Hypnotism: Wikis

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Hypnosis
Applications

Hypnotherapy
Stage hypnosis
Self-hypnosis

Origins

Animal magnetism
Franz Mesmer
History of hypnosis
James Braid

Key figures

Marques of Puységur
James Esdaile
John Elliotson
Jean-Martin Charcot
Ambroise-Auguste Liébeault
Hippolyte Bernheim
Pierre Janet
Sigmund Freud
Émile Coué
Morton Prince
Clark L. Hull
Andrew Salter
Theodore R. Sarbin
Milton H. Erickson
Ernest Hilgard
Martin Theodore Orne
André Muller Weitzenhoffer
Nicholas Spanos

Related topics

Hypnotic susceptibility
Suggestion
Post-hypnotic suggestion
Age regression in therapy
Neuro-linguistic programming

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Hypnosis is a mental state (state theory) or set of attitudes and beliefs (non-state theory) usually induced by a procedure known as a hypnotic induction, which is commonly composed of a series of preliminary instructions and suggestions.[1] Hypnotic suggestions may be delivered by a hypnotist in the presence of the subject, or may be self-administered ("self-suggestion" or "autosuggestion"). The use of hypnotism for therapeutic purposes is referred to as "hypnotherapy".

The words 'hypnosis' and 'hypnotism' both derive from the term "neuro-hypnotism" (nervous sleep) coined by the Scottish surgeon James Braid around 1841. Braid based his practice on that developed by Franz Mesmer and his followers ("Mesmerism" or "animal magnetism"), but differed in his theory as to how the procedure worked.

Contrary to a popular misconception - that hypnosis is a form of unconsciousness resembling sleep - contemporary research suggests that it is actually a wakeful state of focused attention[2] and heightened suggestibility,[3] with diminished peripheral awareness.[4] In the first book on the subject, Neurypnology (1843), Braid described "hypnotism" as a state of physical relaxation accompanied and induced by mental concentration ("abstraction").[5]

Contents

Characteristics

Skeptics point out the difficulty distinguishing between hypnosis and the placebo effect, proposing that hypnosis is so heavily reliant upon the effects of suggestion and belief that it would be hard to imagine how a credible placebo control could ever be devised for a hypnotism study.[6]

It could be said that hypnotic suggestion is explicitly intended to make use of the placebo effect. For example, Irving Kirsch has proposed a definition of hypnosis as a "non-deceptive mega-placebo," i. e., a method which openly makes use of suggestion and employs methods to amplify its effects.[citation needed]

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Definitions

The earliest definition of hypnosis was given by Braid, who coined the term "hypnotism" as an abbreviation for "neuro-hypnotism", or nervous sleep, which he opposed to normal sleep, and defined as:

a peculiar condition of the nervous system, induced by a fixed and abstracted attention of the mental and visual eye, on one object, not of an exciting nature.[7]

Braid elaborated upon this brief definition in a later work:

[...] the real origin and essence of the hypnotic condition, is the induction of a habit of abstraction or mental concentration, in which, as in reverie or spontaneous abstraction, the powers of the mind are so much engrossed with a single idea or train of thought, as, for the nonce, to render the individual unconscious of, or indifferently conscious to, all other ideas, impressions, or trains of thought. The hypnotic sleep, therefore, is the very antithesis or opposite mental and physical condition to that which precedes and accompanies common sleep [...][8]

Braid therefore defined hypnotism as a state of mental concentration which often led to a form of progressive relaxation termed "nervous sleep". Later, in his The Physiology of Fascination (1855), Braid conceded that his original terminology was misleading, and argued that the term "hypnotism" or "nervous sleep" should be reserved for the minority (10%) of subjects who exhibited amnesia, substituting the term "monoideism", meaning concentration upon a single idea, as a description for the more alert state experienced by the others.

A new definition of hypnosis, derived from academic psychology, was provided in 2005, when the Society for Psychological Hypnosis, Division 30 of the American Psychological Association (APA), published the following formal definition:

New Definition: Hypnosis

The Division 30 Definition and Description of Hypnosis

Hypnosis typically involves an introduction to the procedure during which the subject is told that suggestions for imaginative experiences will be presented. The hypnotic induction is an extended initial suggestion for using one's imagination, and may contain further elaborations of the introduction. A hypnotic procedure is used to encourage and evaluate responses to suggestions. When using hypnosis, one person (the subject) is guided by another (the hypnotist) to respond to suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought or behavior. Persons can also learn self-hypnosis, which is the act of administering hypnotic procedures on one's own. If the subject responds to hypnotic suggestions, it is generally inferred that hypnosis has been induced. Many believe that hypnotic responses and experiences are characteristic of a hypnotic state. While some think that it is not necessary to use the word "hypnosis" as part of the hypnotic induction, others view it as essential.

Details of hypnotic procedures and suggestions will differ depending on the goals of the practitioner and the purposes of the clinical or research endeavor. Procedures traditionally involve suggestions to relax, though relaxation is not necessary for hypnosis and a wide variety of suggestions can be used including those to become more alert. Suggestions that permit the extent of hypnosis to be assessed by comparing responses to standardized scales can be used in both clinical and research settings. While the majority of individuals are responsive to at least some suggestions, scores on standardized scales range from high to negligible. Traditionally, scores are grouped into low, medium, and high categories. As is the case with other positively-scaled measures of psychological constructs such as attention and awareness, the salience of evidence for having achieved hypnosis increases with the individual's score.[9]

Induction

Hypnosis is normally preceded by a "hypnotic induction" technique. Traditionally this was interpreted as a method of putting the subject into a "hypnotic trance"; however subsequent "nonstate" theorists have viewed it differently, as a means of heightening client expectation, defining their role, focusing attention, etc. There are an enormous variety of different induction techniques used in hypnotism. However, by far the most influential method was the original "eye-fixation" technique of Braid, also known as "Braidism". Many variations of the eye-fixation approach exist, including the induction used in the Stanford Hypnotic Susceptibility Scale (SHSS), the most widely-used research tool in the field of hypnotism. Braid's original description of his induction is as follows:

James Braid's Original Eye-Fixation Hypnotic Induction Method
Take any bright object (I generally use my lancet case) between the thumb and fore and middle fingers of the left hand; hold it from about eight to fifteen inches from the eyes, at such position above the forehead as may be necessary to produce the greatest possible strain upon the eyes and eyelids, and enable the patient to maintain a steady fixed stare at the object.

The patient must be made to understand that he is to keep the eyes steadily fixed on the object, and the mind riveted on the idea of that one object. It will be observed, that owing to the consensual adjustment of the eyes, the pupils will be at first contracted: they will shortly begin to dilate, and after they have done so to a considerable extent, and have assumed a wavy motion, if the fore and middle fingers of the right hand, extended and a little separated, are carried from the object towards the eyes, most probably the eyelids will close involuntarily, with a vibratory motion. If this is not the case, or the patient allows the eyeballs to move, desire him to begin anew, giving him to understand that he is to allow the eyelids to close when the fingers are again carried towards the eyes, but that the eyeballs must be kept fixed, in the same position, and the mind riveted to the one idea of the object held above the eyes. It will generally be found, that the eyelids close with a vibratory motion, or become spasmodically closed.[10]

Braid himself later acknowledged that the hypnotic induction technique was not necessary in every case and subsequent researchers have generally found that on average it contributes less than previously expected to the effect of hypnotic suggestions (q.v., Barber, Spanos & Chaves, 1974). Many variations and alternatives to the original hypnotic induction techniques were subsequently developed. However, exactly 100 years after Braid introduced the method, another expert could still state: "It can be safely stated that nine out of ten hypnotic techniques call for reclining posture, muscular relaxation, and optical fixation followed by eye closure."[11]

Suggestion

When James Braid first described hypnotism, he did not use the term "suggestion" but referred instead to the act of focusing the conscious mind of the subject upon a single dominant idea. Braid's main therapeutic strategy involved stimulating or reducing physiological functioning in different regions of the body. In his later works, however, Braid placed increasing emphasis upon the use of a variety of different verbal and non-verbal forms of suggestion, including the use of "waking suggestion" and self-hypnosis. Subsequently, Hippolyte Bernheim shifted the emphasis from the physical state of hypnosis on to the psychological process of verbal suggestion.

I define hypnotism as the induction of a peculiar psychical [i.e., mental] condition which increases the susceptibility to suggestion. Often, it is true, the [hypnotic] sleep that may be induced facilitates suggestion, but it is not the necessary preliminary. It is suggestion that rules hypnotism. (Hypnosis & Suggestion, 1884: 15)

Bernheim's conception of the primacy of verbal suggestion in hypnotism dominated the subject throughout the twentieth century, leading some authorities to declare him the father of modern hypnotism (Weitzenhoffer, 2000). Contemporary hypnotism makes use of a wide variety of different forms of suggestion including: direct verbal suggestions, "indirect" verbal suggestions such as requests or insinuations, metaphors and other rhetorical figures of speech, and non-verbal suggestion in the form of mental imagery, voice tonality, and physical manipulation. A distinction is commonly made between suggestions delivered "permissively" or in a more "authoritarian" manner. Some hypnotic suggestions are intended to bring about immediate responses, whereas others (post-hypnotic suggestions) are intended to trigger responses after a delay ranging from a few minutes to many years in some reported cases.

Consciousness vs. unconscious mind

Some hypnotists conceive of suggestions as being a form of communication directed primarily to the subject's conscious mind, whereas others view suggestion as a means of communicating with the "unconscious" or "subconscious" mind. These concepts were introduced into hypnotism at the end of 19th century by Sigmund Freud and Pierre Janet. The original Victorian pioneers of hypnotism, including Braid and Bernheim, did not employ these concepts but considered hypnotic suggestions to be addressed to the subject's conscious mind. Indeed, Braid actually defines hypnotism as focused (conscious) attention upon a dominant idea (or suggestion). Different views regarding the nature of the mind have led to different conceptions of suggestion. Hypnotists who believed that responses are mediated primarily by an "unconscious mind", like Milton Erickson, made more use of indirect suggestions, such as metaphors or stories, whose intended meaning may be concealed from the subject's conscious mind. The concept of subliminal suggestion also depends upon this view of the mind. By contrast, hypnotists who believed that responses to suggestion are primarily mediated by the conscious mind, such as Theodore Barber and Nicholas Spanos tended to make more use of direct verbal suggestions and instructions.

Ideo-dynamic reflex

The first neuro-psychological theory of hypnotic suggestion was introduced early on by James Braid who adopted his friend and colleague William Carpenter's theory of the ideo-motor reflex response to account for the phenomenon of hypnotism. Carpenter had observed from close examination of everyday experience that under certain circumstances the mere idea of a muscular movement could be sufficient to produce a reflexive, or automatic, contraction or movement of the muscles involved, albeit in a very small degree. Braid extended Carpenter's theory to encompass the observation that a wide variety of bodily responses, other than muscular movement, can be thus affected, e.g., the idea of sucking a lemon can automatically stimulate salivation, a secretory response. Braid therefore adopted the term "ideo-dynamic", meaning "by the power of an idea" to explain a broad range of "psycho-physiological" (mind-body) phenomena. Braid coined the term "mono-ideodynamic" to refer to the theory that hypnotism operates by concentrating attention on a single idea in order to amplify the ideo-dynamic reflex response. Variations of the basic ideo-motor or ideo-dynamic theory of suggestion have continued to hold considerable influence over subsequent theories of hypnosis, including those of Clark L. Hull, Hans Eysenck, and Ernest Rossi. It should be noted that in Victorian psychology, the word "idea" encompasses any mental representation, e.g., including mental imagery, or memories, etc.

