T H E USE OF HYPNOSIS IN T H E CARE
OF THE CANCER PATIENT
BYRONBUTLER,M.D.,
I
that is important in cancer, for it alone carries the burden of the
disease.37 Hans Zinsser expressed this thought
when he said: “As it is, my mind and my spirit,
my thoughts and my love, all that I really am,
is inseparably tied up with the failing capacities
of these outworn organs.” Philosophically, only
mind is important.
We need not stress the treatment of cancer,
for that is the main intent today. T h e attack
on cancer has been so consistently emphasized
that the emotional aspect of this disease is entirely in the background. At this time when
radical surgery, high-voltage radiotherapy,
glandular extirpation, hormone administration, and radioactive drugs are used freely, it
may be timely to appraise that cancer patient
who is an individual with a death sentence.
Most of us with our occidental philosopsy of
life, believe that death is the end of consciousness, and few approach it without the feeling
of Hamleto? when he said that death is a land
Erom which no traveler returns. Certainly, this
threat of extinction is the most difficult problem the conscious mind has to reconcile.
This psychological approach may be traced
to Freud’s4 revolt against the cellular philosophy of Virchow, and, as a result, our knowledge of functional disease has been greatly
enriched.3. % 16, 22*
Mental factors in what
were previously considered to be purely organic
disease, such as hypertension,2, 48 diabetes29
tuberculosis,6 ulcerative colitis,17 and peptic ulcer, Cave been demonstrated. Finally Virchow’s
own citadel has been invaded, and the cancer
patient has been found to exhibit defenses identical with those observed in psychoneurotics.e*
As the microscope, Virchow, and Pathology
led to the great advances in exact laboratory
investigation and physical medicine, so did
mesmerism, Freud, and Psychiatry lead to an
T IS ONLY THE MIND
MED.SC.D.
understanding of the mind. Since i t has been
clearly indicated that there are important emotional disturbances in patients with cancer,68it
is to be expected that these reactions will vary
from patient to patient. If the emotional tension present in these patients can be channeled
away from a neurotic exaggeration of fear and
!self-pity to a more constructive and realistic
point of view, then this energy could be available to support the patient during therapy and,
when that is finished, to give him a more serene
and confident attitude until the end. With
such an approach there will be less pain, less
disturbance in bodily function, and a reduction in the degree of dread that surrounds
the subject of cancer.
Hypnosis has many attributes that lend
themselves to this problem. Indeed, it can be
used to suppress symptoms or through application of analytical principles to express emotionally charged ideas. It allows, at least in
some patients, a control over the subconscious
mind in spite of resistance by and without the
knowledge of the conscious mind. Thus, the
mind can be maneuvered to aid the cancer
patient in his struggle for survival. The therapist is like the master of a marionette, who can
manipulate his charge as required by the occasion. T h e act can run smoothly if the master is
capable of his task, but it may be disastrous if
he does not know each phase of the plot.
I
HISTORY
Arnold J. Toynbee has made history a useful
study, for from it one learns not only what has
happened in the past, but also what may occur
at the present, and what is likely to develop in
the future. It is in this vein that a brief sketch
of the history of hypnosis is presented.
Hypnosis is older than medicine. It was used
by the adepts before the medicine men had
From the Department of Obstetrics and Gynecology, separated from the priests. More than 3000
College of Physicians and Surgeons, Columbia Univer- years ago it was used in India2’ and in the
sity, Sloan Hospital for Women [Columbia-Presbyterian
Medical Center] and the Francis Delafield Hospital, British Museum there is a bas-relief taken from
New York, New York.
a tomb in Thebes that shows an Egyptian hypPartially supported by a grant from the American notist and his ~atient.~T
Aesculapiusl5. 72 was
Cancer Society, Lnc.
able to relieve pain by stroking with his hands
Received for publication. April 24. 1953.
1
2
CANCER
January 1954
to induce long a n d refreshing sleep in his patients, while, according to Tacitus,lb Hippocrates spoke of impressing health on the ill by
“passes.”
T h e pertinent history of hypnosis can be
divided into four periods. Each period has been
characterized by a crescendo, a fortissimo, and
finally a pianissimo.
I. Period of Magnetism (1587-1789). T h e
first period began with Cardan’s Works on
Precious Stones, 1584,s in which he reported an
experiment whereby anesthesia was produced
by a magnet. P a r a c e l ~ u sbelieved
~~
that the
human body exhibited magnetic properties,
and in forbidden writings Maxwel1,s van Helmont,72 and others propounded the theory that
in the magnet one could find the universal
principle that could explain all natural phenomena. Influenced by these writings and his
own doctorate thesis, De Planetorunz Influxir,
1766,53 Franz Anton Mesmer formulated his
brilliant theory on animal magnetism, which
he published in Paris i n 1779.30 This theory
was summarized in twenty-seven propositions
or axioms, which postulate that there is a “magnetic fluid” that permeates the whole universe.
It is because of this that “impressions” from one
part may be transmitted to and may influence
another; for to this incomparably rarified substance there is no vacuum. This material may
be communicated, propagated, and concentrated by sound, mirrors, and light. H e believed
that his “fluid” was important in medicine and
that, when the physician understood it, he
could diagnose, cure, and prevent disease. This
theory is today still thought-provoking, for
fundamentally the first part differs little from
a theory of the universe presented recently by
Herbert L. Samuel. Mesmer became fascinated
with the “crises” he produced and thought the
proof of his theory required curing of illness by
this means. T h e Commission appointed b y
Louis XVI denied him this evidence, and from
their experimental studies they concluded that
these “crises” were due to the imagination of
the patient. T h e investigators coidd neither
feel, hear, nor see “animal magnetism,” therefore how could it exist? Also they showed great
concern about the possible moral abuses of
it,a*52 for was not the subject the pawn of the
magnetizer’s will? With this crushing defeat
Mesmer left Paris, but before this great first
chapter closed Count Maxime de Puys6gur,lg
a pupil of Mesmer, demonstrated the phenomenon of “somnambulism” and described how,
on awakening, the subject had complete amne-
VOl. 7
sia for the trance period. H e also called attention to the ability of the somnambulist to feel
and describe accurately conditions in other
bodies and to prescribe cures for them. Edgar
Cayce’s work utilizing this phenomenon ten to
fifteen years ago has been reported in Theye
Is a River.71 PuysCgur’s work, however, could
not reverse the charges already made, and animal magnetism slipped from prominence with
the upheaval of the French Revolution in 1789.
