by Giustina Viarengo

This month’s interview page contains the experience of Dr. Giustina Viarengo, nurse and psychologist, who wished to tell us about her personal history in which, at first, she suffered from a severe form of chronic pain and then found a way to fight it: self-hypnosis.
 “My adventure pertaining to my pathology began in 1995, with an accident at work: I am a nurse and while I was mobilizing a patient, I caused myself a slipped disk. Shortly after, classic symptoms of this pathology appeared: lumbar pain that irradiated to the right leg, dorso-lumbar rigidity and impossibility to carry out everyday activities.
With the passing of time a loss of sensitivity to the leg appeared; however, not wanting to undergo surgery, I took drugs the orthopaedist prescribed me, which were anti-inflammatories, muscle relaxants, and painkillers.
I obviously associated pharmacologic therapy with physiotherapy, tractions, postural gymnastics. Despite therapies, I was unable to engage even in the simplest of everyday activity; I was forced to quit all sports that I practiced before the accident (swimming included). Pain was always very strong, symptoms and signs (paraesthesia to the entire leg) worsened, making surgery inevitable. It was 1996 and microinvasive techniques were not routinely applied. The surgeon who intervened to remove the herniated disk, conducted a very aggressive operation and, together with the removal of a section of the intervertebral disk, he performed an emilaminectomy that caused me vertebral instability. The outcome of the operation was not positive: scar tissue adhesions appeared around the nerve root, back mobility was compromised, inflammations became chronic, pain persisted and, with the passing of time, it became less and less treatable, almost unstoppable even with invasive (antalgic epidurals) and oral therapies.
Somehow I carried on and in 2002 I started to study psychology. In the worst moments I was forced to take morphine; I was in the care of the Service of Antalgic Therapy. An association of different kinds of drugs was suggested, including anticonvulsants and antidepressants (administered in certain dosages they have an analgesic effect). Side effects made me feel drowsy, my attention was impaired along with the ability to memorize and to react to stimuli.
My life changed. Habits, expectations, dreams! I found it difficult to accept my new condition and pain was predominant. It never went away entirely; periods in which symptoms remitted were followed, after one or two months, by periods in which my condition violently worsened, forcing me to stay in bed. I looked for alternatives; I was slowly accepting my physical – that was never only physical – condition, but I  didn’t give up: I went on studying and I looked for someone who could help me. I found a neurosurgeon in Treviso, who operated my scar tissue adherences with microsurgery; after 3 operations the problem was only 50% solved and pain kept following me always, at time less cruel, at times unbearable.
The turning point came in 2008, when I “directly” discovered hypnosis. My first graduation thesis concerned hypnotic trance; I had been interested in this topic since long time and I wanted to go deeper into the matter: that’s the reason why I arrived to the Milton Erickson Institute of Turin; I wished to start a practical and experiential course. During the first level I immediately understood that I could use self-hypnosis to manage pain. I began, with the support of dr. Gava and dr. Di Bartolomeo, to train in order to learn how to reach and to deepen trance states. With time, care and constancy, I learned to utilize it in a more and more operative way. Learning self-hypnosis is like doing “mental gymnastics”, thus, in order to obtain good results, daily training is needed.
At the beginning it was difficult. This difficulty however came from a belief of mine; that the trance was a state of mind that one needed to reach. Actually, it is “embedded” in us since far off times and it has accompanied the evolution of our species.
I always had a predisposition to visualize, thus, with time and training, I improved a natural ability! I learned to identify the images that are more useful for the self-induced hypnotic process. During trance, images are suggested to me by the mind itself… simply “visualizing them”. For instance, I visualize clear water that enters my body through the head, that flows through my body, through my spine taking away “rust”, until this water, now reddish, flows out through my feet, leaving my back “clean” and less aching. Other times I imagine pain as a “big, red sphere with sharp quills”, located where my back aches the most. During trance I imagine that the colour of the sphere gradually fades to a pale yellow and quills get blunter; the sphere becomes smaller and smaller and rolls away through my feet. I often associate these visualizations to simpler ones, I may even say “summarizing”, images; symbols, colours, smells or small gestures, so that, by using my anchor in waking state when needed – that is thinking about the symbol, the colour or making the gesture –, the effect comes more rapidly. When the trance is over, the painful sensation becomes weaker. By now I use drugs only exceptionally and dosages, in those occasions, are much lower compared to the past. I know that pain will always be with me, but now I have another instrument to manage it. I move, walk and I am able to do things that I thought that I would never have been able to do again – even if with many limitations. My life changed again. This time it got better!
I now work as a psychologist; I am attending a psychotherapy school. Sometimes physicians ask me to support patients who suffer from drug resistant chronic pain; I use hypnosis and aim to transmit them the ability to self-induce themselves in order to manage pain. I don’t always succeed. Pain management through hypnosis is a process that, as I said, it is learned with time. It is, above all, the patient’s motivation that counts. I had a very strong one, I wanted and I still want to fight. Firstly it is important to accept one’s own clinical situation, to want to get better, maybe even “to vividly dream it”, that is to perceive oneself differently, leaving the role of “patient”, to strongly desire to become free from pain (but keeping in mind that this can only happen partially), to emotionally activate oneself, to truly “feel” what and how we desire. Setting realistic objectives and perseverating knowing at the same time that failure is possible. If feasible, it is a good thing to take as little drugs as possible; cognitive, emotional and behavioural alterations caused by these drugs often cause problems to the induction and for the memorization of mental paths and anchors “found” during trance states. It is important to give us the time to understand what is our personal “best way” to get into trance, finding the right stimuli and the ways to use them. I use visualizations because vision is my prevalent modality, but I also discovered that I can achieve good results even with olfactory anchors, especially when I want to induce myself physical relaxation and when I want to relieve tension and negative thoughts. Everyone finds his/her own way, even if technique and training are essential. With time, commitment and will, self-hypnosis becomes an automatism. Simply by breathing with the diaphragm, focusing attention anywhere – that is, focusing it on the inside of myself – I can achieve good results in managing pain and in other areas of my life.
Hypnosis helps me to regain control of my body and my sensations. The wheelchair that they presented me as inevitable is a far bugbear. Being able to consciously manage pain using my own resources gives me much strength to proceed on this road; strength for Giustina and for those people who, just like me, need it and wish for it.