By Dr. Prabath Wickrama
Though hypnotherapy has only a small place as a treatment option in modern psychiatry, it appears to be a popular form of therapy for psychiatric conditions among Sri Lankans. One can find several advertisements in a Sinhalese daily newspaper of therapists offering hypnotherapy as a treatment for a variety of illnesses ranging from psychosis to depression and from phobias to addictions.
Some even boast of being able to recover memories from a previous birth through hypnosis. It is not infrequent that patients request treating psychiatrists to use hypnotherapy to treat their illnesses. It is also common for patients to follow hypnotherapy while discontinuing psychiatric treatments. This being the case, it is worthwhile to probe the reason for the popularity of hypnotherapy in Sri Lanka.
State of relaxation
Hypnosis is a state where a person is relaxed, drowsy and more suggestible than usual. This suggestibility is a central part in hypnosis and can lead to diminished sensitivity to painful stimuli, vivid imagery, failures in memory and age regression. When the therapist’s suggestions are added to these, the output of a hypnotic session could be quite fantastic though essentially not quite accurate.
As a treatment option, authors claim effectiveness of hypnotherapy in conditions like alleviating acute and chronic pain, addiction, anxiety disorders, insomnia and conversion disorders. However, when one goes in to more scientific reviews these claims are questioned due to insufficient evidence. Further, modern psychiatry offers more effective and tested treatment for the above conditions, which are freely offered at Government Hospitals island-wide by mental health professionals.
A classic condition that therapists use hypnosis is in conversion disorders (dissociative disorders) which were previously known as hysteria. Conversion disorder is a condition where there is a partial or a complete loss of integration between past memory, immediate bodily sensations, control of body movements and self-identity. Typically, the conversion is associated closely in time with traumatic events, insoluble and intolerable problems, or disturbed relationships. It is believed that the conversion shifts the anxiety from the immediate problem in life to the manifested physical symptom.
Conversion in Sri Lanka is known to occur as sudden paralysis, amnesia, speech difficulties and pseudo fits. The most common form of conversion in Sri Lanka is possession states. Claims to be possessed by gods, deities, demons and dead relatives are actually conversion states. These conditions can be cured by suggestion. Traditional rituals, religious procedures and hypnotherapy are all helpful to alleviate symptoms of conversion due to their suggestibility. However, the best way to treat conversion is to gradually guide patients to identify their problems and resolve to better coping methods than conversion. This empowerment of clients is not seen in hypnosis and sudden removal of symptoms alone can lead to further distress in the individual. Another claim especially by local therapists is their ability to guide clients to recover memories from a past life. It is just enough to mention that the accuracy of recovered memory through hypnosis, even from childhood, is questioned by experts due to the fact that suggestibility is a core factor in hypnosis.
So what lends hypnosis popularity in Sri Lanka? Probably one major reason is the unawareness among the majority of our public that mental illness is just another form of illness. They are oblivious to the fact that mental illness occurs due to physical dysfunction of the body similar to any other illness, and can be treated fully by medications or other evidence based treatment.
Another key factor is that as a nation we reject scientific thinking and tend to look more favourably upon the sort of magical thinking. We favour the unknown like the planets and super natural powers to guide our lives, whilst ignoring the more rational paths. The recent flocking of our public in the thousands at the Yala jungle to seek the blessings of a god is a classic example of our obsession in believing the unknown. Hypnosis also carries a mystical quality which attracts our people.
This unscientific thinking often becomes a challenge for health providers in their quest to provide better service. How this magical thinking affects our development as a nation is another topic for discussion.
Dr. Prabath Wickrama, MBBS, MD Psychiatry, is Consultant Psychiatrist at the Trincomalee Base Hospital.