II. Mesmerism (1823-1860). When the
French Academy appointed a second Commission of nine men to restudy magnetism in 1823,
a revival of interest occurred. After a five and
a half year period this Commission reversed
the opinion of the first. They concluded that
“research on magnetism should be encouraged
as constituting a most curious branch of psychology.”B
T h e Commission undoubtedly realized that
there was something to mesmerism when they
observed the following case, which was referred
to by Pyne, Elliotson, Hollander, and Didier.
Briefly, M. le Docteur Chapelain had used mesmerism over a period of several months to relieve the suffering of Madame Plantin, who had
a n ulcerated cancer of the right breast with
massive enlargement of the right axillary
lymph nodes. He was able to induce “a profound sleep in which sensation appeared suspended, but intellect remained perfect.” On
April 1, 1829, in Paris, Chapelain “threw her
into a mesmeric sleep” and Jules Cloquet removed the breast and dissected out the axillary
nodes. T h e operation lasted ten to twelve minutes and during this time the patient conversed
calmly with the operator and gave not the
slightest indication of pain. T h e wound was
closed with sticking plaster. T h e patient was
pvt to bed and left in a mesmeric state for ten
hours.
An important figure at this time was John
ElliotsonzE of London, who introduced Laennec’s stethoscope into England. He was also
the first Professor of the Practice of Medicine
at the University Hospital, 1831. Elliotson believed in Mesmer’s theory and staked his reputation upon the belief that a coin of nickel
would mesmerize, while a coin of lead would
not. When, in a crucial experiment, Thomas
Wakely, the editor of the powerful Lancet,
switched the coins by subterfuge, of course,
Elliotson was defeated. H e was forced to give
u p his academic position but continued to
have a large practice, published a new journal,
T h e Zoist, and had such eminent admirers as
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USEOF HYPNOSIS
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Butler
3
With the discovery of chloroform62 and
ether13 this period of attempted useful application of mesmerism came to an end.
T h e case of a man whose right knee was like “a
ZZZ. Braidism-Hypnotism
(18434900).
bag of bones.” T h e patient was in such agony
With
James
Braid,
a
Manchester
surgeon and
that he had not slept for three weeks, could
not eat, and had excruciating pain if anyone oculist, we enter the scientific phase of hypwalked heavily across the room. He was mes- nosis.9 Braid recognized that with the inducmerized on three successive days. His pain tion of the mesmeric state, the eyes exhibited
was relieved and he ate and slept. On the third a peculiar type of movement that he thought
day his leg was amputated above the knee was of a reflex n a t ~ r e . 7He
~ broke away from
without evidence of pain. When he was awak- Mesmer’s theory and believed that the “state”
ened, he did not know the operation had resulted from some physiological change in the
occurred.
individual induced by tiring the eyes, and this
James Esdaile, inspired by Elliotson, used resulted in a peculiar physiological condition
mesmerism to perform painless operations up- of the brain and the spinal cord. It was Braid
on the natives of Bengal. In 1846, he per- who recognized the importance of suggestion
formed seventy-three major operations and re- and devised the name “hypnosis.” Volgyesi
lieved pain in eighteen medical conditions. He considers that he was not only the founder of
used trained natives to perform the mesmeriza- scientific hypnotism but also the father of
tion, while he performed the operations. Most psychosomatic medicine.
T h e Nancy School, largely represented by
of his cases were witnessed by reliable observers,
who traveled great distances to his little coun- LiCbeault56 and Bernheim, believed that hyptry hospital in Hooghly, India. He was later notism was closely allied to natural sleep and
to learn upon his return to England that the was largely a product of suggestion, while the
philosophical, oriental mind of the Bengalese Paris School, headed by the noted neurologist,
lends itself to a greater depth and a greater Charcot, thought that it was a pathological
ease of induction than the mind of the average state, a neurosis, and that it was due to a
Englishman. The native magnetizers used somatic change. There was great rivalry bepasses mainly, and certainly, in this accurate tween these two groups, but the Nancy School
record of profound mesmerism, there was little won out and received official recognition from
use made of suggestion, which is thought to be the Academy of Medicine in Paris.7. 86 T h e use
all-important today. In every case reported by of hypnotic and suggestive therapy became
Esdaile there was irrefutable evidence of con- comonplace throughout the world, but there
trol of pain, and at least twelve of his cases was little attempt to select suitable cases, nor
could have been cancerous tumors. Typical of could it live u p to the exaggerated claims made
by its proponents. By 1900, it fell into disuse
his cases is the following report:
again.
“Oct. 25, 1845. G . S., a shop-keeper, aged 40.
During this period, however, it was directly
He has a ‘monster tumour,’ which prevents him
applied
to the control of pain in a few cancer
from moving because of its great weight. He
patients.
Tuckey referred to reports by Arthur
has used it for a writing desk for years. He became insensible on the fourth day of mesmer- of the East-End Wesleyan Hospital:
ism, and I removed it with a circular incision. Arthur used hypnotism to relieve pain in cases
T h e rush of blood was great, but was soon of cancer of the uterus and breast and, by this
arrested. The tumour weighed eighty pounds. means, he achieved excellent palliative results.
On recovery, he said that nothing had dis- The pains, however, returned from time to
turbed him.”
time, and it was impossible for the patients
always to go to him for relief. He, therefore,
Didier reports in detail:
hypnotized them and told them that, whenever
A case of cancer of the breast which was re- their symptoms recurred, they had only to take
moved by Mr. Tubbs in 1854. The patient was a dose of the medicine he would give them, and
mesmerized, the breast and axillary nodes re- they would experience immediate relief. This
moved, and the wound edges sutured. T h e pa- procedure was successful and he termed this
tient was awakened and stated without res- method “treatment by indirect suggestion.”
ervation that she felt no pain during or after
I V . Hypnology, Narcoanalysis, Hypnoanalythe procedure. Doctor Elliotson, Col. Baynold,
Dr. Symes, Mr. Goff, and Mr. Amon were sis (2900-1953). During the past fifty years
through the application of laboratory experiwitnesses.
