Hypnosedation - Mind over matter in the operating room

An article by Tineke DC & Mattias Desmet

Hypnosis has been a controversial topic in academic circles for several centuries. In particular, the use of hypnosis for anesthesia during surgery led to heated debate. Recently, Professor Mattias Desmet (the second author of this article) brought it back to attention in the context of his theory of mass formation during the corona crisis. In his opinion, mass formation and hypnosis are almost identical. Both focus attention on one small aspect of reality and cause people to lose awareness of the rest of reality. That mechanism is very strong. So much so that a person whose attention is focused on one specific thing by a simple hypnotic procedure - for example, on a certain sequence of images evoked by the hypnotist's voice - no longer experiences pain even when a surgeon cuts into his body.

In some interviews, such as the one with Alex Jones, Desmet stated, "I've seen it with my own eyes - a surgeon can cut through the skin and flesh, even saw right through the sternum and perform open-heart surgery without the patient noticing”. It was not difficult for the benevolent listener to understand that Desmet spoke in a somewhat hyperbolic style about operations that he had seen on video (or at least thought he had seen on video), something that he also attempted to make clear immediately after the interview on his social media (see Facebook post of September 5) and in a later substack.

The reaction from the media was nevertheless fierce. They accused him of being a liar and fantasist. Open heart surgery under hypnosis? Ridiculous! Time to calmly ask ourselves the question: To what extent can hypnosis actually be used as anesthesia during surgery? We will see that the findings are fascinating. And we will also see that the topic of hypnotic sedation has been heavily stigmatized for centuries. Virtually every doctor who wrote about it – no matter how thorough and observational his work was – faced scorn, contempt, marginalization and, in some cases, excommunication.

Let us start with the current state of affairs. Nowadays, hypnosis is indeed being used in the operating room. There can be no doubt about that. However, its function is usually limited, in the sense that it is mainly used as a replacement for general anesthesia, usually in combination with (light) local anesthesia. That does not alter the fact: sometimes it is also used completely on its own, without any form of anesthesia.

The list of operations that can nowadays be performed under hypnosis – whether or not in combination with local anesthesia – is long, although the technique is not yet used very often (1). And make no mistake, it also concerns (very) invasive procedures, such as thyroid operations (e.g. Queen Fabiola in Belgium), breast (cancer) operations, eye surgery (e.g. cataract), the removal of tumors (e.g. skin - but also thyroid tumors - such as with the French singer Alama Kante who sang throughout the entire operation in order to save her voice), female sterilization (removal of the uterus), groin or umbilical hernia operations, urological procedures, hernia operations, bone transplants, carotid artery operations, even brain and heart operations. At the time (in 2018), misleading information was circulating about this last (French) case: both videos on the internet and the French press spoke (loudly) about open heart surgery, while in reality it involved heart surgery via the groin. This 'fact check' rightly corrected this. In addition to (newspaper) articles, there is also visual material available of (invasive) operations under hypnosis (such as here, here, here and here). The Brussels anesthesiologists Christine Watremez and Fabienne Roelants also apply hypnosis to their surgical patients and even made an impressive documentary about it in 2020, entitled Ma voix ’t accompagnera (‘My voice will accompany you’).

It is important to mention here that hypnosis as used today in the operating room is actually just ‘the tip of the iceberg’. In general, people hardly realize the rich history that precedes this contemporary rediscovery.

The modern history of hypnosis begins around 1768 with the Viennese physician Franz Anton Mesmer (1734-1815). We can summarize Mesmer's ideas as follows: some persons have the ability to influence others due to a fluid that he called the ‘animal fluid’ (2). According to him, the universe was filled with a magnetic fluid, subtler than ether, that could be transferred from magnetizer to patient. This transmission of ‘animal magnetism’ was said to have a strong therapeutic effect. However, public sentiment turned against Mesmer and academia, in turn, followed public opinion. The medical school credited his success to the power of ‘imagination’ and labeled him an outright fraud. Mesmer was expelled from the Vienna Faculty of Medicine in 1774 for ‘charlatan practices’ and then left for Paris.

