When a newly burned patient arrives in the Emergency Room, his mind is concentrated and hypnosis is easy to induce if he is not already in a spontaneous trance. He is often a stranger to the physician, and the first communication is an introduction and suggestion:
Verbalization Comment doctor: I'm Dr-and I'll be tak- This question is to bring to his immedi-
ing care of you [pause]. Do you know ate attention that he does not know and how to treat this kind of burn? that he must put his faith in the medical team. Precise wording is important because if you ask 'Do you know anything about treating burns?' he may think he knows something and tell you about butter, Solarcaine, or kiss-it-and-make-it-well, which is complete avoidance of recognizing the dependence.
doctor: That's all right, because we The standard reply. In the rare instance know how to take care of this, and of a physician or nurse who actually you've already done the most impor- does know about burns, you simply use tant thing, which was to get to the that knowledge to say: 'Then you al-hospital quickly. You are safe now, ready know that you need to turn your and if you will do what I say, you can care over to us and that we will take care have a comfortable rest in the hospital of you'. This exchange lets the patient while your body is healing. Will you know that he is on the team and has do what I say? already done his biggest job, so he can safely lay aside his fight or flight response (he's already fled to the hospital), which mobilizes hormones that interfere with normal immunity and metabolism. It includes a prehypnotic suggestion (Alexander, 1971) that he is safe and can be comfortable if he makes a commitment. With his affirmative answer he has made a hypnotic contract that is as good as any trance. Frightened patients tend to constantly analyze each sensation and patient : Yes [or 'I'll try'].
new symptom to report to the doctor. By turning his care over to us (the whole team), he is freed of his responsibility and worry. Next, his attention is diverted to something he had not thought of before.
doctor: The first thing I want you to Even dark-skinned patients are aware do is turn the care of this burn com- of this phenomenon in light-skinned pletely over to us, so you won't have people. to worry about it at all. The second thing is for you to realize that what you think will make a great deal of difference in your healing. Have you ever seen a person blush red, or blanch white with fear?
patient : Yes.
doctor: Well, you know that nothing The patient needs something he per-has happened except a thought, an ceives as useful to occupy his mind. The idea, and all of the little blood vessels laughing place may be the beach, televi-in the face have opened up and turned sion, fishing, golfing, needlepoint, playred, or clamped down and blanched. ing dolls, anything. It becomes the key What you think is going to affect the word for subsequent rapid induction for blood supply to your skin, and that dressing changes, and so on—to simply affects healing, and you can start right 'go to your laughing place.' now. You need to have happy, relaxing, enjoyable thoughts to free up all of your healing energy. Brer Rabbit said 'everybody's got a laughing place,' and when I tell you to go to your laughing place, I mean for you to imagine that you are in a safe, peaceful place, enjoying yourself, totally free of responsibility, just goofing off. What would you choose for a laughing place?
doctor: Let's get you relaxed and go to your laughing place right now, while we take care of the burn. Get comfortable and roll your eyeballs up as though you are looking at the top of your forehead and take a deep, deep, deep breath and as you take it in, gradually close your eyelids, and as you let the breath out, let your eyes relax and let every nerve and fibre in your body go [slow and cadenced] loose and limp and lazy, your limbs like lumps of lead. Then just let your mind go off to your laughing place and ... [visual imagery of laughing place].
It helps the doctor to know what the laughing place is and to record it, because he may enhance it later with some visual imagery. This simple rapid induction usually produces a profound trance almost immediately.
This short amount of conversation does not ordinarily delay the usual emergency hospital care. Most often, when the patient arrives in the Emergency Room an analgesic is given, blood is drawn, IV drips are started, and cold water applications are put in place by the time the doctor arrives. If not, these can proceed while the conversation takes place. A towel dipped in icewater produces immediate relief of the burning pain that occurs right after a fresh burn. Since frostbite is as bad an injury as a burn, the patient should not be packed in ice, but icewater towels are very helpful. In fact, Chapman (Chapman, Goodell & Wolff, l959a) showed that applying icewater to a burn holds the inflammatory response in check for several hours, so there is ample time to call for the assistance of a qualified hypnotist if the primary physician is not skilled in the technique of hypnosis.
Verbalization doctor: Now while you are off at your laughing place, I want you to also notice that all of the injured areas are cool and comfortable. Notice how cool and comfortable they actually are, and when you can really feel this, you'll let me know because this finger [ touch an index finger] will slowly rise to signal that all of the injured areas are cool and comfortable.
By this time, the patient has iced towels on and the analgesic is taking effect so that he actually is cool and comfortable. It is much easier hypnotically to continue a sensation that is already present than it is to imagine its opposite. The suggestion 'cool and comfortable' is anti-inflammatory, and if he accepts it, he cannot be hot and painful. From now on, the word injured is substituted whenever possible for the word burn, because patients use the word burning to describe their pain. (Do not specify a particular area such as hand, neck, etc., because while these areas may do well, some area you forgot may do poorly.)
doctor: [after obtaining ideomotor I then leave the patient in trance, go signal] Now let your inner mind lock ahead with his initial care, and get him in on that sensation of being cool and moved to the Burn Unit. Often, he will comfortable and you can keep it that drop off to sleep. way during your entire stay in the hospital. You can enjoy going to your laughing place as often as you like, and you'll be able to ignore all of the bothersome things we may have to do and anything negative that is said.
doctor: Go to your laughing place. On subsequent days, this is all the signal the patient usually needs to drop into a hypnoidal state and tolerate bedside procedures, physical therapy, and so on.
With burns covering less than 20% of the body surface, the single initial trance generally suffices, while in more extensive burns, repeated suggestion helps control pain, anorexia, and uncooperativeness (Crasilneck et al., l955; Ewin, l973; Schafer, l975; Wakeman & Kaplan l978; Knudson-Cooper, l98l; Patterson, Everett, Burns & Marvin, 1992). In more extensive burns requiring multiple surgeries, the patient's outcome may be influenced by subconscious hearing of pessimistic conversation while under general anesthesia (Ewin, 1986a,b).
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HYPNOTISM is by no means a new art. True, it has been developed into a science in comparatively recent years. But the principles of thought control have been used for thousands of years in India, ancient Egypt, among the Persians, Chinese and in many other ancient lands. Miracles of healing by the spoken word and laying on of hands are recorded in many early writings.