Post-hypnotic suggestion

It has been alleged post-hypnotic suggestion can be used to change people's behaviour after emerging from hypnosis. One author wrote that "a person can act, some time later, on a suggestion seeded during the hypnotic session". A hypnotherapist told one of his patients, who was also a friend: 'When I touch you on the finger you will immediately be hypnotised.' Fourteen years later, at a dinner party, he touched him deliberately on the finger and his head fell back against the chair."[12]

An Altay shaman beating a gong. Music was one way that Siberian shamans entered trance.[13]

Susceptibility

Braid made a rough distinction between different stages of hypnosis which he termed the first and second conscious stage of hypnotism; he later replaced this with a distinction between "sub-hypnotic", "full hypnotic", and "hypnotic coma" stages. Jean-Martin Charcot made a similar distinction between stages named somnambulism, lethargy, and catalepsy. However, Ambroise-Auguste Liébeault and Bernheim introduced more complex hypnotic "depth" scales, based on a combination of behavioural, physiological and subjective responses, some of which were due to direct suggestion and some of which were not. In the first few decades of the 20th century, these early clinical "depth" scales were superseded by more sophisticated "hypnotic susceptibility" scales based on experimental research. The most influential were the Davis-Husband and Friedlander-Sarbin scales developed in the 1930s. Andre Weitzenhoffer and Ernest R. Hilgard developed the Stanford Scale of Hypnotic Susceptibility in 1959, consisting of 12 suggestion test items following a standardised hypnotic eye-fixation induction script, and this has become one of the most widely-referenced research tools in the field of hypnosis. Soon after, in 1962, Ronald Shor and Emily Carota Orne developed a similar group scale called the Harvard Group Scale of Hypnotic Susceptibility (HGSHS).

Whereas the older "depth scales" tried to infer the level of "hypnotic trance" based upon supposed observable signs, such as spontaneous amnesia, most subsequent scales measure the degree of observed or self-evaluated responsiveness to specific suggestion tests, such as direct suggestions of arm rigidity (catalepsy).

History

Precursors

According to his writings, Braid began to hear reports concerning the practices of various Oriental meditative practices soon after the release of his first publication on hypnotism, Neurypnology (1843). He first discussed some of these oriental practices in a series of articles entitled Magic, Mesmerism, Hypnotism, etc., Historically & Physiologically Considered. He drew analogies between his own practice of hypnotism and various forms of Hindu yoga meditation and other ancient spiritual practices, especially those involving voluntary burial and apparent human hibernation. Braid’s interest in these practices stems from his studies of the Dabistān-i Mazāhib, the “School of Religions”, an ancient Persian text describing a wide variety of Oriental religious rituals, beliefs, and practices.

Last May [1843], a gentleman residing in Edinburgh, personally unknown to me, who had long resided in India, favored me with a letter expressing his approbation of the views which I had published on the nature and causes of hypnotic and mesmeric phenomena. In corroboration of my views, he referred to what he had previously witnessed in oriental regions, and recommended me to look into the “Dabistan,” a book lately published, for additional proof to the same effect. On much recommendation I immediately sent for a copy of the “Dabistan”, in which I found many statements corroborative of the fact, that the eastern saints are all self-hypnotisers, adopting means essentially the same as those which I had recommended for similar purposes.[14]

Although he rejected the transcendental/metaphysical interpretation given to these phenomena outright, Braid accepted that these accounts of Oriental practices supported his view that the effects of hypnotism could be produced in solitude, without the presence of any other person (as he had already proved to his own satisfaction with the experiments he had conducted in in November 1841); and he saw correlations between many of the "metaphysical" Oriental practices and his own "rational" neuro-hypnotism, and totally rejected all of the fluid theories and magnetic practices of the mesmerists. As he later wrote:

In as much as patients can throw themselves into the nervous sleep, and manifest all the usual phenomena of Mesmerism, through their own unaided efforts, as I have so repeatedly proved by causing them to maintain a steady fixed gaze at any point, concentrating their whole mental energies on the idea of the object looked at; or that the same may arise by the patient looking at the point of his own finger, or as the Magi of Persia and Yogi of India have practised for the last 2,400 years, for religious purposes, throwing themselves into their ecstatic trances by each maintaining a steady fixed gaze at the tip of his own nose; it is obvious that there is no need for an exoteric influence to produce the phenomena of Mesmerism. […] The great object in all these processes is to induce a habit of abstraction or concentration of attention, in which the subject is entirely absorbed with one idea, or train of ideas, whilst he is unconscious of, or indifferently conscious to, every other object, purpose, or action.[15]

Franz Mesmer

Franz Mesmer (1734–1815) believed that there was a magnetic force or "fluid" within the universe which influenced the health of the human body. He experimented with magnets to influence this field and so cause healing. By around 1774 he had concluded that the same effects could be created by passing the hands, at a distance, in front of the subject's body, referred to as making "Mesmeric passes." The word mesmerize originates from the name of Franz Mesmer; and was intentionally used to separate its users from the various "fluid" and "magnetic" theories embedded within the label "magnetism".

In 1784, at the request of King Louis XVI, a series of French scientific committees, one of which included the American ambassador to France, Benjamin Franklin, scrutinized Mesmer's theories. They also investigated the practices of a disaffected student of Mesmer, one Charles d'Eslon (1750–1786), and despite the fact that they accepted that Mesmer's results were valid, their placebo-controlled experiments following d'Eslon's practices convinced them that Mesmerism's were most likely due to belief and imagination rather than to any sort of invisible energy ("animal magnetism") transmitted from the body of the Mesmerist.

In other words, despite accepting that Mesmer's practices seemed to have efficacy, both committees totally rejected all of Mesmer's theories.

James Braid

James Braid.

Following the French committee's findings, in his Elements of the Philosophy of the Human Mind (1827), Dugald Stewart, an influential academic philosopher of the "Scottish School of Common Sense", encouraged physicians to salvage elements of Mesmerism by replacing the supernatural theory of "animal magnetism" with a new interpretation based upon "common sense" laws of physiology and psychology. Braid quotes the following passage from Stewart:[16]

It appears to me, that the general conclusions established by Mesmer’s practice, with respect to the physical effects of the principle of imagination [...] are incomparably more curious than if he had actually demonstrated the existence of his boasted science [of "animal magnetism"]: nor can I see any good reason why a physician, who admits the efficacy of the moral [i.e., psychological] agents employed by Mesmer, should, in the exercise of his profession, scruple to copy whatever processes are necessary for subjecting them to his command, any more than that he should hesitate about employing a new physical agent, such as electricity or galvanism.[17]

In Braid's day, the Scottish School of Common Sense provided the dominant theories of academic psychology and Braid refers to other philosophers within this tradition throughout his writings. Braid therefore revised the theory and practice of Mesmerism and developed his own method of "hypnotism" as a more rational and "common sense" alternative.

It may here be requisite for me to explain, that by the term Hypnotism, or Nervous Sleep, which frequently occurs in the following pages, I mean a peculiar condition of the nervous system, into which it may be thrown by artificial contrivance, and which differs, in several respects, from common sleep or the waking condition. I do not allege that this condition is induced through the transmission of a magnetic or occult influence from my body into that of my patients; nor do I profess, by my processes, to produce the higher [i.e., supernatural] phenomena of the Mesmerists. My pretensions are of a much more humble character, and are all consistent with generally admitted principles in physiological and psychological science. Hypnotism might therefore not inaptly be designated, Rational Mesmerism, in contra-distinction to the Transcendental Mesmerism of the Mesmerists.[18]

Despite briefly toying with the name "rational Mesmerism", Braid ultimately emphasised his approach's uniqueness, carrying out informal experiments throughout his career to refute the arguments invoking supernatural practices, and demonstrate instead the role of ordinary physiological and psychological processes such as suggestion and focused attention in producing the observed effects.

Braid worked very closely with his friend and ally the eminent physiologist Professor William Benjamin Carpenter, an early neuro-psychologist, who introduced the "ideo-motor reflex" theory of suggestion. Carpenter had observed examples of expectation and imagination apparently influencing involuntarily muscle movement. A classic example of the ideo-motor principle in action is the so-called "Chevreul pendulum" (named after Michel Eugène Chevreul). Chevreul claimed that a pendulum can be made to swing by appropriate concentration alone.

Braid soon assimilated Carpenter's observations into his own theory, realising that the effect of focusing attention was to enhance the ideo-motor reflex response. Braid extended Carpenter's theory to encompass the influence of the mind upon the body more generally, beyond the muscular system, and therefore referred to the "ideo-dynamic" response and coined the term "psycho-physiology" to refer to the study of general mind/body interaction.

In his later works, Braid reserved the term "hypnotism" for cases in which subjects entered a state of amnesia resembling sleep. For the rest, he spoke of a "mono-ideodynamic" principle to emphasise that the eye-fixation induction technique worked by narrowing the subject's attention to a single idea or train of thought ("monoideism") which amplified the effect of the consequent "dominant idea" upon the subject's body by means of the ideo-dynamic principle.

Hysteria vs. suggestion

For several decades, Braid's work became more influential abroad than in his own country, except for a handful of followers, most notably Dr. John Milne Bramwell. The eminent neurologist Dr. George Miller Beard took Braid's theories to America. Meanwhile his works were translated into German by Wilhelm T. Preyer, Professor of Physiology at Jena University. The psychiatrist Albert Moll subsequently continued German research, publishing Hypnotism in 1889. France became the focal point for the study after the eminent neurologist Dr. Étienne Eugène Azam presented Braid's research to the French Academy of Sciences. Azam also translated Braid's last manuscript (On Hypnotism, 1860) into French. At the request of Azam, Paul Broca, and others, the French Academy of Science, who had examined Mesmerism in 1784, examined Braid's writings shortly after his demise.

Azam's enthusiasm for hypnotism influenced Ambroise-Auguste Liébeault, a country doctor. Hippolyte Bernheim discovered Liébeault's enormously popular group hypnotherapy clinic and subsequently became an influential hypnotist. The study of hypnotism subsequently revolved around the fierce debate between Jean-Martin Charcot and Hippolyte Bernheim, the two most influential figures in late 19th century hypnotism.

Charcot operated a clinic at the Pitié-Salpêtrière Hospital (thus, also known as the "Paris School" or the "Salpêtrière School"), while Bernheim had a clinic in Nancy (also known as the "Nancy School"). Charcot, influenced more by the Mesmerists, argued that hypnotism was an abnormal state of nervous functioning found only in certain hysterical women. He claimed that it manifested in a series of physical reactions which could be divided into distinct stages. Bernheim argued that anyone could be hypnotised, that it was an extension of normal psychological functioning, and that its effects were due to suggestion. After decades of debate, Bernheim's view dominated. Charcot's theory is now just a historical curiosity.

