TRIBUTE TO WILLIAM S. KROGER (1995)

Dear Paul: Dr. William S Kroger died on December 4, 1995 in Los Angeles.  He was born in Chicago, Illinois on April 14, 1906.   Karnie Starrett (Dr Kroger's secretary)

1. NO ONE HAS A MONOPOLY ON HYPNOSIS: WILLIAM S. KROGER

2. NOTES FROM CLINICAL AND EXPERIMENTAL HYPNOSIS:

3. HYPNOANESTHESIA IN DENTISTRY AND OBSTETRICS: WILLIAM S. KROGER

4. PREVENTION OF PSYCHOSOMATIC ILLNESS: WILLIAM S. KROGER

6. HYPNOTHERAPY IN GENERAL PRACTICE: WILLIAM KROGER

An unexpected but most welcome feature on the program was the impromptu appearance of Dr. William S. Kroger, the author of the Number One book on hypnosis today, CLINICAL AND EXPERIMENTAL HYPNOSIS, and probably the foremost authority on hypnosis in the country. In his talk, Dr. Kroger likened hypnosis to faith, and pointed out that just as no one has a monopoly on faith, so does no one have a monopoly on hypnosis.

"Hypnosis has no boundaries," said Dr. Kroger. He pointed out that hypnosis, the essence of which is suggestion, pervades every phase (of life, and includes advertising and selling. The "soft sell" especially, he said, is a form of indirect hypnosis. His description of hypnosis, which is really a form of communication, concluded with the statement, "No one knows where suggestion ends and hypnosis begins."

Dr. Kroger expressed concern with the attempts of some hypnotists who feel "omnipotent" to exclude people in other fields who may logically and ethically use certain forms of hypnosis. He also felt irked with those who, lacking proper credentials and training, used hypnosis in an illegal or improper manner and in an area in which they were not legally qualified to practice. He felt that "knowing our place" in the field is important. In this regard he expressed succinctly the basis principle of the Association to Advance Ethical Hypnosis.

Dr. Kroger performed an especially worthwhile service in mentioning the International Society for Comprehensive Medicine, of which he is one of the founders. This society, which already numbers more than 400 members, invites membership by the healing arts and the ancillary professions, as well as by scientists in all the fields, including engineers, physicists, educators, etc. A prime purpose of the Society is to "cross-fertilize" all the arts and sciences, and, by working together, to enable all to "speak the same language." Dr. Kroger invited membership applications from convention attendees who were qualified, stressing that all those who fulfilled the membership requirements of the Society would receive due consideration. Readers, especially professional persons, who wish to join this Society should write to the editor, who will submit the applicant's name to Dr. Kroger.

What is important is not the depth of the "trance" but the degree of rapport and emotional participation by the patient. Dr. Kroger repeatedly indicates that the therapist only "sets the stage," but that ultimately it is the patient who permits the hypnotic relationship to develop by selective attention. (p viii)

Hypnotherapy is a tool direct to the patient's needs rather than those of the therapist, and therefore can be employed with other types of psychotherapy. The basis for successful psychotherapy depends to a large degree on the rapport or the strength of the interpersonal relationship between the physician and patient. Suggestion at different levels of awareness is wittingly or unwittingly utilized in this relationship. Since no one knows where suggestion end and hypnosis begins, the real basis for, all forms of psychotherapy must be "suggestion" and/or "hypnosis in slow motion." (p. xi)

My thesis, at the risk of oversimplification, is that emotional illness and health are conviction phenomena that are "programmed" into the neural circuits by negative, destructive, and harmful experiential conditioning; positive, constructive reconditioning results in adaptive behavior. Such reconditioning by hypnosis incisively mobilizes the "built in" adaptive processes that already are present in the organism. (p. xii)

Nearly all subjects believe that their response are produced by the hypnotist. In reality, it is the subject who initiates the acts in response to an appropriate expectant attitude. Where criticalness is reduced, a suggested act usually is automatically carried out without the individual's logical processes participating in the response. And when one suggestion after another is accepted in ascending order of importance - task motivate suggestions - more difficult ones are accepted, particularly if the sensory spiral of belief is compounded from the onset. This is called abstract conditioning and, in part, helps to explain the role that suggestibility plays in the production of hypnotic phenomena. Suggestibility is further enchanted by a favorable attitude or mental set that establishes proper motivation. (p. 7)

One of the most important ingredients for hypnotic suggestibility is the expectation of help form one who is in a prestigious position. If convinced of the truth of this person's words, the subject behaves differently because he thinks and believes differently. From time immemorial, all healing by suggestion or hypnosis has been based on his mechanism. If the idea is accepted that increased suggestibility is produced by a favorable mind-set or attitude, catalyzed by the imagination, then hypnotic responses fall into the realm of conviction phenomena. As such, they are subjective mechanisms which are inherently present, to a degree in all individuals. They result from the subject's imagination compounding the sensory spiral or belief until conviction occurs. Hence, "It is indeed a wise hypnotist who knows who is hypnotizing whom!" (p. 9)

Rapport has been defined as a harmonious relationship between two persons. In hypnosis, it results from restricted attention to some or all stimuli residing in the field of awareness. Thus rapport, as it relates to the hypersuggestibility produced by the hypnotic situation, is a special kind of relationship in which the operator's suggestions are followed more readily. This is due to the greater belief and confidence established by him... Even blind persons and deaf mutes can be hypnotized through other sensory modalities if there is good rapport... It has been contended that the rapport in hypnosis is due to emotional dependency on the operator. However, there is no more dependency in the hypnotic situation than in any other psychotherapeutic relationship. When autohypnosis is incorporated into therapy, whatever dependency exists is minimized or eliminated.

