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The history of hypnosis as a healing art has varied from acceptance as a treatment modality to dismissal as a parlor trick. Discredited in 1784 by a French royal commission appointed to investigate the healing techniques of Mesmer (although commission chairman Benjamin Franklin did note that belief might influence bodily effects), hypnosis has since regained respectability. Hypnosis appears to be a special manifestation of the mind–body system's ability to process information by transforming it from a semantic to a somatic modality. Its therapeutic effectiveness is supported by both research and clinical experience. Today, hypnosis is widely used to treat a variety of conditions—pain, airway restriction, gastrointestinal disorders, skin lesions, burns, and anxiety—as well as to prepare patients for surgical procedures and to facilitate habit change (such as smoking cessation or dieting).

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Trance and suggestion occur naturally throughout human experience and are a function of how the mind works. Becoming absorbed in a novel and being unaware of surrounding sounds, or daydreaming while driving and not remembering the last few miles, are common experiences that illustrate the ubiquitous nature of trance. Responding to subliminal messages in advertising by thinking about purchasing a product—or actually doing so—represents ordinary reactions to suggestions made in a carefully crafted trance. These common experiences of trance and suggestion also occur with patients in health care. The power of certain somatic sensations (e.g., abdominal pain) to evoke a trance (a restriction of the field of the patient's awareness to the abdominal region), coupled with autosuggestion as to the meaning of the symptom (e.g., "I wonder if that could be cancer"), increases attention to the sensation and may prompt a visit to the doctor.

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The medical encounter can be considered to be similar to a trance phenomenon; patients are naturally absorbed in their somatic symptoms, and the clinical environment concentrates their focus of awareness. Because patients in this naturally occurring trance may be in a suggestible state, it is important for clinicians to avoid making negative suggestions and to be alert to opportunities for making positive, health-promoting suggestions. Because clinicians, too, can be induced into a trance in which they focus narrowly on biomedical pathology, they must be alert to finding ways of shifting their awareness to the larger context of the clinician–patient relationship.

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This chapter will describe the therapeutic use of suggestion within the context of the patient's naturally occurring trance states and in the course of clinician–patient discourse. This application can be used routinely by clinicians in all patient encounters. We will also describe the role of therapeutic hypnosis, usually provided by a specialist trained in this procedure, in treating a variety of medical conditions.

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Derived from a Greek word meaning "sleep," hypnosis is in fact a therapeutic procedure that requires active cooperation on the part of the patient. The following definitions, used in this chapter, describe the states and processes involved:

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  • Trance: A state of focused attention, ...

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