Pierre Janet

Pierre Janet (1859–1947) reported studies on a hypnotic subject in 1882. Charcot subsequently appointed him director of the psychological laboratory at the Salpêtrière in 1889, after Janet completed his doctorate in philosophy which dealt with psychological automatism. In 1898 Janet was appointed psychology lecturer at the Sorbonne, and in 1902 became chair of experimental and comparative psychology at the Collège de France. Janet reconciled elements of his views with those of Bernheim and his followers, developing his own sophisticated hypnotic psychotherapy based upon the concept of psychological dissociation which, at the turn of the century, rivaled Freud's attempt to provide a more comprehensive theory of psychotherapy.

Sigmund Freud

Sigmund Freud, the founder of psychoanalysis, studied hypnotism at Paris school and briefly visited the Nancy school.

Initially, Freud was an enthusiastic proponent of hypnotherapy, and soon began to emphasise hypnotic regression and ab reaction (catharsis) as therapeutic methods. He wrote a favorable encyclopedia article on hypnotism, translated one of Bernheim's works into German, and published an influential series of case studies with his colleague Joseph Breuer entitled Studies on Hysteria (1895). This became the founding text of the subsequent tradition known as "hypno-analysis" or "regression hypnotherapy."

However, Freud gradually abandoned hypnotism in favour of psychoanalysis, emphasizing free association and interpretation of the unconscious. Struggling with the great expense of time that psychoanalysis required, Freud later suggested that it might be combined with hypnotic suggestion to hasten the outcome of treatment,

It is very probable, too, that the application of our therapy to numbers will compel us to alloy the pure gold of analysis plentifully with the copper of direct [hypnotic] suggestion.[19]

However only a handful of Freud's followers were sufficiently qualified in hypnosis to attempt the synthesis. Their work had a limited influence on the hypno-therapeutic approaches now known variously as "hypnotic regression", "hypnotic progression", and "hypnoanalysis".

Émile Coué

Émile Coué (1857–1926) assisted Ambroise-Auguste Liébeault for around two years at Nancy. After practicing for several years as a hypnotherapist employing the methods of Liébeault and Bernheim's Nancy School, Coué developed a new orientation called "conscious autosuggestion." Several years after Liébeault's death in 1904, Coué founded what became known as the New Nancy School, a loose collaboration of practitioners who taught and promoted his views. Coué's method did not emphasise "sleep" or deep relaxation and instead focused upon autosuggestion involving a specific series of suggestion tests. Although Coué argued that he was no longer using hypnosis, followers such as Charles Baudouin viewed his approach as a form of light self-hypnosis. Coué's method became a renowned self-help and psychotherapy technique, which contrasted with psychoanalysis and prefigured self-hypnosis and cognitive therapy.

Clark L. Hull

The next major development came from behavioral psychology in American university research. Clark L. Hull, an eminent American psychologist, published the first major compilation of laboratory studies on hypnosis, Hypnosis & Suggestibility (1933), in which he proved that hypnosis and sleep had nothing in common. Hull published many quantitative findings from hypnosis and suggestion experiments and encouraged research by mainstream psychologists. Hull's behavioural psychology interpretation of hypnosis, emphasizing conditioned reflexes, rivaled the Freudian psycho dynamic interpretation emphasizing unconscious transference.

Milton Erickson

Milton H. Erickson, M.D. was one of the most influential post-war hypnotherapists. He wrote several books and journal articles on the subject. During the 1960s, Erickson popularized a new branch of hypnotherapy, known as Ericksonian hypnotherapy, primarily characterised by indirect suggestion, "metaphor" (actually analogies), confusion techniques, and double binds in place of formal hypnotic inductions. However, the difference between Erickson's methods and traditional hypnotism led contemporaries such as André Weitzenhoffer, to question whether he was practicing "hypnosis" at all, and his approach remains in question.

Erickson had no hesitation in presenting any suggested effect as being "hypnosis", whether or not the subject was in a hypnotic state. In fact, he was not hesitant in passing off behaviour that was dubiously hypnotic as being hypnotic.[20]

Cognitive-behavioural

In the latter half of the twentieth century, two factors contributed to the development of the cognitive-behavioural approach to hypnosis. 1 Cognitive and behavioural theories of the nature of hypnosis (influenced by the theories of Sarbin[21] and Barber[22]) became increasingly influential. 2 The therapeutic practices of hypnotherapy and various forms of cognitive-behavioural therapy overlapped and influenced each other.[23] Although cognitive-behavioural theories of hypnosis must be distinguished from cognitive-behavioural approaches to hypnotherapy, they share similar concepts, terminology, and assumptions and have been integrated by influential researchers and clinicians such as Irving Kirsch, Steven Jay Lynn, and others.[24]

At the outset of cognitive-behavioural therapy during the 1950s, hypnosis was used by early behaviour therapists such as Joseph Wolpe[25] and also by early cognitive therapists such as Albert Ellis.[26] Barber, Spanos & Chaves introduced the term "cognitive-behavioural" to describe their "nonstate" theory of hypnosis in Hypnotism: Imagination & Human Potentialities (1974).[22] However, Clark L. Hull had introduced a behavioural psychology as far back as 1933, which in turn was preceded by Ivan Pavlov.[27] Indeed, the earliest theories and practices of hypnotism, even those of Braid, resemble the cognitive-behavioural orientation in some respects.[28]

Hypnotherapy

Modern hypnotherapy has been used in a variety of forms, such as regression hypnotherapy (or "hypnoanalysis") and Ericksonian hypnotherapy.

Hypnosis has been studied clinically with varying success.[29] Applications include:

  • pain management[30]
  • weight loss[31]
  • skin disease[32]
  • soothing anxious surgical patients
  • psychological therapy[33]
  • habit control,[34] a way to relax,[35]
  • sports performance.[36]

Self-hypnosis is popularly used to quit smoking and reduce stress, while stage hypnosis can persuade people to perform unusual public feats.[37]

Medical applications

Relaxation techniques and suggestion have been used to reduce pain in childbirth (sometimes called 'Hypnobirthing')[38]

Hypnotherapy has been used to treat irritable bowel syndrome. Researchers who recently reviewed the best studies in this area conclude:

The evidence for hypnosis as an efficacious treatment of IBS was encouraging. Two of three studies that investigated the use of hypnosis for IBS were well designed and showed a clear effect for the hypnotic treatment of IBS.[39]

Hypnosis for IBS has received moderate support in the National Institute for Health and Clinical Excellence guidance published for UK health services.[40] It has been used as an aid or alternative to chemical anaesthesia,[41][42][43] and it has been studied as a way to soothe skin ailments.[44]

A number of studies show that hypnosis can reduce the pain experienced during burn-wound debridement, bone marrow aspirations, and childbirth. The International Journal of Clinical and Experimental Hypnosis found that hypnosis relieved the pain of 75% of 933 subjects participating in 27 different experiments.[45]

In 1996, the National Institutes of Health declared hypnosis effective in reducing pain from cancer and other chronic conditions.[45] Nausea and other symptoms related to incurable diseases may also be managed with hypnosis.[46][47][48][49] For example, research done at the Mount Sinai School of Medicine studied two patient groups facing breast cancer surgery. The group that received hypnosis reported less pain, nausea, and anxiety post-surgery. The average hypnosis patient reduced treatment costs by an average $772.00.[50][51]

The American Psychological Association published a study comparing the effects of hypnosis, ordinary suggestion and placebo in reducing pain. The study found that highly suggestible individuals experienced a greater reduction in pain from hypnosis compared with placebo, whereas less suggestible subjects experienced no pain reduction from hypnosis when compared with placebo. Ordinary non-hypnotic suggestion also caused reduction in pain compared to placebo, but was able to reduce pain in a wider range of subjects (both high and low suggestible) than hypnosis. The results showed that it is primarily the subjects responsiveness to suggestion, whether within the context of 'hypnosis' or not, that is the main determinant of causing reduction in pain.[52]

Treating skin diseases with hypnosis (hypnodermatology)has performed well in treating warts, psoriasis, and atopic dermatitis.[53]

Hypnosis may be useful as an adjunct therapy for weight loss. A 1996 meta-analysis studying hypnosis combined with cognitive-behavioural therapy found that people using both treatments lost more weight than people using CBT alone.[54]

Military Applications

A recently declassified document obtained by The Black Vault Freedom of Information Act archive, shows that hypnosis was investigated for military applications.[55] However, the overall conclusion of the study was that there was no evidence that hypnosis could be used for military applications, and also that there was no clear evidence for whether 'hypnosis' actually exists as a definable phenomena outside of ordinary suggestion, high motivation and subject expectancy. According to the document,

The use of hypnosis in intelligence would present certain technical problems not encountered in the clinic or laboratory. To obtain compliance from a resistant source, for example, it would be necessary to hypnotise the source under essentially hostile circumstances. There is no good evidence, clinical or experimental, that this can be done.

Furthermore, the document states that:

It would be difficult to find an area of scientific interest more beset by divided professional opinion and contradictory experimental evidence…No one can say whether hypnosis is a qualitatively unique state with some physiological and conditioned response components or only a form of suggestion induced by high motivation and a positive relationship between hypnotist and subject…T.X. Barber has produced “hypnotic deafness” and “hypnotic blindness,” analgesia and other responses seen in hypnosis—all without hypnotizing anyone…Orne has shown that unhypnotized persons can be motivated to equal and surpass the supposed superhuman physical feats seen in hypnosis.

The study concludes:

It is probably significant that in the long history of hypnosis, where the potential application to intelligence has always been known, there are no reliable accounts of its effective use by an intelligence service.

Research into hypnosis in military applications is further verified by the MKULTRA experiments, also conducted by the CIA.[56] According to Congressional testimony,[57] the CIA experimented with utilizing LSD and hypnosis for mind control. Many of these programs were done domestically and on participants who were not informed of the study's purposes or that they would be given drugs.[57]

The full paper explores the potentials of operational uses.[58]

Psychotherapy

Photo of unconscious woman
Professor Charcot (left) of Paris' Salpêtrière demonstrates hypnosis on a "hysterical" patient, "Blanche" (Marie) Wittman, who is supported by Dr. Joseph Babiński.

Hypnotherapy is the use of hypnosis in psychotherapy.[59] It is used by licensed physicians, psychologists, and others. Physicians and psychiatrists may use hypnosis to treat depression, anxiety, eating disorders, sleep disorders, compulsive gaming, and posttraumatic stress.[60][61]

Certified hypnotherapists who are not physicians or psychologists often treat smoking and weight management. (Success rates vary: a meta-study researching hypnosis as a quit-smoking tool found it had a 20 to 30 percent success rate, similar to other quit-smoking methods,[62] while a 2007 study of patients hospitalised for cardiac and pulmonary ailments found that smokers who used hypnosis to quit smoking doubled their chances of success.[63])

In a July 2001 article for Scientific American titled "The Truth and the Hype of Hypnosis", Michael Nash wrote:

...using hypnosis, scientists have temporarily created hallucinations, compulsions, certain types of memory loss, false memories, and delusions in the laboratory so that these phenomena can be studied in a controlled environment.[45]

Controversy surrounds the use of hypnotherapy to retrieve memories, especially those from early childhood or (alleged) past-lives. The American Medical Association and the American Psychological Association caution against repressed memory therapy in cases of alleged childhood trauma, stating that "it is impossible, without corroborative evidence, to distinguish a true memory from a false one."[64] Past life regression, meanwhile, is often viewed with skepticism.[65]

Self-hypnosis

Self-hypnosis happens when a person hypnotises himself or herself, commonly involving the use of autosuggestion. The technique is often used to increase motivation for a diet, quit smoking, or reduce stress. People who practice self-hypnosis sometimes require assistance; some people use devices known as mind machines to assist in the process, while others use hypnotic recordings.

