Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
IN HYPNOSIS
MODERN TRENDS
IN HYPNOSIS
Edited by
DAVID WAXMAN
Chairman of the Scientific Program
International Society of Hypnosis
London, England
PREM
C.
MISRA
Gartloch Hospital
Glasgow, Scotland
MICHAEL GIBSON
Child Guidance Centre
Edinburgh, Scotland
and
M. ANTHONY BASKER
British Society of Medical and Dental Hypnosis
Westcliff-on-Sea, England
ISBN-13: 978-1-4684-4915-0
DOl: 10.1007/978-1-4684-4913-6
e-ISBN-13: 978-1-4684-4913-6
(C)
FOREWORD
viii
FOREWORD
correlates, on the subjective experiences within whatever the hypnotic condition may be found to be, the nature and consequences of
self-hypnosis, and the characteristics of the dissociative phenomena
manifested in hypnosis. On the clinical side there are cases and
discussions reflecting the use of hypnotic methods in the treatment
of disorders of self-control, in obstetrics, in pain and anxiety
reduction, in psychosomatic disorders, in symptoms met in dentistry,
and with problems met in children and adolescents. Comparative
studies relate hypnosis to meditation and behavior therapy. Hypnosis
and the law receives attention in several contributions.
One cannot help but be impressed by the seriousness with which
the direction has been taken to move away from "it has been my
experience " as the way of validating hypnotic practices to the
interest in comparative and controlled studies which place hypnosis
on the same status as other medical or psychiatric practices as they
are taught and studied in our medical schools and university departments.
The battle to establish hypnosis on a sound scientific basis has
not yet been won; even where it is accepted as permissible, there are
still too few scientists among those outside its active practitioners
who show any enthusiasm for it. The gains that are being made,
however, as these Proceedings show, augur well for its future.
Ernest R. Hilgard
PREFACE
ix
PREFACE
In view of the high quality of all the talks given the referees
were faced with a formidable task and it is hoped that those speakers
whose papers do not appear in this volume will in no way feel that
their efforts were in vain. Abstracts of all papers were published
in the issue of The International Journal of Clinical and Experimental Hypnosis of April 1982 and the Editor has given his kind permission for this to be used as a citable reference.
The principal aim of the Scientific Program was the encouragement of learning and research in hypnosis both in clinical practice
and experimental study, with the actual participation of as many as
possible in the wide range of subjects which were offered.
The general scientific papers consisted of clinical reports and
experimental findings covering as extensive an area as time permitted. The subjects included the neuroses, pathological anxiety and
the many incapacitating symptoms resulting therefrom. Other papers
covered the considerable field of personality problems, the addictions and sexual dysfunctions. Hypnosis for the modification of pain
and its use in obstetrics and in pediatrics was discussed and a full
session was devoted to hypnosis in dentistry. Dynamic and behavioral
techniques were included and the many lectures dealing with selfhypnosis proved very popular. Of particular interest were the' case
histories which provided evidence of the practical results of hypnotherapy. One fact that has emerged clearly over the past few years
is that clinical hypnosis, however good the results, will never be
fully accepted unless validated by experimental studies and scientific evidence. It is essential that the clinician works closely
with the experimental psychologist and the research neurophysiologist. With this in mind, theories explaining hypnotizability and
suggestibility as well as the neurophysiology of hypnosis were
explored and numerous experimental studies were described. The use
of hypnosis in criminology occupied several hours of talks as well
as the final Plenary Session.
In addition to the scientific papers Special Invited Addresses
were given by recognized authorities and National Presidents talked
on their individual specialities. Other Invited Addresses and
Speciality Seminars were designed to complement the workshops.
In the concluding paper, the President Elect of the International Society of Hypnosis, Professor Germain Lavoie combining
learned experimental studies with clinical findings, chose as his
subject The Clinical Relevance of Hypnotizability in Psychosis. This
presentation will undoubtedly prove a valuable contribution to future
research.
Thus after five days of intensive work and study, of scientific
lectures and learned discussion, the 9th Congress was bought to a
close. Perhaps it was because of the considerable amount of well-
PREFACE
xi
ACKNOWLEDGMENTS
xiii
CONTENTS
SPECIAL ADDRESSES
15
29
41
BEHAVIOR IN HYPNOSIS
In Search of Hypnosis
A. M. Weitzenhoffer
67
89
97
xv
109
CONTENTS
Visual Memory Processing During Hypnosis:
it Differ From Waking?
H. J. Crawford and S. N. Allen
Does
III
119
131
ELECTROPHYSIOLOGICAL STUDIES
139
149
161
169
181
SELF HYPNOSIS
209
215
223
235
CONTENTS
xvii
V HYPNOSIS AND THE ALLEVIATION OF PAIN
249
259
VI
An
269
277
291
297
VIII
309
317
327
IX
359
CONTENTS
xviii
Results of Anxiety Control Training in the
Treatment of Compulsive Disorders
R. P. Snaith
371
X CASE HISTORIES
379
385
391
401
409
Index
421
SPECIAL ADDRESSES
M. R. BOND
Scots have been no less involved in the development of psychosomatic medicine than of hypnosis and perhaps the most well known
contribution of all was that made by Dr. John Halliday still living
in Glasgow, who, as a Public Health Officer in the city, threw new
light on psychosomatic medicine when he published a book entitled
'Psychosocial Medicine' in 1943. In it he drew attention to the role
of social factors in the development and maintenance of illness. His
work and that of other Scots in particular, Kissen and Aitken, will
be discussed in the final section of this paper.*
INTRODUCTION - AN HISTORICAL PERSPECTIVE
Scots played a major part in the birth of the practice of hypnosis and its therapeutic uses, and also in the development of the
modern concept of psychosomatic medicine. In order to understand why
this prominence was achieved, particularly with regard to hypnosis,
it is necessary to understand something of the growth of medical
education in Scotland up to the early years of the 19th century prior
to discussing a number of the main characters involved.
In his book, 'The Healers, a History of Medicine in Scotland',
David Hamilton (1981), a surgeon in Glasgow, commented, "Scotland
offers almost unique opportunities for medical historians there is
a rich stock of famous doctors and their discoveries, there are also
the contributions of the ancient Universities and of three equally
old Colleges of Physicians and Surgeons". It might be imagined that
having four very ancient Universities - St. Andrews, Glasgow,
Edinburgh and Aberdeen, they would have long been involved in the
education of Scottish doctors, but that is not the case. A post of
'mediciner' was established at King's College, Aberdeen, in 1497 and
for a brief period between 1637 and 1642 there was a Chair of Medicine in Glasgow but this was suppressed by the Church which, at that
time, held the reigns of power in the University.
University medical degrees were not established until the 18th
century and even then most of them were awarded without formal teaching or examination to medical men of good repute who could find
others to sponsor them. The degrees were sought to increase the
status of doctors and also to give weight to those who wished to
practice medicine in England where the earliest degrees obtained by
Scots were called 'Scotch Degrees' in a rather derogatory fashion
because of the ease with which they could be obtained. In fact, a
rather amusing scandal arose in London in which an illiterate London
brushmaker obtained an M. D. from Edinburgh and, armed with it,
applied for a post at the London Hospital.
SCOTTISH CONTRIBUTIONS
M. R. BOND
SCOTTISH CONTRIBUTIONS
M. R. BOND
SCOTTISH CONTRIBUTIONS
10
M. R. BOND
SCOTTISH CONTRIBUTIONS
11
Braid also dealt firmly with a number of other issues, for example he
disproved the existence of many of the phenomena associated with
clairvoyance, proved that the cult of electrobiology was essentially
the process of hypnotism induced by the use of zinc and copper discs,
and showed that several phenomena associated with mesmerism were
subjective, that is of the mind's invention and not a result of
magnetic forces or fluid. Interestingly, at an earlier stage
Bertrand, in France, had come to a similar conclusion.
Despite Braid's work the practice of mesmerism continued
(Townsend 1844) and indeed Elliotson, through the medium of the Zoist
attempted to discredit him on several occasions. A Mr. William Davey
(1862), actually established a Scottish Curative Mesmeric Association
in 1853 well after the publication of Braid's book, and he was joined
in this venture by Gregory, the Professor of Chemistry at the University of Edinburgh, who became President of the Society. It was
supported by a number of eminent Scots in the city, including the
President of the Royal Society of Edinburgh, Sir Thomas Brisbane.
As far as Scotland was concerned the interest shown in mesmerism
and hypnotism faded and the dominant features of the medical scene in
the latter half of the 19th century were related to the discovery of
anaesthesia and the control of surgical sepsis, together with the
rapid development of the specialities of surgery and pathology in
both Glasgow and Edinburgh.
The line of hypnosis was not dead. Braid's work was quickly
taken up in France where the Nancy and Parisian Schools of Hypnosis
were established and it was to Paris that Sigmund Freud went to learn
more of hypnosis from the French neurologist, Charcot, who believed
that hypnosis could be induced in neurotic patients and that the
susceptibility to hypnosis was a sign of hysteria.
Freud is the link between the 19th century and between hypnosis
and psychosomatic medicine, because it was in the early years of the
20th century that his pupils established the formal study of psychosomatic disorders.
HYPNOSIS AND PSYCHOSOMATICS IN THE 20TH CENTURY
Interest in hypnosis for the first 50 years of the century was
almost non-existent in Scotland and prior to the 1950s its use was
seldom mentioned except in relation to treatment of shell shock in
the 1914/18 War by a Scot, Dr. John McDougall.
In the 1950s fresh interest was generated in hypnosis and was
reflected in the fact that Professor Ferguson Rodger, then the Professor of Psychological Medicine in Glasgow, headed a group which on
behalf of the British Medical Association investigated the claims of
12
M. R. BOND
SCOTTISH CONTRIBUTIONS
13
Another Scot who made a significant contribution to psychosomatic medicine was the late Dr. David Kissen who, prior to his untimely death in 1968, carried out a series of studies, some with
Professor Hans Eysenck of London University, upon the relation of
psychological and physiological aspects of personality and proneness
to malignant lung disease. Professor Cairns Aitken of the University
of Edinburgh, currently editor of the Journal of Psychosomatic Research and Professor of Rehabilitation Medicine at Edinburgh University, has made significant contributions to our understanding of
anxiety, as an aspect of psychosomatic medicine, and one of his close
associates, Dr. Lorna Cay, has provided much information about
emotional aspects of heart disease and the rehabilitation of victims
of myocardial infarction.
To conclude, the psychosomatic approach to medicine flourishes
and continues to grow in Scotland. It is appropriate to conclude
this paper with the hope that the present trend towards a wider use
of the psychosomatic approach and integration of hypnosis and allied
techniques into the treatment programmes for those with a combination
of psychological and physiological symptoms will continue.
REFERENCES
Colquhoun, J. C., 1836, Animal magnetism, in: Isis Revelata - "An
Inquiry into the Origins, Progress and Present State of Animal
Magnetism," (Vol I), Isis Revelata, ed.,Maclachlan Stewart,
Edinburgh.
Critchley, M., 1979, "The Divine Banquet of the Brain," Raven Press,
New York.
Davey, W., 1862, "The Illustrated Practical Mesmerist," (6th ed.), J.
Burns, London.
Dingwall, E. J., 1968, "Abnormal Hypnotic Phenomena - a Survey of
19th Century Cases," (Vol.IV), United States of America and
Great Britain, J. & A. Churchill Ltd., London.
Dunbar, F., 1946, "Emotions and Bodily Change," (3rd ed.), Columbia
University Press, New York.
Esdaile, J., "Mesmerism in India and its Practical Application in
Surgery and Medicine," 1846, Longman, Brown, Green & Longman,
London.
Halliday, J. L., The incidence of psychosomatic affections in
Britain," 1945, Psychosom.Med., 7:135-146.
Halliday, J. L., 1948, "Psychosocial Medicine: A Study of the Sick
Society," Heinemann Medical Books, London.
Hamilton, D., 1981, "The Healers, A History of Medicine in Scotland,"
Canongate, Edinburgh.
Millingen, J. G., 1837, "Curiosities of Medical Experience," (Vols.
1 and 2), Richard Bently, London.
Townsend, C. H., 1844, "Facts in Mesmerism," (2nd. ed.) Bailliere,
London.
14
M. R. BOND
Fred H. Frankel
Beth Israel Hospital and Harvard Medical School
330 Brookline Avenue
Boston, MA, 02215, USA
Abstract
The or1g1ns of hypnosis are indisputably clinical, but its
current acceptability and recognition stem largely from the high
calibre of academic investment and the findings in experimental
laboratories in recent years. What we know has been accumulated in
the context of a rigorous adherence to finely developed research
methods, constructive scepticism, and cold facts. Clinical results,
on the other hand, demand flexibility, imaginative phrases, deep
feelings, and even lofty thoughts. The poetry and the science are
both essential for survival.
INTRODUCTION
I have wondered in common with many of you I am sure, about the
appropriate nature of a presidential address. It certainly is poorly
timed for a political statement because it comes toward the end of
the term of office, and the line of succession has already been
established for the coming six years. If I were fortunate enough to
be able to make some extraordinarily valuable pronouncements today in
the hope of returning to office in 1989, you will surely all have
forgotten them by then. On the other hand, the address might be
considered to be something akin to a State of the Nation Address - a
review of where the Society has been, where we are at, and where we
are headed.
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F. H. FRANKEL
17
18
F. H. FRANKEL
19
lation of facts, and yet others whose primary commitment was to the
exercise of fantasy.
It seems that in whichever direction one follows hypnosis, one
encounters this juxtaposition of two seemingly contradictory perspectives - a kind of dualism that seeks to explain the phenomenon in the
irreducible terms of one or another system. Is it physical, or all
psychological? Is it rational, or all emotional? Is it fact, or all
fantasy?
There is little to suggest that either Mesmer or the spirit of
his time could have appreciated the pervasiveness of the purely
psychological, the impact of the emotions, or the influence of
fantasy. Mesmer wrote that the explanation of what he accomplished
resided in his Fluid Theory (Mesmer, 1774) in the physical reality of
a magnetic fluid that could pass through the body of the magnetizer
to the patient. As the world was being opened up at that stage in
history by the dramatic discoveries of modern physics, it comes as no
surprise that the important answers were assumed to lie in that
realm. It is interesting to note however, that despite Mesmer's
written commitment to a physical explanation that he hoped would be
acceptable to science, he was not above performing an elaborate and
theatrical ritual in his clinical practice, obviously aimed at what
we today would regard as the psychological sensibilities of his
patients. His method of magnetizing, we are told, was choreographed
with color and sound. Looking into the rear mirror of history we
must wonder whether he really did settle for an amalgam of poetry and
science - or whether, despite the scientific pretensions of his Fluid
Theory, he was not essentially a poet - a committed 18th century
prototype of the modern science fiction writer, perhaps with less
personal insight.
It is useful to note that in our time, in the field of hypnosis,
the contest is lined up in a way that bears the mark of two centuries
of clinical work, and a half century of modern laboratory investigation. We are confronted by the fact that unbridled clinical
experience with hypnosis is now being pitted against the logical
findings of sophisticated methodology. Perhaps the greatest challenge to the field of hypnosis at this time lies in how we resolve
the differences between a richly imaginative clinical focus and the
facts that emanate from the laboratory, between the poetry on the one
hand and the science on the other. Are they irreducibly different,
or are they interdependent? Are they mutually exclusive, or in the
words of the physicists, are they complemetary?
Modern Hypnosis
It might be useful to take stock again of the artistry that has
been an integral part of the practice of clinical hypnosis since its
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F. H. FRANKEL
inception. Mesmer's purple cape, the music, and the general milieu
surrounding the event in his time had a distinctly theatrical
quality. To this day. many clinicians in the induction procedures
assume the studied pose or the voice inflection of the "hypnotizer."
Their behavior is distinctly manipulative. Whether overtly controling or permissive. the tempo of the directions is slow. and the
speech monotonous. quieting. and reassuring. Patients are offered a
"very enjoyable" or even "momentous" experience; they are perhaps
encouraged to believe they are "entitled" to the reward of a deep
sense of relaxation. They are persuaded to disconnect or disengage
from the workaday world, and to soar with the images that are
suggested directly. or encouraged. Existence becomes purple prose or
sheer poetry. It is onto this substrate that the selected therapeutic strategy is grafted - the numb feeling to displace the pain.
the image of the blood vessels expanding to allow a greater degree of
body heat to reach the fingers or the toes afflicted by arterial
spasm, or the wondrous sense of a great confidence like a pillar of
light growing within oneself. Colorful language. vivid imagery, and
a voyage to a make-believe world are closely woven into the whole
experience.
Some clinicians prefer to strip the event of these embellishments; however, even when the induction procedures are pedestrian.
such as "close your eyes. count to ten and relax". the strategy must
still depend on imagination for its energy. This can be fostered by
allowing a spontaneous unfolding of fantasy; it might be brought on
by asking the patient to use whatever images he chooses to create the
numb feelings. or the warm feelings. or the sense of increasing self
confidence. This latter approach is generally favored by those who
graduate to clinical work through a previous involvement in investigative studies in the laboratory. Many clinicians seem to show
little preference for this paler version of hypnosis, while still
others assume a style of practice that lies somewhere in between.
There are few if any dependable studies reporting on the incidence of
the different styles or on their comparable efficacy. My own inclination has been to deemphasize the theatrical in hypnosis, and to
come down on the somewhat conservative side of my ambivalence. Both
my practice and my teaching reflect this. My patients are often
invited to participate in the event. motivated not only by the wish
to get well. but also by a spirit of adventure and curiosity.
I believe I chose to follow this line because of my respect and
continued admiration for the investigative studies that have emerged
in recent decades. By casting hypnosis in a casual mould. stripped
of its magic and mystique, investigators have made it real; their
work with standardized procedures has led to major developments.
With the refinement of the hypnotizability scales and an increasingly
impressive methodology. they have uncovered several parameters of
hypnosis - some of which might have been suspected while others came
as a surprise. Working largely with volunteers from the college
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F. H. FRANKEL
larger than life. This latter aspect seems to belong more to the
hypnotic situation, than to hypnosis. It is carried in the style,
in the language, and in the ambience. Let me try to explain as I
proceed.
In a great spirit of compromise, or possibly complementarity,
the late Ronald Shor described hypnosis as possessing three dimensions (Shor, 1962). The experience of the altered perception or
trance is but one. The other two include the important and special
relationship between the subject and the individual carrying out the
procedure, and the subject's interest in and motivation to participate in hypnosis. This interpersonal interaction, and the inner
preparedness to respond to the hypnosis exert considerable influence
on the way in which the hypnosis proceeds.
In the clinical setting these dimensions are particularly complex, involving many other psychodynamic forces, the attitude of the
patient to his illness, his expectations of hypnosis, the environmental factors - all of which influence the patient's ultimate
response to hypnosis and his symptomatic response to the therapy. It
should be remembered that these two factors, namely the relationship
and the motivation, are equally relevant to the progress of any other
form of psychotherapy. We who use hypnosis are not alone. All who
practice psychotherapy depend, for the effectiveness of their
methods, on the strength of the relationship and the patient's deep
interest in improving.
