XVII. Hypnosis and Nitrous Oxide Conscious Sedation
Why is a section on hypnosis included in the study of N2O conscious sedation? The answer is because the use of suggestion is an essential part of the proper and effective use of N2O for conscious sedation. The more proficient the dentist is in the use of suggestion, the more successful the sedation with N2O will be; in fact, the power of suggestion can be a great adjunct to patient management without N2O. The study of hypnosis is to a large degree a study in the effective use of suggestion. This short chapter is only a simple introduction to hypnosis and is meant to serve only as such; but hopefully, will be an encouragement for further review.
Iatrosedation, sedation produced without the use of chemicals or drugs, is as old as mankind. We have all seen a mother of an injured or frightened child soothe and comfort it with repeated gentle strokes and words of reassurance, and quickly the hurt disappears.
Hypnosis, or at least the use of hypnosis-like methods, can be traced back thousands of years. Greek and Egyptian priests used hypnosis techniques over two thousand years ago in the treatment of various ailments. The rhythms, music, ritualistic dances and tribal rites of primitive societies are known to induce a trance-like state similar to hypnosis. The American Indian tribal dance is a well illustrated example of mental preparation that provided single direction focus for the upcoming battle.
The evolution of modern hypnosis began in 1773 when Friedrich Anton Mesmer, an Austrian physician working with Maximilian Hell, the royal astronomer in Vienna, used magnets in the treatment of several cases of hysteria. Hell believed the magnetism caused the cure, while Mesmer felt it was a "redistribution of some sort of fluid" which he later called "animal magnetism" to distinguish it from "mineral" magnetism. It was probably the "forcefulness" of Mesmer's personality and suggestion that resulted in improvements. The terms "magnetic personality" and "Mesmerism" are still in use today.
Mesmer moved to Paris in 1778 and soon developed a very successful practice treating neurotics which produced a high percentage of cures. In the middle 1800's, Mesmer's theories of magnetism were discredited. However, an English physician, James Braid became interested in the use of suggestion and believed it was the true cause of Mesmer's cures. He developed the eye-fixation technique of inducing relaxation and later coined the word "hypnosis" from the Greek word "hypnos" to sleep, since he thought his patients were in a sleep-trance. Later, he realized his error and suggested the term "monoideism" be used, referring to the concentration on one idea. Even though it is a misnomer, "hypnosis" is the term still used today.
About the same time, 1845, another English physician, James Esdaile, reported on the use of Mesmerism" to obtain anesthesia during 250 surgical operations in India, including major operations such as amputations. In his book, "Mesmerism in India" published in 1850, he described surprisingly accurately, many of the phenomena of hypnosis. However, he was still ridiculed and ostracized by his colleagues for advocating hypnosis.
Others studied hypnosis, including Freud, as an aid in treating neurologic and psychotic diseases. But Freud soon abandoned the techniques and it was used little until World War I, when Simmel, a German psychoanalyst, used hypnosis to treat soldiers with "shell shock". He developed a technique he called "hypnoanalysis". For the first time the use of hypnosis was combined with psychodynamic techniques. During World War II, this was further developed by combining the technique with barbiturates which tended to remove repression.
Today hypnosis and/or hypnotic techniques are used by physicians, dentists, psychologists and others in the health field as a therapeutic adjunct within their specific fields. A number of journals are now devoted to experimental and clinical applications of hypnosis. "Faith healers" appear to employ various forms of hypnotic suggestion.
Still, hypnosis is not accepted entirely by either the medical or dental professions, probably because of the lack of training at the undergraduate and postgraduate education levels. Also unfavorable cultural attitudes have developed from the association of hypnosis with entertainment and comedy.
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