During the course of listening to a sermon one Sunday, this patient, the woman, had become horribly distressed to find unaccountably to utter a variety of obscenities, particularly vulgarisms con- cerning body functions and sexual activity, all being ascribed to Jesus. She fought the overpowering vocal impulses desperately along with compel- ling desires to grimace, to gesticulate, and to posture. Her husband, noticing her distress, tried to make whispered and this inten- sified her symptoms. She finally resorted to the measure of covering her mouth with handkerchiefs and shoving her fingers as far as she could into her throat. This resulted in retching, and she hastened to the ladies' lounge, shouting "Get out" to those who sympathetically came to her assistance. By turning on a faucet and a continuous flushing of the commode, she managed to cover-up a half-hour's exhaustive repetitious vulgar vocalizations. Fortunately, since she had the keys to the family automobile in her handbag, she managed to get to the car and then to drive a mile to reach home, racing the car engine in first gear to cover-up her continuous vocalizations. She locked herself in the bedroom and spent an exhausting afternoon in vocalizations, grimacing, and posturing,
Reprinted with permission from The Journal of Hypnosis,
Experimental Hypnotherapy 125
interrupting herself only enough to yell at her husband that she was all right, that she wanted solitude, to let her that she would see him on the morrow. That evening, without having eaten or dinner, she took a heavy dose of sedatives and managed to sleep.
The next morning she awakened in acute fright, wondering if she had developed a sudden psychosis. The compulsive vocalization was still present as well as the need grimace, to gesticulate, and to posture. She yielded to these and desperately reviewed mentally possible measures of concealing, distorting into more acceptable and passively yielding to the impulses so that she could pattern her symptomatic behavior into some less distressing form. Since she had met the author socially on a previous occasion, she made use of her bedroom telephone extension to solicit his The content of her telephone call was practically diagnostic in its character.
A house call was made, and the husband was reassured after a fashion to permit some reasonable provisions to meet his wife's condition. He was distressed by the secrecy being maintained but yielded to the extreme violence of her demands issued through the bedroom door in halting phrases because of interspersed whispered obscenities.
She demanded hypnotherapy, about which she had read various glowing lay accounts. Despite the adverse nature of the situation the author agreed, but emphatically demanded that she yield completely in utter submission to his choice of procedure. Approximately two hours were spent because of her interruptions of the author in making certain that she agreed without any reservation to any therapeutic procedure the author had in mind. outrageous possibilities were outlined to her to make certain that she understood that the psychotherapy in mind was by no means even remotely orthodox. As soon as she understood this fully, hypnotic induction was undertaken. All appropriate and fitting hypnotic were offered in the proper sequence and progression that the author's experience had disclosed to be most reasonably effective. However, those suggestions were embellished, interlarded, couched, and elaborated with obscenities, vulgarities, and profanities that far exceeded the worst she had uttered.
She was appalled, horrified, and what was most important, completely silenced with a rigid fixation of her attention upon the author and the hypnotic suggestions being offered to her in such a peculiar emphatic fashion. (The fact that she knew the author well socially undoubtedly constituted a highly significant but not measurable factor in the total situation.) At all events, within 10 minutes she developed a profound somnambulistic hypnotic trance in which passivity, and abject obedience were demanded and received. With urgency and calculated haste she was disoriented for time and place, suggestions of a state of fright, of complete obedience to, and of utter dependence
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the author as representation of that was good, reliable, comforting, and helpful were emphatically given to her. Thereupon she was reoriented with extreme care to avoid any possible traumatic event to a time two years in the past with emphatic instruction to remain so oriented or regressed after awakening from the trance despite all and wonder-provoking stimuli of her surroundings.
As soon as the author felt relatively secure in his control of the situation, the husband was summoned. Fortunately, he was a college graduate with a considerable background in psychology. Rapport with his wife was established for him.
The first measure with him was to inform him extensively concerning the syndrome of Gitles de la Disease and to assure him that he would be furnished with references in the literature so that he could understand the peculiarity of his wife's affliction. This was done in his wife's presence in her regressed state, and she was informed of the possibility that sometime in the remote she might develop such a condition. While was thinking this over in the trance state, her husband was separately informed of the true state of affairs and of the regressed trance state of his wife as a temporary measure of controlling her problem. his distress he agreed to the author attempt experimental therapy, since the author could not inform him of any adequate therapeutic procedure.
The therapy worked out then and instituted was:
Informing the patient in the trance state that "in the she would be so afflicted.
2. the patient that was in a regressed trance state and that this was serving to control her problem, which was an actuality in her ordinary waking state. 3. Seeking the patient's in devising some measure of
control of the symptoms.