Charles Dickens and William Thackeray. Elliotson described:
4
CANCERJanuay 1954
mental techniques, hypnotism has become established as a science.36 “hypnology.”12. 75
Those who use this science constructively may
be called “hypnologists.” This science has a
secure basis with its tenets anchored on experimental measurements. Thus, muscular
strength,57. 8 1 cerebral function,28*46* 69 gastric
secretion,45 and respirat0ry3~and cardiovascular actions39.449 76 have been studied as they are
influenced by the hypnotic state. Also pertinent
to this report are experimental investigations
of hypnotic anesthesiaz3-59v
upon which is
based the rationality for the use of hypnosis to
relieve pain in cancer. Its effect upon recall of
past memories,38 the duration of posthypnotic
amnesia,TO and even its possible antisocial
useslo. 259 64, 77, 79, 80 have been scrutinized. Because of this, there has gradually been a diminution in both professional and popular resistance to hypnosis.
Another impetus to social acceptance was the
development of narcohypnosis and narcoanalys i ~ 34. ~
T h~e ~use of drugs made these procedures more acceptable.
It has been said that if psychotherapy is ever
to reach the masses, it will be through a method
more rapid than psychoanalysis, such as hypnosis. This challenge has been acted upon by
Brenman and Gill11 and Wolberg, who have
combined hypnosis and psychoanalytical principles into an integrated form of mental therapy, “hypnoanalysis.”
During this fourth period there were also
a few isolated reports on the use of hypnotism
to relieve the pain of cancer. Miller refers to
a case treated by Betts Taplin:
His patient was a 66-year-old man who had a
carcinoma of the cardiac end of the stomach
diagnosed by a laparotomy. Taplin describes
his results in the relief of suffering in this patient who was getting morphine frequently
and was losing ground rapidly one month postoperatively. “I resolved to try what hypnotic
suggestion would do toward smoothing the
way to the inevitable end. The result exceeded
my expectations. After the first sitting he was
much easier, and slept fairly without his morphia; after the second, the pain disappeared
for three days, and returned (not severely) just
before the third sitting; after that it passed
away altogether, leaving slight discomfort after
food only. As the sittings continued, even this
disappeared; he was able to take solid food
with comfort, his out-standing trouble, constipation, passed away, he slept well nightly, and
began to gain strength and to put on flesh, and
is now, three months after I began treatment,
VOl. 7
eating and digesting ordinary food with ease,
to all appearance in good health and weighing
two stones heavier; nothing but a little weakness in the back after his long suffering and
illness remaining. In any case, hypnotic suggestion has done more for him than I believe
any other treatment could have done.”
In 1932, Hollander reported a personal experience on relieving the pain of a cancer patient with hypnosis:
“Once I was asked by a surgeon to go to a
nursing home in Hampstead, where a young
woman, dying from cancer of the uterus, suffered great pain which caused her to be sleepless. Within a few minutes the patient was
asleep, and, in a few minutes more, wide awake
with spasmodic pain. I persevered for an hour,
at the end of which she seemed more peaceful.
I heard no more for a week, when I received a
letter thanking me for what I had done, stating
that the patient had slept free from pain every
night since my visit.”
Rosen reported the use of hypnosis to control pain in seven patients with various conditions. He was able to obtain hypnotic anesthesia in 25 per cent of his cases.
His only cancer patient was a 39-year-oldwoman with bone metastases from a carcinoma
of the breast. Because of severe hip pain, uncontrolled by morphine, she was hypnotized
twenty-four times during the last six weeks of
life. She was undisturbed by pain during the
hypnotic period, but the pain was not controlled posthypnotically. Rosen thought that
a prefrontal lobotomy would have been preferred to hypnotherapy, since the patient had
derived only partial relief from the latter.
THE
HYPOTHESIS
The hypothesis that the mental and physical
disturbances of the cancer patient may be favorably influenced by hypnotic suggestions
evolved during thirteen years of critical investigation of hypnotic phenomena by the author.
At first, over a period of six years, hypnosis was
used as a tool to study psychological functions
of the mind. Experience was gained in selection of suitable patients, means for allaying
unfounded fears and misapprehensions, methods for inducing the hypnotic state, and procedures of elicitation of various hypnotic phenomena. Approached critically and skeptically,
it was only after repeatedly reproducing the
various phenomena of hypnosis that the conclusion that hypnotism is a “real” phenomenon became inescapable.
No. 1
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USEOF HYPNOSIS
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PATIENT
Defined broadly, mind and body are inseparable, and, as a corollary, since hypnotism is
a means of control of the mind, it can also
regulate the body and its functions. With this
hypothesis one can extend the use of hypnosis
beyond psychological processes and apply it to
the vast field of psychosomatic medicine. Exemplary of this field, seven cases of severe primary
dysmenorrhea were treated. The hypnotic
states were induced, painful periods were “abreacted,” and positive posthypnotic suggestions
were given for the patient to be free of menstrual cramps, headaches, nausea, and vomiting.
From two to twelve treatments were given at
monthly intervals. Superficial psychotherapy
was also utilized. Six of these cases, which were
completely unamenable to all other medical
therapy, were symptomatically cured to a follow-up of two to five years. Others have also
found hypnotherapy effective in otherwise refractory cases.20~
41 42
When this hypothesis is carried a step further, control of painful organic conditions
should be possible. In this respect during the
past six years, the author used hypnosis to
facilitate the care of twenty selected obstetrical
patients. Hypnosis was used successfully in relieving severe nausea and vomiting during the
early months of pregnancy, in the elimination
of heartburn, in alleviating back and muscular
pains, and in allaying fear and anxiety. Also,
at the time of labor and delivery, it was successful in partially or completely relieving the
pain of the entire labor. Through the use of
hypnosis, infants were delivered spontaneously,
and by breech, without anesthesia. In two cases,
episiotomies were made and repaired with the
patient experiencing or remembering little or
no pain. Postpartum, lactation could be influenced. In two cases, postpartum depression
responded to positive supportive suggestions.
Similar results have been obtained by others.’,
40. 41. 43, 64
The application of this same successful technique to gynecological cancer patients being
cared for concurrently by the author was an
unavoidable progression; for, more than any
other group of patients, the cancer patients
need mental-physical therapy.
METHODS
AND PROCEDURE
Cases for this study were gradually accumulated from referrals by various physicians who
thought their patients were particularly in
need of and suited for this form of therapy.
