The Early Period A Pessimistic View Of Hypnosis With Severely Disturbed Patients

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The current status of clinical hypnosis in the treatment of Personality and Psychotic Disorders has been evolving since the mid-1800s. The earliest notation of successful hypnosis with a psychotic patient was reported by Esquirol in 1838. In this report, Esquirol described experiments done by Abbe Faria and himself in 1813 and 1816 on the effects of magnetism in mental disease. Esquirol reported that he and Faria experimented on eleven women, either insane or monomanic. He stated that only one of these eleven women responded to the magnetic influence (Lavoie & Sabourin, 1980).

Later, in 1868, Dr Andries Hoek, a practicing physician in The Hague, reported on his successful treatment of a psychotic patient with hypnosis in 1851 (van der Hart & van der Velden, 1987). Following this report by Hoek, the French psychiatrist Auguste Voisin also reported positive clinical work with psychotic patients (1884, 1887, 1897a,b). Voisin described work with patients with delusional psychotic conditions and was enthusiastic about the therapeutic results of the use of hypnosis with these conditions. Voisin estimated that 10% of the psychotic population was hypnotizable.

However, following these moderately encouraging reports of Esquirol, Hoek and Voisin, several subsequent clinical reports indicated varying and conflicting results with hypnosis and severe mental illness. Pitres (1891), reporting on his clinical studies with psychotics, concluded that persons suffering from nonhysterical delusions did not usually profit from 'suggestive therapy'. Terrien (1902) concluded from his studies that hypnotism was not useful in the treatment of severe mental

* See the Editor's Note on page 186.

International Handbook of Clinical Hypnosis. Edited by G. D. Burrows, R. O. Stanley and P. B. Bloom © 2001 John Wiley & Sons, Ltd illness in general. Tuckey (1902) also concluded that the possibility of hypnotism being successful in the treatment of severe mental illness was very poor. Gilles de la Tourette (1889) reported, in partial agreement with Pitres, that hypnosis was successful only with delusional hysterics or manic patients. Grasset (1916) concluded that hypnosis did some good for hysterical psychotics (if they were hypnotizable), but he did not feel that hypnosis was useful for psychotic disorders of attention, or 'true psychosis'. In general, many clinicians in the late 1800s and early 1900s held a rather pessimistic attitude toward the hypnotizability and use of hypnosis with psychotics, but nevertheless reported on some successful and useful individual cases (Lavoie & Sabourin, 1980).

However, an exception to this pessimistic attitude was presented by Wetterstrand (1902). With unusual perceptiveness and foresight for his time, Wetterstrand stated that the main difficulties in utilizing hypnosis with severely disturbed mental patients were the difficulty in obtaining consent of the subjects and the difficulty in maintaining their attention and cooperation over a sufficient time period. Wetterstrand concluded that hypnosis could be possible and useful in certain stages of psychosis depending on these factors of attention and cooperation. He further proposed that, in order to work successfully with psychotic patients with hypnosis, it was essential to reach the subjective world of the patient. Wetterstrand also reported some success in clinical hypnosis with psychotics in influencing various symptoms, including hallucinations and persecutory ideation.

Again sounding a more pessimistic note, Copeland & Kitching (1937) reported on a study utilizing hypnosis in the diagnosis and treatment of severely mentally ill hospitalized patients. They concluded, with somewhat circular reasoning, that 'true psychotics' could not be hypnotized. They stated that, 'If susceptibility to hypnosis developed, we were compelled to reverse the diagnosis'.1

As recently as the mid-1900s, clinical reports continued to note the difficulty of utilizing hypnosis with psychotic patients (Schilder & Kauders, 1926 [1956]; Kraines, 1941; London, 1947). However, they also began more frequently to note limited, specific areas of successful hypnotic work with psychotic patients. Schilder and Kauders noted that cases of schizophrenia that initially presented the clinical picture of neurosis were frequently amenable to hypnotic intervention. London reported the uncovering of important clinical material in the hypnotic treatment of a paranoid condition.

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