It is unfortunate that the theoretical and investigative concept
of the altered perception, useful as it is, when examined out of
context conveys a predominantly intellectual interpretation of the
event of hypnosis. While this does an injustice to the idea as it
was originally formulated (Orne, 1959) there is no escaping the
inhospitable reaction to it among many clinicians. Perhaps it is
because the other factors contributing to the hypnotic situation
appear to receive short shift in comparison. Perception is discussed, described, and measured. Even though subjective it qualifies
as science. On the other hand the importance of the interpersonal
relationship involved in hypnosis, the rapport, or the transference,
and the sum total of the psychodynamic forces which influence motivation, acknowledged though they be, still appear to be relegated to
a minor role. They are essentially the derivatives of feelings,
ubiquitous, and challenging to any would-be scientist. They promote
the illusions and give life to the metaphors; and as such they are
the poetry.
Few clinicians will deny the importance of the therapeutic
relationship, whether they regard 'it merely as rapport, or whether
they invest it with the complexities that make up the psycho-analytic
transference. The psychiatric literature is replete with references
to the phenomenon. We know it has much to do with the emotional
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F. H. FRANKEL
25
26
F. H. FRANKEL
Conclusion
I propose that we have, in a sense, been dealing with the ageold contest between the head and the heart. History amply chronicles
the shifts from romance to reason, and then back again. In the
search for truth our reach seems always to exceed our grasp; functioning in the one mode seems to interfere with our effectiveness in
the other. We fail to acknowledge the romance when we plod the heavy
path of logic; and we repudiate the rational when caught up in the
exuberance of the spirit. Clearly, neither reason nor romance alone
can lead us to the answers. In hypnosis, one is the life blood of
the other.
If the field is to survive as an academically and clinically
acceptable entity, it must remain poised between an imaginative blend
of illusion and affect on the one hand, and cold objectivity on the
other. A seasoned perspective demands that we encompass and pay
homage to both viewpoints. I submit, however, that one crucially
important caveat must be added. Above all, the seasoned perspective
demands that we know how to tell them apart. While paying homage to
both we need to learn how to recognize that which is the voice of
poetry, and how to differentiate it from the substance of science.
REFERENCES
Bohr, N., 1934, The quantum postulate and the recent development of
atomic theory, in: "Atomic Theory and the Description of
Nature", Cambridge, University Press, New York, Macmillan Co.
Einstein, A., 1924, Das Comptonsche Experiment, Berliner Tageblatt,
Suppl. p. 1.
Ellenberger, H. F., 1970, "The Discovery of the Unconscious," Basic
Books Inc., New York.
Frankel, F. H., Apfel, R. J., Kelly, S. F., Benson, H., Quinn, T.,
Newmark, J., and Malmaud, R., 1979, The use of hypnotizability
scales in the clinic: A review after six years, Int.J.clin.
exp.Hypnosis, 27:63-73.
Frankel, F. H., and Orne, M. T., 1976, Hypnotizability and phobic
behavior, Archs.gen.Psychiat., 33:1259-1261.
Hilgard, E. R., 1965, "Hypnotic Susceptibility," Harcourt, Brace and
World, Inc., New York.
Hilgard, J. R., 1970, "Personality and Hypnosis: A Study of
Imaginative Involvement," University of Chicago Press,
Chicago.
Lindemann, E., 1945, Symptomatology and management of acute grief,
. Am.J.Psychiat., 101:141.
Mesmer, F. A., 1948, Memoire sur la decouverte du magnetisme animal,
Geneva, 1774, With the Precis historique ecrite par M.
Paradise en mars 1777, Paris, Didot, 1779, English version:
Mesmerism by Doctor Mesmer Dissertation on the discovery of
27
Ernest R. Hilgard
Department of Psychology
Stanford University, Jordan Hall, Building 420
Stanford, C A 94305, USA
Abstract
The distinction between what is conscious and what is unconscious in human mentation is by no means clear and obvious. The
problem arises because unconscious processes which are of interest
are those which closely resemble conscious ones. Completely
"unconscious" processes such as homeostatic mechanisms and habits
that have become automatized are not relevant in this connection.
The frequent assertion that one can "talk directly to the
unconscious" in hypnosis is not a precise statement. The "hidden
observer" approach provides a method for examining the basis for such
claims.
E. R. HILGARD
30
Heightened Suggestibility
The interpretation of hypnosis that for many years was most
popular in America was that hypnosis was the study of suggestibility.
This was noted in the title of Clark Hull's book, Hypnosis and
suggestibility: an experimental approach, published in 1933. Hull
was an out-and-out behaviorist, who preferred to measure movements
and time-relations in as physical a manner as possible. His book was
a model of good experimentation and the statistical tests of differ-
31
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E. R. HILGARD
33
(see Gill, 1967). Ernst Kris (1952) had proposed the concept of
regression in the service of the ego - a partial regression that
could be halted and reversed, particularly in the support of the
creative thinking of the artist. This idea then became the basis for
the interpretation of hypnosis by Gill and Brenman (1959), two
American psychoanalysts who made extensive use of hypnosis in their
practice.
According to their view, hypnotic induction disrupts the ordinary ego structure, and the fractions that remain are then reassembled at a more primitive level as the hypnotic condition is
established. The thought processes that persist at a partially
regressed level give evidence of what is called primary-process
thinking, to distinguish between it and ordinary rational thinking
and problem-solving known as secondary process thought. Primaryprocess thought is more primitive, illogical and impulsive. By
definition, fantasy and hallucination are taken as signs of primaryprocess thinking. This assignment of hallucination to primaryprocess is based on selecting the dream as the model of primaryprocess thinking, because the dream goes on primarily in the form of
visual hallucinations rather than in words. The presence of fantasied and hallucinated experiences in hypnosis makes it clear that, by
these definitions, the hypnotic consciousness gives signs of primaryprocess thinking and therefore illustrates regression.
In their effort to make an experimental approach to this problem, Fromm et al., (1970) studied the presence of primary-process
thinking in a group of moderate to high hypnotizable subjects by
administering the Rorschach inkblot test in both the waking and the
hypnotic condition. They found, not unexpectedly, that there was
more primary-process thinking evidenced in hypnosis than in waking,
as judged according to scoring system of Robert Holt (1963). However, they did not find convincing evidence for an adaptive regression, that is, regression in the service of the ego, as posited by
Gill and Brenman.
I find some limitations to an experiment of this kind. In the
first place, the assumption is made that after hypnosis the subject
is in an altered state of consciousness that has its own defining
characteristics. The conception of a characteristic hypnotic state
may lead to the faulty conception of a 'neutral' state of hypnosis,
that is, the state while the hypnotized person just sits or lies
there, doing nothing. If a relaxation hypnosis has been undertaken,
then this may well be a state of relaxation, as described by
Edmonston (1981), who equates hypnosis with relaxation. However,
hypnosis may also be an aroused state, as Banyai and I (Banyai and
Hilgard, 1976) showed by inducing hypnosis while the subject rode a
laboratory bicycle ergometer. The conscious condition and the physiological condition, under hypnosis, depend on what the patient is
doing while hypnotized. Consequently, physiological processes while
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E. R. HILGARD
35
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E. R. HILGARD
The preconscious is usually conceived as the residue of available memories, not conscious only because they are not attended to.
Unlike the unconscious, they are not the result of repression. If
one uses a familiar conception of hypnosis on the basis of concentrated attention to one source of information with neglect of other
information, one can easily think that the neglected information
belongs to the preconscious. I find this congenial because the
preconscious can be used as equivalent of divided consciousness, for
when the preconscious is made conscious there are no unusual surprises in it, the material that emerges was once conscious, and
emerges as such.
But what about the deeper unconscious? In psychoanalysis, this
is inferred from its derivatives. Yet some of our colleagues like to
speak as if, through hypnosis, they can talk to the unconscious.
Let us be a little clearer about this. A favorite technique has
been to use finger signalling while hypnotized (Cheek and LeCron,
1968). An open discussion has been carried on between the hypnotized
person and the hypnotist. The hypnotist may suspect, on psychodynamic grounds, that there is a hint of unconscious material that
may contradict the open conscious report. Suppose, for example, that
the inference is that a male patient hated his mother, but he insists
that he loves her wholeheartedly and nothing untoward ever went on
between them. Anyone familiar with dynamic interpretations will know
about the ubiquity of ambivalence, so that it is a fairly safe inference that all was not so uniformly loving and congenial. Hence the
finger technique can be used to expose a deeper level. I have seen
this done and carried on to still deeper levels. It was concluded
that at last the hypnotist was talking to the unconscious. I am not
questioning the fact that this procedure may have turned out to be
therapeutic, but I doubt that the hypnotist was talking to the unconscious. The unconscious is not a directly accessible repository
of memories or wishes or warded-off affects. It is a metaphorical
concept that has to be used cautiously in relation to broader aspects
of a theory of motivation and personality, and is not to be used
glibly, no matter how serviceable the metaphor may be in some instances. It can lead to such abuses as uncovering birth experiences
and prior lives, such extensions will make it more difficult for
hypnosis to find its rightful place in psychological and medical
science.
Dissociation Theory as an Alternative
A rather different view of the relationship between the conscious and the subconscious was proposed by Pierre Janet. I use the
word subconscious rather than unconscious because that was the term
that Janet introduced, even though he spoke more frequently of dissociation. Janet viewed dissociation as pathological, related to
37
38
E. R. HILGARD
called hidden observers. Therefore it was a finding of more theoretical than practical interest because it was rare, and the conditions for its appearance were not clearly known. It turned out to
have been discovered by others in the past, such as Alfred Binet and
William James, but was relatively unfamiliar in contemporary experimental hypnosis. I am aware of the criticisms offered against the
hidden observer concept, but I cannot take time to examine the debate
at this point except to note that most of those who object are also
critical of the reality of psothypnotic amnesia and of pain reduction
through hypnosis.
Offhand, this looked a little like unconscious processing. I
prefer, however, to relate it to the literature on subliminal registration, and, in terms of the models about which I have been speaking, to attribute it to the preconscious rather than to the unconscious. When the concealed material is brought to consciousness
through automatic writing or through a related technique that I have
called automatic talking, the language is that of secondary process,
and there is no welling up of deep thoughts or feelings associated
with the unconscious. These experiments were quite limited and
others are carrying them on. I hope that some experimenters will use
more affect-loaded or guilt-arousing episodes than laboratory experiences of pure tones, or the pain of circulating ice water or of a
tourniquet on the arm, which express little personal meaning. Possibly such experiences would dredge up more deeply repressed material
through the hidden observer inquiry.
The advantages of the dissociation position, as I use it, is
that it permits recognition of the partial dissociations that occur
in response to simple suggestions, when the only modification of
consciousness is in the automatization of a simple act that is otherwise performed voluntarily. The executive control systems are the
first to respond to suggestions, as they are the first responses to
occur in imitation. other kinds of dissociation, such as multiple
personalities, are most difficult, and appear less frequently in a
population of patients. One can study these matters, and attempt to
theorize about them, without adopting a fixed position about hypnosis
as an altered state of consciousness, or as a derivative of the deep
unconscious.
REFERENCES
Banyai, E. I., and Hilgard, E. R., 1976, A comparison of activealert hypnotic induction with traditional relaxation,
J.abnorm.Psychol., 85:218-224.
Barber, T. X., 1969, Hypnosis: A scientific approach, Van Nostrand,
New York.
Barber, T. X., 1979, Suggested ("hypnotic") behavior: The trance
paradigm versus an alternative paradigm, in: "Hypnosis: Devel-
39
40
E. R. HILGARD
42
In this paper on "the clinical relevance of hypnosis in psychosis". we will examine two basic questions. The first question
deals with the nature of hypnosis and psychosis: why can we reasonably expect psychotic patients. especially the schizophrenic ones. to
be able of experiencing hypnosis. in spite of their often severe and
bizarre thinking disorders? In trying to answer that question. we
will contend that as long as metaphoric and metonymic thinking and
communication is present in the schizophrenic experience. hypnosis is
a potentiality. And we will report some data in support of this
point of view.
The second question deals with the distribution of hypnotic
responsivity in schizophrenic samples. and some of the parameters of
hypnotizability in schizophrenia. Here we will attempt to demonstrate that the mean susceptibility score of available schizophrenic
samples cannot be said to differ from the mean susceptibility scores
of comparable normal samples. The dispersion of individual scores
around the samples' means. however. is typically smaller with schizophrenic samples than with normal comparable samples. a fact that
still awaits proper explanation.*
METAPHORIC LANGUAGE. PRIMARY PROCESS AND HYPNOSIS
A striking characteristic of the literature on hypnotic techniques lies in the fact that the hypnotist typically appears to act
upon the meaning of the words he uses. At this end. he largely
relies on the use of two widespread figures of speech: metaphor and
metonymy. and upon the primary process "techniques" underlying these,
i.e. chiefly. condensation and displacement (Jakobson. 1956).
Metonymy consists of the use of the name of one thing for that
of another. of which it is an attribute. or with which it is associated. Examples of this are: "lands belonging to the crown" or "smoke
a havana". If we refer to the "first violin of the Glasgow orchestra". we are not speaking of the concrete musical instrument, but of
this specific musician as a person. The first meaning of "violin".
however. is not abolished. but only temporarily put aside.
Metaphor is defined as a figure of speech in which a word or
phrase literally denoting one kind of object or idea is used in place
of another to suggest a likeness or analogy between them. As
examples: "the ship plows the sea". or. in Erickson's words: "My
English is rusty". or "in my voice, you can hear the whispering wind.
the rustle of leaves". Similarly. when Erickson was treating an
impotent patient by speaking extensively about cigarette smoking and
*The authors wishe to thank Professors R. R. Holt. M. T. Orne and C.
Perry for their helpful comments.
HYPNOTIZABILITY IN PSYCHOSIS
43
44
HYPNOTIZABILITY IN PSYCHOSIS
45
46
HYPNOTIZABILITY IN PSYCHOSIS
47
48
indexes are derived. one can find the formation of composite images.
arbitrary combination of separate percepts. arbitrary use of color.
puns and ma10propisms. hyperbole and inappropriate simile. displacement in time. explicit use of symbolism. impressionistic language.
peculiar verbalizations and some types of contradiction of reality.
Altogether. it is the amount of such occurrences that constitute the
numerator of our index for socialized forms of primary process (SF
ratio). Many of these form-varieties of primary process were found
to be significantly increased under hypnosis (p <.006) in a study by
Gruenewald. et a1 (1972) with normal Ss. In contrast. the AF index
includes such categories as autistic logic. autistic elaboration and
verbal incoherence. well illustrated in the previously reported
example from Neal and Oltmanns (1980).*
These measures were recently applied to Rorschach protocols
previously collected and scored on a sample of 56 male psychotic
patients. mainly schizophrenics. who had also been evaluated with the
Stanford Scale Form A (SHSS:A) (Lavoie. et a1 1976. for a detailed
account of the experimental procedure for collection of the data).
HYPNOTIZABILITY IN PSYCHOSIS
49
55
More hypnotizable
~I
~
~
~
~
~
~
50
Less hypnotizable
45
40
35
30
25
20
15
10
5
Absent (N
= 14)
.01-.65 (N
= 22)
.66-2.17 (N
= 20)
Fig. 1.
50
75
~ More hypnotizable
65
...
~I
~ Less hypnotizable
..,
o
21. 55
....c
...u
8!.
45
35
25
15
5
0-50 (N = 18)
51-75 (N 18)
76-100 (1'1
= 20)
Fig. 2.
HYPNOTIZABILITY IN PSYCHOSIS
51
8
7.64
Kramer
& Brennan
6.53
Vingoe
& Kramer
(1964)
7
>,
+'
:0
(1966)
:;::;
0OJ
<Il
:>
<Il
c::
'"OJ
5.82
5.78
5.64
Greene (1969)
Lavoie et al. ( 1973)
SHSS:A
:;:
4.81
4.80
4.05
3.99
HIP
2.30
1.71
1.56
Fig. 3.
BSS
NORMATIVE DATA
Let's now examine the available evidence concerning the level
and variations of hypnotizability in schizophrenia.
Figure 3 presents in decreasing order of the values of the
means, the results from 12 studies having used individual assessment
of hypnotizability with schizophrenic patients. Three (3) of these
used the Barber Suggestibility Scale (BSS; Barber, 1969) and reported
52
means of 1.56 (N = 194), 1.71 (N = 64) and 2.30 (N = 80) respectively. One (Spiegel et al., 1982) used the Hypnotic Induction
Profile (HIP; Spiegel, 1974) and reported a mean of 3.99 for a subgroup comprised of 18 schizophrenics, 4 schizoaffective disorders and
1 paranoid state. The eight (8) studies using the Stanford Hypnotic
Susceptibility Scale, Form A (SHSS:A; Weitzenhoffer and Hilgard,
1959) reported means ranging from 4.05 (Lavoie et al., 1978) to 7.64
(Kramer and Brennan, 1964). The combined mean for the three studies
using the BSS is 1.76 (N= 338), while the combined mean (see Table 1)
for the SHSS:A is 5.32 (SD = 2.29, N = 306). No other parameter
seems to be more determining than the psychometric structure, especially the number and type of items in the scale, to explain these
differences (compare also Lieberman, 1975 and Lieberman et al.,
1978).
DATA FROM THE SHSS:A
Table 1 presents SHSS:A (12 items) results for seven (7) samples
of schizophrenic patients and eight (8) subgroups of normal ~s. One
sample of schizophrenics (Greene, 1969) was excluded from the computation since Greene used only 10 of the 12 standard items. The mean
age for the 306 patients is 42.0 (SD = 10.22; range 17-63). The
estimated corresponding age mean for 217 normal Ss is close to 37
(range 29-73). The mean hypnotic scores for the-patients' ~ample
vary from 4.05 to 7.64, and the SD 2 from 3.39 to 7.13. The mean
hypnotic scores for normal Ss vary from 4.5 to 7.3, and the SD2 from
9.61 to 13.69. The average-susceptibility score for the 306-Patients
is 5.32 (SD 2 = 5.26) compared with a mean susceptibility score of
5.79 (SD 2 = 11.56) for 217 normal Ss. Two outstanding features ot
this table deserve consideration: -first, the sampling variations of
the means across samples of schizophrenics is quite similar to sampling variations of the means in normal subgroups of increasing age.
This is a good example of a limited sampling distribution when the
means of a number of more or less biased samples tend to cluster
around a central mean presumably representative of the true mean of
the total population of schizophrenics. Second, there is no overlap
between the distribution of SD 2 scores in schizophrenic samples and
the distribution of SD2 scores in normal subgroups. The variance is
consistantly lower with schizophrenic than with normal groups.
