Rebel Without a Cause (5 page)

A hypnoanalytic course of investigation or therapy is initiated by training in hypnosis. The writer’s method is first to instruct patients or subjects in the technique of achieving the trance state with a minimum of effort on the part of either participant. In a series of daily sessions wherein the aim is to enable a rapid passage from the waking state to sleep, patients are familiarized with hypnosis and its functions. The usual response—no matter what the condition of the patient or his problem—is a rapid mobilization of all those factors which comprehend a workable and manipulable transference. By the end of this preliminary period (to which no more than a week is given) that unique relationship is in a state of readiness for exploitation.

The close of the first week then finds the patient adept at passing confidently from a waking to a sleeping state almost on the merest suggestion of the clinician. If progress has not been unusually difficult during this time, the trance state will also have been explored and examined both for any special characteristics it may contain as such, or for any sequelae to which it might lead. In a statistically insignificant number of cases special reaction types to trance may be encountered which will enforce a slightly different approach; just as it will be necessary for alternate methods of inducing hypnosis to be utilized from time to time. (In this connection a case is recalled wherein traces of multiple personality were discovered during exploration of the trance. This caused a redirection and re-emphasis to be given to the entire problem.) So far as exceptional sequelae to trance are concerned, none have been observed in the experience of this reporter; but the caution would seem to be in order in view of the paucity of knowledge on this score.

Energy should also be devoted to ‘depth levels’ of trance and to the problem of post-hypnotic suggestion. Testing for depth of trance is simple but most important. As will be shown, in distinguishing
real from screen memories it is often necessary to achieve a decisive penetration (viewing the trance state as a vertical phenomenon) through progressive removal of the patient’s ‘conscious’ control over his utterances. Finally, the “training-in-hypnosis” period should not be abandoned until it has been established that post-hypnotic suggestions are carried through in a fashion that leaves no doubt of the mastery of the situation by the operator. It is necessary that amnesia and recall be emphasized in this connection. Patients should be brought to the point where, on the suggestion of the clinician, they are able either to recall accurately or forget completely what has transpired during a session.

The second phase of the work deals with recall under hypnosis. The aim is to develop the facility of a patient in reverting (
Cf.
below) to earlier times and places, at the same time presenting them for consideration in as explicit a fashion as possible.

It is best that encouragement in recall under hypnosis proceed cautiously and by easy stages. Experience shows that the method of choice is one in which the patient is requested to remember and report events of the instant day, then of immediately preceding days, finally of preceding weeks. Often this requires some ‘scene-setting’ on the part of the hypnoanalyst: and he should be prepared for such tasks by an acquaintance with at least the formal history of the patient.

Toward the close of the second week a patient or subject should possess a number of accomplishments which are prerequisites for successful therapy or research. He should be able to enter a deep trance almost as soon as he is instructed to do so; he should be able to revert memorially to earlier periods of his life: he should be able to verbalize while in the trance state: he should be able to carry out suggestions for post-hypnotic behavior especially as these apply to recall or amnesia. By this time, moreover, he will have entered into a reciprocal rapport with the hypnoanalyst that will bear fruit in the work on which they will presently become engaged.

During the approximately two weeks of preparation, that which led the patient to seek out the clinician is not touched upon formally. It has been found that one runs the danger of precipitating a change in a patient’s attitude if, during the training phases, symptoms, complaints,
characterological problems or conflicts are discussed. He is likely to feel—with some justification—that his difficulties are not being given the attention they deserve. In general, it is feasible either to explain or to state categorically that the initial period of treatment is to be devoted solely to mastering a special technique.

Following the sessions devoted to training, the actual hypnoanalysis is entered upon. As in other forms of psychotherapy, the patient is seen daily. He is instructed to utilize the method of free-association; to begin each session with whatever topic he brings to the hour, or whatever occurs to him at the time. Alternate procedures are available for the clinician in the matter of deciding upon the point at which free-association should be abandoned and the analysis aided by hypnosis. In the case which is presented in this volume—the first of a long series to be handled hypnoanalytically throughout by this writer—hypnotic recall was delayed until it became apparent that the resistance to disclosing crucial material was of serious proportions. Latterly, however, it has been found efficacious to hypnotize
immediately upon striking the variety of resistance which does not originate from the transference.
That is, where resistances are encountered, and where they arise naturally rather than from a shift in
entente
between the participants, hypnosis should be resorted to at once; and under its influence the patient encouraged to reveal what he had been withholding so reluctantly. Such revelations can be expedited merely by repeating to the patient the last few associations and recollections he had produced prior to the hypnoidal sleep. Following the subsequent disclosures during hypnosis, it is necessary to give the patient complete amnesia for the events that transpired
after
he had been placed in the trance. At the following session, however, the key associations,
i.e.
those which had been given by the patient immediately before he was made to sleep, are again presented.

Now it is a constant and unvarying phenomenon that patients repeat, soon after such an hypnoidal session, the material which they had already presented
if it is memorially valid and not a screen-memory.
The importance of this fact cannot be over-estimated. It provides us, first of all, with an objective tool for estimating the validity of analytical material and, secondly, with a prepotent weapon for the literal disintegration of resistances. Apparently the mechanism
involved is that of a subliminal appreciation by the organism of diminished ‘need’ for preserving secrets. In spite of the complete induced amnesia—which can be proved beyond question—the material which resisted disclosure actually flows as smoothly post-hypnotically as if no reluctance against its production had ever been present. This single benefit of hypnoanalysis is perhaps responsible for the saving of more than half of the total treatment-time. It effectively counters the already-noted objection that the total personality rarely if ever participates in the disclosures made under hypnosis, and removes what was perhaps the only objection to the employment of hypnosis in the treatment of psychogenic disorders that ever counted for very much in an academic or practical sense.

