The Strange Case of Medical Hypnosis – 1

How the placebo effect implies learning, and learning is hypnotic.

Chronic illness involves forms of mental dysregulation to which we are attached.

Our client’s problem is that they have lost rapport with their unconscious mind.
Our job is to help restore that relationship.”

— Milton Erickson
, psychiatrist & hypnotherapist

Lincoln Stoller, PhD, 2021. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license (CC BY-NC-ND 4.0)

The mind-body

Besides thinking, your brain directs your awareness, collects information from your body, and synchronizes basic functions. Hormones produced in association with your brain manage your daily metabolic rhythms, attention, and arousal.

Even though your nervous system extends throughout your body, it’s not clear how involved your brain is with your body’s many functions. Many of your muscles operate autonomically, such as your heart, lungs, and circulatory system. Aspects of your intentional musculature are controlled by your cerebellum, a component of your lower brain, but there remain aspects of movement that are unconsciously linked to hearing, sight, balance, and orientation.

The mind and body affect each other at many levels. There is no single way to describe this structure. Control is a combination of hierarchies, series, and parallel connections. To a large degree, organs of your body perform their own regulation, communicate with your brain, and affect your mind on unconscious levels. Their operations rarely comes to your conscious awareness, and when they do their effects can be both direct, through pain or pleasure, or indirect, through moods and metabolic adjustments. This much we can agree on.

There are aspects of our body’s functions that appear in our consciousness, and there are aspects of our consciousness that affect our somatic function. No one should be surprised that this happens at a superficial level of concern, perception, and intention. We are all concerned about our health and take actions to maintain and protect it.

Just as we have physical or mental dysfunctions, we also have psychosomatic dysfunctions. That is, there are mind-body connections that can improve or degrade. These holistic mind-body connections—our mind’s regulation of bodily function and the body’s ability to direct our minds—lie outside of psychology and somatic medicine. These connections between mind and body are not cognitive or intentional, and they can enhance or impede health and function.

Unconscious behaviors elude your awareness by being rooted in reflex and habit. Some of these behaviors you may have learned, and others may be intrinsic or instinctive, such as needing to sleep or eat. They may be good habits, bad habits, or simply familiar patterns.

Justifying what’s unhealthy

Unhealthy behaviors can be rooted in memories and associations of the subconscious, thought patterns developed under different circumstances that you no longer fully remember and may no longer apply. We are conscious of some of our reflexes, memories, and associations, but most are beyond thought and reach. Dreams reveal the kinds of associations our minds can make when unfettered, but the conscious mind is rarely creative to that degree.

Our conscious mind always justifies itself to itself. Our justifications, which only appear when we question ourselves, help us be accurate and consistent, but we do not require they reflect a high degree of sanity. When we cannot fathom our condition or maintain control, we look to others to provide guidance for us.

Allopathic medicine offers to take over responsibility, redirect our environment, and re-pattern our behavior when we surrender to it. Medicine prescribes new patterns that offer better health, these include changes in our diet, daily rhythms, chemical intake, and behaviors. Prescriptive therapy, following this model, suggests better ways to think and address situations. The idea is to solicit full compliance with healthy patterns of thought, behavior, and function.

But there are those areas below consciousness that not only contribute to your behavior, but determine it, and sometimes these subconscious patterns conflict with your better psycho-somatic judgment. It is these areas that we address with medical hypnosis.


A common notion of “the placebo effect” is an action that appears to work, but either doesn’t work or only works superficially. The concept is mechanical by its nature, and presumes a false, mechanical view of medicine. In reality, many paths connect cause and effect, and virtually none of the body’s mechanisms are understood well enough to trace all causes to all their effects. Even saying something as simple as, “an analgesic relieves pain” is full of caveats and presumptions.

To gain a better understanding of cause and effect in medicine–for actions that are direct, indirect, or have little effect–break the action into a cause, perception, and result. We would like to know if we can rely on these occurring together, even if we don’t understand how one connects to the other.