Actually, the overall variance for the 217 normal Ss (11.56) is more
than twice as great as the overall variance for the 306 schizophrenics (5.26) (F = 2.198, p <.001).
In contrast, Spiegel et al., (1982) reported HIP variance for
patients with thought disorders (10.18) was twice as great as his
reported HIP variance for normal control Ss (5.02), exactly the
opposite of the results presented here with the Stanford Scale, Form
A. This lends additional support to the demonstration that the HIP
HYPNOTIZABILITY IN PSYCHOSIS
12
11
SCHIZO. (N-306,
Age: M '~42; SD
53
7 samples)
NORf1ALS (N=114)
~~10.22
Age: 29-36
NORf-1ALS (N-103)
Age: 37-up
10
c(
Vl
Vl
:c
Vl
:;;
-;::;
8
7
a.
.....................X: 6.5
QJ
VI
:::>
VI
c:::
'"
QJ
'"
.................................... X:
5.3
.. X:
5.1
4
3
2
Fig. 4.
Mean SHSS:A score, with one SD below and beyond the mean,
for 7 samples of schizophrenics and 8 samples of normal Ss
from Morgan and Hilgard (1973).
54
Table 1.
Nonna1s
(Morgan & Hi1gard, 1973)
(Age:x ! 42.0;SO!10.22)
FV
FV
S02
25
7.64
5.24
15
6.53
4.84
FV
45
5.82
4.33
MV
32
5.78
6.15
FMcv
54
5.64
7.13
Mcv
56
4.80
3.39
Mcv
79
4.05
5.11
306
5.32
5.26
TOTAL
S02
29
5.2
13.69
34
7.3
9.61
25
6.5
10.24
26
6.7
12.25
6.45
11.39
Age
29-36 114
14
4.5
10.24
24
5.0
12.25
r~
31
5.4
13.69
34
5.0
10.24
Age 1
37-73 03
5.05
11.75
217
5.79
11.56
HYPNOTIZABILITY IN PSYCHOSIS
55
the 29 to 36 age range, totaling 114 Ss, and the right part, the
means of four (4) groups of normal Ss: 37 years and older, totaling
103 SSe Each mean is accompanied by a line representing 1 SD beyond
and 1 SD below the mean. Figure 4 illustrates the data presented in
Table ~ The variance is smaller in all the schizophrenic groups
than in any of the normal groups. The variation of the distribution
of the means in schizophrenics is similar to the variation of the
distribution of the means in normals. The overall mean of the 306
schizophrenics (M = 5.32, SD 2 = 5.26) falls between the mean of
normals in the 29-36 range-of age (M = 6.45, SD 2 = 11.39, N = 114)
and the mean of normals, 37 years of age and older (M = 5.05, SD 2 =
11.75, N = 103).
Further inspection of the distribution of the schizophrenics'
means in Table 1 and Figure 3 reveals that the highest means were
obtained in three (3) samples, where ~s were female, volunteering for
experiment, and where on the whole, 38.4% of the initially identified
sample were ruled out of the experiment. The highest mean of 7.64
(SD 2 = 5.24) (Kramer and Brennan, 1964), from 25 female patients, 28
years of age (X) does not differ significantly from Morgan and
Hilgard's (1973) reported mean of 7.34 (SD 2 = 9.1) for 172 normal
female Ss, aged 21 to 36. Therefore, Kramer and Brennan's mean is
not especially "high", as has been reported by numerous authors
including ourselves, but is in line with comparable normal means.
The lowest means were obtained with male schizophrenics, defined as
coerced volunteers, and where very few patients from initial samples
were excluded. Given a standard measure of hypnotic responsivity,
high-and-low scoring schizophrenic samples differ significantly among
themselves essentially because of a conjunction of 4 main factors:
age, sex, type of volunteering, and - as we have seen (Figures 1 and
2) - the capacity of the patient for a shared, socialized use of
signs, images and symbols.
DISCUSSION
It should be clearly understood that results presented here in
Figures 1 and 2 are not tantamount to a demonstration that hypnotizability is linked with "mental health" per see Such a view would
rapidly lead to a dead-end. There is enough evidence (see Figure 4)
that you can be very sick and hypnotizable, and that you can be in
good mental health and barely hypnotizable. What our results do
suggest is that across the whole spectrum of normality and psychopathology, one of the conditions of hypnotizability is a certain
inclination to metaphoric thinking, and a capacity to establish a
communication along this pathway, with minimal disruption from either
the censorship or critical thinking (that would indicate full restoration or ordinary waking life controls and/or failure of the selective controls of hypnosis) and with minimal instrustion of autistic
material (that would indicate failure of ordinary waking life controls and/or failure of the selective controls of hypnosis).
56
This post hoc analysis of our 1976 data (Lavoie et al., 1976)
seems to have more heuristic value than our previous report on adaptive regression. The study of form-varieties of primary process such
as condensation, displacement, symbolization, metaphor and metonymy
is of interest to all specialities of clinicians and researchers in
the clinical field. It is further at the core of differential diagnosis, psychotherapy, and cover the whole range of normality, creativity and psychopathology. It is amenable to experimentation, with
or without hypnosis, and can be readily scored from projective techniques or from free interview transcripts. In contrast, the adaptive
regression theory of hypnosis, such as proposed by Gill and Brenman
(1959) is, from a conceptual point of view, very difficult to apply
in groups of patients precisely characterized by severe pathological
regression. This was, according to Gill and Brenman (1959) a
"crucial" problem for their theory.
Whatever the inner connection between the many interrelated
form-varieties of primary process (see Footnote 3), we could demonstrate, in this sample, that they lead to hypnosis to the extent
where they convey a shared meaning. And they prevent the development
of hypnosis to the extent that they appear queer, incoherent, or
autistic. It is therefore a certain agreement of the sender and of
the receiver concerning the signification of a given message, even if
far-fetched, that support the hypnotic relationship. As long as this
agreement persists, the considerations of representability are expended: the thoughts that can, through-displacement, be meaningfully
replaced by substitutive images and symbols is astonishingly high,
and monitored imaginative processes are permitted (J. R. Hilgard,
1979).
Concerning the hypnotizability of schizophrenic patients, evidence presented here in Table 1 and Figures 3 and 4 compelling:
schizophrenic patients do present mean susceptibility scores essentially similar to the ones obtained by normal Ss of comparable age.
Their scores cover the whole range of susceptibility (0-12) although
the standard deviation is significantly lower than with available
samples of normal ~s. In the total sample, the scores of psychotics
tend to cluster around the mean, in the middle range of susceptibility, and suggest that there is likely to be a lower occurrence of
very high and/or very low scores. However, both the available experimental and clinical evidence do indicate that high hypnotic
responsivity is not incompatible with a diagnosis of psychosis and/or
schizophrenia (Lavoie and Sabourin, 1980; Baker, 1981; Podvoll,
1979).
The belief in lower hypnotizability for psychotic and schizophrenic patients generally seems to result from 7 main sources of
bias (1) the failure of most studies (except Gordon, 1973; Horne et
al., 1981; Pettinati, 1982) to compare the mean of patients with that
of normal Ss of the same age; age does appear to be the single most
HYPNOTIZABILITY IN PSYCHOSIS
57
58
One way of approaching the problem would be the study of schizophrenic' hypnotizability as a function of demand characteristics
(Orne. 1962. 1969. 1972). In effect. this concept does remind us
that there can be no univocal correspondence between a given clinical
or experimental observation and its meaning or interpretation. One
has to keep into account the six corners of signification. as defined
by Van Lier (1980): (1) the sender. (2) the receiver. (3) the signifier. (4) the signified (the concept or mental scheme). (5) the
interpreters ("interpr~tants"). or alternative signifiers. and (6)
the referent in reality.
Distinguishing genuine hypnotic experience from compliance would
be a first target for research. It may be that the scarcity of very
low scores on SHSS:A reflects the tendency of the patient to comply
with the various requests by doctors. and the fear of disappointing
the experimenter or the clinician. This could readily be illustrated
in several individual protocols. To what extent this model could
partly account for the scarcity of high hypnotic scores is more
problematic. But as long as there is a widespread unfounded belief
that "schizophrenics are not hypnotizable". the ones who will get a
12 on SHSS: A will be regarded with suspicion. And schizophrenics do
know as well as anyone else what doctors expect from them. From a
clinical point of view. feigning (Lacan. 1981) or simulation (Orne.
1962). if present, could be as instructive, in view of the theory
presented here. as hypnotizability itself.*
*The complexity of meaning is best examplified in two critical
instances of human communication: simulation. and testimony. Orne
(e.g. 1982) studied both with experimental or quasi-experimental
methods. The French structuralist Jacques Lacan put both at the
root of inter-subjective relationship: "Feigning is the hallmark of
the relationship between two subjects. by which it can be distinguished from the rapport from a subject to an object You know you
are in presence of a subject to the'extent that what he says and
does can be supposed to have been said or done in order to feint
you. with all the dialectic so implied. up to and including the
possibility that he tells the truth in order to make you believe he
is lying What the subject says is always in a fundamental relationship with potential feigning. where he sends and where I
receive the message in an inverse form It is essentially this
unknown in the otherness of the other. which is characteristic of
the spoken word as spoken to another subject This structural
description is the only appropriate basis for stating the problems." (Lacan. 1981).
And about testimony: "It is clear that everything that has some
value as a communication. is in connection with testimony The
whole thinking of scientists is based on the possibility of a communication whose terms could be settled once and for all in an ex-
HYPNOTIZABILITY IN PSYCHOSIS
59
conti
periment about which everybody could agree. The founding of the
experiment itself is a function of testimony." (Lacan. 1981).
It is out of the scope of this paper to develop Lacan's thinking
about feigning, testimony and acknowledgement of the unknown in
otherness. For him. these issues are at the root of any possible
distinction of the three essential orders of the psycho-analytic
field. namely the Real, the Symbolic and the Imaginary (Lacan 1981)
and they are basic to his theory of psychosis. Lacan introduced the
term "Foreclosure" (Repudiation) denoting a specific mechanism held
to lie at the origin of the psychotic phenomenon and to consist in a
primordial expulsion of a fundamental "signifier" from the subject's
symbolic universe" (Laplanche and Pontalis, 1973). "Foreclosure
consists in not symbolizing what ought to be symbolized (e.g. castration): it is a "symbolic abolition," One might say that the
lifting of this "abolition" is correlative of the re-establishment
of the primacy of the symbolic order in inter-subjective relationships, and is at the basis of a reasonable discrimination between
reality and imagination.
60
HYPNOTIZABILITY IN PSYCHOSIS
61
1846. This abridged account is found in A. E. Waite. Synopsis of counter-experiments undertaken by James Briad to
illustrate his criticism of Reichenbach. Appendix III,
352-361, in J. Braid, 1889. Another abridged version, 3-19,
31-36, is reprinted in: "Readings in the history of psychology", W. Dennis, (ed-:), Appleton-Century-Crofts, New York,
178-193.
Erickson, M. H., Rossi, E. L., and Rossi, S. I., 1976, Hypnotic
realities: The induction of clinical hypnosis and forms of
indirect suggestion, Irvington, New York.
Fliess, R., 1959, On the nature of human thought: The primary and the
secondary processes as examplified by the dream and other
psychic productions, in: "Readings in psychoanalytic psychology," M. Levitt (ed.)-,-Appleton Century Crofts, New York,
213-220.
Frankel, F. H., and Orne, M. T., 1976, Hypnotizability and phobic
behavior, Archs.gen.Psychiat., 33:1259-1262.
Freud, S., 1953, The interpretation of dreams, Standard Edition, 4
and 5. Hogarth Press, London, 530.
Freud, S., 1957, The unconscious, Standard Edition, 14. Hogarth
Press, London, 166-215, 187.
Freud, S., 1960, Jokes and their relation to the unconscious,
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Freud, S., 1964, Splitting of the ego in the process of defence,
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Gill. M. M and Brenman. M 1959. Hypnosis and related states:
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normal males matched for age. Int.J.clin.exp.Hypnosis.
21:284-288.
Greene. J. T. 1969. Hypnotizability of hospitalized psychotics,
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Ham, W. M., Spanos, N. P., and Barber, T. X., 1976, Suggestibility
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62
Hilgard, J. R., 1979, Personality and hypnosis: a study of imaginative involvement, (2nd. ed.)., University of Chicago Press,
Chicago.
Holt, R. R., 1963, Manual for scoring of primary process manifestation in Rorschach responses, (9th ed.)., Research Center for
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Jakob son , R., 1956, Two aspects of language and two types of aphasic
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raison depuis Freud, in: "La psychanalyse," 3:47-81. (Reprinted in Lacan, J. Ecrits, Editions du Seuil, Paris, 1966.
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Int.J.clin.exp.Hypnosis, 21:157-168.
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Lavoie, G., Lieberman, J., Sabourin, M., and Brisson, A., 1978,
Individual and group assessment of hypnotic responsivity in
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Bicentennial: Selected papers," F. H. Frankel and H. S.
Zamansky (eds.), Plenum, New York, pp. 109-124.
HYPNOTIZABILITY IN PSYCHOSIS
63
64
IN SEARCH OF HYPNOSIS
Andre M. Weitzenhoffer
Veterans Administration Hospital
921 N. E. 13th Street
Oklahoma City, Oklahoma, USA
Abstract
Starting out as de Puysegur's "magnetic somnambulism," hypnosis
has gone through a number of transformations over the last 140 years,
culminating in today's "Ericksonian hypnosis." Factors leading to
the changes are discussed. There have been many, clinicians rather
than researchers having the main influence upon this transformation.
In contrast to earlier research, carried out prior to 1920, modern
research has contributed very little new to our understanding or
utilization of hypnosis. Some of the reasons for this are also
examined.
Today we are faced with no certainty that what passes as hypnosis is the same as what passed for it 140 years, or even 50 years,
ago. Nevertheless, when we speak of hypnotism most of us have in
mind the phenomenology that essentially characterized hypnotism prior
to 1910. These are the phenomena also ascribed to de Puysegurian
somnambulism. It needs to be recognized that the latter condition
probably occurs in less than 1% of individuals; thus it is rarely
encountered in the laboratory and office. The proper study of hypnosis, nevertheless, should focus on this group rather than on the
much larger group of suggestible but nonsomnambulistic subjects, as
has been the case in recent times. Implications of these considerations and speculations regarding traditional hypnosis conclude the
presentation.
67
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A. M. WEITZENHOFFER
IN SEARCH OF HYPNOSIS
69
Whence came the authoritarian element in this phase of hypnotism? I could only speculate. Since I do not see it as representing
a significant conceptual change or leading to one, I will limit
myself to saying there are several possible origins for it and leave
it at that. On the other hand, the shift from hypnosis as an all-ornone state to a graded one, does represent a major conceptual change
which bears further discussion. This becomes more evident when one
considers that, whereas for de Puysegur and Braid artificial
somnambulism was the whole, entire state, by 1947 artificial
somnambulism was merely viewed as the upper range or segment of a
scale.
In this transformation, the hypnotism of Braid had lost its
unique identity to become a part or aspect of a wider condition now
given the label "hypnosis." Hypnotism had thus been redefined. Put
another way (using Braid's criteria for hypnotism), the hypnosis of
1947 included behavior he would not have agreed to call hypnotic!
As many of you know, this state of affairs came about mainly as
the result of the work of Liebeault, and especially of Bernheim.
Influenced in this by Faria, Liebeault introduced suggestion as a
major tool in the production of hypnotic phenomena. It was left for
Bernheim to elaborate this use and to point out in 1886 that: (1)
suggestibility is to be found in non-hypnotized as well as hypnotized
individuals; (2) in either case, it is found present in different
degrees; (3) hypnosis is a state of enhanced suggestibility par
excellence; (4) hypnosis is a physiological state which can be
brought about by appropriate suggestions alone. Bernheim reached
these conclusions strictly on the basis of informal observations made
in the course of working with hypnotism. While he did perform some
elegant formal experiments to test various issues, there is no evidence that he ever formally tested any of these points. However, if
by hypnotized and non-hypnotized we understand a formal induction of
hypnosis has been or has not been performed, then all but the last of
these propositions are demonstrable. Bernheim made an important
BRA 10' S HYPN OTiSM
~ ..........
\
oI
REFRACTORY THROUGH DEEP
HYPNOSIS
' .....
,,
...................
' .....
"
""'>1
SOMNAMBULISM
"--------------~-------------~
MODERN CONCEPTION OF HYPNOSIS
Fig. 1.
MAX
70
A. M. WEITZENHOFFER
fifth proposition: (5) hypnosis has depth or degree, and the latter
is measured by the suggestibility of the hypnotized subject.
Although this last proposition appears most reasonable, it cannot
logically be deduced from the other four propositions, nor is it
demonstrable. This fifth proposition holds a further gratuitous
assumption: that individuals are hypnotized if they show any degree
of suggestibility following the use of a formal induction.
In the light of these observations, there is little scientific
validity in the position that the study of hypnotism from Bernheim on
has been entirely the study of Braid's hypnotism.
Although he failed to do so, Bernheim had the possibility of
insuring some sort of continuity with Braid's concept of hypnosis.
For Bernheim also ascribed to the notion that a spontaneous, i.e., a
non-suggested, post-hypnotic amnesia, occurred with some subjects.
And even though he seems to have felt obligated to place these subjects on his continuum of hypnotic depth, he also appears to have had
some difficulty doing so. He compromised by distinguishing a range
of hypnotic sleep and a range of hypnotic somnambulism on his
scale of hypnotic degree. However, by 1947 post-hypnotic amnesia was
routinely suggested. And while persons scoring high on suggestibility were frequently referred to as "somnambulistic" subjects, relatively few thus labelled could have been identified as being so in the
de Puysegurian sense. Unfortunately, investigators did not realize
this or chose to ignore it, and the scientific study of hypnotism has
proceeded without taking this possibility into account. Without
going so far as to state categorically that there is an artificial
somnambulism in the de Puysegurian sense, or hypnotism in Braid's
sense, to be distinguished from other conditions of high suggestibility, I will state that there is a good chance that there is.
This matter of the changing concept of hypnosis does not, however, stop here. Until the middle 1950's, training in hypnotic
techniques had been largely a matter of self-training and training at
the hands of stage hypnotists. Around 1955, a small group of professionals banded together in the United States to teach and promote
the use of hypnotism by physicians, dentists, and psychologists. At
their head was Milton H. Erickson. They set out with a certain
evangelical zeal to sell hypnotism to as many professionals as they
could. And sell it they did, frequently in an atmosphere reminiscent
of religious revivals and seances. However, at first this was not an
easy task. In the early days, many interested or potentially interested professionals were nevertheless wary of the subject matter.
They feared adverse reactions from their peers and'patients and real
and imaginary dangers inherent in hypnotism. The reputed relatively
low hypnotizability of the average individual was a further deterrent. To many, the use of hypnotism appeared fairly complex and
often time-consuming. Many felt foolish when performing inductions
or testing procedures. Failures were a great concern to many.
