This article was downloaded by: [Central Michigan University] On: 31 December 2014, At: 07:10 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
The Use of Self-Hypnosis by Children with Cancer a
a
Wallace Labaw M.D. , Charlene Holton M.D. , Karen a
Tewell RN & Doris Eccles ACSW
a
a
Childrens Hospital , Denver, USA Published online: 20 Sep 2011.
To cite this article: Wallace Labaw M.D. , Charlene Holton M.D. , Karen Tewell RN & Doris Eccles ACSW (1975) The Use of Self-Hypnosis by Children with Cancer, American Journal of Clinical Hypnosis, 17:4, 233-238, DOI: 10.1080/00029157.1975.10403749 To link to this article: http://dx.doi.org/10.1080/00029157.1975.10403749
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
THE AMERICAN JOURNAL OF CLINICAL HYPNOSIS
Volume 17, Number 4, April 1975 Printed in U.S.A.
The Use of Self-Hypnosis by Children with Cancer!
Downloaded by [Central Michigan University] at 07:10 31 December 2014
WALLACE LaBAW, M.D., CHARLENE HOLTON, M.D., KAREN TEWELL, RN and DORIS ECCLES, ACSW Childrens Hospital, Denver
This is a clinical report relating the experience gained in 24 months of study of 27 children using contemporary medical hynosis in combating some aspects of malignancies. The afflicted children, aged 4 to 20, were trained at Childrens Hospital in Denver in group trance sessions to induce trance in themselves. Varying degrees of success are recorded, from poor to excellent. The anxiety which was the common experience of all concerned is recognized; its alleviation through denial is discussed. Obtained with the trance state were more rest, easier and longer sleep, more adequate food and fluid intake and retention, and greater tolerance for and manageability during diagnostic and therapeutic procedures. Fear, anxiety, depression, overdetermined response to discomfort, and anticipatory vomiting prior to treatment were diminished. A net positive opinion of the value of this adjunctive treatment is shared by the authors.
The hopeless plight of children dying of malignant tumors was seen by oncologists as a clinical situation in which some of the demonstrated advantages of contemporary medical hypnosis (LaBaw, 1969a) could be provided to patients to minimize aspects of their terminal disability. The agonal struggle of these children, so difficult for them, their parents, and their attending professionals to endure, is the result of combined insult from their basic pathology and toxic elements in their treatment. Part of the motivation of physicians in command of dying children, to seek such adjunctive means of treatment, emanates partially from their understandable need to share the burden. The endeavor which spawned this clinical report was launched following documentation of the local demonstration
of the usefulness of suggestive therapy (contemporary medical hypnosis) in acutely injured children (LaBaw, 1973) chronically impaired children (LaBaw, in press) and in terminal patients (LaBaw, 1969b), as the subject patients variously fi t all three categories. Accordingly, a two year clinical trial of the efficacy of adjunctive trance therapy was pursued at Childrens Hospital in Denver; 27 children were involved. The patients were about half boys and half girls, ranging in age from 4 to 20. Among the things encouraged during the trance state, in direct response to referrals for those purposes, were more rest, easier sleep, more adequate food and fluid intake, and greater tolerance for and manageability during diagnostic and therapeutic procedures such as spinal taps, bone marrow aspirations, and intravenous medication administration. 1 Presented to the 17th Annual Scientific Meeting Among those things discouraged were anxof The American Society of Clinical Hypnosis, New Orleans, 1974. iety and depression, seemingly inordinate 233
LABAWET AL.
