Sometimes hysterical symptoms are grafted on to the anxiety, and then we have another very common nervous condition known as Anxiety Hysteria. Many of the symptoms may mimic real organic disease and, as we have shown before, paralysis or spasm is just as inconvenient and disabling to the patient, whether it is organic or not.

Among the more common symptoms are those of ‘eye strain’ with ‘blurring of vision’ and headaches. Disturbances of breathing may give rise to ‘Asthma’ attacks, while upset of the digestive system may give rise to vomiting or diarrhoea. Very frequently the part of the body affected is that which is used most at work. This is particularly marked if the work is such that the patient dislikes it for one reason or another.
Thus ‘Miners’ Nystagmus’ and ‘Writers’ Cramp’ are well-known examples of this condition.

In addition to the main presenting symptom, the usual signs of anxiety appear as attacks of panic, depression and headaches. As we have seen, upsets of other organs in the body may give rise to conditions which resemble real organic disease. Thus, palpitation, pain in the chest and difficulty in breathing may suggest real heart disease, and the symptoms may affect any portion of the body, for no part of the human organism is immune to the effects of anxiety. Even ‘Hay Fever’ and ‘Catarrh’ are often hysterical.
A typical example of this condition of anxiety hysteria is seen in the case of a man who suffered from ‘writers’ cramp’. This young man had been unable to write for over four years. On taking hold of a pen and endeavouring to write, the patient’s hand would go into such a spasm that he could not write a single word.

The trouble started while in the Army, which he thoroughly disliked. Here he was engaged in clerical work, which he also disliked, and he had a grievance because he had been overlooked and received no promotion. He developed marked feelings of inferiority and became extremely bad-tempered. On one occasion he became so annoyed at conditions in the Army that he wrote a rude letter about a certain General and intended to send it to a newspaper. Fortunately, he was able to stop it in the post; but the incident gave rise to feelings of panic as to what might have happened. Visions of court martial and punishment impressed on his mind the undesirability of writing rude letters to newspapers concerning the superior officers he disliked and the Army short-comings in general.
As a result of this bottled-up resentment and fear, the patient developed panic attacks, and his hand went into spasm whenever he tried to write, thus effectively preventing him making a fool of himself.

Owing to this, he was invalided from the Service, a fact which did not trouble him very much. Now, however, his condition was useless to him, and he confidently expected it to vanish as he resumed civilian life. On the contrary, the symptom became more firmly established than ever, and the patient had difficulty in main-taining his position.
At first he proved to be a very poor hypnotic subject, as his intense anxiety to be cured prevented him from concentration. However, after a few sessions he was able to enter a medium trance with consequent rapid improvement in his condition. When last seen, the patient had been able to write several pages without difficulty and expressed his intention of writing a book!

Another patient was unable to write a certain number. He could write anything else, but owing to emotional circumstances this particular number had great significance for him, and he was absolutely unable to form this figure. Before the hypnotic session, he was asked to set down a row of figures, including the significant figure. He managed the other numbers easily, but when he came to the dreaded numeral, his hand simply ‘froze’ into immobility and no amount of straining could produce a single dot on the paper.
Only a light hypnosis was induced, but after this the patient was able to form the figure repeatedly with no difficulty whatsoever. He was advised to have further treatment to consolidate the cure as the condition had been present for many years. As he came from a considerable distance he was unable to arrange this, but the cure has apparently been maintained.
Yet another case was that of a professional man. This patient was of a highly sceptical type with a keenly analytical mind. He had great difficulty in writing reports and had suffered from this disability for years. On endeavouring to write, his hand would be-come jerky and spastic, so that he had considerable difficulty in writing anything. Owing to his scepticism, hypnotism was induced by the so-called ‘waking’ method. Although the patient was unable to open his eyes or move his arm when challenged, he insisted, on waking, that he had not been ‘off’ as he had heard every word of the suggestions; it was intended, of course, that he should.

He was handed a pen and told to test the matter by the results. To his utter amazement, he could write perfectly. Instead of accepting the fact joyfully, he kept exclaiming over and over: ‘I can’t understand it - I can’t believe it. Surely it won’t last?’, etc. He was warned against this foolish attitude of mind and advised to have further treatment to consolidate the position in view of the severity of his condition and the many years he had suffered from the disability. He considered that he was cured, however, and went away apparently quite happy but still marvelling and expressing his incredulity at the cure.