IN SEARCH OF HYPNOSIS
71
Others were greatly perturbed by the seeming lack of clear cut criteria for ascertaining when a person is hypnotized. In those early
days, the only available techniques were highly authoritarian, and
many clinicians did not take too well to these. Finally, for some,
whose perception of the hypnotized person was that of a mindless
robot, this feature was repellent, and for others the thought of so
much power and responsibility was frightening. All these features
made hypnotism less than attractive to many.
Strategies were developed to deal with these issues and others.
One was to present hypnosis to students and patients as being an
everyday experience. Thus people were told that when they were
engrossed in an experience, enraptured by a musical composition,
daydreaming, or in a so-called brown study, they were actually hypnotized. The word "trance" was increasingly substituted for "hypnosis." Accordingly, it was stated that people went into all kinds
of "trances" all of the time. Life was essentially a succession of
trances. The issue of who is in control was handled by telling
everyone that all hypnosis really is self-hypnosis. Incidentally,
this last was not altogether a new idea. It had the further advantage of placing the onus of failure on the subject. The success rate
was very much increased by the simple subterfuge of accepting indiscriminately any evidence of suggestibility as a sign of hypnosis. In
the course of time, any response, any spontaneous act (whether relevant or not to such suggestions as might have been given) was
turned, at appropriate moments, into evidence of hypnosis. This
particular gambit had the additional advantage of giving the whole
affair a very permissive character. Another highly favored subterfuge was the substitution of the term "relaxation" for "hypnosis."
This was recommended to those professionals who wanted to hypnotise
their patients but were afraid of the latter's reaction to the idea.
In time, attaining an obvious condition of muscular relaxation became
a widely accepted single index of a successful induction. Finally,
the term "resistant" was substituted for "insusceptible" and "low
susceptibility" to hypnosis, thus again placing the onus of failure
on the patient or subject.
Perhaps more than in any other period in the past, a great deal
was made at this time by clinicians, of the idea that hypnosis was
the royal road to the "unconscious" - that when a person is hypnotized, the hypnotist is then in communication primarily and even only
with that person's unconscious. The idea that so-called unconscious
processes are accessed when hypnotic behavior is brought about goes
back at least to Bernheim and his contemporaries. Bernheim, in
particular, considered ideo-dynamic action, an unconscious process
par excellence, as central to all suggested behavior and hence, to
hypnotism. But with Bernheim, it was merely a matter of suggestion
initiating unconscious activities in a pure stimulus-response fashion, whereas in the middle 1950's suggestion became increasingly a
matter of intelligent communication with the subject's so-called
72
A. M. WEITZENHOFFER
IN SEARCH OF HYPNOSIS
73
to ascertain when a suggestion had been given. as well as what consitituted a suggestion. More than once those of us who watched him
work. and had sufficient temerity. were led to ask him point blank
questions relevant to these issues. We rarely received straight
answers. In any event. from 1960 onwards. Erickson increasingly took
the position that the elicitation of any suggested effect was tantamount to entering or being in a trance. and eventually extended this
to the elicitation of any "unconscious" response. Erickson also
developed great faith in the ability of a person's unconscious to tap
a bountiful reserve of human potentials and to utilize the latter for
good without being told how to proceed. He held to this as early as
the middle 1950's. and not only did he teach this. but so did many of
his students. in turn. teach this to others.
In still later years. Erickson made the accessing of the unconscious of a subject synonymous with the evocation of a trance and
hence. of hypnosis. since he used both terms interchangeably.
Erickson increasingly centered the production of hypnotic phenomena
around communication techniques. presumably aimed at bypassing conscious processes and reaching unconscious ones. NLP. short for Neuro
Linguistic Programming. the latest potential American fad. has been a
natural outgrowth of this approach. I do not plan to deal with NLP
further except to remark the following. Although NLP ostensibly
deals with Ericksonian hypnotism separately from NLP proper. it
should be noted that according to its originators. Bandler and
Grinder (1979). "All communication is hypnosis." and throughout the
practice of NLP proper one encounters elements reminiscent of
Ericksonian techniques. Thus. the distinction between NLP proper and
Ericksonian hypnotism NLP style may be more academic than real.
This brief history of hypnotism reveals certain rather clear and
perturbing facts. Namely. under the impact of increased clinical
interest in them. the concepts of hypnotism and hypnosis have suffered an ever increasing dilution from 1900 on. Today these concepts
have become so diffused as to have ceased to be meaningful. Indeed.
as Bandler and Grinder (1979) have also recently stated in a different context. "Hypnosis is everything." If so. it is. therefore. also
nothing. The reasons for this evolution are probably not something
we can all agree on. There is. however. one fact we may be able to
agree on since it is easily verifiable. This is that the literature
provides no scientific foundation for this evolution.
Not only does the scientific literature provide no solid support
for these conceptual changes but, as a matter of fact. research since
Bernheim's time has done little to clarify the picture.
By 1900. and really earlier, all of the essential phenomenology
of hypnotism had been described. Nothing new has been added, and
much of the research since 1900 (and especially since 1920) has been
characterized by re-discovery rather than discovery. In fact, if
74
A. M. WEITZENHOFFER
IN SEARCH OF HYPNOSIS
75
76
A. M. WEITZENHOFFER
77
IN SEARCH OF HYPNOSIS
(a)
o
(b)
(c)
>>-'
(d)
'"
Fig. 2.
TIME
78
A. M. WEITZENHOFFER
Similarly. I must seriously question the description and definition of hypnosis as a state of relaxation. Again. we need to ask:
Relaxation of what? Presumably. of muscles. Or are we using it to
mean a reduction of. say. vigilance. ego control. or still something
else? Insofar as muscular action is concerned. a moment's thought
will clearly show how inappropriate this view is. To begin with. it
is well established that not all accepted induction techniques have
required or called for either physical or mental relaxation.
Furthermore. even when an induction calls for intense physical or
mental relaxation. it is always an agreed-upon fact that the relaxed
condition can give place to a very active mental or muscular state.
the subject being no less hypnotized. The human plank demonstration
fully attests to this!
In brief. the traditional phenomenology of hypnotism as it was
generally described at least until 1950 is not compatible with the
notions of hypnosis as being purely a state of concentration or of
relaxation. On the other hand. I would agree that these may be
compatible notions when applied to certain approaches to hypnosis.
for instance. when the subject is asked to close his eyes and do
nothing more than relax his body and mind in a recliner chair while
the hypnotist talks on and on. But are we now dealing with the same
condition as traditional hypnosis or a different one? I certainly do
not know which for a fact. nor does anyone else. But I do know that.
in the absence of any other objective sign than that a profound
physical relaxation has occurred. there is very little scientific
validity in asserting that this is a case of traditional hypnosis.
The most prevalent definition of hypnosis by state adherents is
that it is an altered state of consciousness. Without specification
of just how consciousness is altered. this is a really meaningless
definition. It is the more so because "consciousness" itself is not
much more tangible than hypnosis. As I pointed out several years
agot (Weitzenhoffer. 1978b). in the final analysis. whatever we can
say about consciousness is ultimately derived from subjective reports
- even whether or not is is present on any occasion. As for what we
mean by an altered state of consciousness. it would appear that we
invariably are referring to alteration of its contents. In any case.
this is the only way I find I can talk intelligently about altered
states of consciousness. and the remainder of my discussion will be
in this context.
Strictly speaking. anytime a process is set into motion in us or
ceases. there is a state change. It does not follow that there is
also a change in consciousness. In particular. a personality or an
attitude change, even a change in response to a stimulus. may not
necessarily be associated with an altered consciousness. And most
important. the initiation of a non-conscious or of a non-voluntary
IN SEARCH OF HYPNOSIS
79
80
A. M. WEITZENHOFFER
IN SEARCH OF HYPNOSIS
81
ANIMAL HYPNOSIS
SAMADHI
BALINESE
DANCE TRANCE
STATES OF
NON-CONSCIOUSNESS
PSYCHOSES +
LIKE-STATES
NAT URA L --+--t-.-,
S LEE P
-===:at----Il..-. LS D- S TATE
NATURAL
PSYCHOSIS
SLE E P
NATURAL
SOMNAMBULISM
Fig. 3.
NATURAL
SOMNAMBULISM
NON-REM
SLEEP
Fig. 4.
REM
SLEEP
ARTIFICIAL
SOMNAMBULISM
82
A. M. WEITZENHOFFER
person. All of which would seem to bring us right back to Janet and
Grasset. So much for progress!
Worse, there is no solid foundation for any of this modern
development. If anything, one needs strongly to suspect that hypnotists holding dialogues with unconsciouses, various and sundry
"parts," and Hidden Observers in hypnotized subjects may most likely
have created them by the very procedures they use. That is, they are
very likely to be artifacts. As Berillon, the editor of the Revue de
l'Hypnotisme, used to point out, hypnotized individuals are extremely
malleable. To tell a subject. for instance, that he will feel no
pain but that there is a Hidden Observer within him who can report on
the pain which nevertheless is there, can be tantamount to telling
him that he will be two persons, one who fe~ls no pain and one who
does. A good hypnotic subject can be expected to comply quite literally. Indeed, the kind of contradiction introduced by telling the
subject there is and there is not any pain might well be expected
alone to promote a spontaneous response not unlike a dissociation of
this kind in some subjects. Whether or not "Hidden Observers" and
the likes are used metaphorically, the end result may be anything but
a metaphor. I grant there is some speculation on my part here, but
no more than on, say Hilgard's part. If there is one fact to be
observed here, it is that there is nothing clearcut anymore in this
area - not even who it is we are interacting with when a person is
hypnotized.
--The speculations I have taken up thus far are all concerned with
explaining hypnosis in terms of other concepts. The view of hypnosis
as self-hypnosis does not aim to do so. In fact. being circular, it
can not explain anything. On the other hand. the concept of selfhypnosis is of some theoretical and, especially, practical interest.
Because of this I will make a few more remarks regarding it. There
are two distinct issues involved here. The first is the production
of a state of hypnosis in oneself using methods believed to produce
it in others. The second issue is utilizing this state in a way
comparable with heterohypnotism. I do not know of many recorded and,
especially, well-documented cases of self-inductions not preceded by
a first exposure to hypnosis in a heterohypnotic setting. Braid
reports a case with himself as the subject. I believe I have experienced two occurrences of Braid-type hypnosis, one induced by accident
and one deliberately. Erickson has also reported spontaneous occurrences in himself of a like state. Although I feel reasonably sure
that my accidental production of hypnosis was a true case of Braidtype hypnosis, I believe one needs to be very cautious in labelling
accidental and spontaneous occurrences of presumed hypnosis as such.
In any case, most cases of so-called self-hypnosis are clearly responses to heteropost-hypnotic signals and suggestions and are,
therefore, "self-hypnosis" only as a result of a play on words
IN SEARCH OF HYPNOSIS
83
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A. M. WEITZENHOFFER
IN SEARCH OF HYPNOSIS
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
85
86
14)
15)
A. M. WEITZENHOFFER
Hypnotized subjects always try (often compulsively) to give a
response. More often than not they will produce the best
approximation they can of what is asked of them rather than give
no response. This may lead to apparent confabulation and role
playing.
Prior to entering on a career of research or therapy with
hypnotism, it is essential to become thoroughly familiar with as
many aspects of hypnotism as possible in a naturalistic setting,
one free of the restrictions imposed by experimental design or
therapeutic goals. Too many would-be hypnotists read one book,
attend one weekend workshop, and assume they now know all there
is to be known about hypnotism.
IN SEARCH OF HYPNOSIS
87
Fred H. Frankel
Beth Israel Hospital and Harvard Medical School
330 Brookline Avenue
Boston, MA, 02215, USA
Abstract
Scepticism regarding hypnosis and its clinical value can be
countered by the accumulation of knowledge. Separating the effects
of hypnosis from the influence of other factors common to several
treatment methods contributes importantly to this. Hypnotizability
ratings in the experimental context set the stage, initially, for the
growth of information. Clinical studies using the rating scales
developed in the laboratory continue to reveal that the incidence of
specific clinical behaviors correlates well with hypnotizability.
This contributes to our understanding of diagnosis and treatment in
both psychiatric and psychosomatic problems.
INTRODUCTION
Clinicians have tended to look askance at the investigative
studies involving the use of the hypnotizability scales with the same
impatience and intolerance, unfortunately, as the experimentalists
have at times shown to single clinical case reports - even good ones.
A not uncommon clinical view denounces the laboratory scales, essentially the group of Stanford susceptibility scales (Weitzenhoffer and
Hilgard, 1959; Weitzenhoffer and Hilgard, 1962) as too lengthy, as
intrusive, and as not entirely relevant to the demands and patterns
that prevail in clinical work (Sacerdote, 1982). Even the Hypnotic
Induction Profile (Spiegel, 1978) and the Stanford Hypnotic Clinical
Scale (Morgan and Hilgard, 1975) both developed in the clinical
sphere, have met with limited enthusiasm among clinicians.
89
90
F. H. FRANKEL
This attitude prevails despite the fact that the formal testing
of hypnotic responsiveness has achieved considerable recognition in
scientific circles in recent years. largely. I believe. as a consequence of the compelling data that have been accumulated. The
measuring instruments are clearly not beyond improvement. However.
it is primarily to the standardized rating of hypnotizability that we
owe the growing body of knowledge and the evolving basic science
related to hypnosis. It is from the analyses of the laboratory data
that we can confidently declare. for example. that hypnotizability
is not universally distributed. that it is not related to sex or to
educational level. and that it is unlikely to alter much on a permanent basis. regardless of what the individual is subjected to
(Hilgard. 1965). In essence. the development of the scales. and the
concomitant growth of a highly sophisticated investigative methodology have enabled the study of hypnosis to emerge from the shadowy
world of assumptions. to take its place among the academically
acceptable behavioral sciences.
In keeping with my purpose in addressing this subject at this
time. I will choose this opportunity:
1.
2.
3.
4.
91
92
F. H. FRANKEL
the customary clinical practice is to proceed with hypnotic techniques (modified of course by the kinds of clinical responses
elicited) regardless of the limited hypnotizability. Disadvantageous
because it impedes any growing understanding of what takes place in
the therapy.
Let me elaborate on these two aspects. Any benefits to the
patient from the use of hypnotic techniques in the absence of moderate hypnotizability must be a consequence of other factors in the
hypnotic encounter. What can we assume takes place in such an
encounter? Generally the procedure is initiated by encouraging a
strong relationship, and involves suggestions for relaxation, for
optimism, for a lessening of discomfort, and for increased confidence. None of these are essentially hypnotic events nor are they
dependent on the hypnotic capacity to dissociate or to alter perception (Orne, 1959). They can be achieved equally well with the administration of a placebo, with techniques aimed at reassurance, or by
some event which distracts attention. The experienced clinician
knows, of course, that he is likely to shatter the gains of his
therapy if he then directs his relaxed patient to respond with more
dramatic hypnotic behavior than he, the patient, is capable of.
However, the hypnotic situation or total clinical context in which
the hypnotic suggestions are given is of particular importance. If
it is appropriate, patients can benefit to some extent from suggestions to relax and gain confidence even in the absence of what I
would call a central hypnotic event.
Even though I hope to demonstrate that the concept of hypnotizability is both relevant and important clinically, I personally
will use hypnotic procedures that are shaped by the patient's
responses, in the absence of even moderate hypnotizability.
Now for the disadvantages of disregarding the concept of hypnotizability, which though relatively stable for a particular individual, varies from person to person. It is generally the busy pragmatist who belittles the notion. Keen on impringing therapeutically
as expeditiously as he can, he usually has little time to pursue an
understanding of his practices. While one can respect him for clinical achievements under conditions that are not always convenient for
academic inquiry, we must grieve over the lost potential. Great
opportunities for increasing our knowledge of the event slip away
under such circumstances. For example, the clinical literature
abounds in case examples describing how a hypnotic induction procedure was followed by a series of therapeutic suggestions which were
followed by a satisfactory outcome. The reasoning in the paper not
infrequently assumes that because the outcome was successful the
patient must have been hypnotized. Even a brief inspection of the
logic will expose the fallacy of that conclusion of one acknowledges
that therapeutic forces in the hypnotic situation can stem almost
entirely from the transference, from the sense of relaxation, or from
93
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F. H. FRANKEL
1.
Common sense seems to dictate that if the majority of patients
suffering from a particular syndrome respond to treatment with hypnosis, they might, as a group, be more hypnotizable than others.
Patients suffering from asthma and migraine have been treated successfully with hypnotic procedures. We know from one study of
asthmatic patients (Collison, 1978) that those who were responsive to
hypnosis did better than those who were not. To date, however, we
have no systematic study of the range of hypnotizability among
asthmatics generally or among patients subject to migraine headaches,
or how their ratings compare with those of other patients. I am
referring here to the need for simply studying the hypnotic responsiveness of a group of asthmatic patients, or a group of migraine
patients and comparing the results with those of a control group.
2.
Reports on the hypnotizability of schizophrenic and depressed
patients tend to disagree with one another. Here again, is an opportunity for the further administration of the hypnotizability scales
in order to determine to what extent hypnosis is facilitated or
suppressed by, or has anything to do with, the nature of the disorders.
3.
Highly hypnotizable healthy subjects responding to a questionnaire regarding personal experiences reported the occurrence of
spontaneous trance-like phenomena considerably more often than
healthy subjects who are poor hypnotic subjects (Shor et al., 1962).
We have no equivalent study among a patient population, neurotic or
psychotic. If healthy, highly hypnotizable subjects report more
trance-like events than others, is it not possible that highly hypnotizable psychiatric patients will also report more trance-like
events? If that is the case, to what extent do those trance-like
events color the clinical picture?
4.
One area that pleads for attention is the impact of hypnotizability on the outcome of psychotherapy that does not include
hypnosis. Apart from one recent study (Nace et al.,-r982) reporting
a positive relationship between clinical improvement and hypnotizability, few data have been accumulated that address the influence
of high hypnotizability on therapeutic outcome.
To describe such clinical investigations as complicated and
difficult to mount is a masterpiece of understatement. That, however, is no reason for us to avoid them or to draw premature conclusions.
THE RELEVANCE OF LABORATORY SCALES TO CLINICAL EVENTS
We have already completed two studies (Frankel and Orne, 1976;
Apfel et al., in preparation) which point to the relevance of the
laboratory scales to clinical events. In the first, we tested the
95
96
F. H. FRANKEL
A SOCIAL
97
98
E. I. BANYAI ET AL.
INTRODUCTION
In hypnosis-research attention is generally focussed on the
alterations occurring only within the hypnotized person. As a result
of this approach standardized tests have been elaborated to study the
characteristic differences between persons entering hypnosis. This
way the "talent" of a person to respond to standardized hypnotic
suggestions has come to be considered to be a stable personality
trait (Hilgard, 1965, 1975, 1977, 1981).