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234
or inappropriate response to discomfort which thwarted needed treatment, and anticipatory vomiting and apprehension prior to treatment, which also markedly complicated requisite therapy. Suggestive therapy was utilized in group trance sessions with both a child psychiatrist and a registered nurse, in group sessions with the nurse alone, in individual sessions with patients requiring same, and through self-induction of the trance state by indi vidual patients alone. There was no control group; objective evaluation was at times difficult. However, data supplied by patients, parents, teachers, and others, coupled with observations of professionals in the hospital, left the unqualified impression that results of trance therapy with children with cancer were satisfactory. METHOD
Patients and parents were informed through an introductory letter of our intended offering of adjunctive trance therapy. Word of mouth, embellishment of the idea through personal contact, and telephone explanation followed. The focus of an initial meeting between professionals and the subject families was to further exchange information, establish rapport, set individual and group goals, and to foster a realistic view of the usefulness of modem medical hypnosis. Part 'of the latter effort had to do with subduing magical expectations among the loved ones of cancer victims, and correcting aspects of the lay mythology accreted to hypnosis over the years. The children then embarked upon a program of an additional two visits to the hospital each month. Mothers usually brought their children, though one father was frequently in attendance with his son. Casual conversation occupied the beginning minutes of the hour as the participants assembled. The meeting place was a naturally
well-lighted treatment room devoid of clinical trappings. The children sat in chairs of appropriate sizes in a semicircle around the therapists. Patients of all the included ages met together. Parents were always invited by the therapists to participate with their children or to sit in to observe; they sometimes did so. One therapist, more commonly the nurse, intoned the suggestive utterances, while the other participated with or observed the children. The atmosphere was one of casualness, permissiveness, and good cheer. The induction technique employed was the progressive body relaxation method followed by restful psychic imagery of fantasied idyllic scenes common in the childrens' experience, such as a tranquil mountain view. The appearance of the room in a short time was one of a crescent of little figures slumped pleasantly or draped lanquidly across their seats before the therapists. Most faces displayed a smile. The characteristic involuntary flutter of the eyelids in the trance state was commonly seen. Specific suggestions as to betterment were then offered to the group, embracing the array of clinical problems listed above. A simple parlance was employed to make the proceedings explicable to our youngest members. The word, "sleep," was avoided, as children are particularly literal in their interpretations while in the trance state; we had work to do and had not invited the kids there to slumber. The nurse had to refer to "the top of the leg," rather than the "thigh," as another example. The children were assured that they could easily achieve a similar relaxed state of mind and body by themselves if they wished, merely by assuming a position of repose and thinking about the sound of the therapists' voices in our group sessions. It was our feeling that youngsters who thus equipped themselves with the ability to self-induce the trance state most fully put to work their suggestive capability. Many could not, or chose not to do so, as they
Downloaded by [Central Michigan University] at 07:10 31 December 2014
CHILDREN WITH CANCER
were boys and girls who needed to be very dependent upon others. Following the induction of the initial trance state in the group, small talk again ensued, ranging from comment on the conjoint suggestive effort just finished to totally unrelated topics of interest to the kids. Then the trance experience was repeated, the last thing before we parted company. (The value of this double exposure to the trance state in each formal get-together was established earlier in work with hemophiliacs, where, in a 40-month controlled study (LaBaw, in press), it was found that greater relaxation was often possible to the participants during a second repetition.) Continuity was maintained between various aspects of the childrens' treatment by occasional participation with us by the oncologists, by the services of the oncology staff nurse as a suggestive therapist following her postgraduate study of clinical hypnosis, and by the efforts of social workers who helped us deal sensitively with the maximally distressed families of our patients.
235
was a useful group catalyst, he did not extend this performance to solo endeavor for clinical purposes. He could participate capably by himself in practice even, but never rallied this ability under the stress of hospital procedures. He expired as the first year of this study came to an end. Another six-year-old boy, moribund after combatting his acute lymphocytic leukemic disease for more than a third of his life, remained quite anxious despite all his adjunctive trance efforts in the hospital. But, he did achieve some control of his pain while at home. Thus, when he had external resources upon which to depend, as drugs in the hospital, he could not summon his internal resource to his aid. He let his suggestibility idle except when he had little else to depend upon. He died within two months of his embarkation with us. A boy a year older, harboring the same illness as the aforementioned patients, was remarkably anxious during