Hypnotism under the Knife; Hypnotism Has Been Called 'A Believed-In Fantasy,' and Believers Are Using It as an Anesthetic in Surgery. It Is, Literally, All in the Mind

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Hypnotism Under the Knife

The young woman lies on an operating room table, alert and listening intently to Frank Marlowe, a Philadelphia plastic surgeon and otolaryngologist. Several weeks before the surgery, Marlowe had a 20-minute hypnosis session with the patient. He put her in a trance and gave her a posthypnotic suggestion -- that when he said "deep deep relax," she would completely relax and spread her fingers as a signal that the surgery could begin.

Now he softly tells the patient what will be going on during the operation and says the passwords. The patient, a nurse, has wanted a nose job for years but has avoided it because of fear of anesthesia. Marlowe tells her she won't have any discomfort. Nor, for that matter, will she receive any conventional anesthesia. Her fingers spread slowly, her eyes close and the operation begins.

Marlowe injects her nose with saline solution, using a large-gauge needle to show that she is not reactive to pain, and inserts a scalpel into her nostril. Hecarves out several pieces of cartilage. Then he gives the nose a smart rap with hammer and chisel, pulls out several bone chips, carefully sews up the tissue inside the nose, packs it with gauze and tapes it into shape.

Marlowe tells her the operation is over. The patient smiles and moves herself onto a gurney for the trip to the recov ery room.

While the medical literature includes an occasional description of hypnosis being used as the primary anesthetic in a major surgical procedure--it hasa reportedly been used for everything from dilatation-and-curettage to open heart surgery--proponents of the practice say its real value is as an adjunct to chemical anesthesia, relaxing the patient and allowing less anesthesia to be used, thus shortening recovery time. But even as an adjunct, they say, hypnosis has for the most part gone unrecognized by the medical profession.

Neither the American Society of Anesthesiologists in Park Ridge, Ill., nor the American Society of Clinical Hypnosis in Des Plaines, Ill., has exact figures on how widely hypnosis is used in surgery, but at least some of the clinical society's 3,900 members use it for surgical anesthesia. In 1972, the American Medical Association's Council on Mental Health stated that hypnosis has a "recognized place in medicine" and is a useful technique in treating certain illnesses when used by qualified personnel, but didn't refer directly to anesthesia.

Nevertheless, its practitioners say there has been a slow but steady increase in the use of hypnosis in surgery. One possible reason is the renewed interest in acupuncture, says Marlowe, who is on the faculty at the Medical College of Pennsylvania. Like hypnosis, acupuncture's exact physiological basis is not understood, and its efficacy may rely in part on faith in the procedure. "I think acupuncture is largely hypnosis," Marlowe says.

Hypnosis in surgery -- both formally putting someone in a trance and informally suggesting a person will not feel much pain -- "is not done as much as I'd like," says psychologist Harold J. Wain of Walter Reed Army Medical Center in Washington, D.C. "I think it's one of the most outstanding adjuncts [to anesthesia] we have," he says.

Wain has been studying the use of hypnosis in the emergency room, where he has found that many patients are already in a trancelike state, making formal induction of hypnosis "a snap." Standing in its way, Wain says, are misperceptions that inducing a trance in unreliable, difficult and time-consuming.

Hypnosis as anesthesia is something utterly unfakeable -- the ultimate placebo effect. Though the exact physiological mechanism by which it works is unknown, medical hypnotists say it relies on two factors: that painful stimuli in surgery are not nearly as great as some people imagine, and that the mind can be trained to ignore them.

Many surgical procedures, though gory, can be "very trivial procedures as far as pain goes," says David Mayer of the Medical College of Virginia in Richmond, who did a study in the late 1970s showing that hypnosis can double a person's pain threshold. …