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Intl.

Journal of Clinical and Experimental Hypnosis, 61(3): 336–341, 2013


Copyright © International Journal of Clinical and Experimental Hypnosis
ISSN: 0020-7144 print / 1744-5183 online
DOI: 10.1080/00207144.2013.784100

AN UNANTICIPATED ALLERGIC REACTION


TO A HYPNOTIC SUGGESTION FOR
ANESTHESIA: A Brief Communication
and Commentary
Kenneth Guttman

Citrus College, Glendora, California, USA

Thomas S. Ball1

Private Practice, Diamond Bar, California, USA

Abstract: During a demonstration of hypnotically induced anesthesia


and following a suggestion for a Novocain-like numbness, a totally
unanticipated and dramatic swelling of 1 cheek appeared. The partici-
pant had forgotten to inform the psychologist that she had experienced
the identical reaction to Novocain when she received an injection
a few weeks earlier. The swelling was quickly removed by a coun-
tersuggestion based upon a simulated injection of the antidote pre-
viously administered by the dentist. This case report is relevant to
current research and theorizing on the interaction of hypnosis with
the immune system. The fact that it was retrospectively recognized
as a single-case time-series B-A-B design significantly enhances its
scientific value beyond that afforded by the traditional case report.

The Case: by Kenneth Guttman

Approximately 15 years ago, as an example of an altered state of con-


sciousness, I prepared to demonstrate hypnotically induced analgesia
using a Kroger (Kroger & Fezler, 1976) procedure. The first to volun-
teer from the psychology class was a 30-year-old Hispanic female who
had never been hypnotized before but who hoped it would teach her
how to relax and study more effectively. She confirmed that she was
without any physical or psychological conditions that would hamper
her ability to be hypnotized except for feeling very nervous. Prior to
the induction, I showed her the hatpin with which I would later simu-
late an injection of Novocain. I then gently stuck her in the side of her

Manuscript submitted October 31, 2011; final revision accepted April 26, 2012.
1 Address correspondence to Thomas S. Ball, 1637 Butternut Way, Diamond Bar, CA

91765, USA. E-mail: drtsball2010@hotmail.com

336
A BRIEF COMMUNICATION 337

left hand. When asked to rate the discomfort or pain on a 1-to-10 scale,
1 being no pain and 10 being extremely painful, she reported a 9. As she
listened with eyes closed, I counted from 1 to 10 with each number rep-
resenting a progressive deepening of relaxation and feeling of heaviness
beginning with her toes and progressing to the head. She reached a deep
level of hypnosis, supported by the appearance of eyelid fluttering, arm
catalepsy, slow and rhythmic breathing, and 20 minutes of immobility.
I suggested that once injected with Novocain her left hand and fingers
would feel very heavy, numb, and wooden-like. After an alcohol wipe,
I simulated an injection into the left hand. I told her that in a few min-
utes her left hand would become heavier and heavier and her right
hand lighter and lighter, and the hand injected with Novocain would
become like a block of wood, numb, cold, and very heavy. Within a
few minutes of a repeated script, I observed her slumping toward the
left. I announced the forthcoming injection and suggested that, as in
a dentist’s office, she would feel the effects very shortly. I suggested
that the needle would be sharp but not painful and, after the alcohol
wipe, stuck her left hand with the hatpin. I told her to continue to relax
and that we would soon see how the Novocain works. Approximately
1 minute later, I asked her to remain in a trance and to open her eyes
while under hypnosis. I placed the pin in her right hand and asked
her to stick the left hand where she had originally verbalized a pain
rating of 9. She did and reported 1 for no feeling. The participant expe-
rienced the same result when asked to stick various other parts of the
left hand. For independent verification of the results, I had other stu-
dents observe the procedure from within several feet of the site, and
they observed the skin being punctured. In fact, one puncture was deep
enough to cause some visible bleeding. Subsequently, when asked to
pick up the pin with her left hand and to stick her right hand, her
fingers proved cataleptic. When I assumed the task by picking up the
pin and sticking her right hand, she reported a 10 and, simultaneously,
a completely unanticipated and startling event occurred—the left side
of her face was suddenly and clearly—to all present—very noticeably
swollen. Within seconds, her left eye was nearly swollen closed. While
she remained under trance, I asked if she had experienced any changes
in her face. She said, “no.” I had her close her eyes and immediately
suggested that she had received a placebo, not Novocain. I announced
that when I counted to three and snapped my fingers, she would be
out of the trance, perfectly normal, and feeling relaxed and alert. When
I did so, she opened her eyes and remarked that the left side of her
face was numb and her mouth completely broken out with bumps. The
bumps inside her mouth and the continued facial swelling were con-
firmed through direct observation. I asked if this had ever happened
before. She thought for a moment and replied, “This is weird.” She said
that she had forgotten to report that a few weeks earlier she experienced
338 KENNETH GUTTMAN AND THOMAS S. BALL