Self-hypnosis is claimed to help with stage fright, relaxation, and physical well-being.[66]

Stage hypnosis

Stage hypnosis is a form of entertainment, traditionally employed in a club or theatre before an audience. Due to stage hypnotists' showmanship, many people believe that hypnosis is a form of mind control. However, the effects of stage hypnosis are probably due to a combination of psychological factors such as peer pressure, social compliance, participant selection, suggestibility, physical manipulation, stagecraft, and trickery.[67] The desire to be the centre of attention, having an excuse to violate their own fear suppressors and the pressure to please are thought to convince subjects to 'play along'.[68] Books by stage hypnotists sometimes explicitly describe the use of deception in their acts, for example, Ormond McGill's New Encyclopedia of Stage Hypnosis describes an entire "fake hypnosis" act which depends upon the use of private whispers throughout.

[The hypnotist whispers off-microphone:] “We are going to have some good laughs on the audience and fool them… so when I tell you to do some funny things, do exactly as I secretly tell you. Okay? Swell.” (Then deliberately wink at the spectator in a friendly fashion.)[69]

Stage hypnosis traditionally employs three fundamental strategies:

  1. Participant compliance. Participants on stage tend to be compliant because of the social pressure felt in the situation constructed on stage, before an expectant audience.
  2. Participant selection. Preliminary suggestion tests, such as asking the audience to clasp their hands and suggesting they cannot be separated, are usually used to select out the most suggestible and compliant subjects from the audience. By asking for volunteers to mount the stage, the performer also tends to select the most extroverted members of the audience.
  3. Deception of the audience. Stage hypnotists are performers who traditionally, but not always, employ a variety of "sleight of hand" strategies to mislead their audience for dramatic effect.

The strategies of deception employed in traditional stage hypnosis can be categorised as follows:

  1. Off-microphone whispers. The hypnotist lowers his microphone and whispers secret instructions to the participant on stage, outside of the audience's hearing. These may involve requests to "play along" or fake hypnotic responses.
  2. Failure to challenge. The stage hypnotist pretends to challenge subjects to defy a suggestion, e.g., "You cannot stand up out of your chair because your backside is stuck down with glue." However, no specific cue is given to the participants to begin their effort ("Start trying now!"). This creates the illusion that a specific challenge has been issued and effort made to defy it.
  3. Fake hypnosis tricks. Stage hypnosis literature contains a large repertoire of sleight of hand tricks, of the kind used by professional illusionists. None of these tricks require any hypnosis or suggestion, depending on physical manipulation and audience deception. The most famous example of this type is the "human plank" trick, which involves making a subject's body become rigid (cataleptic) and suspending them horizontally between two chairs, at which point the hypnotist will often stand upon their chest for dramatic effect. This has nothing to do with hypnosis, but simply depends on the fact that when subjects are positioned in the correct way they can support more weight than the audience assumes.

Other uses

Hypnotism has also been used in forensics, sports, education, physical therapy and rehabilitation.[70] Hypnotism has also been employed by artists for creative purposes most notably the surrealist circle of André Breton who employed hypnosis, automatic writing and sketches for creative purposes. Hypnotic methods have been used to re-experience drug states,[71] and mystical experiences.[72][73]

Some people have drawn analogies between certain aspects of hypnotism and areas such as crowd psychology, religious hysteria, and ritual trances in preliterate tribal cultures.[74]

Many famous sports figures like Tiger Woods have used hypnosis to gain an edge on their competition. This is accomplished by accessing an athlete's altered conscious state and incorporating a different way of processing information.[75]

The state versus nonstate debate

The central theoretical disagreement is known as the "state versus nonstate" debate. When Braid introduced the concept of hypnotism he equivocated over the nature of the "state", sometimes describing it as a specific sleep-like neurological state comparable to animal hibernation or yogic meditation, while at other times he emphasised that hypnotism encompassed a number of different stages or states which were an extension of ordinary psychological and physiological processes. Overall, Braid appears to have moved from a more "special state" understanding of hypnotism toward a more complex "nonstate" orientation.

State theorists interpret the effects of hypnotism as primarily due to a specific, abnormal and uniform psychological or physiological state of some description, often referred to as "hypnotic trance" or an "altered state of consciousness." Nonstate theorists rejected the idea of hypnotic trance and interpret the effects of hypnotism as due to a combination of multiple task-specific factors derived from normal cognitive, behavioural and social psychology, such as social role-perception and favorable motivation (Sarbin), active imagination and positive cognitive set (Barber), response expectancy (Kirsch), and the active use of task-specific subjective strategies (Spanos). The personality psychologist Robert White is often cited as providing one of the first nonstate definitions of hypnosis in a 1941 article:

Hypnotic behaviour is meaningful, goal-directed striving, its most general goal being to behave like a hypnotised person as this is continuously defined by the operator and understood by the client.[76]

Put simply, it is often claimed that whereas the older "special state" interpretation emphasises the difference between hypnosis and ordinary psychological processes, the "nonstate" interpretation emphasises their similarity.

Comparisons between hypnotised and non-hypnotised subjects suggest that if a "hypnotic trance" does exist it only accounts for a small proportion of the effects attributed to hypnotic suggestion, most of which can be replicated without hypnotic induction.

Hyper-suggestibility

Braid can be taken to imply, in later writings, that hypnosis is largely a state of heightened suggestibility induced by expectation and focused attention. In particular, Hippolyte Bernheim became known as the leading proponent of the "suggestion theory" of hypnosis, at one point going so far as to declare that there is no hypnotic state, only heightened suggestibility. There is a general consensus that heightened suggestibility is an essential characteristic of hypnosis.

If a subject after submitting to the hypnotic procedure shows no genuine increase in susceptibility to any suggestions whatever, there seems no point in calling him hypnotised, regardless of how fully and readily he may respond to suggestions of lid-closure and other superficial sleeping behaviour.[77]

Conditioned inhibition

Ivan Pavlov stated that hypnotic suggestion provided the best example of a conditioned reflex response in human beings, i.e., that responses to suggestions were learned associations triggered by the words used. Pavlov himself wrote:

Speech, on account of the whole preceding life of the adult, is connected up with all the internal and external stimuli which can reach the cortex, signaling all of them and replacing all of them, and therefore it can call forth all those reactions of the organism which are normally determined by the actual stimuli themselves. We can, therefore, regard ‘suggestion’ as the most simple form of a typical reflex in man.[78]

He also believed that hypnosis was a "partial sleep" meaning that a generalised inhibition of cortical functioning could be encouraged to spread throughout regions of the brain. He observed that the various degrees of hypnosis did not significantly differ physiologically from the waking state and hypnosis depended on insignificant changes of environmental stimuli. Pavlov also suggested that lower-brain-stem mechanisms were involved in hypnotic conditioning.[79][80]

Pavlov's ideas combined with those of his rival Bekhterev and became the basis of hypnotic psychotherapy in the Soviet Union, as documented in the writings of his follower K.I. Platonov. Soviet theories of hypnotism subsequently influenced the writings of Western behaviourally-oriented hypnotherapists such as Andrew Salter. However, this theory of hypnosis as a specific state of conditioned cortical inhibition has received little support.

Neuropsychology

Neurological imaging techniques provide no evidence of a neurological pattern that can be equated with a "hypnotic trance". Changes in brain activity have been found in some studies of highly responsive hypnotic subjects. These changes vary depending upon the type of suggestions being given.[81][82] However, what these results indicate is unclear. They may indicate that suggestions genuinely produce changes in perception or experience that are not simply a result of imagination. However, in normal circumstances without hypnosis, the brain regions associated with motion detection are activated both when motion is seen and when motion is imagined, without any changes in the subjects' perception or experience.[83] This may therefore indicate that highly suggestible hypnotic subjects are simply activating to a greater extent the areas of the brain used in imagination, without real perceptual changes.

Another study has demonstrated that a color hallucination suggestion given to subjects in hypnosis activated color-processing regions of the occipital cortex.[84] A 2004 review of research examining the EEG laboratory work in this area concludes:

Hypnosis is not a unitary state and therefore should show different patterns of EEG activity depending upon the task being experienced. In our evaluation of the literature, enhanced theta is observed during hypnosis when there is task performance or concentrative hypnosis, but not when the highly hypnotizable individuals are passively relaxed, somewhat sleepy and/or more diffuse in their attention.[85]

The induction phase of hypnosis may also affect the activity in brain regions which control intention and process conflict. Anna Gosline claims:

"Gruzelier and his colleagues studied brain activity using an fMRI while subjects completed a standard cognitive exercise, called the Stroop task.
The team screened subjects before the study and chose 12 that were highly susceptible to hypnosis and 12 with low susceptibility. They all completed the task in the fMRI under normal conditions and then again under hypnosis.
Throughout the study, both groups were consistent in their task results, achieving similar scores regardless of their mental state. During their first task session, before hypnosis, there were no significant differences in brain activity between the groups.
But under hypnosis, Gruzelier found that the highly susceptible subjects showed significantly more brain activity in the anterior cingulate gyrus than the weakly susceptible subjects. This area of the brain has been shown to respond to errors and evaluate emotional outcomes.
The highly susceptible group also showed much greater brain activity on the left side of the prefrontal cortex than the weakly susceptible group. This is an area involved with higher level cognitive processing and behaviour."[86][87]

Dissociation

Pierre Janet originally developed the idea of dissociation of consciousness from his work with hysterical patients. He believed that hypnosis was an example of dissociation, whereby areas of an individual's behavioural control separate from ordinary awareness. Hypnosis would remove some control from the conscious mind, and the individual would respond with autonomic, reflexive behaviour. Weitzenhoffer describes hypnosis via this theory as "dissociation of awareness from the majority of sensory and even strictly neural events taking place."[88]

Neodissociation

Ernest Hilgard, who developed the "neodissociation" theory of hypnotism, hypothesised that hypnosis causes the subjects to divide their consciousness voluntarily. One part responds to the hypnotist while the other retains awareness of reality. Hilgard made subjects take an ice water bath. They said nothing about the water being cold or feeling pain. Hilgard then asked the subjects to lift their index finger if they felt pain and 70% of the subjects lifted their index finger. This showed that even though the subjects were listening to the suggestive hypnotist they still sensed the water's temperature.[89]

Mind-dissociation

This surprisingly simple theory was proposed by Y.D. Tsai in 1995[90] as part of his psychosomatic theory of dreams. Inside each brain, there is a program " I " (the conscious self) which is distributed over the conscious brain and coordinates mental functions (cortices), such as thinking, imagining, sensing, moving, reasoning … etc. "I" also supervises memory. Many bizarre states of consciousness are actually the results of dissociation of certain mental functions from "I".