Butler
5
These were patients with pain and widespread
cancer. Frequently, they were emotionally disturbed and had been difficult nursing problems. In these cases the usual form of medical
care, including sympathetic and understanding
attention and the administration of various
pain-killing drugs, had not been entirely satisfactory. Also, hypnosis was suggested as a last
resort before considering a prefrontal lobotomy.
The patient referred for treatment was interviewed, and a detailed history was obtained
with special attention to psychosomatic factors,
previous impressions of hypnosis, and the present social mesh in which the patient was
caught.
The subject of hypnosis was forthrightly discussed, and, if the patient was co-operative, the
hypnotic procedure was started. Attempts were
made to have the patient in a relaxed position,
either sitting or prone, in a darkened, quiet
room. There was always a “disinterested” third
person present. The techniques used to induce
hypnosis were eye-fixation with attention focussed on a small bright light, coin, or crystal,9
hand levitation,gO*82 or lid closure with eyeball
pressure by the fingertips.s
Appropriate verbal suggestions were given
depending on the style of induction and the
personality of the patient. Soft, soothing, classical music was played on a phonograph, not
only to help the patient relax but also to eliminate extraneous noise. When the operator suspected a light stage of hypnosis had been obtained, he commanded that the patient could
not open his eyes. If this order was effective,
progressively more complicated and more elaborate mental pictures were constructed. A floating or light feeling was usually easily obtainable, as well as epigastric warmth. Then, in
sequence, extremity rigidity, “automatic”
movements, visual and auditory hallucinations,
and anesthesia were elicited. Posthypnotic phenomena were produced when the depth of
hypnosis obtained would permit it. After the
greatest depth possible was reached, pertinent
suggestions were made to remove disabilities
and pains, and positive commands given as
demanded by the situation. When abreaction
of some relevant event in the patient’s memory
was indicated, this was elicited. T h e patient
was then awakened. His experience was discussed with the hypnologist and superficial
psychosomatic guidance was given.
Narcohypnosis was used in some patients
who had a superficial resistance to the usual
6
CANCER
January 1954
technique of hypnotic induction. While either
sodium pentothal or sodium amytal was given
slowly intravenously in a very low concentration, the hypnotic techniques were followed as
used in the regular patients. A state of conscibusness was maintained as much of the time
as:‘possible. Some patients, following this procedure, became excellent hypnotic subjects and
no longer required the drug. I n strongly resistant cases, the drug did not influence the patient, and resistance was evident even when the
maximum drug was given. It appears that narcosis and hypnosis are dissimilar states, although one may aid the other when used conjointly. Narcohypnosis was not used to any
great extent because of the ever-present risk of
sudden respiratory or cardiac failure.
The frequency of the treatments varied
greatly. Out-patients were seen daily or weekly;
hospitalized patients were seen at least daily
and sometimes two to four times a day. Because
of the amount of time required, phonograph
recordings were made for specific patients on
twelve-inch records at 33% r.p.m. in a recording studio. Agairi, the technique and suggestions previously found effective for that patient
were specifically recorded, and effective, selected music was recorded simultaneously as
a background. An automatic phonograph was
placed at the patient’s bedside, and, when the
patient was in a ward, the phonograph was supplied with headphones, so that adjacent patients were not disturbed. Either the patient,
doctor, or nurse could start the recording; it
would stop automatically.
The effect of the phonograph records was
usually good, but they were not so effective as
personal contact with the hypnologist. Also,
the patient soon memorized the record and
tired of it. New records were made to combat
this, and new suggestions included when indicated. Personal hypnosis was continued at intervals while the records were being used to
give the patient further support.
When hypnotherapy was stopped for the
purpose of determining the effect of its withdrawal, if done suddenly, there was a dramatic and severe change for the worse. It
was as if a prop had been knocked away. Pain
became more intense, disabilities increased,
and the patient was now more difficult to care
for than before. If the hypnotherapy was gradually withdrawn, the patient could be maintained greatly improved without the actual use
of hypnosis until that time when pain suddenly
recurred or some other event demonstrated to
VOl.
I
the patient that his course had again turned
downward. Then hypnosis was used again to
recover lost ground, but, each time this happened, it was more and more difficult to return
the patient to the same emotional level of
confidence and cheerfulness; for, each time, the
“truth” became more firmly imprinted and
harder to erase.
I n all of this, the depth of hypnosis is the
deciding factor. For practical purposes there
are three stages: light, medium, and deep
trance. I n a light trance, the patient recognizes
some “influence” but doubts that he was hypnotized. In a medium trance, the patient is sure
he was hypnotized, but he can recall freely all
the events that occurred. I n a deep trance, the
subject realizes that he was hypnotized, but his
recall of the trance period is under the control,
to some extent, of the hypnologist’s suggestions. After three one-hour periods of intensive work, cancer patients who reach only the
light trance cannot be helped. Those who go
into a medium trance can be helped but, the
more severe and “organic” the pain, the more
ephemeral the hypnotic control. Those who
reach the deep or somnambulistic trance can be
helped. Unfortunately these people are rare
and constitute only 10 to 20 per cent of the
population. Extensive disease, a distraught
mind, pain, and the fear of death make induction of hypnosis more difficult than in normal
people, because it seems that the most difficult
thing to control under hypnosis is the function
you want most to affect.
The hypnologist is an important factor in
this problem, for hypnosis is a transference and
countertransference relationship just as is psychoanalysis. In hypnosis this interplay is not
well understood by either party and is not well
handled. Here, the differences in sex, age, race,
and social station of the patient and the hypnologist become acutely important and may, if
these factors are adverse, militate against
success.
Since Braid limited the role of the hypnologist and expanded the importance of the subject, there has been practically no study of the
effect of hypnosis upon the hypnologist. The
hypnologist is, however, affected by the treatments. He gives of himself to the patients, and
he receives the discards from them. If he is in
good health, comes in contact with the patient
only at intervals, and takes his work lightly, he
will be unaware of this, and there will be little
affect. If the reverse is true, however, he will
gradually feel his vitality become reduced and
No. 1
USEOF HYPNOSIS
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will become more susceptible to illness himself.
Even an hour’s treatment with a very sick patient can produce an appreciable tiring of the
hypnologist, and, as the sympathetic bond between the two grows stronger, the hypnologist
may even “feel” the symptoms he is trying to
eradicate from the patient.