the same reactions at the dental office. I asked her what the dentist did
in response. She reported that he gave her an injection and within a few
minutes the symptoms began to disappear.
I reassured her and asked her to close her eyes and to recall the scene
at the dentist’s office as it was just before he administered the antidote.
Then, after the alcohol wipe, I gently stuck the left hand and told her
that I was injecting medication that would remove any negative symp-
toms. To reinstate the trance, I suggested that while the medication was
working she could return for a few minutes to that relaxing place in her
mind while allowing it to take effect. I gave additional suggestions and
stated that in a couple of minutes she would be completely relaxed and
back to normal with no adverse side effects. I counted to three and after
a 3-minute secondary session she was back to normal with no facial
swelling and very few bumps remaining within her mouth. She was,
of course, asked to remain after class to assure that she was sufficiently
alert to drive home and, if not, to arrange for someone to drive her. She
reported complete recovery and drove herself home. An hour later, she
called to inform me that she was completely free of negative symptoms.

The Commentary: by Thomas S. Ball

Guttman’s report is relevant to current theorizing on the interaction


of hypnosis and the immune system (Barabasz, Higley, Christensen, &
Barabasz, 2010; Ewin, 2011; Ewin & Eimer, 2006; Perloff & Spiegelman,
1973). What may pass unrecognized, however, is how this totally
unanticipated episode meets all the criteria for a credible scientific
demonstration far exceeding the limits of the traditional single-case
report (Borckardt & Nash, 2002). It is, in effect, a simplified version
of the B-A-B single-case time-series design (Barlow & Hensen, 1984).
As a demonstration, it is convincing in the same sense that control
over water flow can be demonstrated by turning a faucet on and off.
Thus, the volunteer was completely asymptomatic before the hyp-
notic induction, following which she clearly manifested swelling of the
face and bumps within the mouth, both of which quickly receded in
response to the artfully crafted second suggestion. All aspects of the
incident, including the anesthesia, were independently confirmed by
several classmates. The design is simplified because of the categori-
cal, on/off nature of the symptoms and the brief intervals required for
both induction and symptom removal. It fulfills the requirements of the
B-A-B design without requiring the usual reliability checks, statistical
analysis, or concern over potentially confounding intervening events.
Such adventitious and retrospectively recognized opportunities also
exist in conventional treatment settings (Ball, 2006). Thus, a temporary
treatment failure might lead to a scientifically credible success.
A BRIEF COMMUNICATION 339

The totally unexpected appearance of symptoms and the failure of


the initial countersuggestion, even during trance state, go counter to a
socio-cognitive explanation of the results.
Reconciliation of the participant’s localized allergic response with
a system-wide immune-system response is beyond the scope of this
study. However, this psychoneuroimmunological paradox is not with-
out precedent. For example, Erickson, Hershman, and Secter (1961)
reported on an 11-year-old child who was allergic to chocolate. When
hypnotized, hives appeared and then disappeared on one side of his
face in response to successive suggestions. Also consider Mason’s (1952)
treatment of a case of congenital ichthyosis erythrodermia in which
targeted hypnotic suggestions alleviated patches of elephant-like and
warty skin, one area at a time. In the absence of an explanation for these
phenomena, it appears that Perloff and Spiegelman’s (1973) call for
collaborative research in this area is as relevant today as it was in 1973.

References

Ball, T. S. (2006). Reassessment of hypnotic symptom removal by Freud and Bernheim.