It must be emphasized, however, that no other altered state of
consciousness exists that would be so closely related to an interaction between two persons as hypnosis. The importance of the rerelationship between a hypnotist and subject was brought to the
attention of some authors as early as in the late 1950's (Gill and
Brenman, 1959; Haley, 1958, 1961, 1963). While Gill and Brenman
focussed mostly upon the motives of the hypnotist, Haley, on the
basis of Milton H. Erickson's approach, analyzed the manoeuvres of
the hypnotist, reflected mainly in sequences of verbal communication
between hypnotist and subject.
It is striking, however, that in similarly hypnotizable subjects
different subjective and behavioral depths of hypnosis can be reached
even through completely identical verbal communication, i.e. through
the use of standardized texts (the widespread scales of hypnotic
susceptibility). These differences can be explained only if we
suppose that non-verbal elements of communication also play an important role in the interaction between hypnotist and subject.
As a first step towards the goal of determining methods which
help to detect the relevant metacommunicative elements within the
hypnotic interaction, in the present experiment an attempt was made
to study the characteristic psychophysiological alterations accompanying hypnosis both in the hypnotized person and in the hypnotist.
METHOD
Subjects
Six young persons (3 males, 3 females) served as subjects for
the experiment. Moderately susceptible subjects were chosen, as
highly hypnotizable persons can enter hypnosis too easily for the
purpose of the present experiment, while low susceptibles are unable
to reach a sufficient depth of hypnosis. All of the subjects scored
7 on the Hungarian version of the Stanford Scale of Hypnotic Susceptibility, Form A (Greguss et al., 1975).
99
Hypnotists
Six hypnotists (3 males. 3 females) using hypnosis for at least
one and a half years for therapeutic or research purposes took part
in the experiment. None of them had ever hypnotized the experimental
subject before.
Hypnosis
Hypnosis was induced by the standard induction method of SHSS.
Form B (Weitzenhoffer and Hilgard 1959). The following standardized
test suggestions were administered:
1)
2)
3)
4)
5)
6)
7)
8)
Recording
Subjective experiences. behavioral manifestations and electrophysiological indices were recorded and subsequently analyzed in a
complex way. Each session was followed by a detailed tape-recorded
interview in which the subjects and the hypnotists were questioned
separately about their subjective experiences. They were asked to
judge: 1. the depth of hypnosis reached during the actual session on
a 10 point scale with 0 as the waking state and 10 as the deepest
achievable hypnosis for the subject; 2. the degree of "tuning in" to
each other. i.e the degree of focussing their attention on the
other person. A 10 point scale was used for this purpose as well.
where 0 meant lack of paying attention to the other and 10 meant
maximal attention.
The behavioral manifestations of both participants of the hypnotic interaction were recorded on video-tape. In order to include
details of the interaction unobservable on video-tape a trained
observer was also present in the experimental chamber. taking detailed notes. Both of these records were analyzed by three trained
experimenters who also scored the performances of the test suggestions.
E. I. BANYAI ET AL.
100
101
10
Fig. 1.
E. 1. BANYAI ET AL.
102
DEEP HYPNOSIS
LI GHT HYPNOS I S
1-----_................
III '_'8
1__
...
... 4"'. . .
2------------______________..
.... _ FIST'
I
tn
"IW(
bJ .tll
t II!
~'''t
11 ~1f
III
"littdIJlld.~llj 1'1
...........
-.'
i~I~.~Ir________
'JIST flEW'
Fig, 2_
..
11'
II
Q,5mvl
~.II-IIeee:
nil
'"
... ",. ,
I
I'
tlHItII"IJ..,I.
I . . . . . . . .~.~'*li.7~.~'._.I.'
......
III.
A FIST'
III'.
...
If,
.. 41"
..
........IH'.....- ............t----~.~l
'JUST REW'
Fig. 3.
103
SUBJECT
104
E. 1. BANYAI ET AL.
Q
Q'~
Lx+Rx
30
-r-
20
,
,,
10
u
u
z
<
z
.....
x:
,
of
!::
0.....
'"
~\
.. ,
\
.I, ,",
"
II
\'.
Y
'"
..
...J
-10
-20
,,
I
-30
0
INDUCTION
Fig. 4.
DEHYPNOSIS
R L
Hypnosis
fj
Fig. 5.
100
105
R L
After
dehypnosis
R L
R L
DISCUSSION
Under sufficiently controlled experimental conditions it could
be demonstrated that changes in the non-verbal elements of communication themselves exert an influence on the effectiveness of hypnotic
induction.
E. 1. BANYAI ET AL.
106
Lll-Rll
Lx"Rx
-2-
III
oc,
~
2
-0,4
Fig. 6.
In the recorded overt and covert processes, relevant communicative functions were demonstrated in changes in the amount of loss
of visual contact with the situation, in the tone of voice of the
hypnotist and in the muscular tension of both the hypnotists and the
subjects. It should be noted that these processes play an active
role in the hypnotic interaction in spite of the fact that the participants were usually unaware of them.
Although the EEG activity is probably not communicated in the
course of the hypnotic interaction the lateral differences found in
the power spectra seem to be relevant, suggesting that the dominance
of right hemisphere EEG activity can facilitate the marked changes of
consciousness characterizing deep hypnosis, while a left hemisphere
107
dominance is more favorable for keeping the control. Since the right
cerebral hemisphere is generally characterized as an imagery, automatic, analogous, emotional and holistic processor, these results
seem to be in accordance with our data showing an improved capacity
for imagery coding in hypnosis (Meszaros et al., 1982).
The results on the interaction between hypnotist and subject
suggest that a greater understanding of the hypnotic phenomenon can
be achieved if it is studied not only from the aspect of the hypnotized person, but also using the methods of the now developing
social psychophysiology.
REFERENCES
Gill, M. M., and Brenman, M., 1959, Hypnosis and related states:
Psychoanalytic studies in regression, International Universities, Press, New York.
Greguss, A. C., Banyai E., Meszaros, I., Cs6kay, L., es and
Gerber, A., 1975, A hipn6zis iranti erzekenyseg standard
vizsgalata magyar nyelven, in: "A Magyar Pszich. Tars. IV.
Tud. Jub. Nagygyulese. nov.--17-18. L. Benedek es T.-ne Szekely
eds., Budapest, 61-62.
Haley, J., 1958, An interactional explanation of hypnosis,
Am.J.clin. Hypnosis, 1:41-57.
Haley, J, 1961, Control in brief psychotherapy, Archs.gen.Psychiat.,
4: 139-153.
Haley, J., 1963, How hypnotist and subject maneuve~ each other, in:
"Strategies of Psychotherapy," J. Haley, ed., Grune and
Stratton, New York.
Hilgard, E. R., 1965, Hypnotic susceptibility, Harcourt Brace
Jovanovich, New York.
Hilgard, E. R., 1975, Hypnosis, Ann.Rev.Psychol., 26:19-44.
Hilgard, E. R., 1977, Divided consciousness: Multiple controls in
human thought and action, John Wiley and Sons, New York,
London, Sydney, Toronto.
Hilgard, E. R., 1981, Hypnotic susceptibility scales under attack: an
examination of Weitzenhoffer's criticisms, Int.J.clin.exp.
Hypnosis, 29:24-41.
Meszaros, I., Banyai, E. I., and Greguss, A. C., 1982, Evoked potential correlates of verbal versus imagery coding in hypnosis,
Paper presented at the 9th International Congress of Hypnosis
and Psychosomatic Medicine, Glasgow, Scotland, August.
Shor, R. E., and Orne, E. C., 1962, Harvard group scale of hypnotic
susceptibility form A. Consulting Psychologists Press, Palo
Alto, Calif.
108
E. I. BANYAI ET AL.
110
S. J LYNN ET AL.
III
Support for Arnold's (1946) position would be secured if hypnotic and imagination subjects, both instructed to sustain suggestion-related imaginings, respond to suggestions and report involuntariness. In contrast, imaginative processes would likely be of
secondary importance if imagining subjects, in contrast to hypnotic
subjects, resisted suggestions while they continued to imagine and
be absorbed in suggestions. Findings which indicated that hypnotic
subjects respond to suggestions and report involuntariness to a
greated degree than imagining subjects would be entirely compatible
with the dissociation position (Hilgard, 1977; 1979; Kihlstrom et
al., 1980) as well as the view that emphasized the importance of the
experimental context (Spanos et al., 1977; Spanos, 1981). Further
support for the latter position would be secured if, in the second
study, simulating and hypnotic subjects' responses were found to
trace closely their perceptions of appropriate hypnotic behavior.
METHOD
Study I included hypnotic (N=14), imagination (N=9), and simulation (N=12) conditions. In Study 2, hypnotic (N=12) and simulation
(N=ll) conditions were contrasted. In both studies susceptible
subjects scored 9 and above on the Harvard Group Scale (HGSHS:A; Shor
and Orne, 1962); unhypnotizable simulators scored 3 and below.
Studies 1 and 2 differed in two significant respects. In Study 1,
simulators were instructed to abandon their role playing before
completing subjective reports which described their experiences and
responses. In Study 2, simulators role-played throughout the entire
procedure. Subjects also completed measures of involvement in the
events of hypnosis following the administration of the Harvard scale.
Across both studies, the treatment of the hypnotic and simulating subjects was identical. Hypnotic and simulating subjects were
run in the same groups. As part of the simulating instructions,
adapted from Orne (1959), simulators were informed that if their
pretence were detected, the hypnotist would tap them on the shoulder
and excuse them from the experiment. All subjects were tested in
groups of 4 to 8 and carefully seated in a large room in such a way
that precluded observation of other subjects. Imagining subjects
were not tested with the subjects in the other two groups because
they did not receive a hypnotic induction. For these subjects, the
experiment was described as a study of imaginative processes. Subjects were led to believe that they were recruited because of their
participation in the psychology department subject pool.
Subjects in the hypnotic and simulating groups were administered
a modified version of the Stanford Profile Scales, Form 2
(Weitzenhoffer and Hilgard, 1967), adapted for group administration.
Deepening instructions followed. Hypnotic and simulating subjects
received the counterdemand instructions during hypnosis after the
112
S. J. LYNN ET AL.
Hypnotic
Rated Movements
Sensations
Imaginative Involvement
Conflict
Nonvolition
113
Simulating
Imagining
Hypnotic
Simulating
1.97
1.17
1.22
1.95
1.27
4.43
1.91
4.22
3.42
1. 45
3.07
2.08
3.66
4.00
2.36
3.43
2.00
3.22
3.17
2.36
3.53
.67
.33
Movements self f
Movements "Good Subjects"
3.25
.82
2.75
1.18
3.00
1. 45
Note: Anovas
Simulating
simulating
simulating
simulating
simulating
(.01)
(. OS)
(. OS)
(. OS)
(.05)
a.
b.
c.
d.
e.
f.
g.
hypnotic) simulating
hypnotic> simulating
hypnotic> simulating
hypnotic==simulating
hypnotic> simulating
hypnotic> s~mulating
hypnotic> simulating
(.05)
(.05)
(.05)
(n.s.)
(.001)
(.06)
(.09)
aginative involvement, and experienced non-volition in their testimony than simulators, across both studies. The finding that simulators, in Study 2 (in contrast to the first in which they did not
simulate testimony) report as much conflict about responding as the
hypnotic subjects, indicates that simulators are able to recognize
the conflict inherent in the complex instructions employed in this
paradigm. The striking hypnotic-simulating differences secured in
this study are as impressive as any reported in the literature (e.g.,
Evans, 1979; Evans and Orne, 1971; Orne et al., 1968; Peters, 1973).
The finding that imagining subjects reported feeling as absorbed
and involved in imaginings as hypnotic subjects but resisted responding is unsupportive of Arnold's (1946) position that imaginative
processes are a crucial link between suggestion and involuntariness.
The results are more consistent with the position advanced by Spanos
and his colleagues that subjects' imaginings do not directly cause
their actions. The hypnotic induction may be instrumental in translating imaginative involvements into behavior. This role could,
perhaps, be one of legitimizing change, however, the relationship is
not simple, since simulators also behaved like subjects with imagination instructions.
The findings that hypnosis, as opposed to simulation or imagination, results in involuntary experiences is consistent with
Hilgard's (1977, 1979) position. The experience of diminished behav-
114
S. J. LYNN ET AL.
ioral control is reflected in hypnotic subjects' reports of involuntariness and difficulty ignoring the behavioral pull of suggestions
relative to imagining subjects who report similar conflict and
suggestion-related involvements. However, the experience of nonvolition was not shown to be an invariable concommitant of hypnosis
in that more than a third of the hypnotic subjects' movements were in
the no response category. Further, hypnotic subjects reported conflict comparable to imagining subjects, a finding suggestive of
active cognitive processing about the appropriateness of responding
and situational task demands.
The differences between the hypnotized and the simulating subjects suggests that the differences between the hypnosis and the
imagination group may not be an artifact of demand characteristics
and may instead reflect a true difference between hypnotized and
unhypnotized individuals. However, the findings of Study 2 suggest
that hypnotic and simulating differences may be mediated by differences in expectancies about appropriate responding. Inspection of
Table 1 indicates that hypnotic subjects, compared with simulators,
tended to rate both themselves and good hypnotic subjects as moving
in response to more suggestions. Further, for both hypnotic and
simulating subjects, self and observer rated movements are highly
correlated with subjects' judgements about how good hypnotic subjects
respond. The correlation between self-rated movements and perceptions of good subjects' movements for hypnotic subjects was .88; the
corresponding correlation for simulators was .92. The correlation
for observer-rated movements was .81 for hypnotic subjects and .65
for simulating subjects.
These findings seem to be consistent with the view that the
hypnotic and simulating procedures produce different demands (e.g.,
Spanos, 1981) and the view that susceptible subjects may be particularly adept at responding in terms of subtle cues and communications
that simulators may fail to detect (e.g., Sheehan, 1977, 1980;
Sheehan and Perry, 1976). Indeed, the behavioral findings secured in
this study are entirely congruent with the position that hypnotic
subjects are specially motivated to respond to the subtle communications of the hypnotist and resolve conflict in hypnosis in favor of
the hypnotist and his or her intent (e.g., Dolby and Sheehan, 1975;
McConkey, 1979; Sheehan, 1971, 1977, 1980). Imagining and simulating
subjects may not behave accordingly because they are not comparably
involved in the hypnotic relationship and the events of hypnosis
(Dolby and Sheehan, 1975; McConkey, 1979; Sheehan and Dolby, 1975,
1979; Sheehan, 1980). As a function of such differences in involvement, subjects in hypnotic, imagining, and simulating contexts may
develop different expectancies about responding.
In Study 2. involvement indicators of simulating subjects'
experience of group hypnosis were fairly highly correlated with their
later tendency to resolve hypnotic conflict in favor of responding to
115
the hypnotist's repeated suggestions. That is, the more the simulators appeared to be involved in the group hypnosis prior to the
counterdemand study, the more they moved in response to suggestion.
Observer-rated movements correlated .70 with the overall degree of
involvement with the suggestions, .66 with the amount of fantasy or
imagery experienced during hypnosis, .61 with rapport with the hypnotist, and .65 with how closely the hypnotist's suggestions were
followed.
Hypnotic and imagining subjects may appraise and resolve experienced conflict in very different ways. In the imagining condition, with few demands for suggestion-related involuntariness
(e.g., Radtke-Bodorik, et al., 1979; Spanos 1981), conflict may serve
as a cue to remind subjects of the instructions not to respond. In
the hypnotic context, which encourages self-attributions of responsiveness to trance or involuntariness (e.g., Bowers, 1973; Coe and
Sarbin, 1977; Spanos, 1981, 1982), conflict may be resolved by not
inhibiting involvement and moving in response to the hypnotist and
the behavioral pull of the suggestions. This interpretation is
consistent with Spanos' position which empahasizes contextual determinants of involuntariness and the views of Sheehan and his colleagues regarding the special motivation of the hypnotic subject in
relation to the resolution of hypnotic conflict.
Future research efforts might explore the relationship between
rapport and involvement indicators and sustained imaginings, expectancies about appropriate responding, and reports of involuntariness
in hypnotic and nonhypnotic contexts. much more research is needed
to understand better the antecedents of experienced involuntariness
and to resolve the question of whether reports of involuntariness are
"real" or "illusory."
REFERENCES
Arnold, M. B., 1946, On the mechanism of suggestion and hypnosis,
J.abnorm.soc.Psychol., 41:107-128.
Bowers, K. S., 1973, Hypnosis, attribution, and demand characteristics, Int.J.clin.exp.Hypnosis, 21:226-238.
Coe, W. C., and Sarbin, T. R., 1977, Hypnosis from the standpoint of
a contextualist, Annals of the New York Academy of Sciences,
296:2-13.
Dolby, R. M., and Sheehan, P. W., 1975, Cognitive processing and
expectancy behavior in hypnosis, J.abnorm.Psychol., 86:334345.
Evans, F. J., and Orne, M. T., 1971, THe disappearing hypnotist: The
use of simulating subjects to evaluate how subjects perceive
experimental procedures, Int.J.clin.exp.Hypnosis, 19:277-296.
Evans, F. J., 1979, Contextual forgetting: Posthypnotic source
amnesia, J.abnorm.Psychol., 88:556-563.
116
S. J. LYNN ET AL.
ll7
120
H. J. CRAWFORD ET AL.
Results are discussed as being complementary to Paivio's (1971)
imagery based dual-coding theory and to the hypothesis that hypnosis
may facilitate a shift towards holistic. imaginal cognitive functioning.
INTRODUCTION
Hypnotically responsive individuals commonly report that during
hypnosis their imagery is more vivid. spontaneous. and effortless
than during the waking state. Some also report that they are less
analytical and more holistic when processing information. Such
phenomenological reports suggest that hypnosis allows some individuals to shift from a more verbal. detail-orientated encoding system
during the normal state to a more visual, image-orientated encoding
system during hypnosis. Our laboratory has been conducting a series
of studies which are concerned with whether or not information is
processed differently during hypnosis, and if so, what is different
about it. This paper will address some research on visual memory
processing in and out of hypnosis.
Since there is ample evidence in the literature (Paivio. 1971;
Richardson. 1980) that imagery can be a mediating variable in the
performance of certain memory and visuospatial tasks, as well as
there being performance differences between low and high imagers on
these tasks. it can be expected that during hypnosis responsive
individuals should perform significantly better on tasks which seem
to require imagery in their mediation.
Several experimental approaches provide some support for this
hypothesized shift in cognitive functioning during hypnosis. Increases in primary process thinking. as reflected by the Rorschach
(Bowers. 1968; Fromm. et al., 1970) and the TAT and hypnotic dreams
(e.g Levin and Harrison. 1976). have been reported during hypnosis.
Gur and Reyher (1976) reported enhanced performance on figural. but
not verbal. creativity during hypnosis.