One can conclude from the above that patient rapport denotes the ability and willingness of the patient and the operator to enter into an intensified emotional relationship with each other. As a result, the subject is motivated to accept the beliefs that are so necessary for the establishment of conviction. These are the special requisites for hypnotic induction, utilization of the hypnotic state for production of behavioral responses, and subsequent behavioral changes. (p. 12)

IDEOSENSORY ACTIVITIES: Ideosensory activity referees tot he capacity of the brain to develop sensory images, which may be kinesthetic, olfactory, visual, tactile, or gustatory. A common example of Ideosensory activity is looking a fire and "seeing" the "face" of one's beloved. During negative Ideosensory activity, there is the denial of actual sensory experiences, such as not seeing or hearing something that actually is present (e.g., looking for one's pencil and finding it in front of one). A typical example is the complete absorption in an interesting book that produces a selective type of "deafness" to irrelevant stimuli. Imagining the "smell" of a certain odor that does not actually exist is an example to a positive Ideosensory activity. (p. 13)

The posthypnotic act, even though carried out long after it is suggested, is probably a spontaneously self-induced replica of the original hypnotic situation. A posthypnotic suggestion may last for minutes to years. It is agreed, however, that it may remain effective for several months. During this period, decrement occurs in the quality of the posthypnotic performance. Periodic reinforcement, however, tends to increase effectiveness; repeated elicitation does not weaken it. Posthypnotic suggestions usually are followed irrespective of the depth of hypnosis. Completion depends more upon the nature and the difficulty of the suggested task than upon the depth of hypnosis. Internal factors or external factor, of one type or another, can prevent fulfillment. When this happens, profound anxiety may be produced. Therefore, a posthypnotic suggestion should not be of a bizarre nature, but in keeping with the subject's needs and goals.

Some subjects develop a complete amnesia for the posthypnotic act and yet readily follow the original suggestion. Others can be aware of the original suggestion as they carry it out. Still other remember the suggestion only after completion of the act. Response to posthypnotic suggestions might be compared with the compulsive behavior noted in all of us at times. We know what we are doing, but do not know why! If the setting in which the posthypnotic suggestion occurs is altered, of if the expectant attitudes change between the time of the suggestion and the time when it is about to be carried out, then deeply hypnotizes persons can cancel even the original suggestion. (p. 14)

Dissociation is somewhat similar to hypnotic amnesia. It refers to the inherent ability of a hypnotized subject to "detach" himself from his immediate environment. This phenomenon occurs at nonhypnotic level, as in reverie states. An individual may be completely dissociated and yet retain his capacity to function adequately. This dissociated state is similar to dreaming, when one "see" himself performing many activities. Nearly all situations produced in dreams can be attained in the dissociated state by appropriate posthypnotic suggestions. ... Dissociation frequently is used to induce hypnoanesthesia... A portion of the body, such as limb, can be "anesthetized" through dissociation: the person does not feel the "separated" part. (p. 15)

Analgesia, or the first stage of anesthesia is characterized by the lack of startle reaction, facial flinch, and grimaces. Although insensitivity to pain can be simulated readily, hypnotized person seem to withstand more discomfort and pain than would otherwise be possible. Hypnoalgesia is usually more effective than "biting the bullet" or voluntary control of pain. Anesthesia refers to the complete lack of awareness of pain. Electromygraphic studies indicate that in hypnosis the pain is present in the tissues, but there is no awareness of it. Since the physiologic reactions to painful stimuli such as increased heart rate, respiration and galvanic skin reflexes are diminished, hypnoanesthesia apparently is genuine. (p. 19)

It is imperative to remove all the most popular misconceptions about hypnosis before attempting an induction procedure. The most common of these is that the subject is asleep, unconscious, or in a "knocked-out" state. The stage hypnotist has contribute to the widely held notion that hypnosis is a "trance" or a "sleep-like" or "out-of-this-world" state. Apprehensive patients should be informed that they will not necessarily lose awareness or fall asleep. Rather, they will be more aware. Actually, hypnosis has little resemblance to true sleep. Most ideas equating sleep with hypnosis stem from motion pictures ha portray the hypnotized individual with his eyes closed. An explanation that the eyes are closed to facilitate concentration can be amplified by the following remarks, "Have you ever noted how a music lover at a concert often has his eyes closed while he is listening to the performance? Even though he looks relaxed an asleep, he is more alert; he can even follow a single theme through many variations." This analogy is useful for differentiating sleep with hypnosis. (p.36)

Frequently, even after it has been emphasized repeatedly that the hypnotized individual does not fall asleep, patients state, "Doctor, I know I wasn't hypnotized. I heard everything you said." I often remark, "That's right, I wanted you to hear everything that was said. If you heard 100 per cent of what I suggested, you then have 100 per cent chance of absorbing these suggestions and if you absorbed all of these suggestions, there is a much better chance that you will follow these suggestions." This statement, when made in an affirmative manner, clears up any misconception that sleep and hypnosis is synonymous. (p.36)

It is helpful to emphasize that subjects are no dominated by the will of the hypnotist; they are fully capable of making decisions at all times (p. 36)

Some still believe that morons, imbeciles, and weak-minded persons make the best hypnotic subjects. This, too is a misconception. Rather, it appears that people with above average intelligence, who are capable of concentrating, usually make the best subjects. Motivation can be increased by stating, "If you are readily hypnotizable, this indicates that you are above average in intelligence." (p. 37)

Some persons believe that, if they are hypnotizable, this indicates that hey are gullible and believe everything told to them. Mental discrimination is not impaired with regards to stimuli which threaten the integrity of the organism. (p.37)

All misconceptions should be removed by adequate explanations during the initial visit. This discussion should be conducted at the level of the patient's intelligence. Readily understood examples should be used for illustrative purposes. Al tough this is time consuming, the results are rewarding. (p. 37) Mentioning that the phenomena of hypnosis occur as a part of everyday life is helpful in the removal of the commoner misconceptions. (p. 37-38)

