Through a glass darkly: the psychoanalytic use of hypnosis with post-traumatic stress disorder.

A severe case of post-traumatic stress disorder stemming from consciousness (with auditory and pain perception) during surgery was treated with 8 sessions of hypnosis. Abreaction and revivification used alone initially retraumatized the patient, and her symptoms worsened. Ego-mastery techniques were then added; emphasis was placed on the role of the therapist as a new object presence to be internalized in restructuring the traumatic memory; memory consolidation and working-through techniques were instituted. The patient's symptoms abated and her condition remitted. The similarities between hypnotic and analytic work are highlighted. In addition, the case material provides a clinical example of the existence and potential traumatic effects of conscious awareness during surgery. It is like through glass, and you see movement and color and stuff--like you see thick glass--and now the glass is real thick and I can see a mass of colors that are not moving or nothing, like a wall. I can't remember anything past that [The Patient]. In the great majority of cases it is not possible to establish the point of origin by a simple interrogation of the patient, however thoroughly it may be carried out. This is in part because what is in question is often some experience which the patient dislikes discussing; but principally because he is genuinely unable to recollect it and often has no suspicion of the causal connection between the precipitating event and the pathological phenomenon. As a rule it is necessary to hypnotize the patient and to arouse his memories under hypnosis of the time at which the symptom made its first appearance; when this has been done, it becomes possible to demonstrate the connection in the clearest and most convincing fashion [Breuer & Freud, 1893/1955, p. 3].

Posttraumatic stress disorder. A historical perspective on diagnosis and treatment.

The author explores new directions in the diagnosis and treatment of posttraumatic stress disorder (PTSD). Psychological, biological, and sociological findings are contrasted with earlier developments to provide historical continuity. The author addresses such topics as developments in psychoanalytic theory, information-processing theory, normal stress response, multitheoretical syntheses, countertransference, and pharmacological approaches.