An outcome can be labeled a placebo result when direct observation does not see, or current theory does not predict a connection between the action and the result. The mechanical view of the body excludes perception as being irrelevant, and most medical theories exclude awareness as playing any role in connecting a physiological action with its effect.

By considering the trio of cause, perception, and effect, we can better clarify placebo action. Consider these cases:

  1. The action has a plausible effect, a result is felt, and a result is seen.
  2. The action has no plausible effect, but a result is felt, and a result is seen.
  3. Whatever the action, a result is felt, and a short-term result is seen.

The first case is not considered generating placebo effects because the effects exert a “real” influence. In the second case, the cause is considered a placebo because it’s implausible that the effect caused the result.

The third case gives the desired result, but it is not enduring. We might dismiss the transitory effect as an illusion, or a result of an active imagination, but even here we should be cautious. The effect we’re looking for might be a skill that requires learning and practice. The beneficial result might become enduring if the actions are repeated and one’s intentional role is learned.

We might call any skill a placebo, since we don’t know the mechanics of learning. For example, none of the initial actions of walking, swimming, or relaxing generate immediate or initially enduring results. They all take practice, require perception, and develop in ways we never fully understand. Once we learn to master and control these actions, their effects become obvious, and the results are enduring.

Similarly, if we take an ineffectual pill and learn mindfulness in order to cure our depression, we might say the pill was a placebo and mindfulness–or any other behavioral change–was the actual effect. However, clinical trials show that most antidepressants are ineffectual pills, yet antidepressants are given credit for resolving depression. Many clients insist their pills are effective, and they depend on them.


We can learn to control important aspects of our physiology by managing anxiety, fear, stress, and depression. In addition, our subconscious minds can control blood flow to selective tissues, the ratio of different antibodies in our immune system, our circulation, metabolism, hormone levels, and potentially much more.

We don’t know how our subconscious mind accomplishes these feats, but we have found through hypnosis that the conscious mind can enhance and enable these effects. What we don’t know, and might never know, is how much conscious control we can learn in those subconscious areas where we can have an effect.

These should be considered skills since not everyone has them and, like skills, their development requires attention and practice. Not everyone is equally adept, open to this kind of learning, or to the goals of it.

Would you want to learn to control your circulation if your life depended on it? Probably yes, if the effort recovered your health, but probably not if it wasn’t necessary. Quoting either Voltaire or Spider-man, depending on who you read, “With great power comes great responsibility.” But we’re better at acquiring power than upholding responsibility. I believe this is the source of many people’s ambivalence to learning to control themselves; they would rather take a pill and be done with it.


A broad definition of hypnosis identifies it as anything that engages the subconscious or unconscious aspects of our minds. In this regard, all learning is a hypnotic experience. This would include learning to ride a bicycle, paint a picture, control your brain, or manage your emotions.

Hypnosis can be considered a placebo effect in the same way that learning any skill involves initially ineffective mechanisms that are made effective through perception, interaction, and application. Most times, and perhaps for most people, these skills come naturally without therapy, teaching, distress, or hypnosis. I suspect a certain group of people lack all the ‌self-regulatory skills needed for all forms of learning, and that these people are liable to suffer a range of distresses and diseases because of it.

The biggest mystery of hypnosis is not that it works or what it can do, although ‌learning through induction is mysterious. The biggest mystery is why those people who need these skills resist learning them.

I have found that chronically ill clients do not have the self-regulatory skills that hypnosis employs. They reject the suggestion that they could learn these skills, and they actively and creatively resist the learning opportunities offered to them. For these people whose illness involves a lack of self-regulation, allopathic medicine promises an escape from needing to self regulate. Unfortunately, for certain chronic disabilities, this promise is an illusion.

In the next installment, I’ll examine how clients manifest this refusal to learn, why they do so, and some ‌suggestions to counter this resistance that others have put forward.

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