Points to be emphasis: (1) intelligent individuals usually make the best subjects; (2) The subject's will is not surrendered; (3) a hypnotized person does not lose control or reveal intimate material unless he wishes to do so: (4) susceptibility to hypnosis is not related to gullibility or submissiveness; and (5) hypnosis can be terminated readily by either the subject or the operator. (p.38)

When using hypnosis in a child, always talk to him at his own intellectual level. If possible, make the induction procedure a sort of game. Use his imagination to "look" at a TV program. Get him to play a role in it or have him resort to some type of daydreaming fantasy. Imagery techniques are more effective if the ideas are incorporated into the child's imagination. Let him think that he controls the situation by having him decide if he wishes to play baseball while getting an injection; there will be less discomfort if he is engrossed in the ball game. Most children go into hypnotic states readily through such naturalistic techniques, especially if ideomotor and Ideosensory involvement is fully utilized. (p. 79)

Weitzenhoffer believes that there is no foundation for the belief that hypnosis weakens the will, leads to over dependency or causes neuroticism." This author is in complete accord with this statement. The incontrovertible fact is that it is doubtful it, when properly used, there is another modality less dangerous in medicine than hypnosis. Yet there is no medical technique which makes a better "whipping boy" than hypnosis. (p. 104)

To protect hypnotherapeutic methods from adverse criticism, the therapist should not promise more than can be accomplished, and a guarantee of cure should not be made. However, if there is a valid indication, one can state that everything will be done to help the patient recover. All patients should be informed that the results obtained in hypnosis are based wholly on the patient's cooperation and willingness to cooperate. The following remark is helpful, "You are not being treated by hypnosis but rather in hypnosis. Hypnosis merely facilitates the understanding so necessary in all successful therapy. You are the one who developed the condition that you wish removed; therefore, it can be accomplished only by reversing those faulty thinking patterns which produced the symptom. Naturally, this will require your utmost concentration, receptivity, self-objectivity, and understanding."

Hypnosis should always be employed for definitive goals. The dictum that "Hypnosis should be used for the good of the patient, not to enhance the prestige of the operator" must be kept in mind. It should never be used for entertainment by a physician or dentist. Otherwise, respect for the method and the operator is destroyed. Finally, as emphasized, the inexperienced operator must never attempt to elicit deeply repressed and traumatic material unless he has been trained to recognize it and to know what to do with is when it appears. (p. 107)

In a Presidential address to the American Cancer Society in 1659, Pendergrass stated: "I personally have observed cancer patients who have undergone successful treatment and were living and well for years... There is solid evidence that the course of disease generally is affected by emotional distress... We may learn how to influence general body systems and through them modify the neoplasm which resides within the body... As we go forward... searching for new means of controlling growth both within the cell and through systematic influences... we can widen the quest to included the distinct possibility that within one's mind is a power capable of exerting forces which can either enhance or inhibit the progress of this disease." (p. 282)

Today, many clergymen are employing hypnotherapy with astonishing success. Since they are already sort of a father-confessor to many of their parishioners, they are in an enviable position to help them because of well-established faith. Pastoral counseling has made raid strides, and it is only a matter of time until there will be many more clergymen making use of hypnotherapy. The author has taught hypnotherapy to several clergymen. They report gratifying results when hypnosis is utilized within a religious framework. (p. 368)

3. HYPNOANESTHESIA IN DENTISTRY AND OBSTETRICS: WILLIAM S. KROGER: JOURNAL OF PSYCHOPHYSICAL SCIENCES AND HYPNOSIS: 1967:

The goal of hypnosis in dentistry as well as obstetrics is the prevention or relief of discomfort and pain. We are all well aware of the anxiety and tension powered by the fearful anticipation of pain in both procedures. Hypnoanesthesia may be employed to completely prevent or alleviate this anxiety thereby raising the obstetrical or dental patient's pain threshold to a point where they experience little or no discomfort whatever. Since only 20%. of patients are amenable to a stage of hypnosis where surgical anesthesia can be achieved, it must be used more in combination with chemoanesthesia. This applies to both dental and obstetrical problems .

In both dental and obstetrical patients, tile factors responsible for the anxiety and subsequent lowering o f the pain threshold must be elicited. These are often unconscious and are often based on the severity of the patient's anxiety, the resulting tension and the type of personality structure. The aptitude for hypnosis can usually be facilitated by group training. The structural dynamics for training in hypnosis in dental and obstetrical anesthesia are similar. When group training in the techniques of hypnotic relaxation are utilized, more patients will be good hypnotic subjects because of the identification that usually occurs in a group. However, this may not work as well as an individual. approach for some patients. Specific suggestions may have to be given as to allow insight into the symbolic meaning of the anticipated dental or obstetrical discomfort that each patient harbors . Here a keen sensitivity to the patient's subtle states of feeling, conscious or unconscious, as manifested in their verbalization and/or behavior, will produce more desirable results -- provided of course, that the doctor has adequate psychologic skills and training. The intensity of the patient's anxiety and the likelihood that it may render him a poor candidate for group training must also be considered. Although I have no figures on the matter, it seems possible that this situation may occur more frequently in obstetrics than in dentistry. For instance, I have encountered women in my past experience, who would rather have had all their teeth extracted than endure childbirth. Yet, there were all women endured toothache month after month rather than experience the temporary pain of dental care. These women are not in the least intimidated by pregnancy, Why does tooth pain prove more anxiety provoking than childbirth for one patient and not for another?

Naturally cases like these would present a challenge even to the experienced psychiatrist and would cause at times an almost insurmountable difficulty for the dentist or obstetrician in attempting to understand how to approach them for the purpose of hypnoanesthesia. It would appear necessary to understand as thoroughly as possible the deep meaning of the procedure - obstetrical or dental - as well as the symbolic meaning of the pain associated with it.

