Ever since mankind first sought help from his fellows for his afflictions of body or mind, confidence in the efficiency of the adviser’s ability has been an essential factor in leech-craft. To be able to convince a patient that he is going to recover and that medical advice will help towards that end is certainly not the least of the physician’s qualifications. But unless the assurances given him are based upon real insight and understanding, the process of securing the patient’s confidence is not very different from the charlatan’s blatant boasting. In other words, it is analogous to the confidence trick.
The confidence which is inspired in the patient by his conviction of the physician’s real understanding of his condition is an altogether different matter. Such “suggestion” necessarily enters into all successful treatment and this applies in a very special manner to the cure of mental ailments.
But the question arises, is it useful or desirable to supplement these measures of suggestion which are incidental to all human intercourse, by more positive measures of induced “suggestion” or hypnotism? There are wide discrepancies of opinion with regard to this matter. And, in endeavouring to come to a conclusion concerning it, it is important to eliminate as far as possible the emotional tone which the warm discussion of this question has aroused in the past.
The positive usefulness of hypnosis in relieving many of the acute symptoms in recent cases of shell-shock has been fully demonstrated by the important series of articles by C. S. Myers, in the Lancet.[32] When it is possible by such means to restore to the patient his lost memory or speech or banish his despondency it often proves that the only hindrance to the complete restoration of his normal personality has been removed.
“It may be argued,” to quote Myers’s own account, “that mutism, rhythmical spasms, anæsthesia, and similar purely functional disturbances disappear after a time without specific treatment. But no one who has witnessed the unfeigned delight with which these patients, on waking from hypnosis, hail their recovery from such disorders can have any hesitation as to the impetus thus given towards a final cure. More especially is this the case in regard to the restoration of lost memories. Enough has already been said here about the striking changes in temperament, thought, and behaviour which follow on recovery from the amnesia... The restoration to the normal self of the memories of scenes at one time dominant, now inhibited, and later tending to find occasional relief in abnormal states of consciousness or in disguised modes of expression—such restoration of past emotional scenes constitutes a first step towards obtaining that volitional control over them which the individual must finally acquire if he is to be healed.
Thus the minimal value that can be claimed for hypnosis in the treatment of shock cases consists in the preparation and facilitation of the path towards a complete recovery.”[33]
Even if we admit that other measures, such as the administration of chloroform for the cure of hysterical mutism, may in some cases effect similar improvements, this should not blind us to the incontrovertible fact that hypnotism has been proved to be a valuable therapeutic agent in the early stages of shell-shock.
As a cure for certain patients who have passed the acute stages of shell-shock or other forms of war-strain, its use requires great discrimination in the selection of suitable cases and extreme care in its practice. It is very probable, too, that hypnotic suggestion by itself should never be regarded as sufficient treatment for these cases, though undoubtedly it may be of great use as a part of such treatment.
A view endorsed by some well-known physicians is that all psychotherapy should be addressed to the functions of consciousness, and that hypnosis, which is addressed to the functions of automatism, is therefore undesirable. As a general statement this is undoubtedly true of a great number of cases, but there occur instances in which it seems that this sensible rule may be wisely and judiciously broken. In some cases hypnosis helps in more quickly breaking down resistances, which occur in patients too beset by their own auto-suggestion and false beliefs to be able easily to grasp the arguments and persuasions which the physician may have spent days and weeks in vainly endeavouring to get accepted. Thus assistance may be sought without in any way interfering with subsequent treatment of the patient by psychological analysis and re-education.
The following instance illustrates the use of hypnotic suggestion in the manner described above.