As to the memories which in the course of hypnoanalysis are called forth by hypnosis, Erickson has best described the two forms in which they appear. He distinguished—as the reader will undoubtedly do during his review of the material presented—the
regressive
and the
revivified.
With the regressive, memories appear in terms of the patient’s or subject’s present regard of his past. That is to say, his attitude toward what has happened to him is predicated on his present understanding of his recollections and colored by the sum of his experiences since the events he reports. Such memories, as they come to the surface, reveal themselves as regressive by the fact that they are more frequently than not accompanied by expressions of value or attitudes of judgement. In the revivified form, the patient actually lives again the time of which he is telling; and it exists
now,
uninfluenced by the accumulations of life since the event. The revivified form of recall discloses itself, for the most part, behaviorally. In other words, the hypnoanalyst by observing the motor performing of the patient during the recital under hypnosis of a crucial historic episode can not only distinguish it as revivified, but he can also determine (often more accurately than by any other method) the exact period of life when it transpired. Scrutiny of the motor apparatus in terms of skill and coordination, and comparison with known developmental standards (
e.g.
Gesell’s) provides a useful time-line.

The types of recall which appear under hypnosis furnish handy manipulative machinery for the hypnoanalyst, who can so control
them as to substantiate his material, fill in detail, make his data vivid and alive. It has been found that although these memorial varieties appear spontaneously, apparently in no set sequence and responsive to no set laws, they can be invoked by a simple formulation under hypnosis. This increases their value many times, for in practice one can observe and record exactly the effect of an event on the patient at the time of its occurrence, as well as the attitude toward it that is maintained at the time of treatment.

Hypnoanalysis takes its place among the active forms of psychotherapy in contrast to those genera which require patients to find their way alone through the psychologic maze. It therefore requires the constant direction of the clinician, who must decide when to employ hypnosis, when to encourage free-association, when to employ revivification or regression, when to demand abreaction in the waking state, when to engraft the interpretations and significances directly onto the personality. The last is probably the most delicate and skill-demanding of all the hypnoanalyst’s tasks. In orthodox analysis the acquiescence of the patient in the new attitudes and ways of behavior is demonstrated by verbalization as well as by action. Apart from utilizing the transference to insure acceptance and comprehension, other means are not available. Hypnoanalysis, on the other hand, has at its command not only the transference but also the prepotent post-hypnotic suggestive method to enforce comprehension and acceptance of those necessary but novel ways of regarding the past, new attitudes, ambitions and patterns of behavior. Through this means the benefits of treatment are assured. And through this means as well is the transference at last dissolved by the displacement and redirection of its energies into the paths prescribed by the recently acquired and developed insights. In all essentials, this is the re-educative process.

The pith and purport of the method of hypnoanalysis as it has been employed in the case to be reviewed and with other patients and conditions as well are contained in the foregoing. It is, like other ways of approach to the functioning organism, an art requiring a blend of technological skill and judgement and knowledge. In the author’s opinion, it is an approach that offers a rapid, sure and valid way to the understanding and treatment of psychogenic disorders
and aberrations of behavior. Its applicability seems limited only by the professional equipment and deftness of the hypnoanalyst. Thus far it has been applied in a wide range of diagnostic entities with a degree of success and a range of usefulness that promises brilliantly for the time when its principles are more fully comprehended.

Beyond everything, however, the success of hypnoanalysis in penetrating to the core of psychopathic personality for the first time in the long history of psychological concern with this puzzling classification, warrants the direction upon it and its tenets of experimental and clinical regard.…

The history of Harold, our subject, has been made available to the writer in many forms. Each of his delinquent acts when subject to court review was supplemented with detailed social service investigations according to the admirable latter-day judicial routine; and on the occasions of his incarcerations further study was made of the essential features of his home, family and personal life. Rarely has a clinician been provided with a more complete and documented anamnesis. This material proved eminently useful as a constant check and source during the hypnoanalysis, and provided a frame of reference, almost a topography, for the incidents and events elicited from the patient.

Harold’s father, an unnaturalized Pole and a machinist by trade, came to the United States during the great exodus from Europe at the turn of the century. He was a big, bluff, hearty peasant of excellent work habits. Within a short time he met and married the native-born girl who became Harold’s mother; and having settled in an industrial suburb of a large city in the East the couple soon became the parents of our subject and in time of two daughters. The father contracted an occupational disease early in his career, and the medical regimen imposed on him forced his abandonment of factory employment but permitted his occupation in a free-lance manner. His average earnings, computed over many years by social workers, were twenty-five dollars a week. Investigators described him as a hasty disciplinarian who is more ready with curses and unkind words than blows. He does not smoke or use intoxicants, is cut off from his family by reason of his unfamiliarity with English and his illiteracy (despite his long residence in this country); and the fact that his standards are, on the whole, old-world and markedly unprogressive. His reputation in the community is excellent and his affiliations with Polish-American organizations have resulted in firm if taciturn and blunt friendships with men of his own temper and kind. Now, at fifty-three, he is still pursuing his trade, more frequently, however, eyeing pastures he should have cultivated twenty years ago. He claims even at this date an interest in Harold, but investigators note his lack of patience toward his son’s problems.