Thus, a more concentrated individual approach is indicated than is possible in a group setting. Once something is understood of the psychological significance of suffering of the patient, the methods of inducing trance are very nearly similar for both types of patients .

One distinct advantage of group training is that it is a time saving procedure for both the dentist and obstetrician. A weekly one-hour class can take care of about 25 patients. Thus, valuable time is saved in the office.

The dentists in this country have blazed the trail in the clinical applications of hypnoanesthesia. They are to be congratulated for their pioneering efforts. One interesting feature stands out. namely that dentists do not educate patients as to how they are going to prepare a cavity or the actual mechanics of the dental worn. They raise the pain threshold by hypnosis. Obstetricians, on the other hand, believe that education in the birth process helps raise the pain threshold.

Since the dynamics responsible for lowering the pain threshold are similar, it is obvious that the education is not essential. I can envisage that patients who have had hypnoanesthesia employed for their dental work may ask obstetricians to utilize similar procedures without the ritualistic exercises and educational procedures. What physicians and dentists must realize is that pain relief is achieved by hypnosis through a strong interpersonal relationship - rapport. This rapport is an essential requirement for altering the conscious perception of/and memory for pain .

Hypnoanesthesia has been discarded several times during the past century because patients and therapists expect it to be the sole method of allaying pain, whereas it has greater utility to alleviate fear, anxiety and tension in the apprehensive dental patient and mother-to-be.

Reassurance and support, which are the mainstays of psychotherapy for an acute psychologic crisis are just as important in preparing the anxious patient for dental and obstetrical anesthesia. Since time is an important factor, this can be rapidly achieved by training groups in the techniques of hypnotic relaxation.

Finally, as mentioned, hypnosis is not a panacea, nor will it ever be a substitute for chenoanesthesia, but should chiefly be used to allay fear, anxiety and tension and only occasionally to produce anesthesia. Since hypnosis is a multifaceted tool, its utility can be broadened if it is used in conjunction with chenoanesthesia. This should have a salutary effect toward a healthier acceptance of hypnosis, especially if unwarranted claims are not made for its numerous advantages, and if its results are not sensationalized.

Even though it has been around for a long time, hypnosis is still a young science in its modern applications, and contrary to popular opinion, it is not a spectacular phenomenon, but is experienced in one fond or another as part of everyday life. Today, hypnosis is rapidly becoming an accepted medical tool in dentistry and obstetrics. It is initially more time-consuming than an injection, but just as practical. Therefore, dentists and physicians now use hypnosis will find new functions for this technique and to many o f them, I am certain that it will help bring insight into the numerous emotional factors associate with the practice of dentistry and obstetrics. Thus, dentists and physicians will do well to direct their attention toward the subtle and reciprocal action of mind and body -- that is, personality.

First, I should like to define the term psychosomatics. This refers to the promotion of health or disease through the normal or abnormal interrelationship and interdependence of the psychological and physiological functions. The word psychosomatic is a bad word because it doesn't completely describe all the factors involved. The reasons being that we cannot divide the mind from the body because the mind is a part of the body. The mind and body 1nterract to produce a given condition. Sometimes the condition is somatopsychic, that is. a disease such as a heart condition or cancer causing a neurotic disorder. However, more often we have tension, producing a physical condition such as stomach ulcers, and then it is truly psychosomatic.

Now, with the advances that have been made in medicine, we must expand our thinking to include environment. This consists not only of the external world, but also the internal forces of the human organism. This approach is called comprehensive medicine. We will be hearing a great deal about this procedure in the next few years. The human is subjected to many stimuli from inside and from outside of the body. Humans are what we call an open system acting with other humans who are open systems. We thus can see the importance of the 1nterract1ons of one person with another.

The human fetus or unborn baby is capable of thinking at 14 weeks, and a personal begins to form from 14 to 40 weeks, when birth usually occurs. The child is affected by the way the mother feels. If the mother is relaxed and has much love, this security will be transferred to the baby. Perhaps this is where we get the expression, "the whole world loves a mother". Any psychological diseases begin in the uterus. What we are saying is that certain chemical compounds do cross the placenta and affect the baby for better or worse. If the baby is over-stimulated with harmful thoughts, the baby is born neurotic. These babies have a higher percentage of asthma and allergies. During this time they exhibit a lot of motion in the uterus. They weigh less at birth, indicating that they use up the carbohydrate that should have formed fat, because of excessive movements.

At birth, a personality is brought into the world and each one is different. The breast-fed infant will be contented and will be less likely to have psychosomatic illness. The mother should want to do this feeding and give warmth and cuddling. The worst thing that can happen is to put the baby in a crib and have him suck on a bottle. This is without loving and cuddling. This is a mechanistic way or starting life. Later on in life one will develop habits to satisfy the lips. In the lips is where the baby gets satisfaction during the first year. This sets the stage for later gratification through the lips including sexual (does not mean intercourse, but a drive for pleasure). The first year is the oral world. Any psychosomatic diseases like obesity can be prevented by proper management of the baby. A person uses food or smoking as a symbolic return to the breast, where he once knew safety and security. This is particularly true for emotionally insecure persons.

The next stage of development is anal when the child receives pleasure from bowel movements and urination. He coks with pride at 2 or 3, at his ability to pass stool. If the child is not trained properly, but instead by rigid training, or by an attitude of no attention, he becomes an anal personality and equates giving up stool with power--thus, all his life he doesn't want to give anything. He is stingy or tight. Set on possessions, he does not want to give anything.

