Changing Minds with Clinical Hypnosis

Narratives and Discourse for a New Health Care Paradigm

Laurence Sugarman, Julie Linden, Lee Warner Brooks, Julie Hope Linden

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780367251956
• eBook ISBN: 9781000060553
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book is a scientifically current, integrative, and practical guide for understanding clinical hypnosis and its place within a new health care paradigm.

Blending four original short stories with a treatise, it alternates narrative prose with health science discourse to create a framework for embracing systemic emotional and relational elements that lie beyond diagnosis, medication, surgery, and psychotherapy. Following the stories of four characters, the authors establish an empirically-grounded conceptualization of the mind, then demonstrate how practical applications of therapeutic hypnosis can help readers use individual and family resources in health and healing.

Clinicians will learn to improve their care by embracing emotional, relational, and narrative elements that powerfully affect health beyond diagnosis, medication, surgery, and psychotherapy. Further, health care educators and policy makers will find inspiration that enriches professional training.

1 Prologue

Main Ideas

1. Kuhn’s thesis on scientific revolutions and Engel’s advance of a biopsychosocial model can be viewed together as predicting a paradigm shift for health care.
2. The current biomedical health care paradigm is moving toward change due to increasing morbidity, mortality, and cost.
3. Clinical hypnosis, as a discipline for driving multisystem change—or psychobiological plasticity—lies at the heart of a new health care paradigm.
4. Four principles are introduced as clinical stances within a new health care model.

To know something is to transcend it.

Anonymous

This book is about how clinical hypnosis fits into our shifting health care paradigm. Why clinical hypnosis? Because it is the practice, within clinical settings, of communication and relationship to drive beneficial change in the embodied mind. We dare to refer to hypnosis as the heart of the healer’s art. We will explore this in our first four chapters, starting with relevant aspects of the history of hypnosis. But the foundational concepts of this book do not lie in hypnosis’s history. They start with a confluence of the work of physician George Engel and philosopher-physicist Thomas S. Kuhn.

More than 50 years ago, George Engel (1977)¹ tilted at the trajectory of biomedicine—the dominant paradigm of healing practice—by conceiving a “biopsychosocial model.” In a reaction to what he viewed as the increasingly technical, reductionist, and dispassionate practice of medicine, he sought to bring personal experiences, relationships, and culture into the therapeutic mix. In so doing, Engel acknowledged and welcomed a broader range of inputs into an open and evolving system of mind and healing. Essentially, he raised two questions. First, how does the reductionist biomedical model expand to include psychological, relational, and cultural factors? Second, how do those factors interact to affect health outcomes? These queries spawned the development of new integrative health research endeavors including, but not limited to, psychoneuroimmunology (Ader, 2006)², placebo effect research (Benedetti, 2014), and psychosocial genomics (Rossi, 2003). Findings generated from these new fields reveal that both our social relationships and the stories we tell ourselves can modify and sometimes even override the effects of medicine and surgery. These discoveries unveil interactive intricacies that challenge the monistic—singular and linear—core of biomedicine. They hint at an ecology of health and care with complexity, unexpected possibilities, and wonder: what we could call “psychobiological care.”

While Engel was still formulating his model, Thomas Kuhn (2012) produced his classic thesis on the making of scientific revolutions. Kuhn “single handedly changed the currency of the word paradigm so that a new reader attaches very different connotations to the word than were available to [Kuhn] …” (Hacking, 2012, p. xvii; italics original). He adopted the word paradigm to mean a system of scientific explanations, tools, and practices. A “dominant paradigm” was that system of explanations, tools, and practices that became so authoritative that it governed our perception of reality. For example (ours, not Kuhn’s), until the 1700s the dominant paradigm of the universe was geocentric: the earth was central and heavenly bodies moved around it. Kuhn proposed that as-yet unexplained phenomena, or anomalies, acted as disruptive quakes in a formerly coherent and dominant paradigm. In our example, anomalies arose as early astronomers applied the practice of mathematics and the tools of optics to the heavens to discover that heavenly objects behaved in ways (e.g., retrograde motion) that challenged geo-centrism. Kuhn observed that as anomalies increasingly threaten the coherence, and so the dominance, of the current model, they compel a revolutionary shift; e.g., in our case, to a heliocentric system and a new cosmological paradigm. Kuhn likened paradigm shifts to a “gestalt switch” (2012, p. 118). The new paradigm re-framed the previous facts, changed our perspective, and thus our reality. The heavenly bodies were still there and moving, but through a new frame of reference, shaped by a new paradigm.