W. L. Howard also found that the effect
upon the operator may be “very severe,” and
that, when the hypnotic treatments are “continually kept up on several cases without mental rest, it may produce some very injurious
conditions” in the operator. William Davey
advised, “If the operator labours under any
deficiency of healthful vigour, the frequent
contact with diseased individuals will be sure,
by the law of mesmeric sympathy, to affect him
with pains and disquietudes, if not perfectly
analogous to those of his patients, yet bearing
such relationship to them, as will suffice to
make him painfully conscious of the source
whence they are derived.”
However, with an expenditure of considerable time, energy, and ingenuity, a very sick
suffering patient may live his last months of
life with a minimum of drugs, a sense of hopefulness and cheerfulness, and relative freedom
from pain. His mind becomes more acute
rather than dulled, as with drugs. The rest of
his body functions as well as it can without
being further inhibited by drug side-action.
He is a rational thinking human until death,
rather than a “vegetating” invalid as may happen after a prefrontal lobotomy. He has been
supported in the last days of his life by the
compassion of his physician rather than let
down with drug addiction and destructive
surgery.
I n summary we have the mind of the patient
struggling for survival, aided by the mental
support of the hypnologist; both are fighting
a losing battle, for, in the end, cancer and
death will win.
7
the second attempt that there was complete loss
of the corneal reflex, loss of sensation to painful
stimuli, and complete amnesia to the entire
trance period. She was a somnambulist.
On the third day, it was decided that the
diagnosis must be confirmed, and then an ex.
ploratory operation was indicated. Since the
patient was in a poor physical condition, hyp
nosis was suggested as the form of anesthesia.
Again the patient was placed in a deep trance.
After two hours, when she had lost the corneal
reflex but still carried out suggestions, she was
taken to the operating room. T h e abdomen
was prepared and draped, and, with no other
form of analgesia or anesthesia except hypnosis, an incision 10 in. long was made from the
umbilicus to the symphysis pubis. Skin towels
were applied, and the incision was carried
down to the fascia through 3 to 4 ,in. of subcutaneous fat. As the fascia was being incised,
the patient moved but did not complain of
pain. With this, however, cyclopropane anesthesia was started, and without waiting the
exploration was continued. Carcinomatosis was
found; the ovarian tumor was biopsied, and
the incision closed.
Postoperatively, the patient stated that she
had felt no pain at any time; however, she also
had no memory concerning the period of time
during which she was hypnotized.
Her physical condition then deteriorated
rapidly, and she died three days later. Since
she had no further severe pain, hypnosis was
not used after the operation.
Case 2. Mrs. M. R., age 48, was admitted to
the hospital because of a tumor the size of a
six-month pregnancy that filled the pelvis and
lower abdomen. It was a rapidly growing sarcoma of the uterus. The patient was in severe
pain. It required the assistance of three people
to move her in bed, for movement made the
pain more acutely excruciating. She had been
bedridden for six weeks and was anorexic and
constipated. Consequently, she was depressed,
frightened, and morbid. She suspected that she
was dying of cancer.
With the first attempt at induction she entered a deep somnambulistic trance. It was
CASEHISTORIES
suggested that she was free of pain, fear, and
anxiety. She was told to get out of bed and
Case 1. Mrs. M. B., age 55, received mor- walk. This she did with but little support.
phine, 15 mg., every four hours for relief of When she was awakened and told of her proglower abdominal pain. The tentative diagnosis ress, it seemed incredible to her. Actually she
on admission was carcinoma of the ovary with was free of pain and could move in bed easily.
metastasis. A hypnotic state was induced easily She ate better than she had in weeks and slept
during which suggestions were made for the without medication.
patient to be free of pain and to become calm
During the next three weeks, the patient was
and relaxed. After the second treatment her kept in a hypnotic state 30 to 40 per cent of
pain was improved, and she required one half the time, and she found that she could take
of her usual amount of morphine to keep her food and control her bowel elimination by givfree of pain. She was so deeply entranced on ing herself suggestions. She was able to get out
8
CANCER
January 1954
of bed alone and to walk unaided; also, sht
was eating well. She required no analgesic
agent.
She had a particular dread of her daily trip
to the radiotherapy department. Since she
would stay in a trance two to three hours without waking, she was hypnotized in her room
and told not to awaken until after she had
returned from her treatment. Thereby, she had
no memory of this experience and, hence, no
dread. It is pertinent to state that the tumor
grew rapidly in spite of radiotherapy.
When hypnosis was discontinued, but the
same amount of personal attention to the patient was maintained, the patient did well for
thirty-six to forty-eight hours; then she would
gradually slip back into her previous condition. She would con,,Aain of severe abdominal
pain and weakness, be unable to get out of
bed, and have again a strong fear of dying.
Then, with as little as five minutes of hypnosis
with appropriate suggestions, she would awaken free of pain, strong, and liberated from
anguish.
By the end of the second month, a phonograph record was made from a tape-recording
of a hypnotic treatment at the patient’s bedside. T h e record was then available for the patient to play on a portable phonograph in her
room. This record, at first, induced a deep
state of hypnosis, but later, as the patient
memorized the words, she became annoyed
with it, and it became less effective. Then other
records were made for specific uses: to induce
sleep, to relieve pain, to restore calmness and
confidence. By using a variety of records, the
patient was maintained and required personal
hypnosis only once a day.
By the end of the third month of hypnotic
treatment, the tumor had grown to the size
of a term pregnancy. T h e bowel was partially
obstructed and vomiting became difficult to
control. T h e records were not effective, and the
patient was kept in a trance most of the time
by personal hypnosis. Even when the tumor
ruptured and drained a copious foul necrotic
material out of the vagina, the excruciating
pain was quickly relieved by inducing a deep
trance. Soon after this the patient died.
Case 3. Mrs. I. M. was a 65-year-old actress
and dramatic coach, who had had a radical
mastectomy two years previously because of
cancer of the breast. She complained of pain
in the occipital portion of her head that radiated down both arms. Her right arm was weak,
so that she could no longer lift a glass or cup.
She could not write, and she was incapacitated
by the pain so that she could not teach. Roentgen-ray examination disclosed that she had
metastatic lesions in the cervical vertebrae, ribs,
ischiurn, a n d right femur. Radiotherapy had
Vol. 7
been given to the cervical region without relief
of pain.
