of those with confirmations 53% had always recalled the abuses that were documented. However, 68% obtained documentation of events that had not been in memory until they were retrieved in therapy. Of patients with memories retrieved in therapy 85% had retrieved the confirmed memory (ies) with the help of hypnosis. The study also found allegations of abuse could be disconfirmed in 9% of the patients; in none of these cases was the pseudomemory the product of heterohypnosis. This study demonstrates that a strong stance against the possibility of the retrieval of once-unavailable memories is not defensible. Nor is it possible to justify a stance that the use of hypnosis invariably is associated with the retrieval of confabulations.

Ross and Norton (1989) were able to show that the use of hypnosis does not have a major effect upon the phenomenology of Dissociative Identity Disorder. Nor does a clinician's interest in Dissociative Identity Disorder appear to make a significant impact upon the phenomenology manifested by his or her patients (Ross, Norton & Fraser, 1989). At this point in time, allegations that the use of hypnosis or the interest a clinician shows in the condition can lead to the iatrogenic creation of dissociative identity disorder continue to be made, but they remain unproven.

The argument that true dissociative identity disorder is rare, and therefore the discovery of many modern cases argues for iatrogenesis, is countered by the fact that studies made with reliable and valid structured instruments in several countries show that the condition is, in fact, fairly common. Ross and his colleagues in Canada (Ross, 1991); Saxe and his colleagues (1993) in the United States; Boon & Draijer (1993) and their associates in the Netherlands; Knudsen, Haselrud, Boe, Draijer & Boon (1995) at the Stavangar clinic in Norway, all have found that previously undiagnosed dissociative identity disorder patients constitute between 3 and 5% of psychiatric inpatients in acute settings. Additional similar studies are underway in Germany and Turkey. Here again, the allegation of iatrogenesis remains easy to make, but it is extremely difficult to elevate such allegations from the level of an accusation to the level of a proof or demonstration (Kluft, 1995c). Without denying the possibility that iatrogenic pressures can transiently induce some of the major symptoms of dissociative identity disorder, proof of the iatrogenic creation of a full-fledged and stably established case of dissociative identity disorder remains to be presented. For example, Spanos' (Spanos, Weekes & Bertrand, 1985; Spanos, Weekes, Menary & Bertrand, 1986) experimental creation of some dissociative identity disorder phenomena under laboratory conditions does demonstrate that such a role can be induced, but it does not establish the actual condition. One must be cautious about behavioural manifestations being overinterpreted, lest, by analogy, those subjects induced by a stage hypnotist to enact the social role of a chicken be taken home and cooked for dinner!

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