Kuhn’s thesis furthered our pursuit of explanatory paradigms to fit our evolving understanding of the world within a rational system called science (see also Kant, 1781/1998). But there is a critical piece beneath that epistemology: the how of it. Kuhn’s thesis, after all, was entitled “The Structure of Scientific Revolutions,” not “The Existence of Scientific Revolutions.” Kuhn defined anomalies not only in relationship to the paradigm, but also to the scientist. An anomaly, he wrote, was a phenomenon “… for which his paradigm has not readied the investigator” (p. 57). The “structure” of the revolution was embedded within the investigators’ minds. Kuhn was not a psychologist, so he did not discuss the self-affirming and liminal nature of our minds and our behaviors. Despite this exclusion, Kuhn’s thesis was fundamentally about how we changed our minds: how we require a system of explanation to fit together with a rationality (in this case, science) and within a social structure. In essence, Kuhn revealed how science provides us stories with which to understand and form our world, stories that we prefer to stick with, despite evidence of their fallacy, until the burden of those errors drives us to change our minds.

Kuhn’s work was necessarily historical, focusing on previous paradigmatic revolutions in physics and chemistry; for example, the discoveries of oxygen and x-rays. But he was also prophetic. He acknowledged dispute—nearly 60 years before this writing—about whether social sciences and psychology were really scientific:

Nowhere does this show more clearly than in the recurrent debates about whether one or another of the contemporary social sciences is really a science. These debates have parallels in the pre-paradigm periods of fields that are now unhesitatingly labeled science.

(p. 159)

Kuhn mentioned neither medical science, nor health care, nor the healing arts. No one was suffering or dying as a direct result of the inadequacy of the dominant paradigmatic revolutions he described.

As we noted in our introduction, we are writing at a critical time in the evolution of the dominant western health care³ paradigm. Currently in the US, at least 60% of adults and 40% of children have body mass indices greater than the upper limit of the “average risk” range of 25, thereby increasing their likelihood of developing cardiovascular and metabolic diseases (NIDDKD, 2018), and half of these at-risk children are obese (BMI > 29). US children also lead the world by five-fold in the consumption of prescribed psychoactive medications, especially in their use of the psychostimulants methylphenidate and amphetamines (Insel, 2014). Opioid addiction affects an increasing proportion of the US population, with estimates that as many as 40% of those suffering from addiction take the drug as prescribed. Overdose deaths have risen nearly three-fold nationally in the last decade (NIDA, 2018). In the US, and increasingly in westernized countries, children who eat average diets, participate in normal (sedentary) activities, and are exposed the dominant culture, are more and more likely to be less healthy than their parents, requiring increasing health care resources to treat metabolic, cardiovascular, and stress-related diseases. It can be argued that the current cohort of US youth is the first generation since the industrial revolution who may die at a younger age than will their parents (SSA, 2018). As such, they represent the last generation of those we may describe as the “accidentally well,” who incur a rising tide of healthcare bills coming due. We consider these factors and more as representing cracks in a shifting paradigm. We imagine that we are ripe for something new.

Putting Hypnosis into Practice

The two clinician-authors (LIS and JHL) of this book explicitly use clinical hypnosis to provide person-centered, mind-integrative, and systems-informed care. We are not alone. We are informed by the work of Daniel Siegel (2012), Bruce Perry (Perry & Szalavitz, 2017), Urie Bronfenbrenner (2005), Yvonne Agazarian (Agazarian & Janoff, 1993), Ernest Rossi (2002, 2003), and many others who have brought concepts together that underscore the benefits of hypnotically-informed communication across the range of the healing arts. Because it utilizes the power of communication and relationship, we consider clinical hypnosis a skill set for ethically influencing “psychobiological plasticity” toward healing and optimizing health. We are going to use the word “plasticity” a lot. It is in the glossary for that reason. But since this is the first time we have used it, we owe you a ready explanation. By plasticity we mean, generally malleability and agility, both physical or imaginative. This can mean, susceptibility to external influence, but it can also be intentionally self-determined, as in being flexible and “open-minded.” This agility can refer to both cognitive and emotional domains. Since we are mostly referring to our embodied minds, with both psychological and biological workings, by “psychobiological plasticity” we mean how able and willing we are to change our minds, whether or not we are aware of it. This has strongly informed our theory and practice of care. We have found that hypnosis and the phenomena it evokes are increasingly congruent with research findings in psychoneuroimmunology, placebo effects research, psychosocial genomics, and other areas that are consistent with the tenets of Engel’s biopsychosocial model. Hence, we regard hypnotic skills as the heart, not the fringe, of health and the healing arts.