Then there are other children, because of faulty treatment, who are unable to control stools and the bladder. They later may develop colitis and bladder disjunctions, they are usually very retarded and hate to give up bed wetting. This bed wetting should be r1n1shed and over by 4 years of age, but it may go to the age or 14 or 15 or often to adulthood. They want to get even with their parents who would not give them love or satisfaction. These are the kinds of people who develop ulcers, headaches, and cardiac disease. The reason for this is that they are so full of hate and resentment that they cannot express their anger and they turn it in on themselves. They must atone for guilt by paying the price of poor health. We call them psychosomatic masochists rather than physical masochists. They love to suffer. This is called the pain and pleasure syndrome. They love to suffer, for example, gamblers who love to lose money. They get involved with love as children, take drugs, and later become alcoholics. This also includes the repetitive smoker, because he knows it is harmful. He has a strong desire to suffer, and many have an unconscious wish to die.

The next stage of development is where the child develops pleasure from genitals (phallic ages 3 to 5). The growing child should have left the oral and anal stages behind for the genital pleasures. Stimulation can be produced by the child himself or when the child is bathed by the mother or nurse. These feelings are necessary to prepare these areas for later adult function. To prohibit this natural function is to initiate problems such as frigidity and impotency. By age five or six the normal child is able and willing to give up this gratification for new ones. The boy turns to mother and becomes closely attached. The mother is his girl. He may develop resentment toward his father. If he is given a warm and close relationship with his mother, he will in time realize that it is normal for his father to love his mother (this is the oedipus stage). Any individuals get an oedipus complex and will be a "mama's boy" and become dependent and weak. They may even become homosexuals. In the case of a girl, it is easier for her to make the transition from mother to father. However, many girls hate to leave their mothers and want to become tied to her apron strings if father is brutal, cold and rejecting. Later in life, she finds men wicked and bad and remains attached to women; and, she may become a lesbian, fearing and hating all men. They may also become gold diggers and exploit men. They do this to get even with their wicked father. She may also become a prostitute because she finds a nice man (a pimp) and subconsciously the pimp is the father she would like to have. They often become attached to men who mistreat them because they want to be a good little g1rl and bring home the money to be a symbolic father. After this stage, the personality is set. The next period is the latent period up to age 12.

After this, at age 12 to 14, the child becomes sexually awakened and replays the phallic stage. Many remain retarded at the earlier stages of development. As adults the may be like children and may develop physical aliments and problems, and, thus, look for love by going from doctor to doctor. They also bare one divorce after another. Many are trying to find a surgeon to operate on them because of a strong masochistic tendency; they enjoy being sick. Doctors could eliminate 75% of all operations by comprehensive medical and psychosomatic examinations. Medicine must be less specialized to understand the problems. There is a need for more family doctors but instead. they are passing away like the American buffalo.

Those who have studied psychosomatic medicine have seen the damage that has been produced by indifference and lack understanding on the part of scientists. Many doctors laugh at the idea that 85% of patients have nothing wrong with them. These patients go to the cults for help. Eighty-five percent of all people need psychosomatic medical care. Often a disease such as cancer is delayed (diagnosis). Patients die because of no diagnosis or late diagnosis (diabetes and other conditions are involved). Sixty-five percent get better with no treatment because of the psychological element.

The whole field of psychosomatic medicine is now being given recognition around the world. It is also moving into sophisticated areas of human engineering. We must remember organs belong to personalities and we must treat the whole patient by what is called Gestalt approach. This is: not the organ or area, but the whole man.

5. HYPNOSIS AND ITS MEDICAL INDICATIONS: WILLIAM S. KROGER: JOURNAL OF PSYCHOPHYSICAL SCIENCES AND HYPNOSIS: 1967:

There is increasing recognition that various types of suggestion and/or medical hypnosis are particularly effective tools for treating psychosomatic conditions.

First, may I define these terms as used in this particular frame of reference. "Suggestion" refers to the uncritical acceptance of an idea perceived through any and all sensory modalities. Thus signs and messages can impinge on the cortex not only through the five senses but as the result of kinesthetic, proprioceptive, thermal and about a dozen other types of stimulation arising from within or without the organism. Suggestions may be verbal. non-verbal (facial expression). intraverbal (the intonation of the voice) and extraverbal ("are you not tired of standing?" Instead of, "Why don't you sit down".)

A good operational definition of hypnosis is the induction of state in the organism wherein there is increased susceptibility to suggestion which alters sensory and motor activities and as a result, initiates appropriate responses. All physicians, consciously or unconsciously. employ various forms of suggestion in their therapy. Yet, they seldom realize that faith and confidence in the doctor is the curative force. Voltaire once stated, "There is more cure in the doctor's words than in the drugs he prescribes. " The validity of this trite observation is supported by the fact that many symptoms often can be relieved by placebo medication. Hence, if the effect of simple suggestion as embodied in these procedures, is so efficacious. then hypnotherapy, the acme of scientifically controlled suggestion, should even be more helpful for the relief of a wide variety of psychosomatic symptoms. The author is not a therapeutic nihilist, but firmly believes that if a doctor is given the antibiotics, the immunologic agents and a choice of about fifteen drugs, along with a good knowledge of differential diagnosis and a profound knowledge of suggestion, he will be a good physician.

It must be emphasized that hypnotherapy refers to symptom removal and is directed only to the functional component of psychosomatic ailments, and only of course, after a thorough physical examination has ruled out organic factors. The term psychosomatic refers to the interaction and interdependence of emotions and bodily functions in the production of symptoms, and it is obvious that in nearly every disease, the psyche must be treated as part of the total approach to the patient. Hence psychosomatic medicine is not a specialty but a point of view that can influence the physician's ministrations. Hypnotherapy thus becomes just another arrow in the doctor's quiver or therapeutic armentarium.

During the last decade there has been more research and clinical applications of hypnotherapy to all branches of medicine than in its entire history. The British Medical Association, after a thorough taught the fundamental principles of hypnosis as it was particularly valuable in the treatment of the psychoneuroses, and for an adjunct to obstetrical and surgical anesthesia. In the United States, the A.M.A. Council on Mental Health is now considering how hypnosis can be integrated into the medical curriculum.