4. Emphasizing that, since hypnotic regression had effected a temporary relief, hypnotic suggestion could and would undoubt- edly be efficacious.
5. Suggesting that the patient be content with minor progress in control and rather than demanding a miraculous cure,
6. Securing her absolute promise to abide by both her condition and the modifications of it that would be suggested. 7. A long discussion concerning the type of motor components that
she would willingly permit and the nature of the utterances in regard to both content and volume.
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subject for either the author or any other therapist who might take responsibility for her.
9. The absolute need for her absolute
piete, and without the slightest request, whether she was awake or in the trance state, and that obedience would be expected even when she personally ob-
to instruction.
10. The teaching of the patient of a series of 10 posthypnotic cues by which to develop a trance state and a regression state. (The author did not want to rely upon one or two such cues.) As this instruction of the patient progressed, it became increasingly difficult to maintain the trance state as as the state of regression. The patient became increasingly distressed about the author's description of her condition; she obviously did not want to believe his statements, yet the demeanor of her husband, with whom she had been given needed rapport, as well as the emphasis with which she was being given instructions, were most of her belief and acceptance. However, it was apparent that this state could not be maintained much longer, and a compromise was offered to the effect that she would arouse from the trance state to remain in the waking state of awareness for whatever time she wished, not to an and that she would then develop a profound somnambulistic regressed trance state. To this she agreed.
She awakened only to burst into a torrent of characteristic utterances accompanied by posturing and gesticulations.
After about 20 minutes of this she managed to express a wish that the author would or could in some way take charge of her situation. This was followed by further uncontrollable behavior and then a brief pause, during which another trance state was induced with explicit and emphatic that henceforth the first sense of uncontrollable behavior on her part she would immediately regress in age to a period of two years in the past. She accepted this instruction with a facial expression of hope. After a second brief orientation of her husband concerning her during which the patient listened attentively, attention was given to the task of outlining further the course of therapy for her. This was to include: (1) periodic visits to the author's office; (2) the systematic learning of a pattern of behavior that would meet the compulsions of her illness and yet enable reasonable daily life adjustments. Blind and complete acceptance of these two requirements was demanded and finally agreed in a most binding fashion.
It was then explained that:
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but "better" manner. That is, since her manifestations would occur in either the presence or absence of others, her symp- tomatology could be entirely adequate if she alone knew of it. Thus, her utterances need not be so loud, since she could hear even the softest of whispers as well as the of shouts. Additionally, the posturing could also be minimal, since she could be aware of it and any associated thoughts, however minimal the postural movements were. There was added the explanation that her illness, however severe, must necessarily be inconstant in manifestation, since she have to eat, to drink, and to sleep, and that each of these activities would constitute temporary barriers to symptom manifestation. Hence, thoughtful and ful consideration of these facts would permit realization that there could be other periods of symptom-freedom and hence that extensive therapeutic procedures could be instituted. Much repetition and explanation of these ideas had to be given together with emphatic instruction that all understandings presented were to become an integral part of her waking state regardless of symptom-distress.
2. Systematic instruction was then given and practice insisted upon in uttering in low tones and whispers both her own utterances and some of those the author had voiced. This was demanded most cautiously, with full instruction that a regressed state would develop instantaneously if the author anticipated difficulty for her. This anticipated difficulty, not explained to her, was the possibility of her arousal from the trance and loss of control of the situation. Perhaps unnecessarily, the author did elicit the re- gressed stale several times as a precautionary measure. Also, she was to develop new gesticulations more awkward and less meaningful to the observer than were the "grinds and bumps" which constituted a part of her motor manifestations. Coughing, gasping, choking, yawning, if necessary learning how to belch voluntarily, crossing her legs violently, or whatever else she felt could be bearable were suggested, and she was made to demon- strate the suggested acts.
The patient became most meditative and subdued, and when a regressed state was induced, she was asked to view herself in the future in a thoughtful situation with the author's right hand on her left shoulder and holding her left hand with his left hand. In this way it was possible to pseudo-orient her to the future while in the regressed state with physical contact constituting a part of the conditioning process. Thus, the composure of her regressed state her comfortably to speculate upon her "future needs" as seem indicated by her visual hallucination of
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herself in suggested special including her actual present con- dition.
In elaborate detail many ideas about her general and behavior were worked in relation to her home, her family, and her various obligations. Provision was made for her family to leave imme- diately on a vacation for two weeks with a complete of all social obligations and all incoming telephone calls. Thus the patient was ensured privacy and opportunity to practice new patterns of behavior.