medical procedures. His laments were louder than most children so afflicted. However, he grasped the new implement offered him through suggestion quickly and firmly. He learned auto-hypnosis with dispatch and underwent RESULTS a bone marrow aspiration from his sternum The outcome of this two years' work using only trance anesthesia. He gloried in seems fairly represented by the brief clini- his accomplishment, obviously feeling cal reports summarized below, recounting good about regaining some modicum of the rather typical experiences of some of control over himself. We encouraged his refusal to attend group sessions thereafter, the participants in this pilot program. A lad nearly six years old, who had and supported his statement to his mother fought acute lymphocytic leukemia for two that he needed no more "lessons, since I years, preferred the social aspects of our already know how." He died shortly aftergroup. He was the recognized class racon- ward. A boy of seven had the diagnosis of teur who prevailed delightfully at every opportunity. That his levity was his obvious Wilm's Tumor made seven months prior to defense was of no consequence, of course; the beginning of our study, with surgical the group needed him and he needed them. treatment accomplished at that time. He He readily embraced the trance state when was subsequently an anxious, depressed, aided by the psychologic contagion of his insecure lad whose obstreperous behavior peers and therapists, but became frightened in school propelled him to our group. He and ineffectual when" alone" in the hospi- participated in only two trance sessions betal clinic or on the ward. So, while his wit fore his teacher was enthusiastic about his
Downloaded by [Central Michigan University] at 07:10 31 December 2014
236
improvement. We noticed aspects of forward progress, as well. If given time to relax, the patient could control his anxiety and concomitant vomiting preliminary to treatment. He needed the time because he induced trance in himself by going through a ritualistic induction procedure contrived by himself as he learned to mobilize his latent trance capability under the guidance of his therapists. (Children are, on occasion, quite mobile as they move from the unaltered to the altered state of consciousness, moving their limbs in a symmetrical manner, swiveling their heads about while pursing their lips spasmodically, and rolling their eyeballs beneath closed eyelids' fluttering a rhythmical tattoo or opening and closing their eyes.) This child survives. A 9-year-old girl with progressive histiocytosis discovered three years prior to the onset of our trance program was plagued with implacable terminal pain which had led to complete withdrawal and inanition. She was seen individually by the nurse therapist for a few weeks before she died. She became happier, began walking for short periods on her crutches, and had a measureable increase in appetite prior to her death. A female child of ten was referred to the trance group midway through the study due to her extreme uncooperativeness during procedures. She had been found to have acute lymphocytic leukemia 15 months before. Her mother was very superstitious regarding the supposedly occult nature of hypnosis; even the lady's timid presence in our group where she witnessed the innocuous proceedings served only to partially alleviate her fears. Thus, she permitted her daughter to participate in only three trance sessions, but the enterprising child did gain greater equanimity in clinical sessions and learned to relax sufficiently to go to sleep more readily. This patient is currently faring satisfactorily. (One of the frequently salutary uses of trance in ill or injured chil-
LABAWET AL.
dren is seen in the ease with which they can move from the relaxed trance state to the sleep state, using the former as a soporific intermediary.) Movement from the altered state of consciousness to the psychically adjacent physiological sleep state is the accomplishment of one of our male patients, aged ten. He was referred for insomnia by a private psychiatrist seeing the boy for extreme temper outbursts, apparently one of the scars bequeathed the patient as a sixyear survivor of a synovial sarcoma. He did achieve partial relief for his insomnia. Reticulum cell sarcoma was the clinical label affixed to another ten-year-old boy whose diagnosis was established a year before our study began. He was still hindered by vomiting prior to and during injections. While he may have assisted himself some through the use of trance, any increment in his control was minimal. His experience with his illness seemed to have awarded him with a defensive apathy and inertia upon which it was hard to intrude by any treatment method. Also, he was alive and faring pretty well; it seemed that he and his parents were unable to let this relative calm even be approached lest it be stirred into negative action once more. A leukemic boy, 14, with acute myelocytic disease joined the trance group when we were beginning the last quarter of the investigation. He was perishing rapidly, seven months after his initial diagnosis. He and his mother had interest in our endeavor as a possible means of securing greater control over severe nosebleeds which caused him great anxiety. He reduced the frequency of episodes of epistaxis. He also learned to use the trance state as one of his analgesics for headaches, which had been another refractory symptom. He remained at home in his final days, and reportedly achieved limited worth from listening to a tape recording of his therapist's voice. A boy of 14 had a lymphosarcoma iden-
Downloaded by [Central Michigan University] at 07:10 31 December 2014
CHll..,OREN WITH CANCER
237