When a person is hypnotized, it might be that his/her imagination is dissociated and sends the imagined content back to the sensory cortex, resulting in dreams or hallucinations; or that some senses are dissociated, resulting in hypnotic anesthesia; or that motor function is dissociated, resulting in immobility; or that reason is dissociated and he/she obeys the hypnotist's orders; or that thought is dissociated and not controlled by reason, hence strives to straighten out his/her body between two chairs. A command can also be acted out long after the hypnosis session, as follows: The subject obeys the voice of reason in normal state, but when hypnotized, reason is replaced by the hypnotist's command to make decisions or believes, and will be very uneasy if he/she does not do things as decided or his/her belief is contradicted. Hypnotherapy is also based on this principle.

Social role-taking theory

The main theorist who pioneered the influential role-taking theory of hypnotism was Theodore Sarbin. Sarbin argued that hypnotic responses were motivated attempts to fulfill the socially-constructed role of hypnotic subject. This has led to the misconception that hypnotic subjects are simply "faking". However, Sarbin emphasised the difference between faking, in which there is little subjective identification with the role in question, and role-taking, in which the subject not only acts externally in accord with the role but also subjectively identifies with it to some degree, acting, thinking, and feeling "as if" they are hypnotised. Sarbin drew analogies between role-taking in hypnosis and role-taking in other areas such as method acting, mental illness, and shamanic possession, etc. This interpretation of hypnosis is particularly relevant to understanding stage hypnosis in which there is clearly strong peer pressure to comply with a socially-constructed role by performing accordingly on a theatrical stage.

Hence, the social constructionism and role-taking theory of hypnosis suggests that individuals are enacting (as opposed to merely playing) a role and that really there is no such thing as a hypnotic trance. A socially-constructed relationship is built depending on how much rapport has been established between the "hypnotist" and the subject (see Hawthorne effect, Pygmalion effect, and placebo effect).

Psychologists such as Robert Baker and Graham Wagstaff claim that what we call hypnosis is actually a form of learned social behaviour, a complex hybrid of social compliance, relaxation, and suggestibility that can account for many esoteric behavioural manifestations.[91]

Cognitive-behavioural theory

Barber, Spanos, & Chaves (1974) proposed a nonstate "cognitive-behavioural" theory of hypnosis, similar in some respects to Sarbin's social role-taking theory and building upon the earlier research of Barber. On this model, hypnosis is explained as an extension of ordinary psychological processes like imagination, relaxation, expectation, social compliance, etc. In particular, Barber argued that responses to hypnotic suggestions were mediated by a "positive cognitive set" consisting of positive expectations, attitudes, and motivation. Daniel Araoz subsequently coined the acronym "TEAM" to symbolise the subject's orientation to hypnosis in terms of "trust", "expectation", "attitude", and "motivation".

Barber et al., noted that similar factors appeared to mediate the response both to hypnotism and to cognitive-behavioural therapy (CBT), in particular systematic desensitization. Hence, research and clinical practice inspired by their interpretation has led to growing interest in the relationship between hypnotherapy and CBT.

Information theory

An approach loosely based on Information theory uses a brain-as-computer model. In adaptive systems, feedback increases the signal-to-noise ratio, which may converge towards a steady state. Increasing the signal-to-noise ratio enables messages to be more clearly received. The hypnotist's object is to use techniques to reduce interference and increase the receptability of specific messages (suggestions).[92]

Systems theory

Systems theory, in this context, may be regarded as an extension of Braid's original conceptualization of hypnosis[93] as involving a process of enhancing or depressing nervous system activity. Systems theory considers the nervous system's organization into interacting subsystems. Hypnotic phenomena thus involve not only increased or decreased activity of particular subsystems, but also their interaction. A central phenomenon in this regard is that of feedback loops, which suggest a mechanism for creating hypnotic phenomena.[94][95]

See also

Historical figures

Modern researchers

Related subjects

Organizations

  • American Association of Professional Hypnotherapists [13]
  • American Board of Clinical Hypnotherapy [14]
  • American Council of Hypnotist Examiners [15]
  • American Society of Clinical Hypnosis [16]
  • Association of Registered Clinical Hypnotherapists [17]
  • Australian Hypnotherapists’ Association [18]
  • Australian Society of Clinical Hypnotherapists [19]
  • British Society of Clinical and Academic Hypnosis ( http://www.bscah.com)
  • British Society of Clinical Hypnosis [20]
  • European Society of Hypnosis and Psychosomatic Medicine (http://www.esh-hypnosis.eu)
  • International Association of Counseling Hypnotherapists [21]
  • International Association of Counselors and Therapists [22]
  • International Hypnosis Federation [23]
  • International Medical and Dental Hypnotherapy Association [24]
  • National Association of Transpersonal Hypnotherapists [25]
  • National Board for Certified Clinical Hypnotherapists [26]
  • National Guild of Hypnotists [27]
  • Professional Board of Hypnotherapy [28]
  • Professional Clinical Hypnotherapists of Australia [29]
  • Society of Psychological Hypnosis [30]
  • The Association for Professional Hypnosis and Psychotherapy [31]
  • The Society for Clinical and Experimental Hypnosis [32]

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  92. ^ Kroger, William S. (1977) Clinical and experimental hypnosis in medicine, dentistry, and psychology. Lippincott, Philadelphia, 31. ISBN 0-397-50377-6
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External links


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

HYPNOTISM, a term now in general use as covering all that pertains to the art of inducing the hypnotic state, or hypnosis, and to the study of that state, its conditions, peculiarities and effects. Hypnosis is a condition, allied to normal sleep (Gr. iirrvos), which can be induced in a large majority of normal persons. Its most characteristic and constant symptom is the increased suggestibility of the subject (see Suggestion).

Other symptoms are very varied and differ widely in different subjects and in the same subject at different times. There can be no doubt that the increased suggestibility and all the other symptoms of hypnosis imply some abnormal condition of the brain of a temporary and harmless nature. It would seem that in all ages and in almost all countries individuals have occasionally fallen into abnormal states of mind more or less closely resembling the hypnotic state, and have thereby excited the superstitious wonder of their fellows. In some cases the state has been deliberately induced, in others it has appeared spontaneously, generally under the influence of some emotional excitement. The most familiar of these allied states is the somnambulism or sleep-walking to which some persons seem to be hereditarily disposed. Of a rather different type are the states of ecstasy into which religious enthusiasts have occasionally fallen and which were especially frequent among the peoples of Europe during the middle ages. While in this condition individuals have appeared to be insensitive to all impressions made on their sense-organs, even to such as would excite acute pain in normal persons, have been capable of maintaining rigid postures for long periods of time, have experienced vivid hallucinations, and have produced, through the power of the imagination, extraordinary organic changes in the body, such as the bloody stigmata on the hands and feet in several wellattested instances. It has been proved in recent years that effects of all these kinds may be produced by hypnotic suggestion. Different again, but closely paralleled by some subjects in hypnosis, is the state of latch into which a certain proportion of persons of the Malay race are liable to fall. These persons, if their attention is suddenly and forcibly drawn to any other person, will begin to imitate his every action and attitude, and may do so in spite of their best efforts to restrain their imitative movements. Among the half-bred French-Canadians of the forest regions of Canada occur individuals, known as "jumpers," who are liable to fall suddenly into a similar state of abject imitativeness, and the same peculiar behaviour has been observed among some of the remote tribes of Siberia.

The deliberate induction of states identical with, or closely allied to, hypnosis is practised by many barbarous and savage peoples, generally for ceremonial purposes. Thus, certain dervishes of Algiers are said to induce in themselves, by the aid of the sound of drums, monotonous songs and movements, a state in which they are insensitive to pain, and a similar practice of religious devotees is reported from Tibet. Perhaps the most marvellous achievement among well-attested cases of this sort is that of certain yogis of Hindustan; by long training and practice they seem to acquire the power of arresting almost completely all their vital functions. An intense effort of abstraction from the impressions of the outer world, a prolonged fixation of the eyes upon the nose or in some other strained position and a power of greatly slowing the respiration, these seem to be important features of their procedure for the attainment of their abnormal states.

In spite of the wide distribution in time and space, and the not very infrequent occurrence, of these instances of states identical with or allied to hypnosis, some three centuries of enthusiastic investigation and of bitter controversy were required to establish the occurrence of the hypnotic state among the facts accepted by the world of European science. Scientific interest in them may be traced back at least as far as the end of the 16th century. Paracelsus had founded the "sympathetic system" of medicine, according to which the stars and other bodies, especially magnets, influence men by means of a subtle emanation or fluid that pervades all space. J. B. van Helmont, a distinguished man of science of the latter part of the 16th century, extended this doctrine by teaching that a similar magnetic fluid radiates from men, and that it can be guided by their wills to influence directly the minds and bodies of others. In the middle of the 17th century there appeared in England several persons who claimed to have the power of curing diseases by stroking with the hand. Notable amongst these was Valentine Greatrakes, of Affane, in the county of Waterford, Ireland, who was born in xiv. 7a February 1628, and who attracted great attention in England by his supposed power of curing the king's evil, or scrofula. Many of the most distinguished scientific and theological men of the day, such as Robert Boyle and R. Cudworth, witnessed and attested the cures supposed to be effected by Greatrakes, and thousands of sufferers crowded to him from all parts of the kingdom. About the middle of the 18th century John Joseph Gassner, a Roman Catholic priest in Swabia, took up the notion that the majority of diseases arose from demoniacal possession, and could only be cured by exorcism. His method was undoubtedly similar to that afterwards followed by Mesmer and others, and he had an extraordinary influence over the nervous systems of his patients. Gassner, however, believed his power to be altogether supernatural.

But it was not until the latter part of the 18th century that the doctrine of a magnetic fluid excited great popular interest and became the subject of fierce controversy in the scientific world. F. A. Mesmer (q.v.), a physician of Vienna, was largely instrumental in bringing the doctrine into prominence. He developed it by postulating a specialized variety of magnetic fluid which he called animal magnetism; and he claimed to be able to cure many diseases by means of this animal magnetism, teaching, also, that it may be imparted to and stored up in inert objects, which are thereby rendered potent to cure disease.

It would seem that Mesmer himself was not acquainted with the artificial somnambulism which for nearly a century was called mesmeric or magnetic sleep, and which is now familiar as hypnosis of a well-marked degree. It was observed and described about the year 1780 by the marquis de Puysegur, a disciple of Mesmer, who showed that, while subjects were in this state, not only could some of their diseases be cured, but also their movements could be controlled by the "magnetizer," and that they usually remembered nothing of the events of the period of sleep when restored to normal consciousness. These are three of the most important features of hypnosis, and the modern study of hypnotism may therefore be said to have been initiated at this date by Puysegur. For, though it is probable that this state had often been induced by the earlier magnetists, they had not recognized that the peculiar behaviour of their patients resulted from their being plunged into this artificial sleep, but had attributed all the symptoms they observed to the direct physical action of external agents upon the patients.

