Published in Cancer Forum: Publication of the Foundation for Advancement in Cancer Therapy, Ltd. (Vol. 18, No. 3/4)

© October 2008 by Gérard V. Sunnen, M.D.

The psychological well-being of patients, in or out of the hospital, is of paramount importance, not only for humane considerations but for reasons connected to health and recovery: patients do better when undergoing procedures and operations, or when negotiating the side effects of treatments, if they are relaxed, rested, and feeling optimistic and hopeful.

The science of human adaptation to stress and trauma is clearly demonstrating the importance of psychological factors in achieving success. Until recently, however, assisting patients to negotiate the labyrinths of their medical trajectories, consisted of supportive or suggestive approaches, emphasizing relaxation in any one of its physical, psychological, and emotional dimensions. A relaxed patient, it was correctly thought, had a better chance of being a successful patient

The new science of psychological adaptation goes a step further. Its premise incorporates the notion that beyond relaxation, the mind, through its innate capabilities, can proactively contribute to the organism's response to stress. Within this perspective, the successful patient is one who can relax and, in addition , who can mobilize special mental processes to gain mastery of medical procedures and operations from the time of their planning to full recovery.

The study of these beneficial mental processes borrows from different yet related disciplines: namely hypnosis, self hypnosis, and meditation. In all of these disciplines tire mind makes use of special pathways to communicate within itself.

Hypnosis extends the range of influence of the conscious mind. To contact the unconscious mind and the deep physiological functions of the body, hypnosis utilizes communications, which because of their special characteristics, may be called the language of hypnosis.

Communication venues for hypnosis include affirmations and mental images. The mind continuously creates mental images. They appear in consciousness in many varieties with wide individual differences. Not necessarily visual in form, mental images can involve all the senses. Images are more likely to have therapeutic impact if they incorporate emotions. Positive images tend to be synergistic with wellness and energy; in the mind they resonate with self confidence, self esteem, optimism, and creativity. So-called negative images which include negative scenarios about the future and allow feelings critical of oneself, tend to be inhibitory to self expression, enticing guilt, pessimism, and fatigue. Therapeutic mental images carefully select their ingredients to respect the unique psychological makeup and imagery style of each individual.

No one can say for sure why negative images exist in the first place. After all, on the surface of things, they do not appear to do much good. Why would such depression-promoting mental processes as negative self esteem exist if they do not (by surface observation) benefit the organism? Whatever the admittedly complex answers to these questions, the fact remains that negative mental images are universally observed in the human psyche. Negative mental images find their home in the repositories of the unconscious mind and are usually absorbed through the repercussions of unfortunate experiences and relationships accumulated during lifetime, They can exert nefarious influence upon the process of mastering medical stress. It is helpful to discover and understand them so they do not detract from therapeutic thrust.

Although the mind's output of thoughts, emotions memories. and images has been likened to the continuous flow of a stream, this is not to say that the mind remains a passive experiencer of its own creations. In this analogy, streams can be altered to change their course and can even be played with to channel them into new territories. The executive functions of the mind describe mental capacities that enable the evaluation of information, the direction of attention, and the planning for future action. This executive branch of the mind can also devote its energy to allow the type of mental images it wishes to favor and to discourage those it wants curtailed. A closely related mental dimension, creativity, has the therapeutic capability of spawning entirely novel thoughts and images.

Mental events have their corresponding resonance in the circuitry of the nervous system. Dr. W. Penfield in the 1930's, stimulating discreet locales of the exposed brain cortex in conscious patients undergoing neurosurgery, demonstrated how thoughts, emotions. and memories, many of which were hitherto unconscious, could be brought into consciousness by pinpointed electrical instigation. It was deduced, as Dr. Sigmund Freud predicted, that each thought owns its proprietary neural circuit. While this notion is not globally false, it is equally true that each mental event has nervous system ramifications that connect it to all other areas of the brain. Visual, auditory, somesthetic, and the still uncharted vast association areas are all communicating neighbors. Synesthesia describes the phenomenon of the simultaneous experiencing of different senses. Through the existence of awesomely intricate feedback networks, every one of our nervous system's billions of cells interactively communicates with all others.

Our grasp of the nervous system is undergoing rapid metamorphosis. Diagrams of its anatomical and biochemical networks are constantly upgraded toward sophistication. Whereas several decades ago only a handful of neurotransmitters -- those molecules that determine the flow of cell to cell message transmission -- identified themselves, there are now hundreds. It is known that the nervous system is constantly in flux biochemically and even anatomically, and that every experience leaves an imprint unto its very fabric.

While every neuron connects in some way to every other cell in the nervous system and projects its influence into the most delicate tendrils of its outer reaches, it also interfaces with all organ systems from heart and endocrine, to gastrointestinal and immune. Recently, the field of psychoneuroimmunology has gathered extensive data to show the closely interlaced relationships of nervous and immune systems to mental functions.

Mental images, through these neural pathways, are thus able to travel from their sites of origin to transport their messages into the entire matrix of the organism. As messengers, therapeutic mental images have the remarkable potential to impart their beneficent influence to the core physiology and the biochemistry that sustain, our life.

The cornerstone ingredients of self hypnosis are relaxation and the universal ability to construct mental pictures. Relaxation decreases the background noise of the mind. In relaxation, the body adopts natural rhythms of repose, and the mind allows its spontaneous creation of thoughts to slow down. Within this tranquility, creative imagination finds opportunities for sustaining mental images that project intensity and therapeutic direction.

