International Handbook of Clinical Hypnosis - E-Lib FK UWKS

CONVERSION DISORDERS 167
plained despite exhaustive and repeated neurological investigations. In the end the
patient had been declared un®t for work. The complaints had remained unchanged
for about 6 years. In addition to the complaints already described, she had arthritis
of the right knee, as a result of which she was becoming less and less able to walk.
The combination of the ataxia and the pain ended in the patient being con®ned to a
wheelchair and this increasing invalidity prompted the treating neurologist to
suggest referral.
During the intake procedure at which her husband was present) the patient
appeared to have little faith in the possibility that a psychiatrist could help her
achieve an improvement in her condition. She had just undergone 2 years of
treatment by hypnosis and had unsuccessfully tried many different medicines. She
had in fact resigned herself to her invalidity and had only kept the appointment on
the urgent entreaty of the neurologist who had referred her.
In her treatment use was made of catalepsy induction as described by Sacerdote.
As an explanation for the complaints, the patient was told that it was evidently an
obscure condition that probably had its origins in neuropsychological, psychological,
neurophysiological and neurobiochemical processesÐtoo subtle, therefore, to
be detected via crude neurological diagnostic procedures. The treatment could
simply consist of an investigation into the possibilities of regaining some control
over the complaints, with the help of hypnosis; not the sort of hypnosis she had
already had, which had been a kind of discovery hypnotherapy, but with a technique
that worked directly on the muscles. Sacerdote's technique was then applied to the
right hand. Within a few minutes the hand was cataleptic and the patient
experienced the hand as dissociated. A demonstration of the resultant analgesia of
the hand was used to emphasize how remarkable a state this was.
The next phase of the treatment was given over to teaching the patient to move
the dissociated hand very carefully. In the ®rst instance the suggestion was given
that the hand could move its position a little by itself. Once this had been achieved
and the hand was still, the patient could eventually move her right hand, albeit very
slowly and stif¯y.
Her husband was then taught how to help his wife achieve the feeling of
dissociation of the hand and an exercise programme was devised in which the
patient would gradually learn how to use the hand again to do some of the tasks
about the house. This was a great success. After four sessions the patient was able
once again to use both arms somewhat robotically but without ataxia.
The coordination disorders in the patient's torso were the second target for
treatment. Here too, use was made of the Sacerdote technique. First, with the
patient standing, a state of catalepsy was evoked in both arms. One of the patient's
hands was then placed on the front of her hipbone. The therapist then put one hand
on the patient's back and the other hand over the hand on her hip. By pushing the
patient slowly backwards and forwards, applying pressure ®rst to one hand and then
to the other, it was possible to extend the cataleptic state to the whole body. In the
end it was barely possible to push the patient off balance. She was then asked to