Some time later he wrote to say that he was still trying to get over his astonishment at the cure. Later still he wrote to say that his condition had relapsed, although his handwriting betrayed no evidence of it. He was advised further treatment, but did not take advantage of this, saying that he feared his condition must be physical rather than mental, although for a time after the treatment he had enjoyed writing!
This case is quoted for several reasons and cannot possibly be regarded as evidence of the failure of hypnosis. It is astonishing to think that an otherwise intelligent and trained professional man, accustomed to thinking, could really expect a complete and permanent cure in one short hypnotic session, of a condition which had existed for years and defied all other treatment.

Nevertheless, this attitude of mind is quite common. Patients who have put up with years and years of orthodox medical and psychiatric treatment without success will express disappointment if not immediately cured after one treatment by hypnosis. Certainly, in rare cases cure may result in a single session; but where the condition has persisted for years, and particularly if the patient is a poor hypnotic subject, it is only reasonable to expect that a short course of treatment will be necessary. It is well known that hypnosis becomes easier and easier with each repeated session, so that even a very poor hypnotic subject can be trained in time to enter a satisfactory condition of trance sufficient for medical purposes.

This case also illustrates another point. Much of the good which has been brought about by hypnotic suggestion can be un-done by long continued counter-suggestion. This is especially likely to occur if the patient has been able to have only one short session of hypnosis. With a few repeated sessions the cure becomes so firmly established that other suggestions have no effect in neutralizing those implanted during hypnosis.
Counter-suggestion may come from either the patient himself, as in the case quoted above, or from those with whom the patient comes in contact most - usually friends or relatives.

In this connection it should be remembered that suggestion does not have to be expressed verbally to register with the patient. Well-meaning but utterly foolish and thoughtless suggestions expressed by those surrounding the patient can help to weaken and undo much of the good which has been brought about by hypnosis.
After a cure by hypnosis of a condition which has defied other forms of treatment, the patient becomes an object of interest. In some cases this is all to the good as everybody likes to feel that they are interesting to others, and so there is an incentive to maintain their cure. 
Where, however, the patients are subjected to constant expression of doubt as to the permanence of the treatment, then eventual relapse is possible.

If the hypnotic influence has been strong enough to tide the patient over this initial period when he is subjected to the foolish opinions of others, then his normal condition becomes firmly established and there will be no relapse. It behoves all those who come in contact with the patient (and this includes medical men) to refrain from expressing any doubt as to the result of hypnotic treatment.

If they have the best interests of the patient at heart, they will refrain from making remarks such as: Yes, it is very good. I only hope it will last!’ Such an expression of doubt immediately puts the thought of failure in the patient’s head. Even a look can express doubt, without a word being spoken; so that those in con-tact with the patient should be especially careful of their attitude, particularly in the early stages of treatment.
Sometimes, of course, the hypnotic influence is so strong that a single treatment will produce an apparently permanent cure. Such a result is seen in the case to be quoted later of the young man who suffered from Hysterical Paralysis of the hand. Hysteria is a serious nervous complaint in which the patient develops severe symptoms which may cover the whole range of all possible bodily ills.

Thus there may be blindness, deafness, loss of voice or stammering. Limbs may be paralysed or affected by spasms. Loss of memory, fits and sleep-walking are common signs, while even some cases of socalled ‘Rheumatism’, ‘Fibrositis’ and ‘Sciatica’ may be hysterical in origin.
In short, there is practically no medical condition which cannot be imitated by hysteria. It will be seen at once that a thorough knowledge of medicine is necessary in order to diagnose with certainty between symptoms due to real organic disease and those of hysteria.

Hysteria is the condition responsible for those cases which are often reported in the newspapers as ‘miracle cures’. Hysteria is not malingering, and the patient will often submit to all kinds of severe treatment in an apparent effort to get well. Some will even go to the length of agreeing to major operations, including amputations, so that it behoves the medical man or surgeon to be on the look-out for hysteria.
Sometimes the condition may be confusing, but it is usually possible to diagnose the condition with a reasonable degree of con-fidence. The symptoms, for instance, practically always take the form which the patient imagines would be the case if real disease were present. 

