Hypnosis

Hypnosis is used as an abreactive technique or for exploration, with the same aim as the administration of sedative drugs. Commonly, it is used to reinforce suggestion.

The technique varies: most hypnotists develop their own. One method is to ask the patient to relax, preferably on a couch. The hypnotist then stands in front of him and holds a small bright object in such a position that a very slight strain is imposed on the patient's eyes. The room is darkened a little. The hypnotist then repeatedly assures the patient that he can't keep awake, feels drowsy, is very relaxed, and so on. Once the patient is hypnotised, the hypnotist ‘suggests’ that the patient's disability will grow less or disappear and that he will not remember it in the waking state. Many sessions of treatment may be required.

The procedure is so frequently followed by relapse and so liable to produce an abnormal dependence on the hypnotist that many authorities consider it of little use in psychiatric illness.

Pavlovian and Learning Theory Methods

Conditioned Reflex. Pavlovian methods of treatment are based on Pavlov's discovery of the conditioned reflex and the branch of biology deriving from this. Pavlov demonstrated that an organism can be trained to respond automatically to a given stimulus and to repeat this response in an identical way on subsequent occasions. For example, whereas the mouth normally waters in response to food, an animal can be trained to salivate at the sound of a bell.

Attempts to apply findings of Pavlovian physiology to the treatment of certain psychiatric disorders have been made in recent years in Great Britain, Russia and the United States of America.

`Learning theory' makes use of Pavlovian ideas together with knowledge gained from watching young animals and young children and studying their processes of learning. Neurotic symptoms are regarded not as part of a disease process but as habits developed on the lines of conditioned reflexes.

Treatment aims, broadly speaking, at conditioning the patient to respond in new and more satisfactory ways, and at deconditioning him from undesirable responses. Many methods of treatment have been devised, of which the following are only examples.

Buzzer for Enuresis. One device which has been developed is designed to help nocturnal enuresis (bed-wetting). When the sleeping patient begins to pass urine an electric circuit is completed and a loud bell or buzzer, placed at the bedside, rings. This wakes the patient who can then complete urination in the toilet. This procedure is repeated nightly for several weeks. The patient then begins to associate a full bladder with the bell-ringing and with awakening. The hope is that, even when the device is withdrawn, the full bladder will now cause the patient to awaken and use the toilet.

Cat Phobia. A method of treating phobias has also been devised and recently applied in the case of a patient who was terrified of cats and everything connected with them. She was first shown furry materiais and later encouraged to touch them. Eventually she was able to hold and even stroke the material. She was soon prepared to tolerate photographs of cats. and later to stroke small kittens. In due course she was able to encounter cats without fear.

Other phobias have been treated in a similar way.

Writer's Cramp is one example of a hysterical condition which has been treated by related methods. In this case small, repeated electric shocks are passed which make maintenance of the `cramp' difficult. Eventually the patient may learn to use a pen without the intervention of the machine.

Aversion Therapy. A form of treatment known as `aversion therapy' has been used to treat alcoholics. The patient is given injections of a drug which causes vomiting; apomorphine and emetine are examples. He is given alcohol to drink just before the drug can be expected to work. Again, the hope is that in due course he will come to associate the drinking of alcohol so strongly with vomiting that such drinks will revolt him. The procedure may have to be repeated separately for beer, gin, whisky and so on.

Finally methods have also been evolved whereby some sexual perversions, notably fetishism, can be treated. These rely on training the patient to become actively averse to the article of clothing concerned instead of becoming excited by it. But it must, of course, be emphasised that none of these methods, even when successful, does anything to resolve the mental conflicts underlying the symptoms.

Occupational Therapy

This term is used to cover a wide range of activities in which patients participate, under the guidance of trained staff, as part of the treatment of medical, surgical and psychiatric illness. At its simplest it provides a series of handicrafts to occupy and divert patients who are bed-bound or otherwise incapacitated. More active and complex programmes are used for rehabilitation and retraining. Individual requirements of psychiatric patients differ greatly, but most in-patients and day patients need a full occupational regime at some stage in their treatment.

Graded Tasks. A patient recovering from a severe illness may be given a series of tasks which can be stimulating or soothing. These may be graded from simple to more complex tasks as the patient's condition improves, to give increasing exercise in concentration and the regaining of self-confidence. He or she may begin with undemanding work such as basket-making, proceed to handicrafts requiring more skill and later take up activities akin to his or her own work. Many occupational therapy departments can provide facilities for housecraft, woodwork, metal work and typing and clerical work. At this stage it is particularly encouraging for the patient if the work is of immediate use to the other patients or to the hospital.

Social Aspects. Patients in hospital for a considerable period tend to lose touch with social activities and with everyday responsibilities. This may impede return to full health. One aim of a psychiatric hospital is to provide for its less incapacitated patients the facilities for a full regime of work, social activity and physical exercise. It is usually helpful for the patient to feel that he retains responsibility for himself, and most hospitals encourage patients to arrange the details of their work and leisure, and to organize work projects and social activities such as dances and discussion groups.

Many of these patients enjoy music, and groups provide entertainment from ‘pop’ bands to church choirs.

The idea of the hospital as a small community of people representing both the family and civic group is an important one. Most psychiatric illnesses are characterized to some extent by an impairment of ability to live happily in reasonable harmony with relatives and society. Through the various activities described and particularly during the course of psychotherapy, the patient may be helped to improve his relationships with people, to function in a way both satisfying to himself and to the community, to accept the needs of the group when they conflict with his own, and to contribute to the group. His day - today experiences in the hospital community may be discussed in psychotherapy sessions and may give him a wider understanding of himself and his difficulties.

Acting a Role. Some additional occupational activities have special aims. In playreadings and psycho-drama, patients may gain understanding of personal problems by acting roles allotted to them. For example, a young girl playing the role of a mother may come to understand more clearly her own mother's interests and difficulties. Art therapy provides the satisfaction of self-expression and the patient may, in depicting his own experience and emotions, gain greater self-awareness.