This article was downloaded by: [New York University] On: 10 January 2015, At: 14:14 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Hypnosis: A Cure for Torticollis Joseph J. Avampato Ph.D. Published online: 20 Sep 2011.
To cite this article: Joseph J. Avampato Ph.D. (1975) Hypnosis: A Cure for Torticollis, American Journal of Clinical Hypnosis, 18:1, 60-62, DOI: 10.1080/00029157.1975.10403773 To link to this article: http://dx.doi.org/10.1080/00029157.1975.10403773
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
60
BRIEF CLINICAL REPORT
Hypnosis: A Cure for Torticollis 1 JOSEPH J. AVAMPATO, Ph.D.
Downloaded by [New York University] at 14:14 10 January 2015
Highland, New York?
cassette tape made for her by me (Insight therapy could not be used effectively, as will become evident later in this paper.). The patient had a chaotic childhood, having been abandoned by her mother and father, and raised apart from her older brother by various relatives, who were undemonstrative and rigid. Her brother was killed at the age of 17 years by a truck, which decapitated him (a traumatic incident that was explored for dynamic implication). She eventually attended a Catholic girls' school in her teens and when she expressed a desire to adopt Catholicism as a religious 'modality, she was again rejected by her relatives and told to "go live with the nuns" by her rigid Protestant aunt and uncle. Surprisingly, although a cloistered group, the nuns did indeed accept her and gave her a small apartment. They encouraged her to date and enjoy the experiences of a teenager. She eventually joined this religious order and stayed for several years, but left before final vows. Soon thereafter she met a man with whom she fell in love and whom she married. This couple has six children (three of whom have danced as children-guests artists in New York with a major dance tour company; two others have appeared on a national television show). She choreographs all of her children's performances, is adept at sewing, is an avid reader, and exhibits all the qualities of a talented adult woman. When the attacks of torticollis man1 Presented at the 17th Annual Scientific Meeting ifested the patient's intolerance to her life of the American Society of Clinical Hypnosis, New stresses, she was in the process of losing Orleans, 1974. 2 Red Top Road; RD 1, Box 440. her home due to her husband's financial ir-
This is a clinical history of a 42-year-old woman suffering from severe torticollis for the one year prior to the inception of hypnotherapy as a treatment modality. Treatment began in September, 1972, and continued for a sum total of 64 visits. Previous modalities employed included neurological and opthomological diagnoses, medication (tranquillizers and muscle relaxants) by a general practitioner, psychiatric intervention, and chiropractic care; all with no appreciable results. This patient came to me with the ability to turn her head back to the proper vertical plane only with extreme difficulty and had to force her head to tilt down onto her shoulders to remain in place. When she first appeared in my office she walked in sideways and held her head by her left hand as she sat on my couch. When I asked her to relase her hand, her neck immediately turned full-force to the left and she began to cry, with the protestation, "Please help me to live with this!" Hypnosis was used from the very first session and within one month's time (at a 3-times-per-week weekly schedule) a substantial alleviation of her symptoms could be estimated at 70%. Since then most ofthe once or twice weekly sessions were spent in a hypnotherapeutic intervention, a supportive device with the patient twice daily using either self-hypnosis or by having a trance induced by playing a recorded
Downloaded by [New York University] at 14:14 10 January 2015
BRIEF CLINICAL REPORT
responsibility. (The husband subsequently came into therapy with me and his psychodiagnostics produced a diagnosis of sociopathy. ) Approximately four months ago, shortly before therapy was abruptly suspended by her, the patient related to me that she regarded herself as much as 80% to 90% cured. She had begun again to walk, shop and eat in public once more. She could attend to household chores (including cooking, which had been an impossibility previously); she could read, watch television, attend the theatre (which involved train travel of some distance), and all symptomfreely most of the time. She has continually thought about her brother's decapitation from that event to the present. Although she was not permitted to view this accident personally, she was for some time continually reminded of it by her aunt and uncle and, I am sure, mentally conceived a picture of the incident. Also, when she was about to lose her home, she went through a psychological separation from her husband (because of a marriagelong estrangement) of "turning away" or of "avoiding a confrontation" with