International Journal of Clinical and Experimental Hypnosis, 54, 480–487.
Barabasz, A., Higley, L., Christensen, C., & Barabasz, M. (2010). Efficacy of hypnosis in
the treatment of human papillomavirus (HPV) in women: Rural and urban samples.
International Journal of Clinical and Experimental Hypnosis, 58, 102–121.
Barlow, D. H., & Hensen, M. (1984). Single-case experimental designs: Strategies for studying
behavior change (2nd ed.). Elmsford, NY: Pergamon.
Borckardt, J. J., & Nash, M. R. (2002). How practitioners (and others) can make scientifi-
cally viable contributions to clinical-outcome research using the single-case time-series
design. International Journal of Clinical and Experimental Hypnosis, 50, 114–148.
Erickson, M. H., Hershman, S., & Secter, I. I. (1961). The practical application of medical and
dental hypnosis. New York, NY: Julian.
Ewin, D. M. (2011). Treatment of HPV with hypnosis-psychodynamic considerations of
psychoneuroimmunology: A brief communication. International Journal of Clinical and
Experimental Hypnosis, 59, 392–398.
Ewin, D. M., & Eimer, B. N. (2006). Ideomotor signals for rapid hypnoanalysis. Springfield, IL:
Charles C. Thomas.
Kroger, W. S., & Fezler, W. D. (1976). Hypnosis & behavior modification: Imagery conditioning.
Philadelphia, PA: Lippincott-Raven.
Mason, A. (1952). A case of congenital icthyosiform erythroderma of Brocq treated
hypnosis. British Medical Journal, 2, 422–423.
Perloff, M. M., & Spiegelman, J. (1973). Hypnosis in the treatment of a child’s allergy to
dogs. American Journal of Clinical Hypnosis, 15, 269–272.

Eine unerwartete allergische Reaktion auf die hypnotische Suggestion einer


Anästhesie : Eine kurze Kommunikation

Kenneth Guttman und Thomas S. Ball


Abstrakt: Während einer Demonstration hypnotisch induzierter Anästhesie
und darauffolgender Suggestion einer Novocain-ähnlichen Taubheit, trat
340 KENNETH GUTTMAN AND THOMAS S. BALL

eine vollkommen unerwartete dramatische Schwellung einer Gesichtshälfte


auf. Die Teilnehmerin hatte vergessen, den Psychologen darüber zu
informieren, daß sie eine identische Reaktion auf Novocain gezeigt hatte,
als sie ein paar Wochen zuvor eine Spritze erhalten hatte. Die Schwellung
ging durch die entgegengesetzten Suggestion der Injektion eines Antidots,
das zuvor von dem Zahnarzt festgelegt worden war, schnell zurück. Diese
Fallbeschreibung ist relevant für die aktuelle Forschung und die Theorien
bezüglich Interaktionen von Hypnose und dem Immunsystem. Die Tatsache,
daß sie retrospektiv als Einzelfall Zeit-Serien B-A-B Design anerkannt
wurde, verbesserte ihren wissenschaftlichen Wert weit über das hinaus, was
normalerweise durch Fallbeschreibungen möglich ist.
Stephanie Reigel, MD

Brève communication sur une réaction allergique imprévue à une


suggestion hypnotique lors d’une anesthésie

Kenneth Guttman et Thomas S. Ball


Résumé: Au cours d’une démonstration d’anesthésie induite par hypnose,
et à la suite d’une suggestion d’engourdissement imitant l’effet de la novo-
caïne, la joue de la participante s’est mise à enfler de façon imprévue et
spectaculaire. La participante avait oublié d’informer le psychologue qu’une
injection de novocaïne reçue quelques semaines auparavant avait provo-
qué une réaction identique. L’enflure a diminué rapidement à la suite d’une
contre-suggestion basée sur une simulation d’injection de l’antidote admin-
istré précédemment par le dentiste. Cette étude de cas est conforme à la
recherche actuelle et donne lieu à l’hypothèse de l’interaction de l’hypnose
avec le système immunitaire. Le fait que cette étude de cas traditionnelle
ait été rétrospectivement reconnue comme un concept expérimental de série
chronologique B-A-B à cas unique augmente de façon significative sa valeur
scientifique.
Johanne Reynault
C. Tr. (STIBC)

Una reacción alérgica inesperada a una sugerencia hipnótica de anestesia:


Una comunicación breve

Kenneth Guttman y Thomas S. Ball


Resumen: Durante una demostración hipnótica de anestesia inducida y tras
una sugerencia de adormecimiento parecido al que produce la novocaina,
apareció una inflamación dramática de la mejilla completamente inesperada.
Al participante se le olvidó informarle al psicólogo que había experimen-
tado una reacción idéntica a la novocaina cuando la inyectaron hacía una
cuantas semanas. La inflamación rápidamente desapareció mediante una con-
tra sugerencia basada en una inyección simulada del antídoto previamente
administrado por el dentista. Este reporte de caso es relevante para la inves-
tigación y teorización actual de la interacción entre la hipnosis y el sistema
A BRIEF COMMUNICATION 341

inmune. El hecho de que se reconoció retrospectivamente como un diseño de


caso único de series temporales B - A - B significativamente aumenta su valor
científico más allá de lo que ofrece un reporte de caso tradicional.
Omar Sánchez-Armáss Cappello, PhD
Autonomous University of San Luis Potosi,
Mexico
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