This issue of BJPsych Advances includes an article on the use of hypnotherapy in psychiatric practice. The article contains a number of errors and misconceptions regarding the characteristics and practice of hypnosis that we address in this commentary.

The use of hypnotherapy in psychiatry has been controversial. However, evidence presented by Chan and colleagues shows that it is beneficial to the promotion of good mental health and well-being, specifically being applicable in the management of mental disorders. But what does this mean for practice? This commentary looks at what we agree and disagree with, what we opine is missing from the article and what now needs to happen. Patients should be able to access hypnotherapy or hypnosis routinely on the National Health Service. Since it works, who may it work for and how may we make this available to those who could benefit from it?

During the late nineteenth century, many British physicians rigorously experimented with hypnosis as a therapeutic practice. Despite mounting evidence attesting to its wide-ranging therapeutic uses publicised in the 1880s and 1890s, medical hypnosis remained highly controversial. After a decade and a half of extensive medical discussion and debate surrounding the adoption of hypnosis by mainstream medical professionals – including a thorough inquiry organised by the British Medical Association – it was decisively excluded from serious medical consideration by 1900. This essay examines the complex question of why hypnosis was excluded from professional medical practice by the end of the nineteenth century. Objections to its medical adoption rarely took issue with its supposed effectiveness in producing genuine therapeutic and anaesthetic results. Instead, critics’ objections were centred upon a host of social and moral concerns regarding the patient’s state of suggestibility and weakened ‘will-power’ while under the physician’s hypnotic ‘spell’. The problematic question of precisely how far hypnotic ‘rapport’ and suggestibility might depart from the Victorian liberal ideal of rational individual autonomy lay at the heart of these concerns. As this essay demonstrates, the hypnotism debate was characterised by a tension between physicians’ attempts to balance their commitment to restore patients to health and pervasive middle-class concerns about the rapid and ongoing changes transforming British society at the turn of the century.

This article gives an insight into some possible intervention strategies using the basic principles of hypnotherapy. An excerpt of a treatment is described, showing the main effect with this individual person. The therapist applied the idea of unconscious seedings by narrating other clients' strategies. At the end, he supports the search of individual strategies. Abstinence was controlled one year after the last meeting by self-report and CO-measurement.

A tropical vignette case history of flashback trauma for a Vietnam veteran beginning with a prison softball game.

This paper examines research on three hypnotic phenomena: suggested amnesia, suggested analgesia, and “trance logic.” For each case a social-psychological interpretation of hypnotic behavior as a voluntary response strategy is compared with the traditional special-process view that “good” hypnotic subjects have lost conscious control over suggestion-induced behavior. I conclude that it is inaccurate to describe hypnotically amnesic subjects as unable to recall the material they have been instructed to forget. Although amnesics present themselves as unable to remember, they in fact retain control over retrieval processes and accommodate their recall (or lack of it) to the social demands of the test situation. Hypnotic suggestions of analgesia do not produce a dissociation of pain from phenomenal awareness. Nonhypnotic suggestions of analgesia and distractor tasks that deflect attention from the'noxious stimuli are as effective as hypnotic suggestions in producing reductions in reported pain. Moreover, when appropriately motivated, subjects low in hypnotic suggestibility report pain reductions as large as those reported by highly suggestible hypnotically analgesic subjects. Finally, the data fail to support the view that a tolerance for logical incongruity (i.e., trance logic) uniquely characterizes hypnotic responding. So-called trance-logic-governed responding appears to reflect the attempts of “good” subjects to meet implicit demands to report accurately what they experience.

It is widely felt that the sorts of ideas current in modern laterality and split-brain research are largely without precedent in the behavioral and brain sciences. This paper not only challenges that view, but makes a first attempt to define the relevance of older concepts and data to present research programs.

In the 19th century, there was a body of literature that held that many mental pathologies could be explained by supposing that each individual potentially had two conscious brains. Madness resulted when these begin to interfere with each other or otherwise functioned independently. The left-sided localization of language by Broca in the 1860s complicated matters by showing that the two brain halves functioned differently. Broca argued that functional asymmetry was a reflection of man's capacity to “perfect” himself; soon, the left hemisphere was transformed into the superior, uniquely human side of the brain. Considerable effort then went into seeing how far the functions of the right hemisphere complemented those of the left. The resulting dichotomies of mind and brain interacted—and sometimes also conflicted—with “duality of mind” theories. In the 1880s, the Paris school of neurology helped bring about a revival of interest in these theories with its startling metalloscopy and hemihypnosis experiments.

A section of this target article is devoted to the views of Hughlings Jackson. Jackson's physiological/philosophical writings on hemisphere specialization and mental duality largely set him outside of the rest of the 19th-century tradition. The article concludes that at least some of the data gathered in the 19th century might prove useful or interesting to certain investigators today. More important, it asks how far an awareness of the “time-bound” nature of 19th-century concepts should change the way in which one surveys the laterality scene today.

Alistair Campbell is Research Editor for the ANZJFT. He is a Senior Lecturer in Clinical Psychology and Director of the Psychology Clinic at James Cook University in Townsville. He speaks provocatively with Ben Hansen about research and training in family therapy, about accountability to our clients, and about practice.

Objective: Hypnosis is an adjunctive, noninvasive treatment with few side effects that can be useful in the management of chronic pain. However, it has fallen into disfavor in recent years and is often perceived by physicians as simple charlatanism. We evaluated the efficacy of this treatment as used clinically in a large, mostly rural, pain management center.

Methods: We conducted a chart review of 300 pain patients from the Pain Treatment Center of the Bluegrass who had undergone hypnosis for their pain concerns. A chart audit tool was developed consisting of basic demographics, pre- and posthypnosis pain ratings, a rating of relaxation achieved posthypnosis, and scores on the Beck Depression Inventory, Perceived Disability Scale, and the Pain Anxiety Symptom Scale.

Results: The sample consisted of 79 men (26.3%) and 221 women (73.7%) with a mean age of 46.3 years (SD = 9.9, range = 19–78). Pain levels recorded pre- and posthypnosis revealed significant improvement as a result of the intervention (mean difference = 2.5, t(1,298) = 25.9, p < .001). Patients reported an average of 49.8% improvement in relaxation level posthypnosis (SD = 24.2%) and had a mean score of 19.0 on the Beck Depression Inventory (SD = 9.9), indicating moderate levels of depression. Also, patients saw themselves as severely disabled regarding their ability to engage in physical (8.3/10) or job-related (7.7/10) activities. Attempts to identify predictors of hypnosis success were not fruitful with one exception. “Poor” responders to hypnosis reported greater levels of perceived dysfunction in their sexual functioning compared to the “good” responders, F(1,187) = 7.2, p < .01.

Significance of results: Hypnosis appears to be a viable adjunct for pain management patients, including those from rural and relatively disadvantaged backgrounds. Prospective trials are needed to examine the utility of this modality in end-of-life and palliative care patients.