her husband (Alexander, 1950). As soon as a loss of her family "nest" (home) was in jeopardy, the symptomatology of torticollis developed (Bateson, 1972). Indeed, as dramatic as it sounds, as she was boarding a bus to take her home from her attorney's office (whom she had consulted about pursuing a divorce) she began to experience a shift of her vision so that she was forced to track from right-to-left to maintain her own balance. The diagnosis of this patient is one of pseudo-neurotic psychosis, an overlay of conversion-type hysterical symptomatology (Chrzanowski, 1967) masking a schizophrenic disorder, schizo-affective type which was amply supported by projective techniques. Although the Rorschach was, on first blush, healthy, the patient
61
bluntly refused to accomplish the inquiry section. Her agitation regarding the inquiry of the Rorschach was parried with the remarks: "You're like my husband!" "Things are never what they appear to be!" "Why must you know what led me to my answers to the Rorschach!" "I won't do that!" and "You're like my husband, deceptive and conniving!" Transference difficulties emerged violently here (Wolstein, 1954). The patient flatly refused to complete the Machover Figure Drawings. Her Bender- Visual- Motor Gestalt test demonstrated that she saw females as more dominant than males. She was unwarrantedly suspicious, "boiling inside", and with a tremendous fear of lesbianism. All of the projective data confirmed a diagnosis of schizophrenia. Hypnosis was the preferred initial treatment because of presenting symptomatology of hysteria. Hypnotherapy, because it invokes an altered state of consciousness, is always beneficial, both mentally and physically, particularly with hysterical traits. With the use of hypnosis, improvement is extremely rapid (Freud, 1946). Because of the desperate straits in which I saw this patient, I had no choice except to begin immediately a psychotherapeutic intervention for symptom relief (to prevent a suicidal gesture). After several months' time, despite an initial, tremendously successful response, the symptom stubbornly held on. At this point I administered a psychological battery to explore for underlying dynamics. The results indicated a pseudoneurotic psychosis. When I attempted to deal with the schizophrenia which was supporting her symptomatology, this was tremendously resisted by the patient; she resisted any interpretation for her symptomatology, refused to share with me her phantasy life or her thought processes, often asking me after a relatively uneventful week (in her view): "What's new with you?" Any attempt to get to her feeling level was inter-
Downloaded by [New York University] at 14:14 10 January 2015
62
preted as either an attack or as evidence that I distrusted her own interpretation of what happened to her during that past week. She had decided a divorce from her husband was her only way out of her difficulties. Her transference became more and more "sticky"; e.g., "Why don't you ever call me beautiful? Why must you continually refer to my symptoms and not talk to me as a real person?" (Sullivan, 1962) etc., etc. Notwithstanding all this, however, the use of hypnosis was viewed by the patient as non-threatening and she always allowed this form of treatment despite her transference difficulties. Sadly, because this woman's problems were of psychotic proportions and because she did not allow me time to treat the psychosis, her cure was not completed (i.e., 100%). Provided I could have been allowed sufficient time there is no question that a full 100% cure could have been effected even without insight therapy, but simply with the continuation of hypnotherapy (J abush, 1972). As it stands now, an 80% to 90% remission of symptoms is all that I can claim in this case. Should she return to therapy, with me or with someone else, the resultant cure would rest with dealing with this woman's
BRIEF CLINICAL REPORT
thought disorder, either with the use of a straight psychotherapeutic intervention or with the continuation of hypnotherapy. A working-through of transference problems would be the optimal therapeutic conclusion, of course. In the event that this had been a case of torticollis uncomplicated by a psychotic underlay, it is my professional judgment that progress would have been much more rapid and also permanently assimilated within the personality structure.
REFERENCES ALEXANDER, F., Psychosomatic medicine. New York: Norton, 1950. BATESON, G., Steps to an ecology of mind. New York: Ballantine, 1972. CHRZANOWSKI, G., Symptom Choice in Schizo phrenic Manifestations. Contemporary Psychoanalysis, 1967, 4, 1. FREUD, S., Analysis of a Case of Hysteria. Collected Papers, Vol. III, London: Hogarth Press, 1946. JABUSH, M., Private communication. Fort Lee, New Jersey, 1972. SULLIVAN, H. S., Schizophrenia as a human process, New York: Norton, 1962. WOLSTEIN, B., Transference, New York: Grone & Stratton, 1954.