The success of Mesmer and his disciples, especially great in the fashionable world, led to the appointment in Paris of a royal commission for the investigation of their claims. The commission, which included men of great eminence, notably A. L. Lavoisier and Benjamin Franklin, reported in the year 1784 that it could not accept the evidence for the existence of the magnetic fluid; but it did not express an opinion as to the reality of the cures said to be effected by its means, nor as to the nature of the magnetic sleep. This report and the social upheavals of the following years seem to have abolished the public interest in "animal magnetism" for the space of one generation; after which Alexandre Bertrand, a Parisian physician, revived it by his acute investigations and interpretations of the phenomena. Bertrand was the first to give an explanation of the facts of the kind that is now generally accepted. He exhibited the affinity of the "magnetic sleep" to ordinary somnambulism, and he taught that the peculiar effects are to be regarded as due to the suggestions of the operator working themselves out in the mind and body of the "magnetized" subject, i.e. he regarded the influence of the magnetizer as exerted in the first instance on the mind of the subject and only indirectly through the mind upon the body. Shortly after this revival of public interest, namely in the year 1831, a committee of the Academy of Medicine of Paris reported favourably upon "magnetism" as a therapeutic agency, and before many years had elapsed it was extensively practised by the physicians of all European countries, with few exceptions, of which England was the most notable. Most of the practitioners of this period adhered to the doctrine of the magnetic fluid emanating from the operator to his patient, and the acceptance of this doctrine was commonly combined with belief in phrenology, astrology and the influence of metals and magnets, externally applied, in curing disease and in producing a variety of strange sensations and other affections of the mind. These beliefs, claiming to rest upon carefully observed facts, were given a new elaboration and a more imposing claim to be scientifically established by the doctrine of odylic force propounded by Baron Karl von Reichenbach. In this mass of ill-based assertion and belief the valuable truths of "animal magnetism" and the psychological explanations of them given by Bertrand were swamped and well-nigh lost sight of. For it was this seemingly inseparable association between the facts of hypnotism and these bizarre practices and baseless beliefs that blinded the larger and more sober part of the scientific world, and led them persistently to assert that all this group of alleged phenomena was a mass of quackery, fraud and superstition. And the fact that magnetism was practised for pecuniary gain, often in a shameless manner, by exponents who claimed to cure by its means every conceivable ill, rendered this attitude on the part of the medical profession inevitable and perhaps excusable, though not justifiable. It was owing to this baleful association that John Elliotson, one of the leading London physicians of that time, who became an ardent advocate of "magnetism" and who founded and edited the Zoist in the interests of the subject, was driven out of the profession. This association may perhaps be held, also, to excuse the hostile attitude of the medical profession towards James Esdaile, a surgeon, who, practising in a government hospital in Calcutta among the natives of India, performed many major operations, such as the amputation of limbs, painlessly and with the most excellent results by aid of the "magnetic" sleep. For both Elliotson and Esdaile, though honourable practitioners, accepted the doctrine of the "magnetic" fluid and many of the erroneous beliefs that commonly were bound up with it.

In 1841 James Braid, a surgeon of Manchester, rediscovered independently Bertrand's physiological and psychological explanations of the facts, carried them further, and placed "hypnotism," as he named the study, on a sound basis. Braid showed that subjects in "magnetic" sleep, far from being in a profoundly insensitive condition, are often abnormally susceptible to impressions on the senses, and showed that many of the peculiarities of their behaviour were due to suggestions, made verbally or otherwise, but unintentionally, by the operator or by onlookers.

It seems, on looking back on the history of hypnotism, that at this time it was in a fair way to secure general recognition as a most interesting subject of psychological study and a valuable addition to the resources of the physician. But it was destined once more to be denied its rights by official science and to fall back into disrepute. This was due to the coincidence about the year 1848 of two events of some importance, namely - the discovery of the anaesthetic properties of chloroform and the sudden rise of modern spiritualism. The former afforded a very convenient substitute for the most obvious practical application of hypnotism, the production of anaesthesia during surgical operations; the latter involved it once more in a mass of fraud and superstition, and, for the popular mind, drove it back to the region of the marvellous, the supernatural and the dangerous, made it, in fact, once more a branch of the black art.

From this time onward there took place a gradual differentiation of the "animal magnetism" of the 18th century into two diverging branches, hypnotism and spiritualism, two branches which, however, are not yet entirely separated and, perhaps, never will be. At the same time the original system of "animal magnetism" has lived on in an enfeebled condition and is now very nearly, though not quite, extinct.

In the development of hypnotism since the time of Braid we may distinguish three lines, the physiological, the psychological and the pathological. The last may be dismissed in a few words. Its principal representative was J. M. Charcot, who taught at the Salpetriere in Paris that hypnosis is essentially a symptom of a morbid condition of hysteria or hystero-epilepsy. This doctrine, which, owing to the great repute enjoyed by Charcot, has done much to retard the application of hypnotism, is now completely discredited. The workers of the physiological party attached special importance to the fixation of the eyes, or to other forms of long continued and monotonous, or violent, sensory stimulation in the induction of hypnosis. They believed that by acting on the senses in these ways they induced a peculiar condition of the nervous system, which consisted in the temporary abolition of the cerebral functions and the consequent reduction of the subject to machine-like unconscious automatism. The leading exponent of this view was R. Heidenhain, professor of physiology at Breslau, whose experimental investigations played a large part in convincing the scientific world of the genuineness of the leading symptoms of hypnosis. The purely psychological doctrine of hypnosis puts aside all physical and physiological influences and effects as of but little or no importance, and seeks a psychological explanation of the induction of hypnosis and of all the phenomena. This dates from 1884, when H. Bernheim, professor of medicine at Nancy, published his work De la Suggestion (republished in 1887 with a second part on the therapeutics of hypnotism). Bernheim was led to the study of hypnotism by A. A. Liebeault, who for twenty years had used it very largely and successfully in his general practice among the poor of Nancy. Liebeault rediscovered independently, and Bernheim made known to the world the truths, twice previously discovered and twice lost sight of, that expectation is a most important factor in the induction of hypnosis, that increased suggestibility is its essential symptom, and that in general the operator works upon his patient by mental influences. Although they went too far in the direction of ignoring the peculiarity of the state of the brain in hypnosis and the predisposing effect of monotonous sensory stimulation, and in seeking to identify hypnosis with normal sleep, the views of the Nancy investigators have prevailed, and are now in the main generally accepted. Their methods of verbal suggestion have been adopted by leading physicians in almost all civilized countries and have been proved to be efficacious in the relief of many disorders; and as a method of psychological investigation hypnotism has proved, especially in the hands of the late Ed. Gurney, of Dr Pierre Janet and of other investigators, capable of throwing much light on the constitution of the mind, has opened up a number of problems of the deepest interest, and has done more than any other of the many branches of modern psychology to show the limitations and comparative barrenness of the old psychology that relied on introspection alone and figured as a department of general philosophy. In England, "always the last to enter into the general movement of the European mind," the prejudice, incredulity and ignorant misrepresentation with which hypnotism has everywhere been received have resisted its progress more stubbornly than elsewhere; but even in England its reality and its value as a therapeutic agent have at last been officially recognized. In 1892, just fifty years after Braid clearly demonstrated the facts and published explanations of them almost identical with those now accepted, a committee of the British Medical Association reported favourably upon hypnotism after a searching investigation; it is now regularly employed by a number of physicians of high standing, and the formation in 1 g07 of "The Medical Society for the Study of Suggestive Therapeutics" shows that the footing it has gained is likely to be made good.

Table of contents

Induction of Hypnosis

It has now been abundantly proved that hypnosis can be induced in the great majority of normal persons, provided that they willingly submit themselves to the process. Several of the most experienced operators have succeeded in hypnotizing more than 90% of the cases they have attempted, and most of them are agreed that failure to induce hypnosis in any case is due either to lack of skill and tact on the part of the operator, or to some unfavourable mental condition of the subject. It has often been said that some races or peoples are by nature more readily hypnotizable than others; of the French people especially this has been maintained. But there is no sufficient ground for this statement. The differences that undoubtedly obtain between populations of different regions in respect to the ease or difficulty with which a large proportion of all persons can be hypnotized are sufficiently explained by the differences of the attitude of the public towards hypnotism; in France, e.g., and especially in Nancy, hypnotism has been made known to the public chiefly as a recognized auxiliary to the better known methods of medical treatment, whereas in England the medical profession has allowed the public to make acquaintance with hypnotism through the medium of disgusting stage-performances whose only object was to raise a laugh, and has, with few exceptions, joined in the general chorus of condemnation and mistrust. Hence in France patients submit themselves with confidence and goodwill to hypnotic treatment, whereas in England it is still necessary in most cases to remove an ill-based prejudice before the treatment can be undertaken with hope of success. For the confidence and goodwill of the patient are almost essential to success, and even after hypnosis has been induced on several occasions a patient may be so influenced by injudicious friends that he cannot again be hypnotized or, if hypnotized, is much less amenable to the power of suggestion. Various methods of hypnotization are current, but most practitioners combine the methods of Braid and of Bernheim. After asking the patient to resign himself passively into their hands, and after seating him in a comfortable arm-chair, they direct him to fix his eyes upon some small object held generally in such a position that some slight muscular strain is involved in maintaining the fixation; they then suggest to him verbally the idea or expectation of sleep and the sensations that normally accompany the oncoming of sleep, the heaviness of the eyes, the slackness of the limbs and so forth; and when the eyes show signs of fatigue, they either close them by gentle pressure or tell the subject to close them. Many also pass their hands slowly and regularly over the face, with or without contact. The old magnetizers attached great importance to such "passes," believing that by them the "magnetic fluid" was imparted to the patient; but it seems clear that, in so far as they contribute to induce hypnosis, it is in their character merely of gentle, monotonous, sensory stimulations. A welldisposed subject soon falls into a drowsy state and tends to pass into natural sleep; but by speech, by passes, or by manipulating his limbs the operator keeps in touch with him, keeps his waning attention open to the impressions he himself makes. Most subjects then find it difficult or impossible to open their eyes or to make any other movement which is forbidden or said to be impossible by the operator, although they may be fully conscious of all that goes on about them and may have the conviction that if they did but make an effort they could break the spell. This is a light stage of hypnosis beyond which some subjects can hardly be induced to pass and beyond which few pass at the first attempt. But on successive occasions, or even on the first occasion, a favourable subject passes into deeper stages of hypnosis. Many attempts have been made to distinguish clearly marked and constantly occurring stages. But it seems now clear that the complex of symptoms displayed varies in all cases with the idiosyncrasies of the subject and with the methods adopted by the operator. In many subjects a waxy rigidity of the limbs appears spontaneously or can be induced by suggestion; the limbs then retain for long periods without fatigue any position given them by the operator. The most susceptible subjects pass into the stage known as artificial somnambulism. In this condition they continue to respond to all suggestions made by the operator, but seem as insensitive to all other impressions as a person in profound sleep or in coma; and on awaking from this condition they are usually oblivious of all that they have heard, said or done during the somnambulistic period. When in this last condition patients are usually more profoundly influenced by suggestions, especially post-hypnotic suggestions, than when in the lighter stages; but the lighter stages suffice for the production of many therapeutic effects. When a patient is completely hypnotized, his movements, his senses, his ideas and, to some extent, even the organic processes over which he has no, voluntary control become more or less completely subject to. the suggestions of the operator; and usually he is responsive to the operator alone (rapport) unless he is instructed by the latter to respond also to the suggestions of other persons. If left to himself the hypnotized subject will usually awake to his normal state after a period which is longer in proportion to the depth of hypnosis; and the deeper stages seem to pass over into normal sleep. The subject can in almost every case be brought quickly back to the normal state by the verbal command of the operator.

