Case Study - Page 4

CASE COMMENTARY

By Dan Short

In 1692, the missionary explorer Girolamo Merolla da Sorrento entered into his diary the following story. A young boy, native to the Congo, went to spend the night with an older boy. The teen host played a trick on his unsuspecting guest by preparing a breakfast of wild hen, a food strictly forbidden by tribal custom and tradition. A few years later, when the two met again, the older man asked the younger whether he’d eat a wild hen. The younger replied that he’d been solemnly charged by the witch doctor not to eat that food. Thereupon the host began to laugh and asked why he refused it now after having eaten it at his table before. On hearing the news, the younger man began to tremble, absolutely possessed by fear. In less than 24 hours, he was dead.

In 1942, Harvard physiologist Walter Cannon, documented similar instances of psychogenic or psychosomatic death, which he termed “‘Voodoo’ Death.” This phenomenon is believed to be the result of strong emotional shock, most often fear paired with a specific suggestion of impending death. Similarly, in a 1992 journal article, titled, “Hex Death: Voodoo Death or Persuasion,” a researcher outlined the case of a man diagnosed with cancer who, along with his physicians and family, believed the cancer would soon kill him. However, after his death, the autopsy revealed that cancer wasn’t the cause of death. The author suggests that the man’s belief in his imminent demise was the actual cause of death. This type of premature death seems most likely to occur if there’s an authority figure involved, with privileged knowledge of the body, who activates a state of emotional shock using the “vision-to-fear pathway” or the “auditory-to-fear pathway.”

I say all of this to highlight the importance of the work done by therapists in cases such as the one described by Steve Andreas. While I wouldn’t go so far as to say that the medical doctor was trying to kill his patient with Voodoo Death, I think it’s fair to say that his lack of psychological sophistication created some serious problems for the patient. When the doctor used the CAT-scan to accompany his verbal suggestion of impending death, he imprinted a terrifying image that wouldn’t easily leave her mind. In other words, he simultaneously activated the vision-to-fear pathway and the auditory-to-fear pathway, thereby increasing the strength of his suggestion for her demise. Briefly speaking, I think this woman was not only in a state of extreme emotional distress, but also in real physical danger.

My guess is that Andreas fully understands the power of suggestion, and that’s why his first action was to nullify the doctor’s semihypnotic suggestion. He accomplished this by attacking the physician’s authority and humorously accusing him of fortune-telling without a license. Although the use of humor may not seem like a hypnotic technique, it’s interesting to note that recent studies using functional magnetic resonance imaging (fMRI) indicate that humor is one of the few forms of communication that simultaneously activates left and right hemispherical functioning. In other words, humor is a useful method for accessing multiple levels of conscious awareness.

Next, the doctor’s grim prediction of death is replaced as Andreas weaves together a series of images from Sarah’s own memory and stories from his life experiences suggesting the possibility of happy productive living, even as imperfections continue to exist within the body. Andreas describes his client’s shift in posture and breathing as evidence that changes were occurring at an unconscious level. Using the language of neuropsychology, we could speculate that these physiological changes signaled a shift in the sympathetic nervous system, from a state of chronic hyperarousal to a state of rest and repair, or parasympathetic activation. As already mentioned, there’s a growing body of research that suggests the presence of unconscious reasoning and its responsiveness to certain types of verbal communication, such as the use of story, metaphor, and imagery—all of which Andreas employed, in some instances with the client having her eyes closed.

Whether we should call Andreas’s intervention Neuro-Linguistic Pro-gramming, hypnosis, mindfulness, cognitive therapy, or something else really depends on the professional lexicon a person is most comfortable with and which aspects of the treatment one wishes to emphasize. For now, I’d like to point out an important fact revealed within the first sentence of the case description. Andreas wrote, “Sarah . . . whom I’ve known for many years.” Right away, we know that a meaningful relationship exists between these individuals. My guess is that Sarah came to Andreas as someone she trusts and respects. In this case, as in all others, I believe that a strong relationship is the most important ingredient for emotional healing. Decades of study in psychotherapy outcomes supports the idea that technique contributes only a small portion to the change that occurs within the sessions, while the strength of the therapeutic relationship accounts for the lion’s share.

The background of this case is a medical authority’s careless communication that heightens a client’s fears to the point of immobilizing her. She comes to Andreas as an authority on healing, and the way he manages the relationship with her is crucial to the outcome of this case. Initially he gives her specific tasks, such as gesturing with her arm, closing her eyes to visualize past experiences, and dealing directly with the piece of paper that had become a focal point for her fears. She responds to his instructions with cooperative compliance, thereby formalizing the alliance and deepening her involvement in the suggestive therapeutics. Because of Andreas’s encouragement to find and utilize inner resources, combined with his implicit confidence in her ability to overcome this challenge, Sarah’s felt sense of impending death is replaced with a healthier expectation that good things can come from a desire to learn and a will to live.

The last point to address would be my criticisms of this case. Unfortunately, I have none to offer. Successful therapy is a psychological endeavor measured by the client’s subjective satisfaction with what’s occurred. According to Andreas, Sarah was very pleased with her visit to him, and continued to be pleased with the outcome when this article was written. Because the client is the ultimate judge of whether the therapist has succeeded in reducing his or her suffering, all that I can say is that it seems to have been a job well done.

Steve Andreas, M.A., has been learning, teaching, and developing personal change methods for more than 53 years. His books include Virginia Satir: The Patterns of Her Magic; Transforming Your Self: Becoming Who You Want to Be; and Six Blind Elephants: Understanding Ourselves and Each Other. His new book, Transforming Negative Self-Talk, will be published in spring 2012. Contact: andreas@qwest.net.

Dan Short, Ph.D., maintains a private practice in Scottsdale, Arizona, supervises the training of doctoral students at Argosy University, and is director of the Milton H. Erickson Institute of Phoenix. He’s the author of Transformational Relationships and the lead author of Hope & Resiliency. Contact: hope@iamdrshort.com.

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