However, ‘mesmerism’, as the procedure was subsequently named after its originator (and thus essentially is the precursor of hypnosis), turned out to be practically relevant to medical practice in many ways. For example, it proved to be very effective for inducing anesthesia in all kinds of surgical procedures (3). A sensational example was the operation of a woman with advanced breast cancer, performed by M. Jules Cloquet, one of the most prominent Parisian surgeons at the time (3, p. 598). The patient in question was hypnotized, subsequently the surgeon made an incision from the armpit to the inside of the chest (both above and below) and excised both the tumor and the swollen glands. The operation took all together 12 minutes. And most interesting of all: during that time the patient continued to talk to the surgeon calmly and didn’t show the slightest sign of pain. There was no detectable movement in the patient's limbs, nor any change in facial features, breathing, or voice. And even the pulse kept its normal rhythm.

We only fully realize the medical value of Mesmer's technique when we realize that we find ourselves in an era in which there were no chemical anesthesia. For example, there was not yet ether and chloroform to anesthetize patients. In those days, surgery was something downright daunting. It was tried to induce some anesthesia with coca leaves, alcohol or poppy juice, or if necessary the patient was knocked unconscious before starting the procedure. None of these remedies led to really convincing results, so the patient was also tied up firmly just to be on the safe side. It was no different. Pain was an insurmountable suffering that was part of human life. God asked for acceptance of that pain - other remedies he had not yet provided.

It should come as no surprise that the mortality rate of operations under those conditions was very high. Patients were therefore often highly motivated to open up to anything that could alleviate their suffering, such as Mesmer's method. Still, doctors and surgeons who used ‘mesmerism’ were mainly treated with disbelief and hostility. The mainstream medical establishment protected itself, even if it directly compromised its original raison d'être – minimizing suffering. Some petty human characteristics are apparently timeless.

Around 1841 we saw a resurgence of the use of hypnosis in medical practice. In France and England, more and more dental procedures (such as tooth extractions) were performed in the mesmeric state. But it was above all the prestigious English physician and professor John Elliotson (1791-1868) who became the leader of the 'mesmeric' movement of the time. From 1837 he devoted himself almost entirely to this subject (3, 4). Here too we saw the typical, fierce resistance of the established order. For example, Thomas Wakley, the founder of the prestigious British medical journal The Lancet, waged a heated battle against Elliotson for years. As a result, under enormous pressure from the medical establishment, he finally resigned from University College Hospital in London in 1838.

That didn't mean that Elliotson stopped his dissident speaking. He remained determined to promote mesmerism in medical practice. This earned him the appreciation and love of a wide and, at times, famous audience. After a while, for example, he could count the British writers William Thackeray and Charles Dickens among his friends. And he also realized something in practice: under his supervision, numerous surgical procedures were performed (painless) under 'mesmeric' induced anesthesia in specially set up wards in Edinburg and Dublin, among others. This was no small achievement. It was without a doubt a major humanitarian advance at a time when chemical anesthesia was not yet available. And it didn’t concern trivial operations. Procedures like amputations of limbs were part of the 'normal' course of events. There are extremely detailed descriptions of these operations in the medical literature (see f.e. here, at pp. 107-111 of the article). Ironically, 60 years later, The Lancet itself published a detailed account of a woman whose leg was amputated - completely painlessly - under hypnosis.

