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A hypnotherapist might be asked to see a cancer patient, for example, where surgical or radiation treatment has successfully

eradi-cated tumor growth or in cases that are advanced and may become terminal.

In the first instance hypnosis would be utilized in motivating the patient for rehabilitation procedures and dealing with emotional con-flicts, whether they preceded the illness or resulted from it.

A 38-year-old mother underwent radical mastectomy for breast cancer, followed by a course of radiation, which was interrupted because of nausea.

Hypnosis was introduced to control this nausea, and was successful. Sugges-tions were then extended to diminish her severe anxiety, and she was taught a self-hypnotic procedure to aid in falling asleep. During the time of her nausea, she had lost considerable weight, but quickly gained weight again when it was suggested in trance that she would be hungry at every meal and would eat everything that was offered to her on the hospital tray. After discharge from the hospital, she was seen on an outpatient basis for several months, and hypno-therapy was used to alleviate some pain she had in an area of scarring, after it had been determined by the surgeon that the pain did not represent a recur-rence. Nevertheless, the pain was only diminished, not removed, so that it could still serve as an indicator of organic processes.

T h e effectiveness of hypnosis was dramatically illustrated 17 years ago in the case that follows:

A married woman in her early forties, the mother of three children, was diagnosed as having inoperable cancer of the stomach. In a very straight-forward manner, she inquired of her physician about the probable remaining

life span. She was told it was almost certainly a matter of only a few months.

She then turned her attention to planning the remaining time, asking if she would be hospitalized and if she would require much sedation and narcotics.

Her physician explained that hospitalization might be necessary and that it was customary to give some medication—narcotics for pain, possibly

tran-quilizers for any severe anxiety. He did mention, however, that hypnosis might supplement or replace some of the medication if she had an aversion to taking

drugs.

The woman outlined her goals as (1) remaining in a normal state of clear consciousness for as long as possible, (2) staying at home with her husband and children if feasible, and (3) being able to die gracefully, not overly sedated, but relatively free from pain. She accepted the offer of hypnotherapy.

At first she was seen weekly, but as her condition approached a terminal stage, she was visited several times a week. She achieved her goals, staying at home until the final week of her life, when she was hospitalized. She remained clear in her thinking until the last few days, when some chemical sedation was used. Although there was no hope for her recovery, she spent her last months in the manner that she wished and died an easy death, with dignity.

Hypnosis is not indicated in all cases of terminal cancer, but certain guidelines can suggest when its use might be of aid. Hypnosis should be considered in a terminal case (1) if the patient is anxious to avoid medication or has a fear of medication clouding consciousness, (2) to control pain without the side effects of narcotic drugs, (3) to aid in maintaining adequate food intake and delay cachexia, and (4) to help the patient psychologically to face the end of his life as normally as possible, with no unnecessary loss of contact with those he loves.

There have been numerous studies reporting the use of hypnosis as an adjunctive treatment in cancer patients, particularly for pain relief, It may also be helpful in decreasing anxiety of certain treatment procedures, such as bone-marrow punctures or radiation treatment involving unfamiliar machinery, often with the patient alone in the treatment room. Other uses are for stimulating appetite and for helping to maintain a relatively hopeful, active emotional state.

In cancer surgery the surgeon has the delicate task of giving his patient "certainty, clarity, and attention without attacking his h o p e "

(Golden, 1965). In reviewing 15 years of clinical experience in the use of hypnosis with cancer patients. Sacerdote (1965, 1966) suggests an experimental study comparing hypnosis to other treatments in terminal

patients, a thought echoed by LaBaw (1969) in a paper titled "Terminal hypnosis in lieu of terminal hospitalization."

Hypnosis may be helpful in assisting the patient to accept the diagnosis, facilitating surgery and postoperative recovery, relieving pain without excessive narcotics, and decreasing such side effects of radiation therapy as severe nausea and vomiting (LaBaw et al, 1975;

Chong, 1968). It is at times possible to maintain the patient in alert, rational contact until shortly before actual death. In this respect, Caracappa (1963) reported the case of a 37-year-old woman with generalized carcinoma of the ovaries and breasts who remained alert,

rational, and interested in her family. On the evening of her death she kissed her baby, said, "Goodnight, darling," and soon expired,

Erickson (1959) suggests the use of time distortion to decrease perception of pain, altering memory to prevent painful recall and anticipation. He stresses that while hypnosis can be used alone as a

means of pain control in many patients, it is more often and more properly employed as an adjuvant to chemical means.

Morphis (1952) has done outstanding work with cancer patients.

He has developed a somewhat unique hypnotic approach in which the patient's mind is emotionally dissociated from the part of the body in which the tumor is localized. This may be done through spatial sug-gestions, as " Y o u r arm with the tumor in it feels to you as if it were

located across the r o o m . " This technique may be likened to an inten-tional production of a state of mind that sometimes occurs spontane-ously as a defense against severe anxiety. Outstanding reports on the use of hypnosis with terminal patients have been published by Butler (1954), Cangello (1961), Marmer (1959), and Sacerdote (1968). Clawson (1975) has even raised the theoretical possibility that hypnosis might itself have some effect to fight cancer.

PAIN

T h e utility of hypnosis in diminishing pain in some patients is clearly established (Margolis, 1982—1983)- This may be of particular use in cancer patients where the chronic course of the disease often leads to increasing amounts of pain medications- Toward the terminal days and weeks of such a disease process, there may be a difficult choice between administering medications to relieve the pain or withholding medications to allow the patient to enjoy his or her last days, to whatever extent is possible without loss of consciousness as a result of high levels of pain medication. Hypnosis may provide a personal sense of coping, a feeling that is not facilitated by high doses of medication (Barber and Gitelson, 1980; Dempster, Balson, and Whalen, 1976;

Olness, 1981). The following two case histories were recently seen by Crasilneck:

A 71-year-old attorney had several surgical procedures for cancer of the tongue followed by repealed chemotherapy and radiotherapy, He was read-mitted by the surgeon because of an increased tumor mass in the side of his neck, together with some chest pain. He had a history of reactions to numerous medications. The limited options for pain relief were discussed with the patient and his wife: chordotomy, nerve block or transcutaneous nerve stimulation, acupuncture, or hypnosis- He chose hypnotherapy and was seen on a weekly outpatient basis for 9 months before his death. Except for the last 3 days, he required little pain medication. His pain management also included instruction in self-hypnosis and the use of a hypnotic induction tape-recording made specifically for him for that purpose.

A 46-year-old woman with cancer of the stomach wished only two things:

to be free of pain and to survive through the Christmas season, which had deep religious meaning to her. During the initial session of hypnotherapy, her pain was rapidly brought under control and she was taught self-hypnosis. Through periodic reinforcement she was relatively free of pain without large doses of medication. Her family was devoted to her, and as with most terminal cancer patients, the family endured agonizing, guilt-ridden, self-doubting and angry thoughts, especially in terms of their helpless inadequacy about her dying.

They tried to coerce her into being more positive about survival. Members of the family, at times, unduly pressure [he cancer patient to fight harder to get well (Oliver, 1982-1983). However, Crasilneck's patient frequently reiterated that she wished "to live through Christmas day." When it was suggested that she might live until the Fourth of July, she said, "Christmas is enough." She died peacefully, 4 days after enjoying Christmas with her family.