Introduction: "Until 1935 physicians relied heavily on God and the deep seated, instinctive will of patients to survive grave threats to life. Since the advent of sulphonamides, antibiotics, corticoids, blood banks, biologic monitoring devices, intensive care units and computers, there has been a tendency to forget the patient. This is a plea for the recognition of the fact that patients are people who can be frightened to death, condemned to long hospitalization, or helped to overcome great odds according to the quality of the information they receive from their attendants." Ernest Rossi and David Cheek. It is not necessary for hospital staff (or any other person for that matter) to be trained in the formal hypnosis models in order to deliver effective hypnotic suggestions to another person. These things are already happening all the time. I am sure I am not the first person to suggest that giving staff formal hypnosis training would actually act to help them stop giving hypnotic suggestions that inadvertently interfere with the well being of their patients. Whilst the terms "hypnosis" and "hypnotic suggestion" will conjure up different things for different people, I suspect that most laymen will consider hypnosis to be a special or even magical skill that lies in the possession of very few. For the sake of this essay, I would like to consider hypnosis as simply referring to a communication that asserts an effect upon the recipient's psychophysiology. By "effective hypnotic suggestion" I do not intend to imply that this refers to only beneficial suggestions and outcomes, but rather is a suggestion that creates a psycho-physiological change in the recipient, regardless of whether the psycho-physiological change is beneficial or not. I also recognize that these changes can occur independently of the intentions of the speaker. It was several years ago that myself and two hospital porters were taking a partially sedated patient to the operating rooms for surgery when a senior nurse called out to him, "Good luck, James!" A few seconds later as we moved down the corridor, James looked up to me and asked, "Do I really need luck? What does she know [that I don't know]?" Awareness Under Chemical Anaesthesia: "...particularly impressive have been some of the reports about what we may call 'fatty' comments where a surgeon made an insulting remark in reference to someone's weight during surgery. It is particularly impressive that such comments, unconsciously registered, seem to be capable of causing continuing psychosomatic problems and can be traumatic enough to cause post operative complications, depression and vegetative responses. A lawsuit has now been settled out of court concerning a 'beached whale' comment made by a surgeon around an anaethetised patient, which was recalled several days later by the patient and confirmed by a nurse who was present." It is my experience that all too often, innocuous and seemingly friendly remarks and communications have an adverse effect upon the patient, independent of the member of staff's intention and even if not directed at the patient himself. Imagine for example the simple comment from a tired nurse to a colleague as she expresses, "You know, I cannot wait for this shift to be over!" It may be just that she is tired, or maybe that she has a great party to go to, but how would such a comment be viewed (and felt) by the overhearing patient who owing to their condition has been dependent of this particular nurse all day? Such a comment, without negative intention, may be the difference that tilts the patient towards helplessness and thus depression and impedes recovery. A while ago I asked a colleague to return to me some important research papers I had lent to him. I wasn't going to see him again until the following Wednesday and I asked that he return them to me then. "I'll try to remember to bring them" he told me. My brain registered the word "try" and inside my head I pictured him saying to me next Wednesday, "I am sorry, but I did try to remember." I strongly suspected that without intervention, I would not be seeing my research papers when I needed them. Hypnotists will often utilize the word "try" to imply failure as it provides permission to fail. People will also hear it differently. For example, the stage hypnotist in the process of selection of volunteers may well have the audience collectively clasping their hands together, being urged to do so ever tighter and tighter. And then, with the same amount of urgency, the hypnotist will suggest that they all now try to pull their hands apart. Now, there is no secret to this. Whilst in a big enough audience, there may well be one or two people genuinely hypnotically stuck with their hands together, what is going on for the majority who remain standing, hands apparently stuck is that they haven't been told to pull their hands apart. Of course, they really could if they wanted to, but what they are doing is the activity of trying. I have often heard inexperienced hypnotists tell their clients to "try to relax" and on one occasion, to an already happily relaxed client, "try to relax and try to forget about