Elliotsons' work was taken over around 1845 by the Scottish physician James Esdaile (1808-1859). He was responsible for a ‘mesmeristic hospital’ in Calcutta in nineteenth-century colonized India. There, in addition to countless minor procedures, the most invasive operations were performed under hypnosis (which was then still referred to as 'mesmerism'). Very important: this happened, just like with his predecessor, without any form of additional chemical anesthesia. The major operations included: amputations (including an amputation of the penis), cataract operations, operations for a strangulated hernia, and several hundred operations to remove giant scrotal tumors (a common condition among the Indian men of that time due to a parasitic disease) (3, 5). One of the largest such tumors removed under hypnosis weighed no less than 80 pounds (!). The concrete description of this operation is still available (you can find the case description here, p. 104 of the article). You can also still read Esdaile's controversial book (from 1851) (download here for free).

Esdaile’s hospital was not only open to doctors but also to the wider public. Greater transparency is hardly imaginable. Every day people ascertained this extraordinary medical practice with a critical eye. The authenticity of the literature on Esdaile's interventions has been extraordinarily well substantiated in other ways as well. For example, even a special commission of inquiry was set up at the request of the local governor. This commission confirmed that (the patients they observed) miraculously experienced no pain during the operations. Esdaile also had his fascinating hypnosurgical findings published in local English and Indian newspapers, so that anyone who wanted to could also find out about them in that way.

But here, too, that remarkable resistance to hypnosedation manifested itself. Despite the great transparency of Esdaile's practice, doctors and the lay public alike questioned his authenticity. As a result, after Mesmer and Elliotson, this Scottish doctor was also marginalized and ridiculed.

Esdaile himself summarized it poignantly: “But the routine practitioner will rarely condescend to divide with nature the merit of the cure. He and his pills, powders, and potions, must have all the credit; and if any one pretends to be able sometimes to cure disease by the unassisted powers of nature, he is called a quack, impostor, or fool…” (James Esdaile, 1846) (5). We note here that Esdaile – like Elliotson – was not deterred by the hostile criticism. He argued that suffering humanity could not afford to wait for the slow process of awareness and mentality change and, marginalized and stigmatized, he quietly continued his practice until he returned to his home base in Scotland in 1851.

A contemporary of Elliotson and Esdaile was James Braid (1795-1860), a Manchester surgeon who renamed mesmerism around 1843. He no longer thought of the phenomenon in terms of ‘animal magnetism’ (as Mesmer and his followers did), but provided a more psychological theory. He viewed it as a special state of the nervous system that leads to a kind of sleep state that can be artificially induced through verbal suggestion. He therefore designated it by the term hypnotism or hypnosis (from the Greek hupnos, ‘sleep’; etymologically derived from hypo-gnosis, meaning ‘decreased cognition or consciousness’). The essence of the hypnotic procedure lies in focusing attention on one idea (mono-ideism). This focusing of attention leads to strong psychological and physical effects through a series of mechanisms.

Braid not only made a conceptual-theoretical contribution; he also used hypnosis effectively in practice. In London, for example, he performed a number of operations on patients who were anesthetized through hypnosis (2). His practice was essentially the same as that of his predecessors, and also the reaction of the medical establishment remained unchanged: he was treated with hostility, and his work died a relatively quiet death. However, the term ‘hypnosis’ has stood the test of time and is still used today.

Besides the fact that these pioneers of hypnosurgery met fierce opposition, there was yet another factor that caused their work to fall into oblivion: the discovery of chemical anesthesia. The introduction of ether in 1846 and chloroform in 1847 would soon diminish the importance of hypnoanesthesia in surgery. Mainstream medicine (rightly) welcomed these remedies with loud cheers, but immediately considered hypnosis to be devoid of all practical relevance. In her enthusiasm, however, she missed something that is now becoming increasingly apparent: the recovery process usually goes much more smoothly after surgery that uses hypnosis instead of general chemical anesthesia. On top of that, hypnosedation also avoids the (often significant) side effects of general anesthesia. Modern proponents of hypnosedation rightly highlight both of these benefits, showing that the practical-clinical importance of hypnosis is by no means a thing of the past.

