The treatment of hypochondriasis by hypnosis

The therapeutic value of hypnosis in the treatment of so-called “functional” nervous and mental affections is still debated, though its usefulness in certain cases of hypochondriasis and dipsomania has been strongly insisted on by certain authors. Dr. Ira van Gieson has recently reported a remarkable case of hypochondriasis and depressive delusions treated by systematic and skilful hypnosis, an account of which is published in the Journal of Nervous and Mental Diseases [sic] for November last. The patient was a Russian, aged 26 years, and had a good family history. In February, 1900, he began to suffer from insomnia, headache, and loss of appetite, and he became despondent. The general health rapidly deteriorated and a local practitioner stated that his trouble was largely “indigestion” and that there were “lumps” in the bowel. Thenceforth the patient developed a delusion that these “lumps” were “worked upon” by worms in the intestine and broken into smaller lumps which were disseminated through his body. “The patient believed that he was rescued from dire distress by three agencies - viz., the spleen, the soul, and the veins, the spleen being the scavenger and the soul the director.” When the attention of the soul was distracted this work was not well done. These delusions engrossed his thoughts and he could speak of little else. There were no sensory disturbances, no hallucinations, and no tendency to suicide, while his ideas regarding his environment were clear and correct. On putting him into a hypnotic trance a striking change occurred, the state of depression giving way to one of great exaltation. Despite this the delusion referred to still persisted, thus showing, adds Dr. van Gieson, that the state of depression was secondary to the delusion and that when the former vanished, as during hypnosis, the latter still persisted. On one occasion during deeper hypnosis than usual the state of exaltation gave way to one of quiet composure which was approximately the patient's normal demeanour. There were thus three states in which the patient lived - a waking state of melancholic depression, a slight hypnotic state of exaltation, and a deep hypnotic state of composure. These states also alternated or varied spontaneously, but throughout them all the central delusion remained unshaken. The great assimilating power of this delusion was wonderful. Various suggestions were made to the patient during hypnosis “with the object of breaking up the nucleus of the delusion, but they were turned about by the patient and fed into the systematised delusion”. It was necessary to employ indirect hypnotic suggestion in order to strengthen the effect in dissipating the delusion, as direct suggestion during deep hypnosis was found to be only temporary in this effect. During hypnosis dreams were suggested to the patient to the effect that his father told him that the “lumps” from which he suffered would go away. These dreams duly followed and impressed him deeply though slowly. When the influence of these suggested dreams had eventually become apparent and dominant the “spleen” and the “soul” ceased to be regarded as agencies in the sense in which they had formed part of his delusion. The galvanic current was now substituted therapeutically with great benefit, and it succeeded very effectually in impressing the patient with its potency. “Small spots” were next substituted during hypnotic states for the large “lumps” and these spots were gradually restricted to certain definite areas by suggestion instead of being vaguely disseminated as the patient had entertained in his delusion. The patient's melancholia finally disappeared completely and he was able to resume his occupation. The case, concluded Dr. van Gieson, was a triumph for the hypnotic method of treatment as systematically and skilfully used. Such a case was not an isolated one but was regarded as a type of similar cases in State hospitals for the insane and in Dr. van Gieson's opinion the treatment employed in the case might be usefully applied to others of like nature.