Monday, October 7, 2013

The Reluctant Hypnotist

The most frequent criticism skeptics receive is that we are not open-minded. I’m sure this is true to some extent but contrary to popular belief, it is not a quality that defines us.  Sure, there are closed-minded skeptics just as there are many non-skeptics who are closed-minded to the value and validity of the scientific method. 

Most of the skeptics I’ve come across are actually what I like to think of as reservedly open-minded, which simply means that they defer acceptance of a belief until after they’ve been presented supporting evidence.  The only exception might be in matters of absolute implausibility based on a preponderance of scientific knowledge, past experience and logic (things like telepathic weight-loss, proven systems for winning the Mega-Lotto and the efficiency of government programs come to mind). 

Many other issues – those that seem to straddle the realms of possibility and unlikelihood – are downright intriguing to skeptics.  For me, one such issue is hypnosis.  I find the topic of hypnosis so intriguing, in fact, that I’ve actually dabbled in it.  I want to share my experiences and offer a rational explanation for what I witnessed.

A few summers ago, I was working as a pediatric hospitalist in South Texas in the midst of an epidemic of viral meningitis.  Nearly every day I was charged with admitting one or more children who presented to the hospital with high fever, chills, vomiting, a stiff neck and the worst headache of their lives.

The treatment for viral meningitis is “supportive”:  pain relief, rest and IV hydration in most cases. The majority of children feel much better after a few rather miserable days. Physicians also give intravenous antibiotics until they’re quite certain that the patient doesn’t actually have bacterial meningitis which is a life-threatening condition.  The only sure-fire way to distinguish viral from bacterial meningitis is to analyze the cerebro-spinal fluid (CSF) which bathes our brain and spinal cord. And the only way to do that is to do a lumbar puncture or spinal tap.

I’ve done hundreds of spinal taps in my life (most of them on infants) but I’ve never had one done on me.  I’m sure it hurts at least a little and, depending on how it’s done, sometimes it hurts a lot. With the exception of newborns, we try to eliminate the pain by using local anesthetics. But the injection of lidocaine to numb up the area stings in and of itself, and the sensation is augmented in a child or teenager who is ill to start with besides being terribly anxious. So we often must resort to providing some form of sedation (you really don’t want a child writhing and jerking when you’re about to insert a needle in their lower spine).

Sedation requires a much higher level of care.  You need adequate monitoring capabilities and more staff in order to quickly recognize and deal with any potential adverse effect from the sedative. You also must have the capability to provide life supportive measures should the child have a complication from the sedation.  In our hospital in South Texas the policy required placing these children in the intensive care unit.  Yet the ICU was often full and we were sometimes short-staffed. So what was one to do?

I was pretty convinced that if I could gain the complete trust of my young patients and succeeded at reducing their anxiety I’d be able to mitigate some or most of their pain.  So I decided to give hypnosis a chance.

My first experience with hypnosis was in high school when a stage hypnotist held a show at our school.  I was pretty darn impressed (but then again, I was a very gullible lad).  Still, I didn’t quite know what to make of the whole thing.  Were the participants on stage actually entering a different state of consciousness or were they just being driven to “play along” with the hypnotist’s suggestions due to some psychological prerogative of being the center of the show, not wanting to disappoint the audience, the hypnotist, or maybe both?  

In college, my studies (including a class titled, Altered States of Consciousness) did little to shed light on the issue.  Interestingly, I started gaining a clearer understanding about the phenomenon from the entertainment world, most recently from Derren Brown (if you don’t know who Derren Brown is, you just have to watch some of his videos which are everywhere on the internet).

So that summer, I decided to resort to hypnotism as an adjunct to local anesthetic in performing spinal taps on any child who was old enough to be able to listen to me and understand what I was saying.  I developed an “induction script” (the series of phrases designed to help subjects enter “trance”) that I felt comfortable with and refined and calibrated it for my purposes.  

The first patient I tried it on was a bright teen-aged girl.  She listened to my script, closed her eyes and lay perfectly still as I spoke to her in my best hypnotist voice.  When I decided to “test” the depth of her trance by suggesting that one of her arms was getting lighter and lighter, as though a bunch of helium balloons were tied to her wrist, her arm began to drift up in the air, at which point her mother (who was sitting quietly in the procedure room) leaned forward wide-eyed and  let her jaw drop.
The procedure went so smoothly that it was an absolute joy. When I was finished I asked the child if she had experienced much pain.  She said, “I didn’t feel a thing.”

My second patient was an extremely anxious boy who was the son of a high-ranking county official. The nurses had struggled to draw blood work and insert an IV because he was so terribly scared by the entire experience of being in the hospital. I honestly didn’t think my hypnosis would work at all with him.  But to my surprise, and to his mother’s utter delight, he too remained comfortable for the entire procedure and later told me, “That was great!”

Over the next few weeks I performed nearly two dozen lumbar punctures under hypnosis.  Most of the patients had extremely pleasant experiences. I was not able to provide comfort in one case.  Overall, I was very happy with the ability to comfort my young patients.  Some of the parents were skeptical at first but thrilled by the end result.  Nurses volunteered to assist me with the procedure, intrigued by the whole process.  None of my patients required ICU stays for sedation.
Let’s be clear. This is complete anecdotal experience, but will I perform hypnosis on the next child or teenager that needs a lumbar puncture?  Absolutely.

This is how I see it.  As a hospitalist, I was providing care to patients who in most cases I had never met.  Along with the anxiety sparked by the child’s illness and by the intimidating surroundings, there was the added apprehension that neither the family nor the child knew me.  So, how could they know if they should trust me?

Hypnosis, in my opinion, goes a long way in such a setting to establish trust.  I clearly communicated to the parents and the children that patient comfort and relief from pain were my utmost priorities.  This in itself was very reassuring.  I listened, answered questions and deliberately did not rush (the process of hypnosis does have a cost in terms of physician time, but is well worth it and may actually save a lot of time in the long run).

So do I believe that hypnosis is a true altered state of consciousness?  I’m still not sure.  I think that for most individuals it is simply a state of great relaxation, of extreme serenity and trust, and of heightened suggestibility.  To me, hypnosis is just an extension of good bed-side manners.  It is an explicit expression and demonstration of concern that requires an investment of time and patience. 
Besides benefitting the patient, hypnosis is a boon to the physician as well.  It helps to establish a cooperative and trusting relationship.  It creates a sense of goodwill and calm that is highly therapeutic for all involved.  And it helps you care more deeply for the patient, which is always a good thing.

And what about those stage hypnotists?  Is that stuff for real? I believe very different psychological mechanisms may be at work there.  I can’t say that I’m very concerned or impressed by them anymore (except for Derren Brown – he is beyond impressive; he’s outright fascinating, but of course he’s not technically a stage hypnotist).

As I was saying, skepticism is not a position of closed-mindedness.  In fact, it is frequently a position of absolute fascination and appreciation for the wonders of the universe.  It is a devotion to pursuing the truth wherever it may lead us.  But the pursuit of the truth is not likely to be fruitful when we leave the path of plausibility. And the truth does not require the investment of faith; it does not require us to believe first so that we may experience the truth first-hand; it does not demand that we forfeit thoughtfulness and a questioning, critical stance; it does not require the sacrificing of objective evidence in favor of subjective validation.

Call me the reluctant hypnotist;  just another soul trying to make sense of the utter complexity of the world we are part of, meagerly equipped with a fallible mind that is prone to error, easily seduced by the siren-song of false prophets but fortunately tied to the mast of a steady ship with the ropes of reason, empiricism and questioning. 

 Am I closed-minded?  I’ll let you decide.

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