The Principal Effects produced by Suggestion during Hypnosis

The subject may not only be rendered incapable of contracting any of the muscles of the voluntary system, but may also be made to use them with extraordinarily great or sustained force (though by no means in all cases). He can with difficulty refrain from performing any action commanded by the operator, and usually carries out any simple command without hesitation. Any one of the sense-organs, or any sensory region such as the skin or deep tissues of one limb may be rendered anaesthetic by verbal suggestion, aided perhaps by some gentle manipulation of the part. On this fact depends the surgical application of hypnotism. Sceptical observers are always inclined to doubt the genuineness of the anaesthesia produced by a mere word of command, but the number of surgical operations performed under hypnotic anaesthesia suffices to put its reality beyond all question. A convincing experiment may, however, be made on almost any good subject. Anaesthesia of one eye may be suggested and its reality tested in the following way. Anaesthesia of the left eye may be suggested, and the subject be instructed to fix his gaze on a distant point and to give some signal as soon as he sees the operator's finger in the peripheral field of view. The operator then brings his finger slowly from behind and to the right forwards towards the subject's line of sight. The subject signals as soon as it crosses the normal temporal boundary of the field of view of the right eye. The operator then brings his finger forward from a point behind and to the left of the subject's head. The subject allows it to cross the monocular field of the left eye and signals only when the finger enters the field of vision of the right eye across its nasal boundary. Since few persons, other than physiologists or medical men, are aware of the relations of the boundaries of the monocular and binocular fields of vision, the success of this experiment affords proof that the finger remains invisible to the subject during its passage across the monocular field of the left eye. The abolition of pain, especially of neuralgias, the pain of rheumatic and other inflammations, which is one of the most valuable applications of hypnotism, is an effect closely allied to the production of such anaesthesia.

It has often been stated that in hypnosis the senses may be rendered extraordinarily acute or hyperaesthetic, so that impressions too faint to affect the senses of the normal person may be perceived by the hypnotized subject; but in view of the fact that most observers are ignorant of the normal limits of sensitivity and discrimination, all such statements must be received with caution, until we have more convincing evidence than has yet been brought forward.

Positive and Negative Hallucinations are among the most striking effects of hypnotic suggestion. A good subject may be made to experience an hallucinatory perception of almost any object, the more easily the less unusual and out of harmony with the surroundings is the suggested object. He may, e.g., be given a blank card and asked if he thinks it a good photograph of himself. He may then assent and describe the photograph in some detail, and, what is more astonishing, he may pick out the card as the one bearing the photograph, after it has been mixed with other similar blank cards. This seems to be due to the part played by points de repere, insignificant details of surface or texture, which serve as an objective basis around which the hallucinatory image is constructed by the pictorial imagination of the subject. A negative hallucination may be induced by telling the subject that a certain object or person is no longer present, when he ignores in every way that object or person. This is more puzzling than the positive hallucination and will be referred to again in discussing the theory of hypnosis. Both kinds of hallucination tend to be systematically and logically developed; if, e.g., the subject is told that a certain person is no longer visible, he may become insensitive to impressions made on any sense by that person.

Delusions, or false beliefs as to their present situation or past experiences may be induced in many subjects. On being assured that he is some other person, or that he is in some strange situation, the subject may accept the suggestion and adapt his behaviour with great histrionic skill to the induced delusion. It is probable that many, perhaps all, subjects are vaguely aware, as we sometimes are in dreams, that the delusions and hallucinations they experience are of an unreal nature. In the lighter stages of hypnosis a subject usually remembers the events of his waking life, but in the deeper stages he is apt, while remembering the events of previous hypnotic periods, to be incapable of recalling his normal life; but in this respect, as also in respect to the extent to which on awaking he remembers the events of the hypnotic period, the suggestions of the operator usually play a determining part.

Among the organic changes that have been produced by hypnotic suggestion are slowing or acceleration of the cardiac and respiratory rhythms; rise and fall of body-temperature through two or three degrees; local erythema and even inflammation of the skin with vesication or exudation of small drops of blood; evacuation of the bowel and vomiting; modifications of the secretory activity of glands, especially of the sweat-glands.

Post-hypnotic Effects

Most subjects in whom any appreciable degree of hypnosis can be induced show some susceptibility to post-hypnotic suggestion, i.e.they may continue to be influenced, when restored to the fully waking state, by suggestions made during hypnosis, more especially if the operator suggests that this shall be the case; as a rule, the deeper the stage of hypnosis reached, the more effective are post-hypnotic suggestions. The therapeutic applications of hypnotism depend in the main upon this post-hypnotic continuance of the working of suggestions. If a subject is told that on awaking, or on a certain signal, or after the lapse of a given interval of time from the moment of awaking, he will perform a certain action, he usually feels some inclination to carry out the suggestion at the appropriate moment. If he remembers that the action has been suggested to him he may refuse to perform it, and if it is one repugnant to his moral nature, or merely one that would make him appear ridiculous, he may persist in his refusal. But if the action is of a simple and ordinary nature he will usually perform it, remarking that he cannot be comfortable till it is done. If the subject was deeply hypnotized and remembers nothing of the hypnotic period, he will carry out the post-hypnotic suggestion in almost every case, no matter how complicated or absurd it may be, so long as it is not one from which his normal self would be extremely averse; and he will respond appropriately to the suggested signals, although he is not conscious of their having been named; he will often perform the action in a very natural way, and will, if questioned, give some more or less adequate reason for it. Such actions, determined by post-hypnotic suggestions of which no conscious memory remains, may be carried out even of ter the lapse of many weeks or even months. Inhibitions of movement, anaesthesia, positive and negative hallucinations, and delusions may also be made to persist for brief periods after the termination of hypnosis; and organic effects, such as the action of the bowels, the oncoming of sleep and the cessation of pain, may be determined by post-hypnotic suggestion. In short, it may be said that in a good subject all the kinds of suggestion which will take effect during hypnosis will also be effective if given as posthypnotic suggestions.

Theory of the Hypnotic State

Very many so called theories of hypnosis have been propounded, but few of them demand serious consideration. One author ascribes all the symptoms to cerebral anaemia, another to cerebral congestion, a third to temporary suppression of the functions of the cerebrum, a fourth to abnormal cerebral excitability, a fifth to the independent functioning of one hemisphere. Another seeks to explain all the facts by saying that in hypnosis our normal consciousness disappears and is replaced by a dream-consciousness; and yet another by the assumption that every human organism comprises two mental selves or personalities, a normal one and one which only comes into activity during sleep and hypnosis. Most of these "theories" would, even if true, carry us but a little way towards a complete understanding of the facts. There is, however, one theory or principle of explanation which is now gradually taking shape under the hands of a number of the more penetrating workers in this field, and which does seem to render intelligible many of the principle facts. This is the theory of mental dissociation. It is clear that a theory of hypnosis must attempt to give some account of the peculiar condition of the brain which is undoubtedly present as an essential feature of the state. It is therefore not enough to say with Bernheim that hypnosis is a state of abnormally increased suggestibility produced by suggestion; nor is it enough, though it is partially true, to say that it is a state of mono-ideism or one of abnormally great concentration of attention. Any theory must be stated in terms of physiological psychology, it must take account of both the psychical and the nervous peculiarities of the hypnotic state; it must exhibit the physiological condition as in some degree similar to that obtaining in normal sleep; but principally it must account for that abnormally great receptivity for ideas, and that abnormally intense and effective operation of ideas so received, which constitute abnormally great suggestibility.

The theory of mental dissociation may be stated in purely mental terms, or primarily in terms of nervous structure and function, and the latter mode of statement is probably the more profitable at the present time. The increased effectiveness of ideas might be due to one of two conditions: (1) it might be that certain tracts of the brain or the whole brain were in a condition of abnormally great excitability; or (2) an idea might operate more effectively in the mind and on the body, not because it, or the underlying brain-process was more intense than normally, but because it worked out its effects free from the interference of contrary or irrelevant ideas that might weaken its force. It is along this second line that the theory of mental dissociation attempts to explain the increased suggestibility of hypnosis. To understand the theory we must bear in mind the nature of mental process in general and of its nervous concomitants. Mental process consists in the interplay, not merely of ideas, but rather of complex dispositions which are the more or less enduring conditions of the rise of ideas to consciousness. Each such disposition seems capable of remaining inactive or quiescent for long periods, and of being excited in various degrees, either by impressions made upon the senseorgans or by the spread of excitement from other dispositions. When its excitement rises above a certain pitch of intensity, the corresponding idea rises to the focus of consciousness. These dispositions are essential factors of all mental process, the essential conditions of all mental retention. They may be called simply mental dispositions, their nature being left undefined; but for our present purpose it is advantageous to regard them as neural dispositions, complex functional groups of nervous elements or neurones. The neurones of each such group must be conceived as being so intimately connected with one another that the excitement of any part of the group at once spreads through the whole group or disposition, so that it always functions as a unit. The whole cerebrum must be conceived as consisting of a great number of such dispositions, inextricably interwoven, but interconnected in orderly fashion with very various degrees of intimacy; groups of dispositions are very intimately connected to form neural systems, so that the excitement of any one member of such a system tends to spread in succession to all the other members. On the other hand, it is a peculiarity of the reciprocal relations of all such dispositions and systems that the excitement of any one to such a degree that the corresponding idea rises to consciousness prevents or inhibits the excitement of others, i.e. all of them are in relations of reciprocal inhibition with one another (see Muscle And Nerve). The excitement of dispositions associated together to form a system tends towards some end which, either immediately or remotely, is an action, a bodily movement, in many cases a movement of the organs of speech only. Now we know from many exact experiments that the neural dispositions act and react upon one another to some extent, even when they are excited only in so feeble a degree that the corresponding ideas do not rise to consciousness. In the normal state of the brain, then, when any idea is present to consciousness, the corresponding neural disposition is in a state of dominant excitement, but the intensity of that excitement is moderated, depressed or partially inhibited by the sub-excitement of many rival or competing dispositions of other systems with which it is connected. Suppose now that all the nervous connexions between the multitudinous dispositions of the cerebrum are by some means rendered less effective, that the association-paths are partially blocked or functionally depressed; the result will be that, while the most intimate connexions, those between dispositions of any one system remain functional or permeable, the weaker less intimate connexions, those between dispositions belonging to different systems will be practically abolished for the time being; each system of dispositions will then function more or less as an isolated system, and its activity will no longer be subject to the depressing or inhibiting influence of other systems; therefore each system, on being excited in any way, will tend to its end with more than normal force, being freed from all interferences; that is to say, each idea or system of ideas will tend to work itself out and to realize itself in action immediately, without suffering the opposition of antagonistic ideas which, in the normal state of the brain, might altogether prevent its realization in action.

The theory of mental dissociation assumes that the abnormal state of the brain that obtains during hypnosis is of this kind, a temporary functional depression of all, or of many of the associations or nervous links between the neural dispositions; that is, it regards hypnosis as a state of relative dissociation. The lighter the stage of hypnosis the slighter is the degree of dissociation, the deeper the stage the more nearly complete is the dissociation.