Despite all the medical and lay publicity, there are still many misconceptions about hypnosis. Namely, that only weak-minded people can be hypnotized; that the hypnotist must be a very powerful figure; that one is rendered unconscious and made subservient to the will of the operator and might be made to do something contrary to his moral code. All of these are fallacious. The only danger from the use of hypnosis is that is is not dangerous enough! Most physicians believe that the main problem is learning to induce the hypnotic trance. This knowledge is readily achieved. Actually, hypnosis is a double edged scalpel which can be utilized as a therapeutic and diagnostic technique. Also, hypnosis has definite limitations and, similar to the surgeons scalpel, its use requires training, experience and judgment to determine when and where it will be of value. Its injudicious use has led to disillusionment twice during the last century. Fortunately, the latest resurgence is being controlled by reputable scientists, who are deriving their data from carefully conducted investigations.

The revitalization of hypnosis began when a few psychiatrists decided to try it in the treatment of battle fatigue, hysteria, anxiety, neuroses, and other depressive reactions which were rampant during World War II. At this time it was noted that when hypnosis was combined with dynamic psychotherapy (hypnoanalysis), the time for treatment was materially shortened. Indeed, so incisively did hypnosis cut to the core of psychosomatic disorders that physicians came to the inescapable conclusion that it was a valuable adjunctive psychotherapeutic procedure. At present many psychiatrists employing hypnosis are convinced that rapport, transference, or empathy in the doctor-patient relationship are, to a degree, a form of hypnosis.

The literature indicates there is a growing awareness that all "schools" of psychotherapy, regardless of methodology, achieve approximately the same results. It has been postulated, therefore, that many of the accepted methods of psychotherapy are merely due to suggestion and are actually due to "hypnosis in slow motion". This would seem to prove that the strength of the interpersonal relationship between psychiatrist and patient is the most important factor in affecting a cure.

Hypnosis enhances this relationship and there is no reason why every physician cannot be his own psychiatrist for the therapy of the milder types of psychoneuroses. Some psychiatrists contend that hypnosis fosters extreme dependency on the therapist. This is undoubtedly true in some cases, but this is the aim of all doctor-patient relationships to keep resistant patient in therapy. This dependency is always worked through in the latter stages of therapy. Modern hypnotherapists seldom use the classical or authoritarian techniques to remove symptoms dramatically, but, but rather allow the patient to go into a hypnotic state in his own manner and at his pace. These symptoms usually serve a defensive need in the patient’s personality structure and they are discussed until they are self-revealing to the patient. This type of patient-oriented hypnosis allows the patient to "save face" and take an active part in his own recovery without being overwhelmed by material dredged up by the therapist. In some cases it may not be necessary for the patient to understand the actual mechanisms responsible for symptoms, but it is extremely important how they patients feel about anxiety-producing situations and how they react to them emotionally.

The psychiatrically oriented physician can utilize hypnoanalysis even for deep-seated personality disorders. Hypnoanalysis differs from psychoanalysis only in degrees. Both utilize interpretation of material which is brought to light through strong rapport, and reintegration of hitherto repressed material into consciousness. In addition, hypnoanalysis uses post-hypnotic suggestions, amnesia, age regression, automatic writing and time distortion to speed the therapy. Post-hypnotic suggestions can redirect the pent-up energy employed by the symptom-complex into productive channels.

During hypnoanalysis, the patient's thoughts (free association) are spontaneous and unfold with ease and maximum latitude of expression. With adequate insight, the nature of his resistances and defenses are unmasked, the result being a significant change in personality and an alteration of behavior. During age regression the patient's verbalizations indicate the vividness with which traumatic experiences can be relived. In some cages, though not always necessary, the symptoms can be traced to their origin and linked up with current behavior patterns.

Hypnotherapy is valuable for harmful habits, including alcoholism, morphinism, obesity due to overeating, excessive smoking, andinsomnia. Tic douloureaux and habit spasms often respond to hypnotherapy. Symptom-substitution can be used if the patient is willing to accept a less harmful symptom. For example, blepharospasm of long standing or a facial tic can be transformed to the twitching of one finger, the patient usually being willing to yield his deeply ingrained symptom for one that is not to bothersome and obvious. When the dynamics responsible for the symptom-complex are elicited, then the twitching of the finger which has not had time to become firmly established, can be easily removed. Naturally, as mentioned, organic factors responsible for all symptoms should always be ruled out by careful differential diagnosis.

Cardiovascular conditions such as paroxysmal tachycarnia, pseudoangina pectoris, idiopathic hypertension, neurocirculatory asthenia, and other cardiac neuroses yield readily to reassurance 1n the hypnot1c state. Hypnotherapy is valuable for the psychogen1c component of asthma, allergy and migraine headaches. It is very effective in neurologic disorders - many remissions have occurred after 1ts use in multiple sclerosis, chorea, paralysis ag1tans, epilepsy and phantom limb pain. Gastrointestinal symptoms of chronic gastritis, mucous co1itis, chronic constipation, duodenitis, pylorospasm, irritable colon, and anorexia nervosa also have been alleviated. Since children are particularly amenable to hypnosis, nail biting, stammering, enuresis and other behavior problems are more easily alleviated by this method.

Many other disorders stemm1ng wholly or partly from emot1onal factors can be helped by hypnotherapy. Among these are neurodermatitis, neurogenic eczema, psoriasis, pruritus and, hysterical contractures, spasmodic torticollis, rheumatic arthrit1i, low-back pa1n, Meniere's syndrome, tinnitus, glaucoma, and globus hystericus.