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Hypnosis: A Cure for Torticollis Joseph J. Avampato Ph.D. Published online: 20 Sep 2011.
To cite this article: Joseph J. Avampato Ph.D. (1975) Hypnosis: A Cure for Torticollis, American Journal of Clinical Hypnosis, 18:1, 60-62, DOI: 10.1080/00029157.1975.10403773 To link to this article: http://dx.doi.org/10.1080/00029157.1975.10403773
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
60
BRIEF CLINICAL REPORT
Hypnosis: A Cure for Torticollis 1 JOSEPH J. AVAMPATO, Ph.D.
Downloaded by [New York University] at 14:14 10 January 2015
Highland, New York?
cassette tape made for her by me (Insight therapy could not be used effectively, as will become evident later in this paper.). The patient had a chaotic childhood, having been abandoned by her mother and father, and raised apart from her older brother by various relatives, who were undemonstrative and rigid. Her brother was killed at the age of 17 years by a truck, which decapitated him (a traumatic incident that was explored for dynamic implication). She eventually attended a Catholic girls' school in her teens and when she expressed a desire to adopt Catholicism as a religious 'modality, she was again rejected by her relatives and told to "go live with the nuns" by her rigid Protestant aunt and uncle. Surprisingly, although a cloistered group, the nuns did indeed accept her and gave her a small apartment. They encouraged her to date and enjoy the experiences of a teenager. She eventually joined this religious order and stayed for several years, but left before final vows. Soon thereafter she met a man with whom she fell in love and whom she married. This couple has six children (three of whom have danced as children-guests artists in New York with a major dance tour company; two others have appeared on a national television show). She choreographs all of her children's performances, is adept at sewing, is an avid reader, and exhibits all the qualities of a talented adult woman. When the attacks of torticollis man1 Presented at the 17th Annual Scientific Meeting ifested the patient's intolerance to her life of the American Society of Clinical Hypnosis, New stresses, she was in the process of losing Orleans, 1974. 2 Red Top Road; RD 1, Box 440. her home due to her husband's financial ir-
This is a clinical history of a 42-year-old woman suffering from severe torticollis for the one year prior to the inception of hypnotherapy as a treatment modality. Treatment began in September, 1972, and continued for a sum total of 64 visits. Previous modalities employed included neurological and opthomological diagnoses, medication (tranquillizers and muscle relaxants) by a general practitioner, psychiatric intervention, and chiropractic care; all with no appreciable results. This patient came to me with the ability to turn her head back to the proper vertical plane only with extreme difficulty and had to force her head to tilt down onto her shoulders to remain in place. When she first appeared in my office she walked in sideways and held her head by her left hand as she sat on my couch. When I asked her to relase her hand, her neck immediately turned full-force to the left and she began to cry, with the protestation, "Please help me to live with this!" Hypnosis was used from the very first session and within one month's time (at a 3-times-per-week weekly schedule) a substantial alleviation of her symptoms could be estimated at 70%. Since then most ofthe once or twice weekly sessions were spent in a hypnotherapeutic intervention, a supportive device with the patient twice daily using either self-hypnosis or by having a trance induced by playing a recorded
Downloaded by [New York University] at 14:14 10 January 2015
BRIEF CLINICAL REPORT
responsibility. (The husband subsequently came into therapy with me and his psychodiagnostics produced a diagnosis of sociopathy. ) Approximately four months ago, shortly before therapy was abruptly suspended by her, the patient related to me that she regarded herself as much as 80% to 90% cured. She had begun again to walk, shop and eat in public once more. She could attend to household chores (including cooking, which had been an impossibility previously); she could read, watch television, attend the theatre (which involved train travel of some distance), and all symptomfreely most of the time. She has continually thought about her brother's decapitation from that event to the present. Although she was not permitted to view this accident personally, she was for some time continually reminded of it by her aunt and uncle and, I am sure, mentally conceived a picture of the incident. Also, when she was about to lose her home, she went through a psychological separation from her husband (because of a marriagelong estrangement) of "turning away" or of "avoiding a confrontation" with her husband (Alexander, 1950). As soon as a loss of her family "nest" (home) was in jeopardy, the symptomatology of torticollis developed (Bateson, 1972). Indeed, as dramatic as it sounds, as she was boarding a bus to take her home from her attorney's office (whom she had consulted about pursuing a divorce) she began to experience a shift of her vision so that she was forced to track from right-to-left to maintain her own balance. The diagnosis of this patient is one of pseudo-neurotic psychosis, an overlay of conversion-type hysterical symptomatology (Chrzanowski, 1967) masking a schizophrenic disorder, schizo-affective type which was amply supported by projective techniques. Although the Rorschach was, on first blush, healthy, the patient