tified three months prior to joining us for intake of analgesics; she learned to sleep adjunctive therapy. He died seven months without sedatives. However, as she faltered later. He had become quite apprehensive to expiration, her confidence waned and due to a number of medical complications she became quite dependent on her trance he had experienced in a short time as his therapist. At her death, she was again relyillness rapidly progressed. His frightened ing heavily upon medications. preoccupation with this fulmination of his disease was very distracting to him, and COMMENT robbed him of the needed concentration to mobilize most ably his suggestive resource. The patients who thus availed themWhile he did apparently gain some inde- selves of the theretofore dormant trance pendent regulation of his pain and anxiety, capability within themselves were able to we scored his use of suggestion as unre- measureably improve the quality of their survival. They likely lived no longer, but markable. A 19-year-old married girl with a tiny they lived more fully and less dependently. daughter had been wasting away with an This was their achievement, not ours, of osteosarcoma for a year. She eagerly course. They used their own latent trance availed herself of instruction in our sessions capability, only mobilized and fortified by in a nearly obsessive manner. She en- our guidance. The therapists were catalysts thusiastically sought and gained control of to the patients' accomplishment. Returning her anorexia, anxiety, and pain. She be- some degree of autonomy to children in came able to take medication without such extremity often had discernible posinausea and vomiting. Despite her precipi- tives for them. While largely subjective, this clinical retous general decline concomitant with the extension of her tumor, she augmented her port needs to include notice of objectively appetite and actually converted her steady collected impressions, as well. Increased weight loss into a gain. This permitted her appetite has a corollary, increased grocery time to achieve some personal goals. She bills. The scales verified weight gain in the dealt with her disease and imminent death face of increased morbidity. Academic in a unique manner, by speaking and writ- grades rise when children become more ing publicly about her situation. Her available for learning. Gratified parents documentation of reluctant dying garnered know when cranky kids become less irwidespread notice as she courageously suc- ritable. Harrassed clinicians immediately cumbed at the halfway point in our study. detect greater tolerance for clinical proAnother salient achievement was a con- cedures. Repose and equanimity in a child tribution to her little girl which she made begets the same in his parents, teachers, right into her quietus, dealing effectively and medical helpers, all of whom immediately note the difference. with the child's impending loss. A primitive psychological defense A medulloblastoma had first compromised the function of a 20-year-old col- mechanism, denial, was the ally of us all, lege student two years before she sought patients, parents, and therapists. It took individual treatment from the nurse many forms personally and professionally therapist. Operation and subsequent treat- familiar to us (LaBaw, 1969c). The most ment had initially quelled her cancer, but a evident manifestation of denial in our recurrence sent her to us to seek solace young charges was their conspiracy of sithrough trance. She quickly became excep- lence regarding the absence of deceased tionally adept. She skillfully reduced her former members of our group. The missing
LABAWET AL.
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were conscientiously ignored, for to heed was to look also at their own evanescence. But, not only the surviving children overlooked the obvious. Once the therapists were surprised to realize that their righteous indignation over poor attendance at a suggestive session was inappropriate, for the absent children had not been deliberate or negligent or ungrateful. They were dead. And the- gradual attrition of the group could finally no longer be denied, a sobering realization which spoke loudly of the stress inevitable in professionals in the .field. It was also noted that clinical rosters of our subject children were inevitably started off with those children still prospering, if only at some precarious level. The kids were not listed alphabetically, by sex, or by age as in this report. Wistful evidence of parental denial was seen in their relentless focus on a relatively minor symptom of their dying child, or their insistence that the impaired youngster not miss an hour of school. We noted that pain served either as a spur or as a deterrent to the use by a patient of his trance capability, usually the former. This is a highly complex matter which will
likely defy accurate appraisal in the absence of an objective measure of pain that is easily applicable. Now, pain is doubly subjective, as a clinician renders an opinion about his patient's opinion regarding the presence, severity, and duration of his discomfort. Apparently, some pain distracts some from sufficient concentration to permit alteration of their states of consciousness, while other pain highly motivates others to be quickly rid of it. REFERENCES LABAW, W. L. Assisting adults and children with remedial uses of their trance capability. Behavioral Neuropsychiatry,' 1969, I, 24-30. (a) LABAW, W. L. Terminal hypnosis in lieu of terminal hospitalization. Gerontologica Clinica, 1969, II, 312~320. (b) LABAW, W. L. Denial inside out. Psychiatry, 1969, 32, 17~188. (c) LABAW, W. L. Regular use of suggestibility by pediatric bleeders. Haematologia, 1970, 4, 41~ 425. LABAW, W. L. Adjunctive trace therapy with severely burned children. International Journal of Child Psychotherapy, 1973, 2, 8~92. LABAW, W. -L. Auto-hypnosis in hemophilia, Haematologia , (in press).