all your worries and concerns that will stop you from going into trance." The physiological shift in this client from one of comfort to discomfort was noticeable as he was inadvertently reminded to consider all the worries and concerns that might prevent him from relaxing further. In any form of health care provision, rapport is very important as people tend to move away (either physically or mentally) from anyone that makes them feel bad - this may play a huge factor in the non-compliance behaviours so often witnessed in health care environments. In the West, with the impact of science and anaesthesia, medical treatments are not expected to hurt. An effective medicine no longer needs to taste very bitter in order that it is perceived as being a good medicine. It is unfortunate then that within the strong hierarchies that exist within hospital cultures we persistently find a small but significant number of individuals who wield their status and power to coerce, intimidate and dominate junior colleagues. It would be hard to correlate, but I cannot help but think that such behaviours have a knock on effect throughout the social system of the care environment ultimately manifesting as delayed healing times in the care recipients. A mistake that is common to many therapists of various fields is the operating belief that the subject or patient responds to the techniques employed by the therapist rather than to the quality of the delivery and the behaviour of the therapist themselves. The relationship the therapist forms with the patient is also critical in this context. In the case of hypnotherapy, a situation commonly arises whereby the subject sits there with eyes compliantly closed as the hypnotist laboriously reads a pre-written script at the subject. Meanwhile, the client is running an internal dialogue to the effect of, "this isn't working, I cannot be hypnotized." To hypnotists who do read scripts at the clients, I offer this advice. Just send them a copy of the script so they can read it themselves and save themselves on the bus fare. With an ever increasing emphasis on standardization of medical treatments we see a two fold result occurring. Firstly, and most importantly, the overall standard in the delivery of care countrywide increases. But secondly, we also witness a squashing of ingenuity and creatively it becomes increasingly harder to be outstanding in the field when the behaviours of care staff are reduced to that of a set of automated responses set against sets of automated criteria. Of course the net effect of all this is that the person that is behind the set of symptoms and criteria is frequently forgotten. And, with the increase in the use of modern technology to monitor and measure these patients we have a situation best summed up by neurologist Dr Richard Cytowic: "Care is something we deliver when we don't have a machine to do it for us." When a patient is in intensive care - his blood pressure is monitored both by automated cuff and via an indwelling arterial catheter; his breathing maintained and supported by a ventilator, his blood pressure and renal function supported by inotropes, parenteral nutrition supplied intravenously, pressure sore risk eliminated by use of flotron mattresses etc etc, when surrounded by all this life-supporting technology and monitoring, it is easy to understand how medical and nursing staff dismiss something as apparently trivial as their use of their voices as an aid to healing and recovery. As one surgeon suggested to me in ITU - we don't really make people well here, the body heals itself, we just try to keep them alive long enough to allow that to happen. Two useful patterns utilized in hypnosis are those of the contingent and adjunctive suggestion. These are common in everyday language and are an exceptionally effective hypnotic tool. Most people use these patterns every day without realizing that they are doing so. The effectiveness of this type of suggestion comes from the way that the suggestion is given on the back of an activity or behaviour that is already occurring. For example, "When you are in town, will you please buy me a pint of milk" and "If you go past the kitchen, will you make me a cup of tea." Now an aspect of these suggestions to bear in mind is that they are not asked as questions, in so much that they are not stated with an upward inflection (indicating a question) but rather with a downward inflection (command). There is no need to overemphasise the intonation, as a casual tone will usually suffice. In the anaesthetic rooms, I often hear anaesthetists say something like, "as I inject this you will begin to drift off to sleep" and then stop there, missing a rich opportunity to deliver additional suggestion. Some will encourage their patient to try to count from one to ten to see how far they can get - few make it past 7, as intravenous barbiturate has a rapidly sedating effect. Since drifting off to sleep is an inevitability and is perfectly predictable in terms of the anaesthetic rooms, we have ourselves an opportunity to create a chain of suggestion...continued....
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