While moderate relationships between hypnotic susceptibility and
self-reported vividness and controllability of imagery are often
reported (for review. see Sheehan, 1979), enhancement of imagery
vividness during hypnosis as reported on these same questionnaires
has met with mixed findings (e.g., Coe. et al., 1980; Crawford, 1979;
Sanders, 1967; Starker. 1974). Such self-reports can be influenced
by demand characteristics, subject expectations, and social desirability (e.g., Divesta et al., 1971). Order effects (Coe et al
1980) and ceiling effects (Crawford. 1979) have also been noted.
Thus. it is important to use more objective measures of imagery
processing.
Several studies (Nomura et al 1981; Wallace et al 1976;
Wallace. 1978) found that a very few high hypnotizables can
121
122
H. J. CRAWFORD ET AL.
be involved during the waking conditions. Additional high hypnotizabIes were assigned to hypnosis - waking and hypnosis - hypnosis
groups. Since reaction time was not an important variable in prior
research. all subjects were permitted to examine the second picture
for 15 seconds. Based upon prior research. it was anticipated that
high. and possibly medium. hypnotizables would show a significant
enhancement in mean number correct on the visual memory discrimination task. We expected a positive correlation between the amount of
enhancement and hypnotic susceptibility scores. We also expected a
shift towards a predominant holistic strategy during hypnosis for the
high. and possibly medium. hypnotizables.
METHOD
Subjects
Subjects were 80 university student volunteers who had been
screened for hypnotic susceptibility on both the Harvard Group Scale
of Hypnotic Susceptibility (Shor and Orne. 1962) and the Stanford
Hypnotic Susceptibility Scale. Form C (SHSS:C; Weitzenhoffer and
Hilgard. 1962). From each of three stratified SHSS:C hypnotic
levels. subjects were randomly selected and assigned to experimental
groups. This resulted in 20 low hypnotizables (SHSS:C scores 0 to
4). 20 medium hypnotizables (SHSS:C scores 5 to 8). and 40 high
hypnotizables (SHSS:C scores 9 to 12). They received either extra
credit for a psychology course or $3 per hour for their participation.
Procedure
Each subject was contacted by telephone and asked to participate
in an experiment that would assess individual differences in visual
memory during the waking state.
Within each stratified SHSS:C hypnotic level. subjects were
randomly assigned to groups. The 20 low. 20 medium. and 20 high
hypnotizables were divided into two groups: 10 to waking - waking and
10 to waking - hypnosis groups. The experimenters were blind as to
their hypnotic levels. Of the remaining 20 high hypnotizables. 10
were assigned to hypnosis - waking and 10 to hypnosis - hypnosis
groups. Alternate forms of the task were counterbalanced within
subj ect groups.
Each subject was seen for one session of approximately 50 minutes by one of two experimenters. Upon arrival. tasks were discussed
and practiced prior to signing a consent form. For those subjects in
which waking conditions occurred first or solely. consent forms made
no mention of hypnosis. If hypnosis was introduced as an experi-
123
mental condition. subjects were informed that if they did not want to
be hypnotized they could participate in a waking condition. A second
consent form was signed by those who indicated a willingness to be
hypnotized. Two subjects refused hypnosis and were replaced by other
subjects.
During all conditions subjects were asked to perform as well as
possible. The hypnotic induction was based upon the SHSS:C induction. with all references to sleepiness removed. and with additional
instructions that the subject would become deeply hypnotized but
remain alert and attentive as in the normal state of awareness.
After the hypnotic induction. subjects practiced opening their eyes
and looking around while maintaining a similar hypnotic depth to what
they felt with their eyes closed. A five minute break occurred
between conditions; this was particularly important if the subject
had been hypnotized in the first condition.
The visual memory discrimination task was similar to that used
by Crawford (1979). This task involved 15 pairs of pictures which
are reproductions of original works of art (Meier. 1940). with one
pair slightly changed so that the shade or perspective is changed or
details are missing. added. or changed. Subjects looked at the first
picture for 10 seconds and then closed their eyes for an interstimuIus interval of five seconds. At the experimenter's request. the
subjects then opened their eyes and were shown the second slide.
Subjects were instructed to indicate what was different in the second
picture from the first within a 15 second period. guessing if they
were unsure at the end of the period. Slides were presented 150 cm.
from the subject within a projection area of 50 by 70 cm. Not reported in the present paper was a same-different simultaneous task
using similar pictures which followed the discrimination task.
No memory encoding instructions were given. Following the
experiment proper. subjects were interviewed as to the approaches or
strategies used in the tasks. Subsequently. they were asked to
indicate to what degree they had used detail or holistic strategies
during the two presentations.
RESULTS
We will first look at the number correct on the visual memory
discrimination task. Out of 15 possible. the range was from 6 to 14
across subjects and conditions. A summary of the data across the
groups and conditions is presented in Table 1.
Performance when Conditions are Same
Across the waking - waking groups. subjects did significantly
poorer the second time. ~(29) = 2.84. ~<.OI. In the waking - waking
124
H. J. CRAWFORD ET AL.
Table 1.
Groups
Means
Waking - Waking
Lows
(N =
10)
Mediums (N - 10)
Highs (N = 20)
Hypnosis - Hypnosis
liighs (N = 10)
Waking - Hypnosis
I..ows
(N
= 10)
Mediums (N
= 10)
Highs (N = 20)
Change
t=
Waking
Waking:
9.30
8.60
- .70
1.56
9.50
9.10
- .40
1.50
10.60
9.50
-1.10
1.88
Hypnosis
Hypnosis
.70
1.25
9.90
10.60
Waking
Hypnosis
p<
10.30
10.10
- .20
.30
9.30
10.60
1.30
2.90
.02
8.60
11.25
2.80
6.23
.001
125
~<.02,
126
H. J. CRAWFORD ET AL.
Table 2.
GROUPS
Wakin~
Waking
35.00
28.50
.72
42.50
34.00
1.58
42.50
54.50
1.25
Hypnosis
Hypnosis
47.00
50.00
H~nosis
Waking
Hypnosis
= 10)
32.50
45.00
1.20
18.50
62.60
4.32
.01
28.40
53.65
3.62
.01
Mediums (N
co
10)
Highs (N .. 10)
-
H~nosis
lIighs (N = 10)
Wakin~
p<
Waking
Wakin~
Lows (N .. 10)
H~nosis
t=
Lows (N
Mediums (N = 10)
Highs (N
10)
.36
127
Lows (N
Incz"ease in
holistic strategy
= 10)
Mean
0.33
-1.00
.82
3.16
Sd
Mediums (N
Mean
1.50
1. 25
2.12
1.39
Sd
Highs (N
N
.07
20)
4
16
Mean
1.50
2.94
1.29
1.94
Sd
-.34
10)
Point
biserial
correlation
.41
128
H. J. CRAWFORD ET AL.
129
130
H. J. CRAWFORD ET AL.
Paivio, A., 1971, Imagery and verbal processes, N.Y., Holt, Rinehart
and Winston.
Richardson, J. T. E., 1980, Mental imagery and human memory, N.Y.,
St. Martin's Press.
Sanders, S., 1967, The effect of hypnosis on visual imagery,
Dissert.Absts.Intern., 30:2936-B.
Sheehan, P. W., 1979, Hypnosis and the processes of imagination, in:
"Hypnosis: Developments in Research and New Perspectives," E:Fromm and R. E. Shor, eds., N.Y., Aldine.
Shor, R. E., 1970, The three-factor theory of hypnosis as applied to
the book-reading fantasy and to the concept of suggestion,
Int.J.clin.exp.Hypnosis, 18:89-98.
Shor, R. E., and Orne, E. M., 1962, Harvard Group Scale of Hypnotic
Susceptibility, Form A., Palo Alto, Calif., Consulting Psychologists Press.
Spanos, N. P., Ansari, F., and Stam, H. J., 1979, Hypnotic age
regression and eidetic imagery: A failure to replicate,
J.abnorm.Psychol., 88:88-91.
Starker, S., 1974, Effects of hypnotic induction upon visual imagery,
J.nerv.ment.Dis., 159:433-437.
Walker, N. S., Garrett, J. B., and Wallace, B., 1976, Restoration of
eidetic imagery via hypnotic age regression: A preliminary
report, J.abnorm.Psychol., 85:335-337.
Wallace, B., 1978, Restoration of eidetic imagery via hypnotic age
regression: More evidence, 87:673-675.
Weitzenhoffer, A. M., and Hilgard, E. R., 1962, Stanford Hypnotic
Susceptibility Scale, Form C., Palo Alto, Calif., Consulting
Psychologists Press.
Zamansky, H. S., Scharf, B., and Brightbill, R., 1964, The effects of
expectancy for hypnosis on prehypnotic performance,
J.Personality, 32:236-248.
131
132
1. BONCZ ET AL.
INTRODUCTION
It is a well-known fact that Hungary has been in a foremost
place in the statistical list of attempted and completed suicidal
acts. The distribution of the suicides is also interesting and
Hungary is almost always in the first place. The team at our clinic
which deals with suicide gained some data through questioning people
who attempted suicide in 1978-1979. We found that in the case of 30
per cent of people we questioned there was a suicide example in their
environment which mainly occurred in their family. It was also
observed. that in certain areas the successive series of attempts
were committed by the same method.
In the middle of the last century the French sociologist Tarde'
(1899) attempted to explain the frequency of suicides by his imitation theory. This is a tautological explanation which does not
explain the whys and hows of imitation.
According to Phillips (1974), completed and widely publicized
suicides can also have a suggestive effect and can aggravate the
frequency of suicides. He called this the "Werther effect" after
Goethe's young hero. He analysed changes in the suicide-statistics
following sensational suicidal deeds on the basis of a convincing
statistical hypothesis. His results indicated that highly publicized
suicidal cases were followed by a considerable increase of the frequency of suicidal acts.
According to Ringel (1953, 1961. 1969) every suicidal act or a
serious attempt is preceded by the same psychological constellation.
This is the so-called pre-suicidal syndrome. Because of its three
characteristics it is often mentioned as the suicidal triad and
consists of the following: (1) dynamic narrowing; (2) blocking of
aggression; (3) escaping into the world of fantasy. Dynamic narrowing means the rigid decline of aperceptions and associations.
emotional narrowing, a decrease of motivations and of interest in the
outside world. This essentially means an altered state of consciousness. Since hypnosis is also a peculiarly altered state of consciousness, the question was raised whether those who attempted
suicide may have a particular sensitivity towards hypnosis and different motor and cognitive suggestions.
Our tests were carried out by the Stanford Hypnotic Susceptibility Scale. (Weitzenhoffer and Hilgard. 1959), Form A. The susceptibility of 37 persons having attempted suicide was tested by this
method. Their ages varied between 15-69 years, the average being
25.5 years. The sex-distribution eonsisted of 11 men and 26 women
i.e. the same as that of the questionnaire investigation. The methods used were as follows: one was run over by a car, one attempted
drowning, one by wrist-slashing and others took drugs, sleeping pills
or tranquillizers. In these latter cases the tests for hypnotiz-
133
ability were carried out after detoxication. i.e. after the total
withdrawal of the drugs from the system. within about one week after
the attempt. Patients suffering from somatic illness. depression or
psychosis were not included in our material. These patients were
filtered out by investigation and tests preceding the examination. A
control group of fifteen persons was used with the same criteria.
Sex and age-distribution were nearly the same as those of the group
of attempted suicidal acts. Our results were also compared with data
from a population of 178 Hungarian students. (Greguss et al 1975).
Results
As is well-known. the maximum score in the Stanford Hypnotic
Susceptibility Scale after completing the motor and cognitive items.
is 12. The mean scores of our samples are demonstrated here. As can
be seen in Figure 1 there are highly significant differences between
the means. That is those who had attempted suicide are significantly
more susceptible to hypnosis. than the controls. In Figure 2 can be
seen the percentage of the performance of the tests on the Stanford
Scale. On the higher curve of those who attempted suicide. the
higher performance rate of the so-called cognitive items is outstanding compared with those of the controls. (9th item; hallucination.
11th item; post-hypnotic suggestion. 12th item; post-hypnotic amnesia). In Figure 3 performances of the different test items are
demonstrated. The number of people attempting suicide was compared
with the Hungarian standard and with our other normal control group.
The high significance differences of the cognitive items as can be
seen in 9-11-12 is outstanding here as well in the case of people
attempting suicide. On the basis of the former fact. taking into
SHSS
scoren
11
10
9
8
7
6
5
4
3
2
I---p<O,OO1-----<
' -p <0,01---<
-I-
8,32
!2,85
suicide
attemptad
Fig. 1.
5,60
~2,4'
5,53
!3,76
control
Hungarian
stcnlard
/students!
134
1. BONez ET AL.
-
",
100
/sudtnls/
90
80
70
60
50
'0
~'i
30
11,.."
......
.. ..,
20
10
1 2 3 ,
Fig. 2.
',.
S 6 7 6
.. Hungaflan standard
'si udenlsl
.p <0.05
.. p <0.01
.,.
'10
90
80
80
70
60
70
60
SO
50
.'
.,
1 2 3 ,
'0
30
20
10
10
Fig. 3.
p < 0.001
100
30
,0
SHSS:A ~ems
100
'0
109 11 12
5 6 7
6 109 11 12 SHSSA
Items
2 ]
, 5 6 7
6 9 10 11 12 SHSS A
~em5
100
135
N- 15
N- 22
90
80
70
60
50
40
30
20
10
1 2 ]
Fig. 4.
I,
5 6
136
I. BONCZ ET AL.
Summary
In our opinion the suggestive effect is only one of the factors
in suicide. Further analysis and detailed investigations are needed
in order to learn the deeper intra-psychic processes of the suicidal
person. Suggestive methods, applied alone or in combination, might
be successful in influencing the 'suicide endemic' in a favorable
way.
REFERENCES
Greguss, A. Cs., Banyai, E., M~szaros, I., Cs6kay, L., and Gerber,
A., 1975, Hungarian standard of hypnotic susceptibility (in
Hungarian), Proc.Hung.Psychol.Assoc.Meeting, Budapest, 61-62.
M~szaros, I., 1978, Hypnosis (in Hungarian), Medicina Press,
Budapest.
Phillips, D. P., 1974, The influence of suggestion on suicide:
.
substantive and theoretical implications of the Werther
effect, Am.Sociol. Rev., 39:340-354.
Ringel, E., 1953, Der Selbstmord Abschluss einer Krankhaften
psychischen Entwicklung. Wien, W. Maudrich.
Ringel, L., 1961, Neue Untersuchungen zum Selbstmordproblem. Wien,
BrUder Hollinek.
Ringel. E 1969. (hrsg). SelbstmordverhUtung. Bern. H. HUber.
Tarde. G 1899. Les lois de l'imitation. Paris. F. Alcan.
Weitzenhoffer. A. M Hilgard. E. R Stanford Hypnotic
Susceptibility Scale. Forms A and B. Palo Alto. Calif., Consulting Psychologists Press.
140
141
142
Hypnotic Induction
After waking state date collection, hypnotic inductions were
completed by the first investigator who was regarded as senior and
experienced (Orne, 1979). Beginning with voluntary eye closure, the
initial phase of the induction (approx. 1 min.) included progressive
relaxation instructions from the Stanford Hypnotic Clinical Scale
(Morgan and Hilgard, 1975). This phase was followed by eye-ball set
instructions (eyes rolled up while remaining closed) and an "eyes
closed" catalepsy test. To promote adequate hypnotic depth Ss were
then asked to assign a number on an open scale (Hilgard, 1979a) as to
their depth of hypnosis. Ss were then asked to double this level and
to indicate when they had reached this deeper level by raising a
finger on their left hand. Once this level of depth was indicated by
Ss, the standardized instructions for anosmia to all odors were
administered from item 9 of the Stanford Hypnotic Susceptibility
Scale: Form C.
Experimental Setting and Olfactory Stimulation
Laboratory AR grade eugenol was used as the olfactory stimulus
because of its "pleasant hedonic tone and relative freedom from
trigeminal effects" (Sandusky and Parducci, 1963). A strong odor
(6.615 mg/L eugenol), a weak odor (4.524 mg/L eugenol) or no odor
(air puff only) was administered to each S in random sequence under
hypnosis and waking conditions. Stimulus repetitions amounted to ten
.1 second exposures per odor condition.
Randomized stimulus conditions and random delays between conditions (approx. 40-70 seconds) were controlled by a PDP-ll/I0 computer. The delay interval was required to avoid significant olfactory habituation (Moncrieff, 1970; Ottoson, 1971). Sst respiration
was monitored using a Lafayette 76607 bellows transducer in conjunction with a Lafayette DGS 76102 Datagraph and 76405 amplifier. Ss
were instructed to breathe only through the nose. The respiration
pen output of the Datagraph was sampled (10 Hz) and digitized by the
PDP 11 computer which used the onset of inhaling as a pre-condition
for stimulus administration.
Olfactory stimuli were controlled for concentration and presented via a continuous flow bypass olfactometer (Mitchell, 1971).
Briefly, a small flow of air was bled off a main airstream and
bubbled through the liquid eugenol, causing the air to become saturated (Ough and Stone, 1961). This air was mixed in a diffusion bulb
and was then returned to the main airstream for dilution and presentation to the S. Concentration was precisely varied by adjusting the
flow of air through a bypass. A signal from the computer controlled
a valve allowing the odor-laden air to reach SIS nose. The valve
could be opened and closed repeatedly for any computer controlled
143
period of 0.1 second or more. When stimuli were not being presented
the olfactorium cubicle was kept odor free by an efficient extractor
ventilation system. Laboratory temperature and humidity conditions
were strictly controlled (Mitchell, 1971).
EEG Measurement
On the basis of previous multi-site electrode placement research
(Barabasz and Gregson, 1979) EEG evoked potentials were recorded at
Ts and 0 1 and at T4 and O2 Bipolar measurement (occipital reference) was necessitated by the proximity of the olfactometer apparatus. Maximizing signal-to-noise ratio took precedence over monopolar measurement as is typically used in the measurement of event
related potentials. Grass gold cup electrodes were floated in Grass
EC2 paste. Prior to applying EEG electrodes the skin was cleansed
with acetone and then gently abraded. Eye movement was monitored by
Beckman Silver/silver chloride biopotential hat electrodes placed at
the outer canthi using Beckman paste and double sided adhesive
washers. Electrode resistances were below 2 k ohms at all EEG loci.
The electroencephalograph consisted of a San Ei 8-channel model 1A61
with computer outputs for digitizing and sampling at 100 Hz. Upper
frequency cut-off on the electroencephalograph was set at 30 Hz. The
time constant was set at 0.3.
RESULTS
Prior to data analysis, electro-oculographic (EOG) amplitudes
from the canthi electrodes were noted for each stimulus condition
presentation. Since these amplitudes did not exceed 15-20 ~volts
during olfactory stimulation conditions, data did not have to be
discarded because of eye movement artifact. EEG analog chart records
were also evaluated for artifacts coincident with stimulation
periods. Artifacts associated with the computer controlled operation
of the olfactometer valve precluded adequate analysis of the early
components of EEG evoked potentials.