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
The Use of Self-Hypnosis by Children with Cancer a
a
Wallace Labaw M.D. , Charlene Holton M.D. , Karen a
Tewell RN & Doris Eccles ACSW
a
a
Childrens Hospital , Denver, USA Published online: 20 Sep 2011.
To cite this article: Wallace Labaw M.D. , Charlene Holton M.D. , Karen Tewell RN & Doris Eccles ACSW (1975) The Use of Self-Hypnosis by Children with Cancer, American Journal of Clinical Hypnosis, 17:4, 233-238, DOI: 10.1080/00029157.1975.10403749 To link to this article: http://dx.doi.org/10.1080/00029157.1975.10403749
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
THE AMERICAN JOURNAL OF CLINICAL HYPNOSIS
Volume 17, Number 4, April 1975 Printed in U.S.A.
The Use of Self-Hypnosis by Children with Cancer!
Downloaded by [Central Michigan University] at 07:10 31 December 2014
WALLACE LaBAW, M.D., CHARLENE HOLTON, M.D., KAREN TEWELL, RN and DORIS ECCLES, ACSW Childrens Hospital, Denver
This is a clinical report relating the experience gained in 24 months of study of 27 children using contemporary medical hynosis in combating some aspects of malignancies. The afflicted children, aged 4 to 20, were trained at Childrens Hospital in Denver in group trance sessions to induce trance in themselves. Varying degrees of success are recorded, from poor to excellent. The anxiety which was the common experience of all concerned is recognized; its alleviation through denial is discussed. Obtained with the trance state were more rest, easier and longer sleep, more adequate food and fluid intake and retention, and greater tolerance for and manageability during diagnostic and therapeutic procedures. Fear, anxiety, depression, overdetermined response to discomfort, and anticipatory vomiting prior to treatment were diminished. A net positive opinion of the value of this adjunctive treatment is shared by the authors.
The hopeless plight of children dying of malignant tumors was seen by oncologists as a clinical situation in which some of the demonstrated advantages of contemporary medical hypnosis (LaBaw, 1969a) could be provided to patients to minimize aspects of their terminal disability. The agonal struggle of these children, so difficult for them, their parents, and their attending professionals to endure, is the result of combined insult from their basic pathology and toxic elements in their treatment. Part of the motivation of physicians in command of dying children, to seek such adjunctive means of treatment, emanates partially from their understandable need to share the burden. The endeavor which spawned this clinical report was launched following documentation of the local demonstration
of the usefulness of suggestive therapy (contemporary medical hypnosis) in acutely injured children (LaBaw, 1973) chronically impaired children (LaBaw, in press) and in terminal patients (LaBaw, 1969b), as the subject patients variously fi t all three categories. Accordingly, a two year clinical trial of the efficacy of adjunctive trance therapy was pursued at Childrens Hospital in Denver; 27 children were involved. The patients were about half boys and half girls, ranging in age from 4 to 20. Among the things encouraged during the trance state, in direct response to referrals for those purposes, were more rest, easier sleep, more adequate food and fluid intake, and greater tolerance for and manageability during diagnostic and therapeutic procedures such as spinal taps, bone marrow aspirations, and intravenous medication administration. 1 Presented to the 17th Annual Scientific Meeting Among those things discouraged were anxof The American Society of Clinical Hypnosis, New Orleans, 1974. iety and depression, seemingly inordinate 233
LABAWET AL.