Over a period of two weeks the patient was
hypnotized ten times. She entered the somnambulistic stage and could be made anesthetic
to painful stimuli. During this period she was
able to get out of bed and walk unassisted. Her
pain became less and she regained the use of
her right arm so that she could lift a pitcher
filled with water and could write. She regained
her courage.
When she was in the hospital she used a
record to help her at night. At the end of this
time she returned to her studio and actively
taught dramatics again. No further hypnotherapy was used.
One month later, however, the pain returned and the patient had to be readmitted
to the hospital. Finally, a prefrontal lobotomy
was performed on the right side of the brain,
but, when the pain continued unabated, in
fact was even more severe, hypnotherapy was
tried again. Now, five months after the first
successful use of hypnosis and one month after
the lobotomy, the patient had a clear sensorium and a good memory, but it was difficult for
her to concentrate. She complained of severe
pain in her right thigh, where she had a pathological fracture of the femur, a severe pain over
the left side of her head, and a heaviness of
her face. Pain had become so severe that she
required morphine every four hours.
Hypnotic techniques were used, but she was
now very sick and debilitated. She said that
she wanted to die and resisted my suggestions.
Also, since she had had the lobotomy, concentration was difficult. Only a medium trance
could be induced and that required great effort
and time. After five long sessions over a period
of eight days, there was subjective improvement. T h e phonograph and recordings were
used at night. Pain became less and appetite
returned. There was some improvement because of the hypnotic treatments, but it was
neither striking nor dramatic. Soon after this
the right hip was nailed, her condition became
rapidly worse, and she died.
It is worthy to note, first, that this woman
who was very intelligent, independent, resourceful, and successful, found it difficult to
adjust to a dependent role. Also, there was a
certain sense of persecution about her pain,
which came in “spasms” and which she associated with “people coming after her.” She believed her present suffering was a punishment
for her inconsideration of others during her
life. Prefrontal lobotomy in this patient interfered with the hypnotic state because concentration was more difficult.
No. 1
USEOF HYPNOSIS
IN CARE
OF CANCER
PATIENT
Case 4. G. P. was a 14-year-oldboy who had
acute myelogenous leukemia. He was referred
for treatment because of severe pain in the
coccyx, depression, apathy, and anorexia. He
was anemic and had responded poorly to transfusions.
This boy was interviewed and hypnotized
six times over a period of one week. On two
occasions he was in a somnambulistic trance
and on the other four reached only a medium
trance. Nevertheless, his pain was entirely relieved while under hypnosis, although it would
return three to six hours after the treatment.
He became congenial, his appetite returned,
and he felt a return of his normal vigor.
Actually, his hemoglobin increased 1.0 gm.during this period, although he received no transfusions, and, by the end of the week, he required no medication for pain.
Six days after this a perirectal abscess was
discovered as the cause of the coccygeal pain
and, following incision and drainage, there
was continued subjective improvement. The
patient left the hospital and returned home.
He did well on supportive therapy. Four
months later, he inadvertently read a letter
that disclosed to him the lethal nature of his
disease. A relapse immediately followed this
experience, and he was readmitted to the hospital. He died eight weeks later. Hypnotherapy
was not used during this last admission.
Case 5. Mrs. I. R. was a 72-year-old colored
woman, who had a carcinoma of the right
parotid gland, which had been treated with
radiotherapy during the past year. As a result
her face was distorted by a seventh nerve
paralysis, and, from the onset of the radiotherapy, she had a bad taste in her mouth.
She was troubled mostly, however, by excessive
salivation that had not responded to any type
of treatment and by the anorexia related to
these disturbing symptoms. She also had pain
in the right side of her face and neck. In addition she was confined to bed or a wheelchair
for the past month owing to deformity of her
legs by rheumatoid arthritis.
The patient would enter a medium trance
and, during one week when she was seen six
times, the bad taste, face pain, and excessive
salivation were controlled during the hypnotic
period and for as long as twenty-four hours
posthypnotically. First, while in a trance, and
then, when entirely awake, the patient was
ambulated, and by the end of the week she
was walking around the ward unassisted. Her
appetite improved &d she ate well as long as
her symptoms were under control.
Hypnotherapy was stopped and all her symptoms returned.
Three weeks later a prefrontal lobotomy was
performed on the right side, but following this
-
Butler
9
there was no improvement. T h e patient was
very weak and bedridden. Two weeks later
hypnotherapy was tried again. Although difficult to evaluate because of a mental lethargy
and dullness, it was possible to elicit a few
hypnotic phenomena during two interviews.
T h e depth of hypnosis, however, was definitely
not so great as had been obtained before the
lobotomy had been performed, and the efficacy
of the treatment was doubtful. Because of the
patient’s poor condition further attempts a t
hypnosis were not tried. She died ten days
later.
Case 6. E. B. was a 49-year-old man with secondary carcinoma of the liver. T h e primary site
was unknown. He was jaundiced, the liver
reached the iliac crests, and he was unable to
eat. Hypnotherapy was utilized in an attempt
to combat the anorexia.
After five interviews during one week only,
a medium trance could be induced. However,
a definite and prolonged improvement in his
appetite occurred with a consumption of a
greater amount of food than previously. Real
hunger could also be suggested. After therapv
was stopped, the anorexia returned, and threc
weeks later the atient left the hospital. He
died at the end o ten weeks.
F
Case 7. Mr. M. R. was a 72-year-old Hungarian, who had had a carcinoma of the right
breast removed twenty years previously. He was
admitted because of a three-month history of
intractable pain in his right hip, thigh, knee,
and to some extent where his right leg had been
(his right leg had been amputated below the
knee during World War I, because of injuries
and subsequent infection). Neurological examination failed to reveal any abnormality and
there were significant emotional factors in his
background. For these reasons hypnotherapy
was suggested.
He was a translator of scientific articles, had
been a teacher of natural sciences, and, when
he lived in Vienna, hypnosis was a new development used in the detection of crime and in the
treatment of shell shock. Although he was fearful of being hypnotized, he quickly entered a
deep trance and was made to relive his past
life, which he described in German. In doing
so he re-experienced pain in his right extremity
and abreacted the appropriate emotional concomitants-a phenomenon like the “crises” described by Mesmer. Following this the patient
was awakened. His pain had disappeared. The
next day he said he felt as though “his body
and soul had been torn apart,” and that he
remembered people he had not seen for decades. Although he continued to complain of
pain in his thigh, it was not severe and in no
way did it affect his sleeping. He refused fur-
10
CANCER
.January 1954
ther hypnosis, and a contemplated neurosurgical operation was decided not to be indicated.