With the introduction of chemical anesthesia, mainstream medicine also immediately absolved itself of the responsibility to further investigate the mysterious impact of consciousness on the body, which is so concrete and unmistakable in the phenomenon of hypnosis. It is precisely this impact, however, that is one of the most fascinating features of the human being. The tendency to disregard it must be seen as a typical consequence of the dominant materialistic-mechanistic, biological-reductionistic view of man and the world in our society. We'll go into that in much more detail in a later substack essay.

Even after the discovery of chemical anesthesia, the use of hypnosis experienced a resurgence from time to time. The Irish surgeon Dr. Jack Gibson (1909-2005) for example became a legend in the world of hypnosurgery. As a newly graduated doctor on a foreign mission, he first came into contact with the beneficial effect of hypnosis in the 1930s. A member of a Bedouin tribe in the Middle East refused any form of anesthesia but still allowed him to remove a growth on his leg that was lodged between the muscles. Gibson was convinced that the procedure had caused his patient great pain, but later realized that the tribesman had been under self-hypnosis and had suffered no pain.

This experience opened a mental door for Gibson. In the decades that followed, he devoted himself wholeheartedly to the use of hypnosis in the operating room. He performed more than 4000 operations without anesthesia, ranging from plastic surgery to amputations. In addition, he helped countless people overcome alcohol and smoking addictions, and also used hypnosis to treat many other chronic conditions. He regarded mind power as one of the strongest, if most underrated, medicines available (6, 7).

His books, audio and video recordings show how hypnosis gives access to the subconscious. He sketched a theory that, in terms of basic ideas, is not far removed from those of Breuer and Freud. To get to the core of a disease, one must be able to use the power of the subconscious. This is the only way to tackle the cause of a problem instead of continuing to treat patients symptomatically: “If we, as doctors, do not accept this fact then we are cowboys. Cowboys without lassoes, for if we cannot catch this elusive beast, we will continue to see the appalling unnecessary suffering and death from readily curable psychosomatic diseases” (7). At the end of his life Gibson was writing a book on hypnosis in surgery, including a chapter devoted to the Scottish surgeon James Esdaile mentioned above. Sadly, his passing (at the blessed age of 95) has prevented the completion of this book.

Although not many doctors followed Gibson's example, the British Medical Association stated in 1955 that "hypnosis has a place in anesthesia and analgesia for surgical and dental procedures". It was also declared that in pregnant women it can be an effective method of relieving the pain of childbirth without disrupting the normal course of the labor process (2). It is worth noting that hypnosis as it appears in the therapeutic arsenal today is different from traditional 19th century hypnosis. Nowadays, 'Ericksonian hypnosis' is mainly used, a term that refers to Milton H. Erickson (1901-1981). This American psychiatrist developed induction and guidance techniques to induce a hypnotic trance that worked for more people. This was an important evolution. Hypnosis therefore became more widely applicable and increasingly met the criteria that every therapeutic instrument must meet: reliability, reproducibility and predictability (2).

We definitely need to introduce another figure in this article. A less well-known name in our region, but anything but unimportant, is Dave Elman (1900-1967). This hypnotherapist developed a radically different - much more direct and faster - style of hypnosis than Erickson's. He became best known for rediscovering the 'Esdaile state' - the hypnotic state we’ve described above in reference to the physician in India who used hypnosis as an anesthetic for even the most invasive operations.

In a sense, however, it is not true that Elman merely rediscovered Esdaile's technique. He did more than that. While at the time it took Esdaile a few hours to reach a deep hypnotic trance, Elman managed to do so in just a few minutes. From 1949 until his heart attack in 1962, Elman trained thousands of doctors, dentists, and medical staff in the United States in the use of his hypnosis techniques and helped countless surgeons perform painless surgeries using only hypnosis as an anesthetic. He did everything he could to achieve a rapid induction of the hypnotic state because he was convinced that if the procedure lasted longer than 3-5 minutes, these doctors would hardly be interested in the technique. And he succeeded. He became famous because his technique allowed him to successfully perform very invasive surgeries under hypnosis, including even open heart surgery using only hypnosedation. In (internet) articles (8, 9, 10, 11) and in Elman's book (Hypnotherapy. Dave Elman, 1970) one can read that no chemical anesthesia was used because the patient in question was so weak that any form of chemical sedation would be fatal.