Downloaded by [Central Michigan University] at 07:10 31 December 2014
234
or inappropriate response to discomfort which thwarted needed treatment, and anticipatory vomiting and apprehension prior to treatment, which also markedly complicated requisite therapy. Suggestive therapy was utilized in group trance sessions with both a child psychiatrist and a registered nurse, in group sessions with the nurse alone, in individual sessions with patients requiring same, and through self-induction of the trance state by indi vidual patients alone. There was no control group; objective evaluation was at times difficult. However, data supplied by patients, parents, teachers, and others, coupled with observations of professionals in the hospital, left the unqualified impression that results of trance therapy with children with cancer were satisfactory. METHOD
Patients and parents were informed through an introductory letter of our intended offering of adjunctive trance therapy. Word of mouth, embellishment of the idea through personal contact, and telephone explanation followed. The focus of an initial meeting between professionals and the subject families was to further exchange information, establish rapport, set individual and group goals, and to foster a realistic view of the usefulness of modem medical hypnosis. Part 'of the latter effort had to do with subduing magical expectations among the loved ones of cancer victims, and correcting aspects of the lay mythology accreted to hypnosis over the years. The children then embarked upon a program of an additional two visits to the hospital each month. Mothers usually brought their children, though one father was frequently in attendance with his son. Casual conversation occupied the beginning minutes of the hour as the participants assembled. The meeting place was a naturally
well-lighted treatment room devoid of clinical trappings. The children sat in chairs of appropriate sizes in a semicircle around the therapists. Patients of all the included ages met together. Parents were always invited by the therapists to participate with their children or to sit in to observe; they sometimes did so. One therapist, more commonly the nurse, intoned the suggestive utterances, while the other participated with or observed the children. The atmosphere was one of casualness, permissiveness, and good cheer. The induction technique employed was the progressive body relaxation method followed by restful psychic imagery of fantasied idyllic scenes common in the childrens' experience, such as a tranquil mountain view. The appearance of the room in a short time was one of a crescent of little figures slumped pleasantly or draped lanquidly across their seats before the therapists. Most faces displayed a smile. The characteristic involuntary flutter of the eyelids in the trance state was commonly seen. Specific suggestions as to betterment were then offered to the group, embracing the array of clinical problems listed above. A simple parlance was employed to make the proceedings explicable to our youngest members. The word, "sleep," was avoided, as children are particularly literal in their interpretations while in the trance state; we had work to do and had not invited the kids there to slumber. The nurse had to refer to "the top of the leg," rather than the "thigh," as another example. The children were assured that they could easily achieve a similar relaxed state of mind and body by themselves if they wished, merely by assuming a position of repose and thinking about the sound of the therapists' voices in our group sessions. It was our feeling that youngsters who thus equipped themselves with the ability to self-induce the trance state most fully put to work their suggestive capability. Many could not, or chose not to do so, as they
Downloaded by [Central Michigan University] at 07:10 31 December 2014
CHILDREN WITH CANCER
were boys and girls who needed to be very dependent upon others. Following the induction of the initial trance state in the group, small talk again ensued, ranging from comment on the conjoint suggestive effort just finished to totally unrelated topics of interest to the kids. Then the trance experience was repeated, the last thing before we parted company. (The value of this double exposure to the trance state in each formal get-together was established earlier in work with hemophiliacs, where, in a 40-month controlled study (LaBaw, in press), it was found that greater relaxation was often possible to the participants during a second repetition.) Continuity was maintained between various aspects of the childrens' treatment by occasional participation with us by the oncologists, by the services of the oncology staff nurse as a suggestive therapist following her postgraduate study of clinical hypnosis, and by the efforts of social workers who helped us deal sensitively with the maximally distressed families of our patients.
235
was a useful group catalyst, he did not extend this performance to solo endeavor for clinical purposes. He could participate capably by himself in practice even, but never rallied this ability under the stress of hospital procedures. He expired as the first year of this study came to an end. Another six-year-old boy, moribund after combatting his acute lymphocytic leukemic disease for more than a third of his life, remained quite anxious despite all his adjunctive trance efforts in the hospital. But, he did achieve some control of his pain while at home. Thus, when he had external resources upon which to depend, as drugs in the hospital, he could not summon his internal resource to his aid. He let his suggestibility idle except when he had little else to depend upon. He died within two months of his embarkation with us. A boy a year older, harboring the same illness as the aforementioned patients, was