He left the hospital two weeks later and did
not return for follow-up.
VOl. 7
CASES SEEN O N A N OUT-PATIENT BASIS
Case 10. Mrs. J. B., age 35, was seen weekly
over a period of two and a half months. Two
years previously she had had a radical mastecCase 8. H. J. was a 50-year-oldman who had tomy on the right for carcinoma. She then dehad a radical removal of a malignant testicular veloped an inflammatory carcinoma of the left
tumor nine months previously. Following this, breast with secondary metastases of the lung.
extensive radiotherapy was given to his abdo- There was considerable unrest at home because
men and lower back. For the past four months, of a 3-year-old daughter, religious differences,
he has had low-back and bilateral leg pain; and a difficult, demanding husband. She comfor two months, spasms of the lower abdomen plained mainly of a burning pain and a tight
and legs shook the patient rhythmically and feeling over her right chest, which accompanied
spasmodically day and night. An electromyo- anxiety states precipitated by arguments at
gram demonstrated forty regular spasms per home. She frequently had terrifying dreams
minute. A myelogram and roentgenograms re- and her sleep was disturbed by protracted perivealed no evidence of a metastatic tumor.
ods of coughing.
The patient said on his first interview, “The
A medium trance could be induced, and by
only time I’ve been free of pain in the past four suggestion her anxiety and fear could be lessmonths was when my mind didn’t know it.” ened. Her chest pain and cough, however,
When only a medium trance could he obtained showed little response. When she went home,
after three attempts at hypnosis, intravenous the arguments and disagreements that ensued
sodium amytal was combined with the hyp- negated these effects quickly; hypnotherapy
notic procedure. During this interview it was was stopped and she died two months later.
learned how he had been affected by the sufferCase II. Mr. A. M. was a 55-year-old man
ing of his father, who had died of cancer a few
years previously. His father had had severe who had had a carcinoma of the right lung
leg pains comparable to the patient’s. The partially removed by pneumonectomy five
patient had also tried to get some drug to put months previously. He ascribed his illness to a
his father “out of his misery,” but, before he blow on the chest while boxing twenty years
could accomplish this act, his father died. ago. The patient was a food fadist and came to
There was considerable expression of feeling the hospital for weekly visits, stooped over and
about this by the patient. The parallelism he complaining of severe chest pain. A medium
had made between himself and his father, as trance was induced on three separate interwell as his self-imposed punishment, was views. When awakened, the patient would cry
pointed out to him. During this interview the and claim that he was finally free of pain. He
lower abdominal and leg spasms stopped com- would leave the hospital walking straight and
pletely, and following it the patient said that smiling, but, by the time he had taken an
he felt “at peace with the world,” and “his legs hour’s subway ride home, he was in pain again.
were absolutely quiet for the first time in He died six weeks later.
three months.” A similar result followed a
Case 12. Mrs. B. L. was a 46-year-oldwoman
second interview of narcohypnosis and in a few
days the patient was discharged from the hos- who had had a carcinoma of the left breast removed locally and treated with radiotherapy
pital 90 per cent improved.
Not long after returning home where family, fifteen years ago. Eight years ago she had a rerelatives, and well-meaning friends gave him currence and finally submitted to a radical
consolation, his spasms and pains returned mastectomy but she would not permit further
radiotherapy. She noticed a lump in the right
with even greater severity.
axilla four years ago, which has continued to
Case 9. Mrs. E. S. was a 52-year-old colored grow slowly, and she has gradually been diswoman with a stage-IV carcinoma of the cervix. turbed by pain and swelling of her right arm.
Weekly cervical biopsies were taken for a re- This area was again treated with radiotherapy.
When seen for the first time for hypnothersearch study until the patient became so afraid
of the pain of the procedure she would not apy, the patient had been having pain for five
permit it. Hypnosis was induced and a medium months and was taking 60 mg. of codeine every
trance with partial skin anesthesia was ob- four to six hours. She was seen twice a week
tained. The cervical biopsy was taken easily. for seven weeks. She entered only a medium
The next week, the patient resisted being hyp- trance state, but her axillary and arm pains
notized, but in spite of this the biopsy was could be relieved while entranced. During this
taken in a medium trance. The third week it entire time, she became less anxious, her pain
was impossible to induce a hypnotic state and lessened, and for twenty-four hours after an
interview her drug requirement was reduced.
the biopsy could not be taken.
No. 1
USEOF HYPNOSIS
I N CAREOF CANCER
PATIENT Butler
*
11
lized by a physician in the care of someone who
had a longer life expectancy. At least, in order
to gain maximum relief for the time spent, one
should select patients who enter’a deep or somnambulistic trance, for in these patients organic pain and subjective symptoms can be‘
relieved, and through posthypnotic suggestions
relief may be continued after the period of
hypnosis. Phonograph recordings are of definite value in this respect, but specificity, flexibility, and variety of suggested mental pictures
and musical background must be kept constantly in mind.
T h e results of this study would not indicate
that further efforts should be made to expand
this type of therapy. However, there are two
aspects of it that are obscure but, nevertheless,
very important. The first is the intuitive knowledge gained by intimate association with these
patients that there is a cancer personality. It is
intangible and from this small experience difficult to delineate in distinctive features, but
nevertheless it is a possibility worthy of further
DISCUSSION
investigation. A rough sketch of this personalHypnosis is an altered state of mind. Philos- ity reveals an individual who fails to express
ophers, theologians, and scientists cannot ade- himself; who represses hate, anger, dissatisfacquately explain what mind is, and therefore tions, and grudges; or, on the other hand, is a
hypnosis, which is a state of ,mind, also remains very “good“ person, who is consumed with selfan enigma. T o describe it as a neurosis,sl a pity and suffers in stoic silence. T h e future of
state of hypersuggeslibility,ll* 36 a period of cancer could lie in the psychosomatic approach,
dissociation of the brain,47 a type of condi- and the precancerous personality might be
tioned reflex,60 or a hysteria19 does not take treated with psychological means. I n this study
into account the facts we know about it. Let us of personality, one should inquire into the psycall hypnosis that state of mind in which phe- chodynamic basis for pain, for, of two patients
nomena described as hypnotic occur.