It is not essential that the theory should explain in what change this stage of dissociation consists, but a view compatible with all that we know of the functions of the central nervous system may be suggested. The connexions between neural dispositions involve synapses or cell-junctions, and these seem to be the places of variable resistance which demarcate the dispositions and systems; and there is good reason to think that their resistances vary with the state of the neurones which they connect, being lowered when these are excited and raised when their excitement ebbs. Now, in the waking state, the varied stimuli, which constantly rain upon all the sense-organs, maintain the whole cerebrum in a state of sub-excitement, keep all the cerebral neurones partially charged with free nervous energy. When the subject lies down to sleep or submits himself to the hypnotizer he arrests as far as possible the flow of his thoughts, and the sensory stimuli are diminished in number and intensity. Under these conditions the general cerebral activity tends to subside, the free energy with which the cerebral neurones are charged ebbs away, and the synaptic resistances rise proportionally; then the effect of sensory impressions tends to be confined to the lower nervous level, and the brain tends to come to rest. If this takes place the condition of normal sleep is realized. But in inducing hypnosis the operator, by means of his words and manipulations, keeps one system of ideas and the corresponding neural system in activity, namely, the ideas connected with himself; thus he keeps open one channel of entry to the brain and mind, and through this one open channel he can introduce whatever ideas he pleases; and the ideas so introduced then operate with abnormally great effect because they work in a free field, unchecked by rival ideas and tendencies.

This theory of relative dissociation has two great merits: in the first place it goes far towards enabling us to understand in some degree most of the phenomena of hypnosis; secondly, we have good evidence that dissociation really occurs in deep hypnosis and in some allied states. Any one may readily work out for himself the application of the theory to the explanation of the power of the operator's suggestions to control movement, to induce anaesthesia, hallucinations and delusions, and to exert on the organic processes an influence greater than can be exerted by mental processes in the normal state of the brain. But the positive evidence of the occurrence of dissociation is a matter of great psychological interest and its nature must be briefly indicated. The phenomena of automatic speech and writing afford the best evidence of cerebral dissociation. Many persons can, while in an apparently normal or but very slightly abnormal condition, produce automatic writing, i.e. intelligibly written sentences, in some cases long connected passages, of whose import they have no knowledge, their selfconscious intelligence being continuously directed to some other task. The carrying out of post-hypnotic suggestions affords in many cases similar evidence. Thus a subject may be told that after waking he will perform some action when a given signal, such as a cough, is repeated for the fifth time. In the post-hypnotic state he remains unaware of his instructions, is not conscious of noting the signals, and yet carries out the suggestion at the fifth signal, thereby proving that the signals have been in some sense noted and counted. Many interesting varieties of this experiment have been made, some of much greater complexity; but all agreeing in indicating that the suggested action is prepared for and determined by cerebral processes that do not affect the consciousness of the subject, but seem to occur as a system of processes detached from the main stream of cerebral activity; that is to say, they imply the operation of relatively dissociated neural systems.

Many authorities go further than this; they argue that, since actions of the kind described are determined by processes which involve operations, such as counting, that we are accustomed to regard as distinctly mental in character and that normally involve conscious activity, we must believe that in these cases also consciousness or psychical activity is involved, but that it remains as a separate system or stream of consciousness concurrent with the normal or personal consciousness.

In recent years the study of various abnormal mental states, especially the investigations by French physicians of severe forms of hysteria, have brought to light many facts which seem to justify this assumption of a secondary stream of consciousness, a coor sub-consciousness coexistent with the personal consciousness; although, from the nature of the case, an absolute proof of such co-consciousness can hardly be obtained. The coconsciousness seems to vary in degree of complexity and coherence from a mere succession of fragmentary sensations to an organized stream of mental activity, which may rival in all respects the primary consciousness; and in cases of the latter type it is usual to speak of the presence of a secondary personality. The coconsciousness seems in the simpler cases, e.g. in cases of hysterical or hypnotic anaesthesia, to consist of elements split off from the normal primary consciousness, which remains correspondingly poorer; and the assumption is usually made that such a stream of co-consciousness is the psychical correlate of groups and systems of neurones dissociated from the main mass of cerebral neurones. If, in spite of serious objections, we entertain this conception, we find that it helps us to give some account of various hypnotic phenomena that otherwise remain quite inexplicable; some such conception seems to be required more particularly by the facts of negative hallucination and the execution of post-hypnotic suggestions involving such operations as counting and exact discrimination without primary consciousness.

Supernormal Hypnotic Phenomena

The facts hitherto considered, strange and perplexing as many of them are, do not seem to demand for their explanation any principles of action fundamentally different from those operative in the normal human mind. But much of the interest that has centred in hypnotism in recent years has been due to the fact that some of its manifestations seem to go beyond all such principles of explanation, and to suggest the reality of modes of influence and action that science has not hitherto recognized. Of these by far the best attested are the post-hypnotic unconscious reckoning of time and telepathy or "thought-transference" (for the latter see Telepathy). The post-hypnotic reckoning and noting of the lapse of time seems in some instances to have been carried out, in the absence of all extraneous aids and with complete unconsciousness on the part of the normal personality, with such extreme precision that the achievement cannot be accounted for by any intensification of any faculty that we at present recognize or understand. Thus, Dr Milne Bramwell has reported the case of a patient who, when commanded in hypnosis to perform some simple action after the lapse of many thousands of minutes, would carry out the suggestion punctually to the minute, without any means of knowing the exact time of day at which the suggestion was given or the time of day at the moment its performance fell due; more recently a similar case, even more striking in some respects, has been carefully observed and described by Dr T. W. Mitchell. Other reported phenomena, such as telaesthesia or clairvoyance, and telekinesia, are hardly sufficiently well attested to demand serious consideration in this place.

Medical Applications of Hypnotism

The study and practice of hypnotism is not yet, and probably never will be, regarded as a normal part of the work of the general practitioner. Its successful application demands so much time, tact, and special experience, that it will probably remain, as it is now, and as it is perhaps desirable that it should remain, a specialized branch of medical practice. In England it is only in recent years that it has been possible for a medical man to apply it in his practice without incurring professional odium and some risk of loss of reputation. That, in certain classes of cases, it may effect a cure or bring relief when all other modes of treatment are of no avail is now rapidly becoming recognized; but it is less generally recognized that it may be used with great advantage as a supplement to other modes of treatment in relieving symptoms that are accentuated by nervous irritability or mental disturbance. A third wide field of usefulness lies before it in the cure of undesirable 'habits of many kinds. Under the first heading may be put insomnia, neuralgia, neurasthenia, hysteria in almost all its many forms; under the second, inflammations such as that of chronic rheumatism, contractures and paralyses resulting from gross lesion of the brain, epilepsy, dyspepsia, menstrual irregularities, sea-sickness; under the third, inebriety, the morphia and other drug habits, nail-biting, enuresis nocturna, masturbation, constipation, facial and other twitchings. In pronounced mental diseases hypnotism seems to be almost useless; for in general terms it may be said that it can be applied most effectively where the brain, the instrument through which it works, is sound and vigorous. The widespread prejudice against the use of hypnotism is no doubt largely due to the marvellous and (to most minds) mysterious character of the effects producible by its means; and this prejudice may be expected to diminish as our insight into the mode of its operation deepens. The more purely bodily results achieved by hypnotic suggestion become in some degree intelligible if we regard it as a powerful means of diverting nervous energy from one channel or organ to others, so as to give physiological rest to an overworked organ or tissue, or so as to lead to the atrophy of one nervous habit and the replacement of it by a more desirable habit. And in the cure of those disorders which involve a large mental element the essential part played by it is to drive out some habitually recurrent idea and to replace it by some idea, expectation or conviction of healthy tendency.

It seems clear that the various systems of "mind-curing" in the hands of persons lacking all medical training, which are now so frequently the cause of distressing and needless disasters, owe their rapid spread to the fact that the medical profession has hitherto neglected to attach sufficient importance to the mental factor in the causation and cure of disease; and it seems clear, too, that a more general and more intelligent appreciation of the possibilities of hypnotic treatment would constitute the best means at the disposal of the profession for combating this growing evil.

The Dangers of Hypnotism

Much has been written on this head of late years, and some of the enthusiastic advocates of hypnotic treatment have done harm to their cause by ignoring or denying in a too thoroughgoing manner the possibility of undesirable results of the spread of the knowledge and practice of hypnotism. Like all powerful agencies, chloroform or morphia, dynamite or strong electric currents, hypnotic suggestion can only be safely used by those who have special knowledge and experience, and, like them, it is liable to abuse. There is little doubt that, if a subject is repeatedly hypnotized and made to entertain all kinds of absurd delusions and to carry out very frequently posthypnotic suggestions, he may be liable to some ill-defined harm; also, that an unprincipled hypnotizer might secure an undue influence over a naturally weak subject.

But there is no ground for the belief that hypnotic treatment, applied with good intentions and reasonable care and judgment, does or can produce deleterious effects, such as weakening of the will or liability to fall spontaneously into hypnosis. All physicians of large experience in hypnotic practice are in agreement in respect to this point. But some difference of opinion exists as to the possibility of deliberately inducing a subject to commit improper or criminal actions during hypnosis or by posthypnotic suggestion. There is, however, no doubt that subjects retain even in deep hypnosis a very considerable power of resistance to any suggestion that is repugnant to their moral nature; and it has been shown that, on some cases in which a subject in hypnosis is made to perform some ostensibly criminal action, such as firing an unloaded pistol at a bystander or putting poison into a cup for him to drink, he is aware, however obscurely, of the unreal nature of the situation. Nevertheless it must be admitted that a person lacking in moral sentiments might be induced to commit actions from which in the normal state he would abstain, if only from fear of punishment; and it is probable that a skilful and evil-intentioned operator could in some cases so deceive a welldisposed subject as to lead him into wrong-doing. The proper precaution against such dangers is legislative regulation of the practice of hypnotism such as is already enforced in some countries.

BIBLIOGRAPHY

The literature of hypnotism has increased in volume at a rapid rate during recent years. Of recent writings the following may be mentioned as among the most important : - Treatment by Hypnotism and Suggestion by C. Lloyd Tuckey,M.D.(5th ed., London, 1907); Hypnotism, its History, Practice and Theory, by J. Milne Bramwell, M.B. (2nd ed., London, 1906); Hypnotism, by Albert Moll (5th ed., London, 1901). All these three books give good general accounts of hypnotism, the first being the most strictly medical, the last the most general in its treatment. See also Hypnotism: or Suggestion in Psycho-Therapy, by August Forel (translated from the 5th German ed. by G. H. W. Armit, London, 1906); a number of papers by Ed. Gurney, and by Ed. Gurney and F.W.H. Myers in Proc. of the Soc. for Psychical Research, especially "The Stages of Hypnotism," in vol. ii.; also some more recent papers in the same journal by other hands; chapter on Hypnotism in Human Personality and its Survival of bodily Death, by F. W. H. Myers (London, 1903); The Psychology of Suggestion, by Boris Sidis, Ph.D. (New York, 1898); "Zur Psychologie der Suggestion," by Prof. Th. Lipp, and other papers in the Zeitschrift far Hypnotismus. Of special historical interest are the following : - Etude sur le zoomagnetisme, par A. A. Liebeault (Paris, 1883); Hypnotisme, suggestion, psycho-therapie, par Prof. Bernheim (Paris, 1891); Braid on Hypnotism (a new issue of James Braid's Neurypnology), edited by A. E. Waite (London, 1899); Traite du somnambulisme, by A. Bertrand (Paris, 1826). A full bibliography is appended to Dr Milne Bramwell's Hypnotism. (W. McD.)


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