remarkably anxious during medical procedures. His laments were louder than most children so afflicted. However, he grasped the new implement offered him through suggestion quickly and firmly. He learned auto-hypnosis with dispatch and underwent RESULTS a bone marrow aspiration from his sternum The outcome of this two years' work using only trance anesthesia. He gloried in seems fairly represented by the brief clini- his accomplishment, obviously feeling cal reports summarized below, recounting good about regaining some modicum of the rather typical experiences of some of control over himself. We encouraged his refusal to attend group sessions thereafter, the participants in this pilot program. A lad nearly six years old, who had and supported his statement to his mother fought acute lymphocytic leukemia for two that he needed no more "lessons, since I years, preferred the social aspects of our already know how." He died shortly aftergroup. He was the recognized class racon- ward. A boy of seven had the diagnosis of teur who prevailed delightfully at every opportunity. That his levity was his obvious Wilm's Tumor made seven months prior to defense was of no consequence, of course; the beginning of our study, with surgical the group needed him and he needed them. treatment accomplished at that time. He He readily embraced the trance state when was subsequently an anxious, depressed, aided by the psychologic contagion of his insecure lad whose obstreperous behavior peers and therapists, but became frightened in school propelled him to our group. He and ineffectual when" alone" in the hospi- participated in only two trance sessions betal clinic or on the ward. So, while his wit fore his teacher was enthusiastic about his
Downloaded by [Central Michigan University] at 07:10 31 December 2014
236
improvement. We noticed aspects of forward progress, as well. If given time to relax, the patient could control his anxiety and concomitant vomiting preliminary to treatment. He needed the time because he induced trance in himself by going through a ritualistic induction procedure contrived by himself as he learned to mobilize his latent trance capability under the guidance of his therapists. (Children are, on occasion, quite mobile as they move from the unaltered to the altered state of consciousness, moving their limbs in a symmetrical manner, swiveling their heads about while pursing their lips spasmodically, and rolling their eyeballs beneath closed eyelids' fluttering a rhythmical tattoo or opening and closing their eyes.) This child survives. A 9-year-old girl with progressive histiocytosis discovered three years prior to the onset of our trance program was plagued with implacable terminal pain which had led to complete withdrawal and inanition. She was seen individually by the nurse therapist for a few weeks before she died. She became happier, began walking for short periods on her crutches, and had a measureable increase in appetite prior to her death. A female child of ten was referred to the trance group midway through the study due to her extreme uncooperativeness during procedures. She had been found to have acute lymphocytic leukemia 15 months before. Her mother was very superstitious regarding the supposedly occult nature of hypnosis; even the lady's timid presence in our group where she witnessed the innocuous proceedings served only to partially alleviate her fears. Thus, she permitted her daughter to participate in only three trance sessions, but the enterprising child did gain greater equanimity in clinical sessions and learned to relax sufficiently to go to sleep more readily. This patient is currently faring satisfactorily. (One of the frequently salutary uses of trance in ill or injured chil-
LABAWET AL.
dren is seen in the ease with which they can move from the relaxed trance state to the sleep state, using the former as a soporific intermediary.) Movement from the altered state of consciousness to the psychically adjacent physiological sleep state is the accomplishment of one of our male patients, aged ten. He was referred for insomnia by a private psychiatrist seeing the boy for extreme temper outbursts, apparently one of the scars bequeathed the patient as a sixyear survivor of a synovial sarcoma. He did achieve partial relief for his insomnia. Reticulum cell sarcoma was the clinical label affixed to another ten-year-old boy whose diagnosis was established a year before our study began. He was still hindered by vomiting prior to and during injections. While he may have assisted himself some through the use of trance, any increment in his control was minimal. His experience with his illness seemed to have awarded him with a defensive apathy and inertia upon which it was hard to intrude by any treatment method. Also, he was alive and faring pretty well; it seemed that he and his parents were unable to let this relative calm even be approached lest it be stirred into negative action once more. A leukemic boy, 14, with acute myelocytic disease joined the trance group when we were beginning the last quarter of the investigation. He was perishing rapidly, seven months after his initial diagnosis. He and his mother had interest in our endeavor as a possible means of securing greater control over severe nosebleeds which caused him great anxiety. He reduced the frequency of episodes of epistaxis. He also learned to use the trance state as one of his analgesics for headaches, which had been another refractory symptom. He remained at home in his final days, and reportedly achieved limited worth from listening to a tape recording of his therapist's voice. A boy of 14 had a lymphosarcoma iden-