with apparently equal metastatic spread of
Hypnotic techniques as used. in this study disease, one will have pain and the other will
did reduce pain, allay anxiety, and aid in organ not. ‘One factor demonstrated in these cases
function; but the results were proportional to was the influence of a sense of guilt and of a
the depth, and only five of these selected twelve need for punishment. Disease and death were
cases, who were somnambulistic, can be said not adequate retribution for the unconscious
to be unequivocally benefited by this therapy. impulse to kill, to lead an immoral life, or to
The remainder of the patients who could enter compensate for the lack of kindness to others.
a medium trance were helped, but it is doubt- It was necessary to add pain to balance the
ful if this improvement is adequate compensa- moral budget.
tion for the time spent to obtain it. Certainly,
The second important finding is not the pracan out-patient basis is not satisfactory if the tical therapeutic aspect of emotional control,
patient is in as much distress on returning pain elimination, and organic function by
home as when he left it.
means of “words,” but rather fundamental and
T h e great amount of time and energy, pa- basic evaluation of the fact that by “controlled
tience, and ingenuity required of the hypnolo- thoughts” alone these things are possible.
gist to produce these results has not been adeElectricity and mesmerism were discovered
quately emphasized, for herein lies the chief and condemned respectively by Benjamin
defect in th& procedure. Certainly, we want Franklin. Electricity has been made the servant
each person to end his life with as little suffer- of man, while our understanding of hypnotism
ing as possible, but from a practical point of has not advanced; in fact, there are reasons to
view this same energy and time could be uti- suspect that Mesmer knew more about it than
Deeply rooted obsessional neuroses that prevented her from riding in a car, walking alone
on the street, and visiting friends were resolved
by hypnotic suggestion. Besides the interviews,
the patient was relieved of two attacks of acute
anxiety and pain through the use of hypnosis
over the telephone.
Hypnotherapy was stopped and, within a
few days, the patient regressed to her former
state. Then her mother died. Immediately she
became worse and again had excruciating
pains. Codeine was no longer adequate and she
required 10 to 20 mg. of morphine sulfate every
four hours. T.hree and one-half months after
hypnotherapy had been stopped, the patient
was seen again. Only a medium trance could be
induced; pain was relieved during the trance
but recurred quickly afterward. However,
again her fears and anxieties were quickly and
effectively brought under control. The possibility of living six months, however, precluded
the use of hypnosis for this length of time and
a chordotomy was advised.
12
CANCER
January 1954
he conveyed in his writings, and there is available scientific evidence to support Mesmer’s
original contentions or propositions. If we
knew fundamentally how the mind could
eliminate pain, then possibly this knowledge
could be used, freed from the disadvantages
that now surround hypnotism.
Our present-day knowledge of hypnosis does
not elucidate or consider the role of the hypnologist. He might as well be a flashing light
or a phonograph record, but this does not explain how hypnosis affects him deleteriously.
Possibly he is imperceptibly hypnotized himself and identifies himself so closely with the
patient that, without his knowledge, he “becomes the patient” and after the treatment feels
the negative affect he has been trying to remove
with positive suggestions. It may later be
proved that this results from a mesmeric
influence. However, if self-analysis may be credited, there is this side of the problem of which
anyone who engages in hypnosis with very sick
patients must be cognizant.
The suggestion that hypnosis is a “psychological” prefrontal lobotomyw has no basis in
fact. At least in the cases reported here in which
hypnosis was tried before and after lobotomy,
hypnotizability was roughly directly proportional to the remaining ability to concentrate
and inversely proportional to the completeness
of the operation. It did not make the patient
more easily hypnotized, as it should if it were
a surgical and permanent form of the same
state of mind.
Hypnotism is not to be considered lightly,
for as Sir William Osle96 said, “It is a twoedged sword, and needs careful handling.” Its
use must be restricted and it is safest in the
hands of the competent psychiatrist, who has
had a particular interest and experience with
it. Other specialists and general practitioners
should use it only after adequate training, and
then only when other methods available are
inadequate. The use of hypnotism can be compared to the performance of a difficult operation. Anyone can cut the skin, many may remove an appendix, but who should remove a
stomach, a pancreas, or a lung? The same is
true of hypnosis-anyone can learn to induce
it, some can get therapeutic results, but only
those with experience and training should attempt to cut out pieces of mind.
Vol. 7
CONCLUSIONS
1. Pain, anxiety, and organ dysfunction in
the cancer patient can be aided by the intensive
use of hypnotherapy. The results are proportional to the depth of trance and the efficiency
of the program of therapy employed.
2. Patients who easily enter a deep trance
can be helped; those who reach only a medium
state can be aided, although the more “organic”
the complaints, the more ephemeral the response; while patients who, after repeated
trials, can only enter a light stage cannot be
helped by this means.
3. The main disadvantages of this form of
therapy are the few good subjects, the large
amount of time required, and the necessity of
an experienced and well-trained hypnologist
to govern each case. The possible deleterious
etfect upon the health of the hypnologist and
the long period of time required for one patient
between onset of symptoms and death, thus
limit the number of patients a single therapist
could manage. Then, too, public resistance to
hypnosis persists.
4. The advantages of hypnotherapy for patients who enter a deep trance are numerous.
Drug requirements are lessened, pain is relieved, organ dysfunction can be corrected as
much as possible, and depression, anxiety, and
fear are minimized. Life is prolonged and death
is approached as is a night’s sleep.
5. Prefrontal lobotomy interferes with the
induction of the hypnotic state in proportion
to the decreased ability of the patient to concentrate and, therefore, appears to be different
from the hypnotic state.
6. Narcohypnosis helps to counteract superficial resistance but does not appear to aid
otherwise in obtaining greater true hypnotic
depth. It does not eliminate all resistance.
7. Future efforts should be expended to
learn what hypnosis is and how i t alters physiological function. When these fundamentals are
understood, its advantages will have a wider
and more satisfactory application.
8. There may be a “cancer personality.”
From a very intensive study of these cases,
either an irihibited individual with repressed
anger, hatred, and jealousy or a “good” person consumed with self-pity may be prototypes
of this personality.
No. 1
USEOF HYPNOSIS
IN CAREOF CANCER
PATIENT
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Butler
13
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