She made regular visits to the but instead of racing the engine, she turned on the car radio to high volume and yielded completely to her vocalizations. Thus, she "got it out of my system" to permit therapeutic interviews with the author. These were barren so far as understandings or information were but they were most useful in augmenting her ability to control, and direct her
One significant oversight in the proposed therapy was disclosed by the events of one night about a month later. She awakened suddenly and the whole household by a violent manifestation of her symp- toms. When interviewed in both waking and trance states the next day, the explanation was that she had to have "escape valves" as a "safety measure." This led to the provision that biweekly, or even less frequently she would go into the garage, close it, turn on the car radio full volume, and loose with everything."
At first this occurred weekly, but slowly came to be more and more infrequent until the practice was discontinued.
Therapy was continued for two years, first at weekly intervals, then finally at monthly That the last year of therapy was necessary was questionable in the author's mind. The patient, however, felt that she would feel more comfortable if therapy were continued, even though it was slowly transformed into essentially little more than social visits.
More than five years have elapsed since therapy was discontinued. The patient is free of her symptoms, and has been wholly so since the completion of the first year of therapy. A year ago (1963) she sought an interview with the author on other matters, reminisced with amusement about her previous and declared, can say all those things and make all those movements voluntarily any distress. Let me show you." She did most comprehensively and then with a laugh remarked, "I am not sure whether some of the things I just said were mine or some of the embellishments with which you horrified me so terribly. Have you or any other psychiatrists any understanding of what an awful mental state descended upon me that time? It makes me shudder to look back upon it, but I remember you telling me that other people got it too. It's really too awful to think about, but I wanted you to be sure over it." (At this writing, she still is.)
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seemed effective elicited no information. The only conclusion was that it was a blind effort that fortunately succeeded with her.
SECOND PATIENT
A year after therapy with this patient was a second, much less severe patient presented himself. His statement was that he was on his way to church one Sunday as he caught sight of the church building, he found himself bursting into incredible obscenities and profanities with grinding of his teeth and much shaking of his fists. Little description was needed of his since he punctuated the narration of his history it.
At first the sight of his own church led to symptom manifestation, then other churches, then the sight of anyone in garb. By occupation he was a bartender in an exclusive bar; but as his symptoms continued he discovered that utterance of a single word of profanity would precipitate an uncontrollable explosion of a minute or two duration from him. At first he avoided going to church, then to streets where there were churches. Finally he had lo resign his lucrative position and secure employment in a rough-and-tumble tavern where he soon became favorably known as "The Cussing Bartender" and where his language and behavior attracted a certain clientele, since his episodes were brief though repetitious. fact, it became a challenge for the tavern's to think up new precipitating phrases which the patient found unable to keep from incorporating in his own vocalizations.
His wife resented his reduced income, swore at him in her anger, and became suddenly and painfully aware of her husband's which he had kept secret from her, enabled to do so by his working hours and careful avoidance of her. She insisted upon psychiatric therapy without delay.
As the patient related his problem, the other patient was called to mind. He differed in that his manifestations seemed to require a "triggering" by sight of something pertaining to religion, religious thinking, or hearing profane and obscene utterances by others.
The patient was then questioned about his to undertake hypnotherapy, and he declared that that was his purpose in seeking the author's assistance.
A satisfactory deep trance was elicited with not too much time or effort being required, and an explanation was given to him in the trance state that before treatment of his problem, there would be undertaken an extensive educational project that enable more rapid therapy once
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was begun. He was reluctant about this since he desired therapy at once, but finally he yielded to the author's persuasions.
Thereupon, a systematic program was instituted to train this patient in sensory exclusion of stimuli, visual and auditory, and to psychological blocks to render various words "nonsense syllables." This was carefully explained to his wife, her cooperation was won; the patient's own high intelligence and psychological sophistication were of significant value in promoting therapeutic intentions.
Extensive a satisfactory list of evocative stimuli, and the patient learned a selective blindness that allowed him to see a church as, for example, a "white building," a nun as "a woman dressed in a ridiculous-looking black dress." to listen to oaths and obscenities as "meaningless nonsense syllables," to regard Sunday as day off duty, and to look upon his wife's church attendance as a special feminine social activity. A thoughtless asking of grace at an evening he regarded with confusion and bewilderment, developed a headache, and went to bed without eating. That incident terminated that practice. For- tunately, there were no children, and the social activities of the man and his wife together were extremely limited.
As for religious thoughts of his own. the patient was extensively instructed in the matter of nonsense syllable experimentation and given to understand that he, too, could devise nonsense syllables. this way any religious thoughts coming to his mind became transformed into nonsense syllables.
He was seen regularly in the office biweekly for about three months. During this time he was instructed in the trance state to put into force his hypnotically acquired learnings, not constantly, but at first infrequently and then with increasing frequency, so that his symptoms would occur with decreasing frequency. The patient was most cooperative, and by the end of three months he had tost his job as "The Cussing Bartender."