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tified three months prior to joining us for intake of analgesics; she learned to sleep adjunctive therapy. He died seven months without sedatives. However, as she faltered later. He had become quite apprehensive to expiration, her confidence waned and due to a number of medical complications she became quite dependent on her trance he had experienced in a short time as his therapist. At her death, she was again relyillness rapidly progressed. His frightened ing heavily upon medications. preoccupation with this fulmination of his disease was very distracting to him, and COMMENT robbed him of the needed concentration to mobilize most ably his suggestive resource. The patients who thus availed themWhile he did apparently gain some inde- selves of the theretofore dormant trance pendent regulation of his pain and anxiety, capability within themselves were able to we scored his use of suggestion as unre- measureably improve the quality of their survival. They likely lived no longer, but markable. A 19-year-old married girl with a tiny they lived more fully and less dependently. daughter had been wasting away with an This was their achievement, not ours, of osteosarcoma for a year. She eagerly course. They used their own latent trance availed herself of instruction in our sessions capability, only mobilized and fortified by in a nearly obsessive manner. She en- our guidance. The therapists were catalysts thusiastically sought and gained control of to the patients' accomplishment. Returning her anorexia, anxiety, and pain. She be- some degree of autonomy to children in came able to take medication without such extremity often had discernible posinausea and vomiting. Despite her precipi- tives for them. While largely subjective, this clinical retous general decline concomitant with the extension of her tumor, she augmented her port needs to include notice of objectively appetite and actually converted her steady collected impressions, as well. Increased weight loss into a gain. This permitted her appetite has a corollary, increased grocery time to achieve some personal goals. She bills. The scales verified weight gain in the dealt with her disease and imminent death face of increased morbidity. Academic in a unique manner, by speaking and writ- grades rise when children become more ing publicly about her situation. Her available for learning. Gratified parents documentation of reluctant dying garnered know when cranky kids become less irwidespread notice as she courageously suc- ritable. Harrassed clinicians immediately cumbed at the halfway point in our study. detect greater tolerance for clinical proAnother salient achievement was a con- cedures. Repose and equanimity in a child tribution to her little girl which she made begets the same in his parents, teachers, right into her quietus, dealing effectively and medical helpers, all of whom immediately note the difference. with the child's impending loss. A primitive psychological defense A medulloblastoma had first compromised the function of a 20-year-old col- mechanism, denial, was the ally of us all, lege student two years before she sought patients, parents, and therapists. It took individual treatment from the nurse many forms personally and professionally therapist. Operation and subsequent treat- familiar to us (LaBaw, 1969c). The most ment had initially quelled her cancer, but a evident manifestation of denial in our recurrence sent her to us to seek solace young charges was their conspiracy of sithrough trance. She quickly became excep- lence regarding the absence of deceased tionally adept. She skillfully reduced her former members of our group. The missing
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were conscientiously ignored, for to heed was to look also at their own evanescence. But, not only the surviving children overlooked the obvious. Once the therapists were surprised to realize that their righteous indignation over poor attendance at a suggestive session was inappropriate, for the absent children had not been deliberate or negligent or ungrateful. They were dead. And the- gradual attrition of the group could finally no longer be denied, a sobering realization which spoke loudly of the stress inevitable in professionals in the .field. It was also noted that clinical rosters of our subject children were inevitably started off with those children still prospering, if only at some precarious level. The kids were not listed alphabetically, by sex, or by age as in this report. Wistful evidence of parental denial was seen in their relentless focus on a relatively minor symptom of their dying child, or their insistence that the impaired youngster not miss an hour of school. We noted that pain served either as a spur or as a deterrent to the use by a patient of his trance capability, usually the former. This is a highly complex matter which will
likely defy accurate appraisal in the absence of an objective measure of pain that is easily applicable. Now, pain is doubly subjective, as a clinician renders an opinion about his patient's opinion regarding the presence, severity, and duration of his discomfort. Apparently, some pain distracts some from sufficient concentration to permit alteration of their states of consciousness, while other pain highly motivates others to be quickly rid of it. REFERENCES LABAW, W. L. Assisting adults and children with remedial uses of their trance capability. Behavioral Neuropsychiatry,' 1969, I, 24-30. (a) LABAW, W. L. Terminal hypnosis in lieu of terminal hospitalization. Gerontologica Clinica, 1969, II, 312~320. (b) LABAW, W. L. Denial inside out. Psychiatry, 1969, 32, 17~188. (c) LABAW, W. L. Regular use of suggestibility by pediatric bleeders. Haematologia, 1970, 4, 41~ 425. LABAW, W. L. Adjunctive trace therapy with severely burned children. International Journal of Child Psychotherapy, 1973, 2, 8~92. LABAW, W. -L. Auto-hypnosis in hemophilia, Haematologia , (in press).