In the field of gynecology and obstetrics, hypnosis reaches its highest potential, frigidity, functional menstrual disorders, premenstrual tension, functional low back and pelvic pain, vasomotor symptoms of the menopause, psychogenic pruritus vulvae, the tubal spasm associated with infertility often respond readily to hypnotherapy response is also indicative for the relief of the intractable pain suffered by the patient dying of carcinoma.

Hypnosis is a valuable adjunct for rapidly controlling nausea and vomiting, heartburn and salivation during pregnancy. It is especially valuable during labor and delivery, alleviating fear, tension, and apprehension, and thereby raising the pain threshold. When combined with chenoanesthesia, preferably local infiltration, this "balanced approach" can reduce fetal anoxia by 50 to 75 per cent. Approximately 25 per cent of primiparae can be delivered without analgesia and anesthesia. Another 50 per cent require minimal amounts of sedation, and the remaining 25 percent will need conventional procedures. With group train1ng, motivation is heightened and the numbers of patients responsive to hypnosis are increased.

The advantages of hypnosis are the shortening of the first stage of labor by several hours, marked reduction in maternal exhaustion, heightened pain threshold, and the ready control of anesthesia and analgesia. Pain perception during labor is optional. There is no danger to either mother or baby or interference with natural process of labor. The disadvantages of hypnosis in obstetrics include the added time needed for prenatal conditioning; the fact that trance depth may be affected by psychosocial factors and therefore, render disturbed patients unsuitable for the procedure. There is also danger of precipitating a latent psychosis in those women who are seeking to overcome deep-seated inadequacies in their personality through a self-glorifying experience. This type should not be accepted for childbirth under hypnosis. Therefore, a personality appraisal is as important as mensuration of the pelvis! Here, of course, the hypnosis is not to be blamed for the psychoses, but what was done under hypnosis can be held responsible.

From time immemorial, hypnosis has masqueraded under a multiplicity of labels. Natural childb1rth, psychoprophylactic relaxation, auto-conditioning, autogenic training, Christian Science, Yogism and progressive relaxat1on - all are based on hypnotic technics. Hypnoanesthesia in obstetrics is not an all or none method and all patients are informed that they can have analgesia or anesthesia when necessary.

Although hypnosis is limited to less than 10 per cent of patients requiring major surgery, It can be used to lessen preoperative fears; it can potentiate or reduce chenoanesthesia by 50 to 75 per cent. When narcotics which cause respiratory depression are reduced or eliminated by hypnosis, danger or anoxia is also reduced. Neurogenic shock is definitely diminished.

Postoperatively, atelactasis and pneumonitis can be prevented by hypnotic relaxation even when chenoanesthesia had been used. Here it facilitates passage of a catheter for aspirating tracheobronchial secretions. The breathing and cough reflex can be regulated through posthypnotic suggestions, and excessive postoperative pa1n and vomiting usually can be decreased. In good hypnotic subjects, these annoying complications can be prevented entirely. Dur1ng the past year the author has induced hypnoanesthesia for a Caesarian-hysterectomy, a thyro1dectomy, several excision biops1es of breast tumors, and many minor surgical Procedures - all without analgesia or anesthesia. These were not performed for definite contraindications to chenoanesthesia but also to demonstrate its usefulness to skept1cal physicians.

In conclusion, hypnosis is not a panacea but can be multifaceted diagnostic and therapeutic tool Its util1broadened if it is used judiciously as an adjunctive in the framework of holistic medicine.

During the past decade there has been a tremendous world-wide resurgence of hypnosis in all branches of medicine. This is, in part, due to the official endorsement of hypnosis as a therapeutic tool by the British and American Medical Societies. At present, the A.M.A. Council on Mental Health through its Committee on Hypnosis is formulating plans by which hypnosis can be integrated into the medical curriculum and also taught at the postgraduate level.

It should be emphasized that hypnosis is not a trance, state of sleep, or unconsciousness, but rather a communication process which utilizes everyday behavioral response mechanisms. These merely enable a patient to better achieve new learnings and understandings. It is not produced by passes, gestures, or a fixed stare although these methods are useful in some cases.

The increased relaxation, concentration, and greater receptivity and objectivity upon the words of the hypnotist lead to hypnosis, especially when criticalness is bypassed. It is the latter which differentiates hypnosis from strong suggestion and persuasion which only mobilize resistant attitudes.

Wittingly or unwittingly, hypnosis has been utilized under one guise or another since antiquity by both medical and religious healers - the common denominator of these approaches makes full use of the imaginative processes to expect a cure. Conviction of cure leads to cure.

In general, even though variants are used, most methods for inducing formal hypnosis use some type of eye-fixation and monotonic method of speaking. All make use of the ideomotor and Ideosensory activities ( the unborn or built-in reflexes ) . They depend chiefly on ritual and expectancy of success these determined to a large degree by cultural attitudes.

Contraindications and Limitations: A physician does not have to be a psychiatrist to employ hypnotherapy, especially for symptom removal. However, he should have a basic orientation in the subject, common sense, judgment, intuition, and a rich clinical experience in dealing with human ailments. If he lacks the necessary confidence, he will only make the sick patient sicker. The generalist should not employ hypnosis on the psychotic unless he has experience in dealing with such patients.

The purported dangers are not due to hypnosis but rather to what is said during the communication process. The same words, at nonhypnotic levels, would be dangerous. The only danger to hypnosis is that it is not dangerous enough. No one has ever died from it. Can the same be said about steroids, tranquilizers, and shock therapy? Since the bulk of medical practice is directed to symptom removal, hypnosis, for proper indications, can be prescribed like a drug. Most physicians are happy if they can get symptom removal.

When the patient is trained in autohypnosis, he is the one who removes the symptom. This is different than direct symptom removal by an authoritarian technique. This also obviates the oft-repeated criticism that hypnosis fosters extreme dependency. Most of the contraindications and limitations are based on the type of hypnosis used during the latter part of the last century. Today, permissive and sophisticated techniques have been developed.