Amplitude measures were made at both Ts (0 1 ref.) and T4 (0 2
ref.) sites at a latency established form stimulus onset (Valve
open-air puff, weak odor, strong odor). "P300" amplitude was determined from the positive going peak within the range 300-450 msec.
Peaks were measured from a baseline determined as the average activity over the 150 msec prior to signal onset (signal baseline-topeak measure).
The amplitude data was analyzed by a 4-way (2x2x2x3) analysis of
variance (ANOVA). The factors were hypnotizability (low, high),
state (waking, hypnotized), electrode position (T s ,T4), odor (weak,
strong, no odor - air puff only). The problems of small sample size
144
usually attendant on ANOVA (Overall and Klett. 1972) are only pertinent to consideration of within-cell data arrays here; the tests used
were conservative (Appelbaum and Cramer. 1973; Box and Tiao. 1973).
First noted were those contrasts. multidimensional or unidimensional
with associated p<.05. A conservative examination of those with
particular importance to this investigation followed employing the
usual ANOVA convention of extracting higher order terms first.
Hypnosis vs. Waking States
Under waking conditions there were no significant differences
(P>.05. R2-.193) between high and low susceptibility Ss among the
odor conditions. Both high and low susceptibility Ss combined.
however. showed significantly higher amplitudes for the no odor (air
puff only) stimulus versus the weak (p<.OOl. R2=.630) or the strong
odor (p<.OOl. R2=.722).
After exposure to the hypnotic induction high hypnotizable Ss
showed significantly higher P300 amplitudes than low hypnotizable Ss
for weak (p<.001.R2=.812) and strong (p<.001.R2=.923). There was no
significant difference in P300 amplitudes between high hypnotizable
(p>.05. R2=.151) Ss and low hypnotizable Ss in response to the no
odor (air puff only) stimulus. Low hypnotizables did. however~ show
significantly higher P300 amplitudes for the no odor condition as
contrasted with the weak (p<.Ol. R2=.681) or the strong odor (p<.Ol.
R2=.589) conditions.
Electrode Position
There was no significant difference for P300 amplitudes between
Ts (0 1 ref.) and T4 (=2 ref.) electrode positions among the conditions (p>.05. R2=-.204).
DISCUSSION
The major results of this investigation support the view that
highly hypnotizable Ss can emit EEG P300 evoked potentials in hypnosis which are uniquely different frpm those emitted under waking
conditions or those emitted by low susceptibility Ss in either waking
or hypnosis exposure conditions. The use of simulator SSt as a
quasi-control group. combined with E's inability to identify these
simulator Ss would seem to make it unlikely that this finding could
be merely the result of situational variables or differentially
applied experimental demand characteristics.
In summary. following exposure to the hypnotic induction. Ss'
indication of increased hypnotic depth. and suggestions for anosmia
to all odors Ss known to be highly hypnotizable demonstrated higher
145
* Acknowledgement
Special thanks are expressed Christopher Howeson, M. A.,
University of Canterbury, for his assistance in this aspect of the
project.
REFERENCES
Appelbaum,M. E., and Cramer, E. M., 1973, Some problems in the
non-orthogonal analysis of variance, Report No. 120, Psychometric Laboratory, University of North Carolina.
146
Barabasz, A. F., 1980, EEG alpha, skin conductance and hypnotizability in Antarctica, Int.J.clin.exp.Hypnosis, 28:63-74.
Barabasz, A. F., and Gregson, R., 1979, Antarctic wintering-over
suggestion and transient olfactory stimulation: EEG evoked
potential and electrodermal responses, Biol.Psychol.,
9:285-295.
Beck, E. C., and Barolin, G. S., 1965, Effect of hypnotic suggestions
on evoked potentials, J.nerv.ment.Dis., 140:154-161.
Box, G. E. P., and Tiao, G. C., 1973, Bayesian Inference in Statistical Analysis, Addison Wesley, Reading.
Deehan, C., and Robertson, A. W., 1980, Changes in auditory evoked
potentials induced by hypnotic suggestion, in: "Hypnosis in
Psychotherapy and Psychosomatic Medicine," E. Pajntar, E.
Roskar and M. Lavric, eds., University Press (Univerzitetna
tiskarna) Ljubljana, Yugoslavia, 93-95.
Donchin, E., and Heffley, E., 1978, Multivariate analysis of event
related potential data: A tutorial review, in: "Multidisciplinary Perspectives in Event-Related Brain Potential
Research," D. A. Otto, ed., U.S. Government Printing Office,
Washington, 555-572.
Donchin, E., Tueting, P., Ritter, W., Kutas, M., and Heffley, E.,
1975, On the independence of the CNV and the P300 components
of the human averaged evoked response, Electroenceph.clin.
Neurophysiol. 38:449-461.
Hassett, J., 1978, A primer of psychophysiology, Freeman, San
Francisco, p.122.
Hilgard, E. R., 1979(a), A saga of hypnosis: Two decades of the
Stanford laboratory of hypnosis research, 1957-1979, Department of Psychology, Stanford University, Stanford, California.
Hilgard, E. R., 1979(b) Consciousness and control: Lessons from
hypnosis, Aust.J.clin.exp.Hypnosis, 7:103-115.
Javanovic, U., 1979, Audio-video polygraphy during hypnosis: A contribution to the verification of hypnotic states. Presented
at the 8th International Congress of Hypnosis and Psychosomatic Medicine, Melbourne, Australia, August.
Meszafos; I., Banya!, E., and Greguss, A., 1980, Hypnosis, EEG and
evoked potential, in: "Hypnosis in Psychotherapy and Psychosomatic Medicine," E-:-Pajnter, E. Roskar and M. Lavric, eds.,
University Press (Univerztetna tiskarna), Ljubljana,
Yugoslavia, 83-87.
Mitchell, M. J., 1971, Investigations of olfactory similarity scaling, Unpublished Doctoral Dissertation University of
Canterbury, New Zealand.
Moncrieff, R. W., 1970, Odours, Heinemann, London.
Morgan, A. H., and Hilgard, J. R., 1975, Stanford Hypnotic Clinical
Scale (SHCS), in: "Hypnosis in the Relief of Pain," E. R. and
J. R. Hilgard,-eds., Kaufmann, Altos, Calif. 209-221.
Orne, M. T., 1959, The nature of hypnosis: Artifact and essence,
J.abnorm.soc.Psychol., 58:277-289.
Orne, M. T., 1965, Demand characteristics and their implications for
147
149
150
INTRODUCTION
Although hypnosis had been known and practiced since Mesmer's
first "magnetic" treatments in 1774 and despite its gain in popularity among the scientific community after a cyclic history of acceptance and rejection, the study of hypnosis has not yet reached an
advanced stage of scientific development. Controversy persists
concerning the nature of hypnosis and even its very existence. We
may assume that the difficulty in resolving this controversy is
largely in a definition of what constitutes an "altered state of
consciousness" and the development of objective measures of the
"altered states". Since the organism is a psychophysiological unity,
special states of consciousness or special states of the organism are
expected to have some physiological concomitants that distinguish
them from the non-special states. Despite continuing research, the
important set of physiological variables, which emphasizes the events
in the central nervous system, has been superficially investigated.
Hypnosis and EEG
Ever since the discovery of the human electroencephalogram in
the late '20s by Berger, the alpha rhythm (8 - 12 Hz) has stood out
as the most prominent feature of the waking state. As a consequence,
investigations of specific EEG patterns during hypnosis involved the
alpha rhythm. Renewed interest in this rhythm has been stimulated by
Kamiya's (1969) claim that the alpha rhythm can be operantly shaped
and brought under voluntary control. In a review of previous EEG
reports, Evans (1972) noted that most studies trying to find EEG
changes concurrent with hypnosis have been anecdotal. However,
according to Engstrom (1976), a significant evidence supports a
"moderate relationship between alpha activity and hypnotic susceptibility"
Hypnosis and Depth EEG
In the study of epileptic patients medically resistant, who are
potential candidates for surgical treatment, Depth EEG (DEEG) recording has been used for many years for the exact delimitation of the
epileptogenic lesion (Talairach et al., 1974; Bancaud and Talairach,
1976).
To our knowledge, hypnosis has never been induced in epileptic
patients during DEEG study. This neurosurgical diagnostic procedure
offers a unique opportunity of obtaining important information on the
possible neurophysiological mechanisms implied in human hypnosis.
In this paper, we report preliminary DEEG findings recorded
during hypnotic and non-hypnotic states in epileptic patients.
151
152
-==~~= A .
~
L
Fig. 1.
PATIENTS
N.
35y - F
DEPTH
EEG
FOCUS
SEIZURES
Psychomotor &
EXPLORED
STRUCTURES
Right
Left
A.
T 1
F .0.
2ly - M
Psychomotor &
Secondarily General.
8 - 16 weekly
N.
A.H.
A.
F . G.
T.Ant.
abnorma 1 i ties
N.
BARBER
SUGGEST! B I LITY SC.
2ly - M
Sensorimotor &
Right Parietal Focus
Secondarily General.
10-20 weekly
Fig. 2.
A.H.
A.
F . G.
Fr.
TPO
T 1
F . O.
A.H.
A.
TPO
Gyr.C.
P.
S.M.
VL ThaI.
A.
A.
conditions: 1) Resting (baseline). 2) Waking suggestions (imagination instructions). 3) Hypnosis. 4) Post-Hypnosis. The patients
were tested as their own control, due to obvious technical and methodological reasons.
DEEG study included: a) background activity; b) focal interictal abnormalities. The variation of interictal activity was evaluated considering number, amplitude and diffusion of interictal
spikes. Ictal activity was not recorded during the periods considered for this study. DEEG recordings of sleep stages were taken
in one patient and compared with hypnotic EEG patterns.
IS3
154
%':C RESTING
0'
10
IS' 0
,
5'
%'::1==
%':1 .... ---..
10'
155
POST
HYPNOSIS
HYPNOSIS
'5 0 '
I
S'
IS' 0 '
10'
RHINEN _
CEPHALON
TEMPORAL
ANTERIOR
CORTEX
,----.----. ' . ~
~
TEMPORAL
POSTERIOR
CORTEX
"
,.' :
: 7 . . ., _- -- __ ..
...
~
"
FRONTAL
CONVEXITY
CORTEX
: p < 001
P " 005
CASE. 1
WAKING
POST
RESTING
SUGGESTION
HYPNOSIS
HYPNOSIS
5'
10' '5' 0 '
5'
'0' '5' 0 '
5'
10'
15' 0 '
5'
'0'
'5'
_-'-_"----'1
1.-1_
,.
,.. ..
;E
~-
' "
.-----. ...... . . .
...
1.
-
,"" .
----- ... --
THETA
ALPHA
DELTA
BETA
1.-1
15'
Fig. 3.
0'
10'
~~
--.---_. .......... .. ... :;- -. . ..
:,:., ........
-- --,
- ",'
5'
'-
50
AMMON HORN
~_------' AMYGDALA
p::.
_-'---1'
.......
,- -
o~--------------------------~------------------- -
MESIAL
- -. POSTERIOR
LZ 100
TEMPORAL
NEOCORTEX
0~
RRHINEN _
CEPHALON
_.
____________________
:L-
HEART RATE _ _
RESPIRATORY
RATE ---- ______ _ _
~=W~D-~
------------ =-=-___
----
_______
=--:--:-"'-----
---------
Fig. 4.
GO BREATHS
: p" 00'
-AMMON HORN
--, AMYGDALA
110 BEATS
MEAN
BLOOD
PRESSURE
: p < 000'
- ANTERIOR
---INFERIOR
p "0,05
30
MIN.
CASE" I
156
RESTING
L-
:}h_ _ _ _ _----------0'
RHINEN_
CEPHALON
II
S'
10'
IS' 0 '
,
S'
10'
IS'
20'
POST SLEEP
25'
30'
35' 0 '
.. "---"- ----
5'
10'
IS
~AMMONHORN
........... - -- . AMYGDALA
O~-------------------------------------------
~---------:===
R-
'0 SO
RHINEN _
CEPHALON
loot
50
----
Fig. 5.
__
MESIAL
------------ POSTERIOR
: : : - - - - - ANTERIOR
-~------- INFERIOR
_
AMMON HORN
------------ AMIGOALA
Our observations demonstrated a statistically significant enhancement of alpha activity, concomitant with a moderate increase of
beta activity and a decrease of slow activity, during hypnotic
states, relative to both pre and post-hypnotic periods.
A discriminating analysis of our data is consistent with quantitative EEG data by Ulett et al., (1972), who observed a decrease of
slow activity and an increase of alpha and relatively high frequency,
fast activity during trance periods. Although both poor and good
hypnotic Ss (case n. 2-3) showed a decrease of slow and an increase
of fast activity, deep hypnosis (case n.1) was ,associated with a
significant increase of alpha production.
These changes were basically different from sleep EEG patterns,
thus supporting the available evidence that there is no similarity
between hypnosis and sleep in the EEG (Evans, 1972). Moreover sleep
is one of the most important "activation procedures" of diagnostic
EEG abnormalities (Schwab and Young, 1973) in epileptic patients,
whereas hypnosis induced a clear-cut reduction of interictal EEG
activity in these patients.
There is increasing evidence that neural correlates responsible
for hypnotic behavior may be mediated by the limbic system. According to Arnold (1959) cortical inhibition during hypnosis may involve
the hippocampal action circuit connected with the diffuse thalamic
system. Moreover suggestions given for cataplexy could be mediated
157
via the limbic system connecting with the premo tor and motor cortex
and represent motor imagination (ideomotor) transformed into action.
Ideosensory visualizations are mediated via the limbic system which
connects with the frontal "association areas" and the primary sensory
receiving areas. Crasilneck et al. (1956), described how hypnosis
terminated each time during brain surgery for epileptic focus when
the hippocampus was stimulated. They suggested that the hippocampus,
which is involved in keeping the brain attentive to carrying out
goal-directed behavior, mediates whatever neural circuits are involved in hypnosis.
Our DEEG data support these assumptions, confirming the primary
role of the limbic structures in mediating hypnotic behavior. However limbic EEG patterns are still far from being strictly related to
discrete typical behaviors, such as hypnotic trance, and further
studies are needed in order to acquire more evidence.
If we consider a convulsion as a result of both physiological
and emotional events operating in the individual, emotions being the
commonest precipitating factor of epilepsy, then any amelioration of
one will raise the convulsive threshold or lower the seizure level
(McCabe and Habovick, 1963; Goldie, 1967). Although "voluntary
control of the alpha rhythm" was achieved over 40 years ago (Jasper
and Shagass, 1941), only in the recent years has such control been
used for clinical purposes (Kamiya, 1968) and suggested as possible
treatment for epilepsy (Miller, 1969). One striking characteristic
of many epileptics is the absence of a 12 to 14 Hz rhythm normally
recorded from the anterior portions of the brain (SMR, sensorymotor
rhythm) and the presence of a 4 to 7 Hz rhythm at the same location
(Olton and Noonberg, 1980). Biofeedback may train the individual to
increase the amount of SMR and to decrease the amount of 4 to 7 Hz
activity (theta rhythm). As a consequence, clinically significant
decreases in seizure activity have been found after biofeedback
training (Sterman, 1973; 1977).
Our observations demonstrate that hypnosis induces a highly
significant reduction of the interictal activity in epileptic patients, concomitant with an increase of alpha and SMR rhythm and a
decrease of slow activity, similarly to biofeedback but without prior
training.
Summing up, DEEG study in epileptic patients during hypnotic and
non-hypnotic states forwards the following conclusions:
(1) hypnosis is associated with significant decrease of slow
activity and an increase of alpha and relatively high frequency,
beta activity.
(2) hypnosis and sleep EEGs are fundamentally different and there is
no convincing evidence of physiological similarities between the
two states.
158
159
M~szaros.
162
I. MESZAROS ET AL.
cepted that the left hemisphere in right-handed people can be characterized as a verbal, voluntary, digital, rational and sequential
processor, while the right can be classified as an imagery, automatic, analogous emotional and holistic processor (Sperry, 1974;
Gazzaniga and LeDoux, 1978; Moscovitch, 1979).
The mode of information processing in a hypnotically altered
state of consciousness seems to be strikingly in accordance with the
prevailing functions of the right cerebral hemisphere. In spite of
this similarity we could find no direct research on this relationship
in the literature. Data, however, do exist showing a positive correlation between susceptibility to hypnosis and the preference for
right hemisphere use (Bakan, 1969; Gur and Reyher, 1973; Gur and Gur,
1974).
It can be hypothesized that this right hemisphere preference in
highly hypnotizable persons will become more pronounced under hypnosis. The purpose of the present experiment was to test this hypothesis, using choice, reaction time and evoked potential as indices.
METHOD
The subjects held a button in each of their hands. They were
instructed to push it either with the right or the left hand according to the contents of a visually presented command. As seen in
Figure 1 the commands were composed of two parts: the triangles,
pointing to the left or right, were chosen to activate the right
hemisphere, while the words within the triangles (meaning left or
right in Hungarian) were aimed at mobilizing the left hemisphere.
Each of the commands was projected as a bright picture onto a black
background by a tachistoscope for 10 msec. In order to focus the
subjects' attention on the brief (20 msec) visual presentations, a
2000 Hz warning tone was administered 400 msec before each picture.
Following the warning tone the subjects were asked to keep their eyes
on a point of fixation in the center of the visual field. One series
of stimuli consisted of 160 pairs of stimuli with each of the four
visual commands appearing 40 times in random alternation.
Procedure
Six right-handed subjects, scoring 12 on the Stanford Hypnotic
Scale of Susceptibility, Forms A and B, who had previously participated in several hypnotic experiments in our laboratory, took part in.
this study.
At the very beginning of each session the stimulus words and
triangles were presented separately to the subjects in order to teach
them to push the button as soon as possible according to the meaning
of the stimulus.
163
<:@~
c
Fig. 1.
164
1. MESZAROS ET AL.
The late components of the evoked potentials showed no difference in latency. In the amplitude measure, however, a significant
difference appeared over the left occipital area (see Figure 5).
Both in hypnosis and in the waking state the peak-to-peak amplitude
of the positive peak at 120 msec latency and the negative peak at 200
165
0,6
0 ,4
0,2
~ ~ [3> ~
stimulus
response ",-
'0
Fig. 2.
right
word
left
hand
sec
response
word
r' gni
Fig. 3.
~rianqle
Ie t
triangle
right
word
Ie
hand
166
I. MESZAROS ET AL.
sec
0 ,8
0,6
0,4
-----hI'
NJ
I,
I
~ -,.,.
~,
IJ
0,05
0,2
waking
Fig. 4.
Hypnotic
167
14
12
10
8
6
s imulu'
resp nse
/ to
' w.
Fig. 5.
+~
rd
rrlarJ
r i ."
If'
Ie
triangl!?