In a case involving loss of feeling, the numbness or loss of sensation will not follow the proper distribution of the nerve supply because the patient has not the medical knowledge of anatomy. Therefore such anaesthesia is always of the ‘glove’ or ‘stocking’ type, a condition which does not appear in real disease.
Similarly, in hysterical paralysis, a whole limb or a particular movement may be involved, but never an individual muscle. In the case of one young man, he awoke one day and found to his great horror that his hand had become paralysed. Orthodox treatment was of no avail, and he was about to be invalided from the Navy when he agreed to try hypnotism as a last resort. He was easily hypnotized and shown that he could use his hand. Further, he was instructed that his hand would be perfectly normal on waking and would always remain so. In addition, it was impressed upon him that no other symptom would develop to take its place. On awakening, he found that his hand was indeed perfectly normal. His mother wrote to express her gratitude for the cure, and nine years later she wrote to say that he was still perfectly well. He had distinguished himself on active service during the war and was happily married.

Such a case must be regarded as a permanent cure and refutes the arguments of the psychiatrists that the cure would not be lasting. Admittedly such a quick cure is relatively rare but circumstances made prolonged treatment impossible.
When we consider how hysteria can mimic real disease and the multitude of symptoms it may present, together with the ease of cure by hypnosis, it becomes easy to understand the ‘miracle cures’ which are occasionally reported. Undoubtedly, such cures do occur, usually in people suffering from hysterical blindness, deafness or paralysis, who have been given up by their doctors as the result of failure to recognize the condition as hysterical. Such failure results more from lack of observation than want of knowledge. The overworked general practitioner under the modern conditions of medical practice has little time for leisurely observation.
When such patients lose faith in ordinary medical treatment, they often fall into the hands of the unqualified medical camp followers, such as ‘faith healers’, ‘spirit healers’, and the like. 

Some of these people honestly believe in their wonderful ‘power’ or ‘gift’ and do not realize that they are merely manipulating the patient’s own imagination. Others, however, are thoroughly unscrupulous and prey on the simple minded.
All these people use a primitive form of hypnotic suggestion without knowing it, while at the same time they proclaim to all and sundry that hypnotism is the work of the Devil! Their cures are seldom lasting, because they do not use hypnotism scientifically; and, not understanding the fundamental laws of suggestion, they have no means of ensuring a permanent result. If they confined their attentions to a few hysterics, it would be bad enough; but having ‘cured’ a case of hysterical paralysis, it is usually announced, with a wealth of publicity in the sensation-seeking newspapers or their own publications, that they can cure all paralysis.

As a result many sufferers from genuine paralysis are grievously disappointed when their false hopes are dashed to the ground by the failure of the ‘magic cure’ in their particular case.
Another very common form of nervous complaint is that known as Obsessional Neurosis. This is much more serious than anxiety or hysteria, and phychiatrists regard it as very difficult to treat. The condition is very distressing to the patient because the mind is constantly occupied with a persistent thought, often of an unpleasant kind. Thus there may be dirty or obscene thoughts or there may be an abnormal fear of becoming dirty.
Sometimes the obsession takes the form of a Compulsion, and the patient may be compelled to go on washing the hands until they are sore. 

Sometimes he may be compelled to touch things a certain number of times or count in a special way. Often the patient will be forced to go back a certain number of times to make sure the door is locked or the gas turned off. Occasionally, the obsession may take the form of Rumination. Such a patient will think all day long on such problems as why the world is round, to the exclusion of all other thinking.
Still another form of obsession is that of Doubt which results in a chronic state of indecision, so that the patient simply cannot make up his mind to do even the simplest thing. The worst part of this mental illness is that the person fully realizes how absurd his obsession is, but he is nevertheless impelled to give in to it. 

In this way an obsession is very like a post-hypnotic suggestion, and this, as we will see in later chapters, gives rise to an interesting theory of the cause of mental illness.

A patient who has been deeply hypnotized and instructed to carry out a post-hypnotic suggestion may have no memory of what he has been told to do, as amnesia is usually complete in the somnambulistic state. Nevertheless, he will feel a compulsion to carry out the order even if it should be quite foolish, provided it is not absolutely contrary to his deeply rooted moral code. Thus it may be possible to make him remove his shoe in front of an audience, but he would refuse to undress completely. It will be seen why this is so later.

If the subject endeavours to resist a strong post-hypnotic suggestion, this will give rise to great uneasiness and anxiety. He usually feels so uneasy and unhappy that he will give in and perform the act to ease his mind. The patient with an obsession feels the same way. He knows perfectly well that what he feels impelled to do is foolish, yet if he tries to resist he feels so unhappy that he has to yield.

