Post-Traumatic Stress Disorder: Hypnosis and the Divided Self
Bower, Bruce, Science News
Post-traumatic stress disorder: Hypnosis and the divided self
New research is challenging the official psychiatric description of post-traumatic stress disorder (PTSD) as an anxiety response. Based on PTSD victims' high susceptibility to hypnosis, the recent findings indicate that a more fundamental "splitting of the self" is at the root of the disorder. If the findings are confirmed, they will have important implications for the treatment of PTSD.
Vietnam veterans suffering from PTSD sometimes describe themselves as "split personalities" who have to "keep the tiger in its cage." That tiger, says psychiatrist Bruce I. Goderez of the Veterans Administration Medical Center in Northampton, Mass., is their combat self -- hyperalert, belligerent, destructive and well adapted to survival in a war zone. At times, notes Goderez in Military Psychiatry: Learning From Experience (W. Walter Menninger, ed., The Menninger Foundation, 1987), the tiger may claw its way out, replacing a veteran's civilian personality that aspires to satisfactions such as marriage and a steady job but is hounded by shame and guilt over wartime actions, such as sadistic or indiscriminate killing, as well as by continuing destructive impulses of the combat self. The internal personality clash leads to failures in all aspects of life, increasing depression and hopelessness, impulsive violence and even suicide.
The struggle between a combat and civilian personality has similarties to multiple personality disorder, which falls under the diagnostic heading of what psychiatrists call "dissociative disorders." Dissociation is a defense against the immediate experience of painful, overwhelming events. Horrifying emotions and memories are psychologically isolated to allow a sense of control to emerge, although a price is paid by splitting the sense of self. For example, a new identity may be imposed on a person's customary identity, as in cases of multiple personality, or the sense of one's self may be temporarily replaced by an emotionally detached feeling of unreality. In some instances, there is amnesia for switches in identity or consciousness.
Yet PTSD, first recognized in the official psychiatric diagnostic manual in 1980, is classified as an "anxiety disorder." It is characterized by the re-experiencing of an unsually stressful trauma in dreams, flashbacks or thoughts; emotional detachment or numbing of responsiveness to the external world; and at least two persistent symptoms of increased arousal, such as difficulty sleeping and violent outbursts.
Combat-related PTSD appears to be rooted in dissociation, not anxiety, says psychiatrist David Spiegel of Stanford University. In the March AMERICAN JOURNAL OF PSYCHIATRY, Spiegel and his colleagues report that Vietnam combat veterans with PTSD are much more easily hypnotized than people with other psychiatric diagnoses, including anxiety disorder, and are also more hypnotizable than healthy control subjects.
Hypnotic susceptibility involves dissociation in a structured setting, says Spiegel. It is like the view through a telephoto lens: One idea is brought into focus while the field of vision is narrowed and all competing thoughts are omitted. The hypnotized individual does not consider consequences or alternatives to the focused idea and becomes extremely open to suggestion.
Among psychiatric patients, says Spiegel, a high level of hypnotizability appears to be a marker of a dissociative disorder. People without psychiatric disorders, he adds, tend to be relatively susceptible to hypnosis, but not to the same degree as PTSD patients. Spiegel and his colleagues compare 65 Vietnam combat veterans with PTSD to 83 healthy controls, 23 schizophrenic patients, 18 patients with excessive and unrealistic anxieties, 56 patients with mood disorders such as severe depression and 16 patients with other psychiatric diagnoses. Each subject is hypnotized through a series of instructions designed to focus attention, and then is asked to imagine that one hand feels like a helium balloon. …