61
bluntly refused to accomplish the inquiry section. Her agitation regarding the inquiry of the Rorschach was parried with the remarks: "You're like my husband!" "Things are never what they appear to be!" "Why must you know what led me to my answers to the Rorschach!" "I won't do that!" and "You're like my husband, deceptive and conniving!" Transference difficulties emerged violently here (Wolstein, 1954). The patient flatly refused to complete the Machover Figure Drawings. Her Bender- Visual- Motor Gestalt test demonstrated that she saw females as more dominant than males. She was unwarrantedly suspicious, "boiling inside", and with a tremendous fear of lesbianism. All of the projective data confirmed a diagnosis of schizophrenia. Hypnosis was the preferred initial treatment because of presenting symptomatology of hysteria. Hypnotherapy, because it invokes an altered state of consciousness, is always beneficial, both mentally and physically, particularly with hysterical traits. With the use of hypnosis, improvement is extremely rapid (Freud, 1946). Because of the desperate straits in which I saw this patient, I had no choice except to begin immediately a psychotherapeutic intervention for symptom relief (to prevent a suicidal gesture). After several months' time, despite an initial, tremendously successful response, the symptom stubbornly held on. At this point I administered a psychological battery to explore for underlying dynamics. The results indicated a pseudoneurotic psychosis. When I attempted to deal with the schizophrenia which was supporting her symptomatology, this was tremendously resisted by the patient; she resisted any interpretation for her symptomatology, refused to share with me her phantasy life or her thought processes, often asking me after a relatively uneventful week (in her view): "What's new with you?" Any attempt to get to her feeling level was inter-
Downloaded by [New York University] at 14:14 10 January 2015
62
preted as either an attack or as evidence that I distrusted her own interpretation of what happened to her during that past week. She had decided a divorce from her husband was her only way out of her difficulties. Her transference became more and more "sticky"; e.g., "Why don't you ever call me beautiful? Why must you continually refer to my symptoms and not talk to me as a real person?" (Sullivan, 1962) etc., etc. Notwithstanding all this, however, the use of hypnosis was viewed by the patient as non-threatening and she always allowed this form of treatment despite her transference difficulties. Sadly, because this woman's problems were of psychotic proportions and because she did not allow me time to treat the psychosis, her cure was not completed (i.e., 100%). Provided I could have been allowed sufficient time there is no question that a full 100% cure could have been effected even without insight therapy, but simply with the continuation of hypnotherapy (J abush, 1972). As it stands now, an 80% to 90% remission of symptoms is all that I can claim in this case. Should she return to therapy, with me or with someone else, the resultant cure would rest with dealing with this woman's
BRIEF CLINICAL REPORT
thought disorder, either with the use of a straight psychotherapeutic intervention or with the continuation of hypnotherapy. A working-through of transference problems would be the optimal therapeutic conclusion, of course. In the event that this had been a case of torticollis uncomplicated by a psychotic underlay, it is my professional judgment that progress would have been much more rapid and also permanently assimilated within the personality structure.
REFERENCES ALEXANDER, F., Psychosomatic medicine. New York: Norton, 1950. BATESON, G., Steps to an ecology of mind. New York: Ballantine, 1972. CHRZANOWSKI, G., Symptom Choice in Schizo phrenic Manifestations. Contemporary Psychoanalysis, 1967, 4, 1. FREUD, S., Analysis of a Case of Hysteria. Collected Papers, Vol. III, London: Hogarth Press, 1946. JABUSH, M., Private communication. Fort Lee, New Jersey, 1972. SULLIVAN, H. S., Schizophrenia as a human process, New York: Norton, 1962. WOLSTEIN, B., Transference, New York: Grone & Stratton, 1954.