In this book, we intend to reorient the principles and practice of clinical hypnosis to align with evolving findings in psychobiology and “mind-body” health, or psychobiological care. We are paying particular attention to the psychobiology of human development, attachment, and trauma in relation to genomics, epigenetics, and the social environment. We believe that an expansive range of evocative, open-ended, and conversational hypnotic interactions must augment the traditional directive and premeditated methods of health care. We hold that hypnosis, as we conceive it, allows for individualistic—even idiosyncratic—person-centered approaches, to produce deeper and more lasting effects than problem-, technique-, or diagnosis-centered strategies. In this way, we expect that hypnosis allows a translation of psychobiological research findings into clinical care. In short, we believe these skills form the heart of a new health care paradigm. This book orients clinical hypnosis to align with the evolving science of mind and inform evolution in the healing arts.

First Principles of Hypnosis-Oriented Communication

1. Systems Thinking—The client/patient always functions as part of, and is influenced by, a nested set of systems.
2. Temporal Touring—Problems and their treatment travel in time with people.
3. Relational Being—We are designed to influence each other. The intensity of our relationships correlates with the intensity of the influence.
4. Narrative Listening—We have a need for coherent and congruent stories, the oldest form of healing art.

In the daily work of clinical care, we can lose sight of the principles and conceptual framework that influence our professional behavior; for example, that each patient is a unique individual within a social system (Engel, 1977). When we take these principles for granted and they are neither freshly delineated nor defined, their influence and meaning can recede, as when simply prescribing takes less time and engagement than listening some more. Our beliefs also need to be challenged regularly. This book endeavors to bring into the foreground concepts and perspectives that deserve clarification and naming so that we may more consciously, even mindfully, welcome their influence.

We consider four principles in the paradigm of psychobiological care to supersede, but not replace, the prevalence of biomedical cause-and-effect reductionism. They are listed at the beginning of this section. These principles are not really new. We are merely aligning and configuring them. We bring them into the core of the new paradigm from their previous place on the anomalous periphery of the biomedical model. Similarly, we believe that these principles interact and, like our integrative narratives, cut across all aspects of professional clinical behavior. They serve as cardinal directions to orient oneself in relationship to a person in care. These orientations are simply introduced here. Their significance unfolds in discussion, clinical application, and the narrative stories of this book.

1. Systems Thinking. Borrell-Carrió, Suchman, and Epstein (2004) note that in formulating his model, Engel rejected the (false) dichotomy contrasting the purely materialist-reductionist perspective (e.g., pills and procedures) on one hand with the ephemeral holistic-energy views (e.g., healing spiritual energy) of clinical care on the other. Instead,

He endorsed what would now be considered a complexity view, in which different levels of the biopsychosocial hierarchy could interact, but the rules of interaction might not be directly derived from the rules of the higher and lower rungs of the biopsychosocial ladder. Rather, they would be considered emergent properties that would be highly dependent on the persons involved and the initial conditions with which they were presented, much as large weather patterns can depend on initial conditions and small influences.

(p. 577)

Among the many implications and decades of clinical research that derived from this principle, three are particularly relevant to this book. First, at whatever level of the system one starts, from intracellular processes to family inter...

Table of contents

• Cover
• Endorsements
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• Foreword
• Introduction
• Robinson’s Story
• 1. Prologue
• Lulu’s Story
• PART I: Hypnosis and Changing Minds
• PART II: Developmental Imperatives
• PART III: Attachments, Relationships, and Modeling
• PART IV: Looking Beyond
• Afterword
• Appendix
• Glossary
• Subject Index
• Author Index