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Erickson, M.H. Kubie, L.S. (1941). The Successful Treatment of a Case of Acute Hysterical Depression by a Return Under Hypnosis to a Critical Phase of Childhood. Psychoanal Q., 10:583-609.
(1941). Psychoanalytic Quarterly, 10:583-609
The Successful Treatment of a Case of Acute Hysterical Depression by a Return Under Hypnosis to a Critical Phase of Childhood
Milton H. Erickson and Lawrence S. Kubie
For special reasons the treatment of this patient had to be approached with many precautions. The circumstances of her illness made a direct approach to her problem (whether by a man or a woman) dangerous because such an approach invariably caused an acute increase of her panic and of her suicidal depression. She could be treated, if at all, only by creating an elaborate pretense of leaving her problems quite alone, without even letting her realize that any therapy was being attempted, without acknowledging the development of a relationship between the patient and the physician, and without open reference to the experiences which had precipitated her illness.
For these reasons, the treatment was begun by pretending to treat someone else in her presence, and through this means, she was slowly and gradually brought into a hypnotic state in which her own problems could be approached more directly.
From this point on the treatment proceeded along lines which are the reverse of the usual psychoanalytic technique. Some points seem to be worthy of special emphasis.
Instead of depending solely upon memory to recover important experiences out of the past, the patient under hypnosis was translated back to a critical period of her childhood, so that in this state she could relive or revive the general quality of the influences playing upon her, but without recapturing the details of specific scenes and episodes. Instead of stirring them up and making them conscious, there was a deliberate effort to avoid the induction of any feelings of guilt or fear. Similarly, instead of insisting upon total conscious recall, permission was freely granted to the patient to forget painful things, not only during but also after the hypnotic treatment. Underlying this permission to forget was the confidence that even those facts which were consciously forgotten could be recovered during the hypnosis when needed for therapeutic use, and that their therapeutic efficacy would continue even during the posthypnotic repression.
The hypnotist's attack on the patient's rigid superego was
interesting from various points of view. Particularly noteworthy, however, was the fact that the attack on the superego began with a complete support of all of the most repressive attitudes which the patient attributed to her dead mother. It was only by forming a bond in this way between himself and the mother that he was able later slowly to undermine the rigidity of this repressive figure and thus to penetrate the patient's tense and automatic defenses of her mother's dictates. Another significant point is the method used by the hypnotist to help the patient silently to assemble her ideas before communicating them. This seemed to assist materially in reducing the patient's fear of remembering presumably because it is not as difficult to recall embarrassing things which one can keep to one's self, as it is to bring them to mind with the knowledge that one must confess them at once; moreover, once such things have been reviewed in thought, it becomes easier to talk of the thoughts than it would have been to talk of the events themselves. This two-stage method of recalling and assembling data before communicating it might have its usefulness in analysis as well.
A point at which the work of the hypnotist coincides closely with that of the analyst is in the use of repetitions in many forms and at each age level investigated. This use of repetitions is quite similar to what is found to be necessary in analysis as well.
In understanding the course of this treatment and of the patient's recovery, there are many gaps in the material, gaps which could be filled in only by conducting a treatment of this kind in a patient who had been under a fairly prolonged analysis.
There are many questions we would like to have answered. Was the basis of the mother's overwhelming authority primarily affection or hostility and fear? Were the dead mother and the dead friend equivalent? If the hypnotist had said instead that he was the dear friend, and that as the dead friend he encouraged and approved of her love-making with the dead friend's husband (an equivalent of a mother telling her that
she could make love to her father), would this impersonation of the friend by the hypnotist have freed the patient from guilt feelings and from her hysterical depression without the induced regression to childhood? What was the mechanism of the cure? Was the hypnotist equate to her mother, and thus enabled to remove the mother's taboos? Or was the fiancé at first a surrogate father until the hypnotist took over the father's rôle, thus removing it from the man, and thereby making it possible for the patient to have an erotic relation with the man without a barrier of incest taboos? What was the rôle of her orality and its significance in relationship to the vomiting? In general, what was the rôle of all of those basic facts of her early life which must have determined the patient's relationship to her parents and to people in general?
The answers to these gaps in information is challenging, both from a theoretical and from a factual point of view. The knowledge of these facts is indispensable for an understanding of the structure of the illness and the dynamics of the recovery. But the fact that recovery could take place so quickly and without hospitalization, in face of the fact that there were so many things which the hypnotist never discovered and that the patient did not know, also has its important theoretical consequences. It faces us with the question: if recovery can take place with the gain of such rudimentary insight, what then is the relationship between unconscious insight, conscious insight, and the process of recovery from a neurosis?