The physician should not promise more than can be reasonably accomplished - hypnosis is not a panacea. The patient should be told that he is not being treated by hypnosis, but in hypnosis; that hypnosis itself does not cure, but allows a clearer view of the self with the ability to meet one's needs with new understandings. This, in psychotherapy, is of the utmost importance and yet difficult of achievement.

Clinical Applications: Hypnotherapy is valuable for harmful habits, including alcoholism, morphinism, obesity due to overeating, excessive smoking, and insomnia. Tic douloureux and habit spasms often respond to hypnotherapy. Symptom substitution can be used if the patient is willing to accept a less harmful symptom. For example, blepharospasm can be transformed to the twitching of one finger, the patient usually being willing to yield his deeply ingrained symptom for one that is not so bothersome and obvious. The recently acquired reflex can more easily be removed by posthypnotic suggestion.

Cardiovascular conditions such as paroxysmal tachycardia, pseudoangina pectoris, idiopathic hypertension, neurocirculatory asthenia, and other cardiac neuroses yield readily when hypnosis is used as the method of reassurance. Hypnotherapy is valuable for the psychogenic component of asthma, allergy, and migraine headaches. It is a helpful aid in neurologic disorders - many remissions have occurred after its use in multiple sclerosis, chorea, paralysis agitans, epilepsy, and phantom-Iamb pain. Gastrointestinal symptoms of chronic gastritis, mucous colitis, chronic constipation, duodenitis, pylorospasm, irritable colon, and anorexia nervosa also have been alleviated. The fact that placebos have been successfully used in these disorders indicates why hypnosis - the acme of scientifically applied suggestion - proves even more helpful. Particularly amenable to hypnotherapy are nail biting, stammering, enuresis, and other behavior problems in children.

Many other disorders stemming wholly or partly from emotional factors can be helped by hypnotherapy. Among these are neurodermatitis, neurogenic eczema, psoriasis, pruritus ani, hysterical contractures, spasmodic torticollis, rheumatoid arthritis, low-back pain, Meniere's syndrome, tinnitus, glaucoma, and globus hystericus.

In the field of gynecology and obstetrics, hypnosis reaches its highest potential. Functional menstrual disorders and frigidity often respond readily to hypnotherapy. Hypnosis is a valuable adjunct in childbirth, especially for alleviating fear, tension, and apprehension, and thereby raising the pain threshold. When combined with chenoanesthesia, preferably local infiltration, this "balanced approach" can reduce fetal anoxia by 50 to 75 per cent. Approximately 25 per cent of primiparae can be delivered without analgesia and anesthesia. Another 50 per cent require minimal amounts of sedation, and the remaining 25 per cent will need conventional procedures. With group training, motivation is heightened and the number of patients responsive to hypnosis is increased. It should be added that some women, seeking to overcome deep-seated inadequacies in their personality through a self-glorifying experience, should not be accepted for childbirth under hypnosis. Therefore, a personality appraisal is as important as mensuration of the pelvis!

The advantages of hypnosis are the shortening of the first stage of labor by several hours, marked reduction in maternal exhaustion, heightened pain threshold, and the reduction of analgesia and anesthesia. Pain perception is optional. There is no danger to either mother or baby or interference with natural process of labor. The disadvantages of hypnosis in obstetrics include: ( 1) added time needed for prenatal conditioning, (2) the fact that hypnosis depth may be affected by psychosocial factors and therefore render disturbed patients unsuitable for the procedure as there is danger of precipitating a latent psychosis.

Natural childbirth, psychoprophylactic relaxation, auto-conditioning, autogenic training, Christian Science, and progressive relaxation- all are based on hypnotic techniques.

Although hypnosis is limited to less than 10 per cent of patients requiring major surgery, it can be used to lessen preoperative fears; it can reduce chemoanesthetic needs by from 50 to 75 per cent. When narcotics, which cause respiratory depression are reduced or eliminated by hypnosis, danger of anoxia is also reduced. Neurogenic shock is definitely diminished.

Postoperatively, atelectasis and pneumonitis can be prevented by hypnotic relaxation even when chenoanesthesia has been used. Here it facilitates passage of a catheter for aspirating tracheobronchial secretions. The breathing and cough reflex can be regulated through posthypnotic suggestions, and excessive postoperative pain and vomiting usually can be decreased. In good hypnotic subjects, these annoying complications can be prevented entirely.

The author has performed cesarianhysterectomy, thyroidectomy, breast tumor biopsies, and many minor surgical procedures such as curettements, culdoscopies, and other painful procedures - all without analgesia or anesthesia. Others have performed lobectomy, plastic surgery, amputations, and numerous major procedures. Its effectiveness in severe burn cases, the dumping syndrome, and postoperative anuria has been demonstrated by numerous investigators.

Summary: There is a growing awareness among psychiatrists that all schools of psychotherapy, regardless of their methodology , achieve approximately a 60 per cent recovery rate. This indicates that there is a powerful placebo effect to all psychotherapy. In all probability the therapeutic effects of conventional psychotherapies are due to subtly concealed suggestion or "hypnosis in slow motion." The therapeutic goal is not so much to have the patient understand the mechanisms supposedly responsible for his symptoms, but rather how he feels about his anxiety-producing tensions, and how he can react to them emotionally on a more mature level.

At present, scientific interest in hypnosis is stronger than ever. This is not surprising as the physician's personality has for centuries been his greatest therapeutic agent. Thus, it is obvious that hypnosis, the acme of scientifically applied suggestion should have a salutary effect in treatment of psychosomatic disorders. Hypnosis is not a panacea but can be used as a multifaceted diagnostic and therapeutic tool. Its utility can be broadened if it is used judiciously as an adjunctive procedure within the framework of comprehensive medicine.