Dave Elman has enriched hypnotherapy with his own, direct style of working. He passed away on December 5, 1967. His practice is continued by his son, Colonel H. Larry Elman. A beautiful, summary answer from Larry Elman to the question of whether it is possible to undergo painless surgery under hypnosis without any form of chemical anesthesia can be found here. We quote the most important passage: “… Possibly the case Dad was most proud of was the first Open Heart Surgery without chemical anesthesia. This was in about 1954. The patient desperately needed the operation and was not expected to survive without it. The anesthesiologist on the case could find no chemical anesthesia suitable — all were too strong and likely to kill the patient. If they didn’t operate, the patient would die. Operate with the available anesthetics, the patient would die. What about hypnosis? Both the Surgeon and the Anesthesiologist were graduates of the Dave Elman Course in Medical Hypnosis, so they called my Dad. He said he had never heard of such a thing. They asked him to be in the Operating Room as Hypnotic Coach, and proceeded with that operation the next day. The patient made a full recovery”.

Dave Elman's son still manages his father's archive, which includes the medical records of open heart surgery under hypnosis. A thorough study of these files is essential in the academic discussion of the value of hypnosis as sedation. Nevertheless, some fanatical adepts of the materialistic-mechanistic view doubt the authenticity of Elman's claims in advance. As we have stated elsewhere, that is their right (see substack Some notes on the tragicomic attempts to burn me at the stake). In the end, we all rely on many things we believe and few things we’ve actually observed. And even then: perceptions are also subjective in many ways.

Professor Dr. Marie-Elisabeth Faymonville – the Belgian anesthetist who relaunched hypnosis in the operating theater after decades of distrust in 1991 – said a few years ago in an interview with the Belgian newspaper De Morgen (read here for non-subscribers), however, that hypnosis cannot be used in open-heart surgery. Her arguments are not entirely clear, but she cites as a reason that the heart must be stopped during such procedures. She suggests that this technical limitation precludes the use of hypnosis as a substitute for general anesthesia. This argument is somewhat questionable for a couple of reasons.

First, a renowned heart surgeon reported us that, contrary to what Prof. Faymonville suggested, the heart is not always stopped during open-heart surgery. A minority of heart surgeries with full sternotomy (i.e. opening the sternum completely) is done on a beating heart, he said. Operating under a beating heart is considerably more difficult and demands a lot from the surgeon and is therefore probably avoided in many cases. But it does happen. This can also be verified on informative websites: there are indeed two ways to perform open-heart surgery, with or without stopping the heart. In the university hospital of Leuven (Belgium), even the majority of such operations are performed on the beating heart, without the intervention of the heart-lung machine (12). In other words, it is not true that open-heart surgery under hypnosis is intrinsically impossible because the heart must always be stopped.

Secondly, in exceptional cases, open-heart surgeries are also performed with only local, not general, anesthesia. There is even footage available of open-heart surgery where the patient remains conscious the entire time and witnesses their own surgery. In these cases, the heart was stopped without the use of general anesthesia. And also operations on beating heart are sometimes done without general anesthesia (as shown in this video).

Since all procedures that can be performed with only local anesthesia can also be performed with a combination of local anesthesia and hypnosis (2), it is obvious that hypnosis can also be used in open-heart surgery. This interesting (and amusing) personal testimony from a man who underwent open heart surgery while fully conscious using pain management techniques, also demonstrates the enormous potential of psychological influence during surgery.

And to take things one step further: if sawing through a leg is possible under hypnosis, without any form of anesthesia (as described f.e. in The Lancet article mentioned above), do we then have many reasons to doubt that sawing through the breastbone under hypnosis, without any form of anesthesia, is possible as well? All the evidence suggests that Dave Elman's achievement - open-heart surgery under hypnosis - is indeed possible.