This patient illustrates a common type of obsession which responded to hypnosis after orthodox methods had failed. The patient was the wife of a doctor and herself a professional woman. Following an unfortunate accident and a tactless remark by a relative when the patient was in an emotional state, she became obsessed with the idea that she had committed murder and should be punished. Orthodox psychiatry was tried without success, and Electro - Convuisant -Therapy resulted in nothing but loss of memory.

The patient was advised to have the operation of Leucotomy, but refused. Her anxiety was very great, and there were times when she seriously contemplated suicide. Her husband persuaded her to try hypnotic treatment as a last resort.
The patient proved to be a fairly good hypnotic subject, thus confounding the psychiatrists, who maintain that obsessional cases are difficult or impossible to hypnotize because they cannot be persuaded to relax.

Several sessions of about half an hour each restored her apparently to normal. No analysis was attempted and only a light stage of hypnosis was induced, use being made of direct and in-direct suggestion.
Some time afterwards, the patient wrote to say how grateful she was at being restored to health and having escaped the horrors of ‘electro - convulsant - therapy’.
The doctor himself wrote later to say that his wife was still well and that he intended to write to the British Medical Journal concerning the value of hypnosis.

Obsessional neurosis can be cured by hypnotism, but the earlier the patients apply for treatment the better. Usually they seek hypnotism only as a last resort, having endured many years of psychiatric treatment, including drastic measures such as electro-convulsant-therapy, without success.
Naturally, an obsession which has existed for ten or twenty years cannot be expected to be removed in a single session of hypnosis. Hypnotism should be tried first in these cases. At least it could do no harm; and if it failed, which is unlikely, then other more drastic measures could be applied.

Another case of obsessional neurosis in which the disorder took the form of chronic doubt illustrates the value of hypnosis. A woman was sent along for treatment, and her husband wrote to say that it was impossible to live with her any longer. She was in a state of chronic doubt about everything. Unable to decide what was right or wrong, she constantly worried if God was punishing her dead sister and if her mother and another sister were committing sin. She recognized that such thoughts were foolish, but could not get rid of them.

Years of psychiatric treatment had produced no result. Enquiry revealed that her mother had impressed upon her the awfulness of sex; and of course the patient was in a constant state of doubt as to which was right - her own feelings and desires for sex, or her mother’s point of view. She really wondered if God would punish her for her sex acts but transferred possible punishment to her dead sister.
After six treatments of hypnosis she returned home apparently cured, and her husband wrote to express his gratitude and stated she was ‘now fit to live with’.

Few people have any conception of the misery which a compulsion neurosis may cause. A compulsion to wash the hands until they are red and sore, even bleeding; inability to get obscene thoughts out of the head; and perhaps a chronic state of doubt, seem almost incomprehensible to the average normal person. it is doubtful, however, if any other form of mental illness can cause such agony of mind to the sufferer. What makes it worse is the fact that they realize how stupid such thoughts are, but they are quite incapable of overcoming them. Orthodox psychiatry considers the outlook for obsessional cases to be very poor. 

Hypnosis, however, can overcome the condition, but unfortunately patients usually seek its aid when the illness has become firmly established after years and years of unsuccessful orthodox treatment.
Although the author has described the cases in this chapter under the generally accepted headings allotted to the psycho-neuroses for the sake of the reader’s convenience, he considers such classification entirely artificial, and that, basically, all these apparently different conditions have essentially the same origin.

Some incident or idea gives rise to fear, and causes the patient to concentrate his mind - a condition of hypnosis. Fear implanted at this time gives rise to tension, which in turn upsets the nervous system, and causes symptoms. Worry over these causes more fear and tension, and so establishes a vicious circle.
The abnormal fatigue of Neurasthenia is merely the result of constant tension. The ‘panicky’ feelings of Anxiety Neurosis are merely the result of the upset of the autonomic nervous system, disturbing the action of organs and glands. Anxiety Hysteria results when an outstanding symptom is grafted on to the above. For instance, spasm of muscles may give rise to writer’s or musician’s cramp. Hysteria results when a symptom such as ‘numbness or anaesthesia’ completely dominates the picture. When the patient attempts to relieve his tension by repetitive acts or ideas, we have Obsessional Neurosis.

The value of this conception of a common origin of the psychoneuroses is that it enables the hypnotherapist to minimize the importance of presenting symptoms, and employ a plan of action which is universally applicable, and so gets quickly to the root cause of the condition.