Self-hypnotic communications have greater impact if they involve a variety of senses. In so doing, they recruit more areas of the brain. Pictorial images correspond to the activity of visual and visual association areas in the occipital lobes. Adding language or music recruits auditory regions around the temporal lobes. Integrating movement invites participation of the parietal lobes. Very importantly, emotions animate the limbic system and its wealth of connections to autonomic neural networks and to the neuroendocrine system.

Certain techniques have the capacity to deepen relaxation and to heighten the impact of mental images. Hypnosis is a special state of mind permitting the experiencing of relaxation in its most profound realms. Awakened is a freedom of mental actions to flow beyond the confines of the waking state. While relaxation is generally believed to be the mere dissolution of tension, it actually embraces the most subtle attributes of human experience. Relaxation is a long continuum comprising physical and mental components. Beyond the dissipation of tension, the body drifts into a state where breathing slows down to become deeply abdominal; heart rate assumes a mellifluous cadence and blood pressure decompresses; and EEG rhythms shift into cerebral harmony. In the exploration of relaxation, the mind enters layers of feelings that traverse calm and move into peacefulness, finally entering states that, because of their essence, may he called spiritual. Indeed, it may be said that relaxation knows no limits in its depths nor in its boundaries.

Self hypnosis seeks the attainment of experiences similar to those searched for in hypnosis. As in hypnosis, deep relaxation is created and the ability to summon mental directives is enhanced, Mental images thus achieve clarity, focus, and steadfastness, and energizing feelings such as self confidence and self mastery are more easily conjured. In self hypnosis, however, the individual acts both as guide and experiencer solely through the impetus of self regulation. Self hypnosis gives patients the opportunity to develop a sense of self determination toward their condition, With practice, the patient can become a self hypnotic virtuoso with possibilities of gaining increasing mastery over their symptoms In meditation, a close relative of self hypnosis the thrust for self transformation is more likely to seek the attainment of experiences, which by nature of their universality, may be called transcendental or mystical.

A persistent cough of a few months duration increasingly irritated this engaging 46 year old realtor. When the cough became mildly productive and took on accompanying pain, she sought consultation. The process of investigation eventually demonstrated an egg-sized lung mass in her right upper lung. She had not smoked for many years, a fact that added to her initial disbelief in her diagnosis. A biopsy was inconclusive but her imaging studies were highly suggestive of a neoplasm. She would have to undergo a surgical exploration with possible tumor excision. A thoracotomy was scheduled. She had spoken to the surgeon but admitted that, in the throes of her emotional turmoil. she had either omitted to ask the proper questions, or failed to process them clearly. Her mind straining under excess anxiety had retained only the most ominous eventualities. She remembered being told that she would be intubated during the operation and that a portion of her lung might have to be removed. Great concern came upon her. She recalled, as a little girl, the intensity of her fright being stuck in a smoky elevator. Would she be able to breathe freely with this tube in her throat? How much of her lung would they take out? Could it leave her breathless subsequent to, or even during the operation?

The procedure was explained to her once again. A diagram was drawn to show her how the operation would proceed. There would be wide patency of breathing conduits. She was told that the greater the relaxation of her entire respiratory system, the easier air would flow.

A method of hypnotic induction which may be called the arm drift was used. With her permission her wrist was taken and her arm brought straight in front of her, in the image of a piece of wood floating on a lake. Eyes closed, she was asked to let her arm float and to create the feeling in her mind's eye that a sense of comfortable heaviness was beginning to fill it, growing more so with each breath. As the strength of her mental image increased, it was suggested, her arm would follow its directive. Her arm, feeling ever heavier, slowly drifted downward until it came to rest on her lap. This pleasant feeling of heaviness could now begin to drift into her other arm, into all her muscles, and finally into her entire body. In this way mental images were shown how to travel into autonomic networks and she could now tap into their therapeutic possibilities.

Therapeutic affirmations were then invited to dispel her fear-laden images. She would be calm and composed in the days preceding the operation. She could visualize herself feeling rested in the hospital, sleeping well, and unbothered by the activity of the personnel. During the procedure she would not fight with operative interventions but would easily move through them. Her breathing would be cadenced and unhurried.

Everything proceeded as in the imagination's best scenario. Before the operation she noted her surprise at her lack of any anxious concern. In the hospital, she was able to observe all the activity around her with a mental attitude of interest, and even at times of amusement. The surgeon had known about the relaxation training of his patient. She called the day after the procedure to report that she had seldom seen a patient so relaxed As a consequence, she said, the operating team was less challenged and time was saved.

In the recuperation phase, the patient used self hypnosis to accelerate healing. Initially bothered by shortness of breath with exertion because of the resection of a portion of her lung, she worked on building her pulmonary reserve. Pain with movement of her right shoulder due to scar formation and the severing of nerves was modulated so as to permit gradually greater ranges of motion. Fleeting yet persistent feelings of being a partial invalid based upon thoughts of having a cancer diagnosis were prevented from taking hold. She progressively replaced them with feelings consonant with her core spiritual convictions.

Gérard V. Sunnen M.D., Board Certified in Psychiatry and Neurology is an Associate Clinical Professor of Psychiatry at NYU-Bellevue Medical Center in New York.