It is of course not surprising that the contemporary practice of hypnosedation doesn’t go as far as the practice of the pioneers in the 19th century, who operated without anesthesia by necessity. Medical developments (such as chemical anesthesia) no longer require this. And perhaps even more importantly: the zeitgeist that is evolving more and more in a biological-reductionist direction, with increasing pressure on doctors to adhere to 'classic' protocols during procedures, simply no longer allows for surgery without some form of anesthesia. If operations under hypnosis are now routinely combined with local anesthesia, it is not because of the limited power of hypnosis, but because of the limited openness of the modern medical mindset.

Also anesthesiologist Dr. Sabine Maes, colleague of prof. Dr. Faymonville, says about the sedative potential of hypnosis that, strictly speaking, hypnosis can completely replace classical chemically induced anesthesia, but its use today is (mostly) limited to certain procedures under local anesthesia, with hypnosis as an adjunct (13). In other words, the old hypnosurgical practice and Western medicine have compromised in the operating room - and we can of course only applaud that. In what direction that compromise will be adjusted in the future, however, remains to be seen. Everything depends on the extent to which the materialistic-mechanistic view of man remains dominant, rather than on whether hypnosis really is so powerful that it allows painless operations without anesthesia. We undoubtly have to answer that last question in the affirmative.

Hypnosis and hypnosedation actually fit into a much wider range of phenomena that show us that human consciousness has an extraordinary influence on the body. The negative impact of anxiety and stress on the immune system, the placebo effect, yes, even ‘psychogenic death’ (when someone dies from a curse) - all are phenomena that demonstrate the curious, far-reaching influence of mental representations on the body (for more information on this, see this previously published article). As much as such phenomena fascinate people, they also arouse great resistance, especially in the academic world. Scientists and doctors who draw attention to it are often ridiculed, no matter how thoroughly they substantiate their discourse. As described above, the fate of the great authors on the medical application of hypnosis illustrates this vividly.

That leaves us with the question: What actually causes this resistance to things like hypnosis? In the final analysis we can only conclude: that is because they shake the dominant view of man and the world.

The dominant view of man and the world is undoubtedly mechanistic-materialistic in nature. The universe is a collection of elementary particles interacting according to the laws of mechanics - it is a great machine. And man is a small machine, a gear that rattles in the great machine of the universe. Man is a biochemical process and everything can be ultimately explained from that process. Man's consciousness - his thoughts and feelings - is an accidental side effect of the rattling of the cogs in his head. This view has great expectations and ambitions. If we understand the human-machine well enough, we can repair any defect in it. All sickness and suffering will eventually be eradicated by the medical engineer.

It is precisely this illusion that is being shattered by the observations about hypnosis. Hypnosis shows us that human consciousness is not just a passive side effect of the brain's biochemical processes. Consciousness is not merely a product of bodily processes; bodily processes are also an effect of consciousness. The mechanistically thinking person becomes frightened by that confrontation with the power of the mind. It threatens his illusion of man's mechanistic malleability. When the mind has power over the physical, the ability to control human existence - and the human mind in particular - through perfect, rational manipulation of the body disappears.

Man then reverts to being a creature that has to deal with the elusive and difficult to control phenomenon of his own mind and soul and slides into a world in which there are no rational certainties anymore. In other words, man is again fully confronted with his greatest torment: the excruciating uncertainty of his existence. To rid himself of this torment, he shuts himself up in a disenchanted, rationalistic world view.

There are, however, other ways of dealing with uncertainty, yes, of even finding in the fundamental uncertainty of human existence the condition of being truly human. And once man has overcome the fear of the limits of his rational understanding, he will also usually be able to see without much effort what the pioneers of hypnosedation mentioned above tried to show us: the mind has the most astounding power, even in the operating room.