",'ord
rig t i e I 1
ha nd
10
B
s imulu
to
response '
' w' h
Fig. 6.
w~rd
,i9',1
+rlangle
left
triangle
ri ht
word
lelt
hand
168
I. MESZAROS ET AL.
Because of the constraints imposed by squeezing all the information I want to summarize into one small conference, paper, I will
report only EEG findings. This means that I will not be referring at
all to other aspects of the experiments mentioned, such as sex differences, or performance scores on the experimental tasks. I will
also confine myself to dichotomized data, i.e. I will contrast highly
169
C. MACLEOD-MORGAN
170
HS
where
R
L
LH task
=
=
=
RH task ..
(LH task)
R- L
R+L
(RH task)
HEMISPHERIC SPECIFICITY
171
A positive score on HS indicates that the subject's lateralization shows task-specific changes. So. however idiosyncratic the
alpha ratio between a subject's cerebral hemispheres may be. his HS
score will be positive provided his alpha ratio becomes more positive
for left-hemisphere tasks. and more negative for right-hemisphere
tasks.
The tasks I use as so-called left hemisphere ones are numerical
and verbal; and for the right hemisphere. spatial and musical ones.
Obviously. there is no such thing as a task which activates only half
the brain! but these kinds of tasks have been shown to bias activation (Morgan et al 1971; Doyle et al 1974).
Apparatus
For all experiments. I use 01-P3 electrode placements for recording left hemisphere alpha. and 02-P4 for the right (10-20
system). Earth electrode is on the right mastoid bone. Impedence is
kept below 5 K ohms for all subjects. A Devices Ltd Type M3 physiological recorder is used, in conjunction with alpha filters measuring integrated amplitude alpha within a digitally controlled time
window - leading to complete rejection outside the waveband. and
complete acceptance within it. (These filters are a more elaborate
version of those described by Hosek and Wilson. 1973).
Scoring of Data
EEG output consists of light-beam traces on photo-sensitive
paper. Four channels are used:
(1) the raw EEG trace. to check for muscle artefact
(2) an event marker operated by the experimenter
(3) and (4) sets of histograms which are analogues. for each
hemisphere. of the amount of integrated amplitude alpha
present in each ten-second epoch. The histograms are
hand-scored. blind to subject identity to avoid any
experimenter bias.
Hypnotizability Scores
All subjects are screened for hypnotizability with the Harvard
Group Scale of Hypnotic Susceptibility (Shor and Orne. 1962). and
subsequently tested individually with the Stanford Hypnotic Susceptibility Scale. Form C (SHSS:C) (Weitzenhoffer and Hilgard. 1959).
Scores are arbitrarily dichotomized for the purposes of this paper
into highly hypnotizable (HI) scoring 8 and over on SHSS:C. and low
hypnotizable (LO) scoring 6 and under. Subjects who scored 7 (the
172
C. MACLEOD-MORGAN
midpoint of the scale from 0 to 12) have been excluded from analyses
in this paper.
Hemispheric Specificity
In 1979 in Melbourne, I reported that HIs showed greater hemispheric specificity than Los, when the EEG alpha ratio during a
series of left-hemisphere and right-hemisphere tasks was compared that is, the difference in the mean alpha ratio between the two types
of tasks was significantly greater for HIs than for LOs. (MacLeodMorgan, 1979). Robert Karlin reported a replication of this finding
at the 1980 SCEH conference.
Experiment 1
Subsequently, I ran a similar experiment in which I also compared continuous and discontinuous tasks. (MacLeod-Morgan and Lack,
1982). By continuous tasks I mean those which require constant
monitoring or responding by the subject, as compared to the question
and answer format of the discontinuous tasks. 44 subjects took part
(18 HI, 26 LO). Once again, hemispheric specificity was significantly greater for the highly hypnotizables, especially during continuous tasks. Since then there have been two more replications;
consistently the HIs show greater hemispheric specificity than the
LOs - that is, they make larger task-predictable shifts in alpha
ratio bias.
Conflicted Tasks
I now became interested in what might happen if subjects were
given conflicted tasks in which information relevant to both cerebral
hemispheres is presented, but the given task asks that only one set
of information is acted upon, while the other is ignored. I wanted
to find a right hemisphere task which could be performed during
presentation of conflicting left hemisphere information, and a left
hemisphere task which could likewise be performed during presentation
of conflicting right hemisphere information. For the right hemisphere task I chose the Stroop test, in which color names are written
in incompatibly colored ink - subjects are required to name the color
of the ink. There is a right hemisphere advantage in color processing (Davidoff, 1976; Pennal, 1977; Biederman and Tsao, 1979) and it
was hoped that the written color names would provide conflicting left
hemisphere infqrmation.
HEMISPHERIC SPECIFICITY
173
KEY:
HI
LO ~
1
YEAR:
Fig. 1.
1978
J
1979
lQSO
1981
Experiment 2 (a)
24 subjects (12 HIs, and 12 LOs) were required to name the color
of ink in which 66 incompatible color names were written (the Conflict condition) and again, to name the color of ink in which 66
groups of XXs were written (Control condition). The HI group's alpha
ratio was not significantly disrupted by the presence of the conflicting information, but the LO group showed a significantly
stronger right hemisphere bias in the Control condition (t (9) =
2.72, P <.02).
Experiment 2 (b)
This was carried out to attempt to replicate these findings, and
also so that a black-and-white reading control condition could be
added to check whether the reading of the simple color names used
(red, blue, green and yellow) was indeed the required left hemisphere
task.
Again, the alpha ratio of the HI group was not significantly
disrupted by the presence of conflicting information. The significant change in bias shown by the LO group was not replicated. However, the reading of the sjmple color names proved not to be a lefthemisphere task. With such simple words, for which the task prepared
the subjects, reading would probably be carried out in a "look-andsay" or gestalt fashion. Further work is now required, manipulating
the difficulty of the color-names used, before the problem can be
said to have been satisfactorily addressed.
For the left-hemisphere task to be performed during righthemisphere conflicting information, I used the Random Number Generation task (Graham and Evans, 1977) performed while familiar music
was being played. The RNG requires subjects to say the numbers
between 1 and 10 randomly, i.e. without falling into sequences or
patterns, in time to a metronome ticking at the rate of one beat per
second.
Experiment 3 (a)
24 subjects (11 HIs, 13 LOs) first sang along with a piece of
instrumental music with which they were familiar from a previous
experiment, then performed the RNG task; then they performed the RNG
HEMISPHERIC SPECIFICITY
175
task a second time while the instrumental music was playing. The
high hypnotizable group's alpha ratio changed significantly in the
task-predictable direction when the singing condition was compared to
the first RNG performance (t (10) = 2.95, p< .008, one-tailed test),
but did not alter significantly when the RNG task alone was compared
to the RNG task during music.
Experiment 3 (b)
Replication of the above finding was sought with a further 24
subjects (12 HIs, 12 LOs). Although the configuration of the HI
groups alpha ratios remained similar to that found in experiment 3
(a), the difference between the singing condition and the RNG task
alone was no longer significant. However, once again the HI group's
alpha ratio did not change significantly between the performance of
the RNG on its own, and during music. When the samples from the two
experiments were combined, the singing condition was found to differ
significantly for the HI group when compared to both RNG conditions
(Singing and RNG (conflict): t (22) = 1.91, P <.04; Singing and RNG
(control): t (22) = 1.76, P <.05 (one-tailed tests)): but the two RNG
conditions were not significantly different from each other for the
HI group.
These conflicted attention experiments leave much to be desired,
and the question of what happens to hemispheric specificity in the
presence of conflicting information appropriate to the other hemisphere remains to be adequately addressed. Nevertheless, in none of
the four experiments was the alpha ratio of the highly hypnotizable
group significantly disrupted, so this problem would seem to be worth
addressing more rigorously.
Hypnosis
Experiment 4
The final piece of evidence which I wish to present is related
to hypnosis per se. I have shown that EEG alpha ratios for the
highly hypnotizable subject are specific to the task he is given, and
i t therefore seems logical that this should also apply to the "task"
of hypnosis no less than to any other task.
There is much evidence (Frumkin et al., 1978; Graham, 1977) to
lead one to hypothesize that hypnosis should be a right-hemisphere
task. The Frumkin et al., paper itself shows that while performing a
dichotic listening task, subjects' normally strong right-ear advantage is significantly decreased. Also Bakan and Svorad (1969) and Gur
and Gur (1974), investigating lateral eye movements, have shown HIs
to be left movers - i.e., they preferentially activate the right
176
C. MACLEOD-MORGAN
KEY:
1980
15
SAMPLE.
(11
= 24
HI.
1981
13
HI_
LO _ _
SAMPLE.
(12
LO)
= 24
HI.
12
LO)
10
15
10
o
-5
;g -10
10
15
CONDITION:
Fig. 3.
SING
RNG
DUAL
SING
RNG
DUAL
Alpha ratios for high and low hypnotizable groups from two
samples (1980 and 1981) while singing along with music
(sing): and performing the random number generation task on
its own (RNG) and while the music from the "sing" condition
is being played (dual).
HEMISPHERIC SPECIFICITY
Low HYPNOT I ZABlES
(N = 47l
177
HIGH HYPNOTl ZABlES
(N = Ill)
15
10
...
co
>-
'"~
...
~
~
...
0
-5
...J
"'"
Fig. 4.
178
C. MACLEOD-MORGAN
HEMISPHERIC SPECIFICITY
179
182
M. PAJNTAR ET AL.
183
Hypnotherapy began sixteen months after the injury, the first electromyographic signals were noticed (nascent potentials) at voluntary
contraction of the extensor carpi radialis muscle. However, no
clinically observable contraction could be perceived. When a contraction of this muscle was observed for the first time after the
injury, the patient was age regressed in hypnosis to the time prior
to the accident. Age regression was additionally supported by a
suggestion that the patient was competing with his friends in lifting
a stone that was lying on the back of his right hand. A palpable and
visible contraction of the mentioned muscle as well as a noticeable
movement of the hand was observed (Pajntar et al., 1977; Pajntar et
al., 1980a).
In the second session a few days later, EMG of the extensor
carpi radialis muscle was recorded during suggested voluntary contraction while the patient was in the awake state (as shown on the
left of Figure 1) and in hypnotic age regression (on the right of the
figure). While in the awake state amplitudes were hardly noticeable.
In hypnotic age regression the amplitudes of the EMG signal increased
considerably.
At the same time, the magnitude and the duration of the muscle
force torque were measured and recorded. Figure 2 shows the records
of voluntary isometric contraction A) in the awake state, D) in
hypnotic age regression, and E) in post-hypnotic suggestion. The
arrow indicates the beginning of a contraction. While in the awake
state the force was very small, but in hypnotic age regression the
Fig. 1.
184
Fig. 2.
Fig. 3.
M. PAJNTAR ET AL.
185
patient achieved three and a half times greater and two and a half
times longer isometric movement. The influence remained noticeable
when the patient responded to post-hypnotic suggestion.
The same patient one week later is shown in Figure 3. After
training in hypnosis, rough force increased and the improvement
became noticeable in the awake state. The progress achieved in
hypnosis, in relaxation, in the suggestion of competition as well as
in age regression was even greater. After a few months of training
in hypnosis and the accompanying physiotherapeutic training in the
awake state, the patient returned home almost completely cured.
It is well known that after long-lasting denervation the patient
either cannot activate the reinnervated motor units or does not know
how to do it adequately. In hypnotic age regression, on the other
hand, when the patient mentally shifted back to the period prior to
the accident, he could apparently contract the affected muscle even
at weak reinnervation. Later on in hypnosis he was able to activate
his neuromuscular system much better. We believe that in such hypnotic age regression, in addition to the memory of adequate contraction, the existing reserves in the human organism are exploited
in a manner still unknown to us.
2. Hemiparetics
Various kinds of disturbance are present in hemiplegic and
hemiparetic patients (after cerebrovascular insult, trauma or tumors)
as a consequence of the reduced voluntary motor control of the affected half of the body. Plegia or paresis of some muscle groups is
coupled with an increased muscle tone spasticity, which results in an
ineffective movement of the upper and lower extremities.
Very good effects of various hypnotic suggestions were obtained
on voluntary contraction of paretic dorsiflexion of the foot and
wrist extent ion (Roskar et al., 1977; Pajntar et al., 1978; Roskar et
al., 1978a; Roskar et al., 1978b; Roskar, 1978c; Pajntar et al.,
1980b). A few cases of such neuromuscular phenomena are shown in
Figure 4.
Here are the results of measurements of maximal voluntary hemiparetic foot dorsiflexion in a three co-ordinate measuring brace for
hemiparetic patient P.M., a year and a half after a cerebrovascular
insult. In the figure are the results of EMG activity and rough
force measured as isometric torque for the fist and control experiment for the affected foot and for the unaffected foot. The third
trace shows the dilated EMG signal. In the first experiment on the
affected foot, in the awake state, only a minimal EMG activity and
only approximately 0.5 Nm intensity of dorsiflexion may be observed.
The dorsiflexion was the greatest in hypnotic age regression, when it
186
M. PAJNTAR ET AL.
ClWoke
EMG
"';V
.l1
loot
do,s.ft
14"" I-'""
hypn reg",sslDn
~ ./
-.:.~
1!!ms
,"
hypn.- relned-
'",
poslhypn eugg-
.,..,.f_"W""III.... , '"
~
"'1If-~.-.-..--.
EMG
loot
do.s.fI
awah
lImV
~.LL
.~.
tzON
..
hypn.- r,I .. ,d
.-
~
,..,1
.'
...
....
~
.I,
'"' I '
lJIIl'U
posth),pn. sugg.
I--A
1.
Unaffected foot
EMGI-~"~--C;~
do.s.fl
Fig. 4.
was suggested to the patient that she was young, that she had an
unaffected leg and that she could do whatever she wanted with it.
The dorsiflexion was about twenty times more intense than before and
the EMG signal was much stronger.
The first experiment was followed by two similar experiments in
hypnosis. In the third experiment the dorsiflexion torque was nearly
the same in the awake state and in the hypnotic states, i.e. fifteen
Nm. Three months after the last experiment a control experiment was
performed. We wanted to find out whether the effects of training in
hypnosis diminished as the time passed. As the figure shows, the
results of dorsiflexion remained unchanged from the last experiment
(15 Nm), but it is interesting that the effect increased again in
hypnotic age regression, so that now dorsiflexion reached about 30
Nm, that is about 60 times more than at the beginning of the experiment.
The effects of hypnotherapy which we discovered brought us to
some interesting conclusions. As the signals for the EMG activity
of the agonist (the dorsiflexor muscle) revealed, an increase of the
amplitude as well as the frequency may be attributed to the effects
of hypnotic suggestion of relaxation and even more to the hypnotic
suggestion of age regression in both experiments as shown in Figure 5.
187
:l
.. .
::>
..... ,.
u .-!
c
IN HYPNOSIS-
..
a:
AGE REGRESSION
AWAKE
1/1 _
POSTHYPN. SUC.
Of RElAIlATION
.~
o .~
0.
100
200
300
400
[Hz)
100
200
300
400
[HZ]
Fig. 5.
188
M. PAJNTAR ET AL.
1st experiment
test
measurement
EIliG
200jN
200)111
hypnr
".d
i2ii
..
EIIIIG a"laOOn'"
100)N
."I'lIon,SI
control of
.. th experi me nt
. ... k.
189
hypn. revr-ion
EMG 100n,II
100)N
2H)lY
Fig. 6.
190
M. PAJNTAR ET AL.
~I,~TPIC
l. Al'l
~UNCTI
(lor
ft
pl
f l.x
ex \.en
ICN(
HIP
R Al'l
do .. (I."
pI
(I
, lex.
d."r
p\
J TO 138
f ' ex
f
'.x
ext..e ...
l.
OCNlE
l.
HIP
"
Al'l.E
( I.x
dor f\ ..::
pI
(I."
ext-.n
(Ie ..
It
HIP
Fig. 7.
(I . . .
HYP~-RELAXfD
-.ide (affected)
l>
Fig. 8.
191
0 "
0 '1 t.
t H1 (
F l
"
C T 1 0 " 5
In order to prove the efficiency of hypnotherapy and to determine the effects of various suggestions upon given pathological
urodynamic parameters, each of our patients was examined by a precise
urodynamic measuring test with the EMG of sphincter. Figure 10 shows
that in the hypnotic suggestion of relaxation the activity of the
sphincter with the full bladder is reduced. In spite of the reduced
activity, the occlusion of the sphincter was sufficient and urinary
incontinence did not occur. This phenomenon was used also in cases
of patients unable to urinate because of various psychic reasons and
of the resulting too intense contraction of the sphincter (detrursorsphincter dysynergia).
192
M. PAJNTAR ET AL.
AWAI\ r.
H,{P
.-RELAXED
Fig. 9.
193
REGRESSION
Fig. 10.
194
M. PAJNTAR ET AL.
Vollinlar Y contr. of
p -Ivir floor mll des
A.... AKE
RE(,RL 'SIO'<
Fig. 11.
195
Fi1-iOi ,.,
,upms
I.,
,..... ,.......,,.
1M
t.
.Bl 01 'N.
,~n
. f~o. 511
... ...
<.J:
II II ll ..11
:.;;
n. ,,,. im,
J
'J
....
,. ,
i. p Liz.
illOlnA
,,~
... l.
h!'i ij
~lIik: lU ~
i.
tlIJ.; ,:.
.,
, :-1
'n'
,...
: ; 1'
.10 Jet!
,'/
'"
1.-1
; - - - . -f--
..
I.: 0Hz. t 10."" ~
,.il till iC:. ~ t il1IU!ac Ij..
L-i _ _ .
. ...
.. !._~ .' ~. te~ru~\,.o1~ 't ~T'
.
... 1 .. I. . . . !
,........ ~tI ni sj imUl:iia ILlREG ESWI _.
HI PNOZA: sugeat i~ HI PEREKSCITABILNOS TI
HYPNOSIS:SU9gestion HYPEREXCITABILITY IN REGRESSION
Fig. 12.
196
M. PAJNTAR ET AL
I ..
DORSIfLEXION
TlltQUE
~J
"r-
I I
-;,Jl
_I .. I
III
;:::';;i
I
1 j
- 1
Dorst!.
.t- -torq.
II HYPIlDSIS -RELAXED
,.-r-
r- r~
"
"n,
,....
:"""'.
""'.
iA
I-
!
- -"-1"-"
Fig. 13.
'---L..;
:..:;
197
to scope trigg.r
to osc:illo.cop.
ground
Iectrod.
I,
::
letency of M - ,r pon. .
,
~di ...cl M -
Fig. 14.
response
198
M. PAJNTAR ET AL.
15'
reltcitlb.
Fig. 15.
1aJ."
1>-"-
keL~ti:i
11
I.,
IholD,
.I,'w.~d
1-
, i'++F~
ITH
."
i -'
irJ\
"1
j
:1+-r
!
I
I
J1J
I I
I~
1_
I =IfN
I \ 1
K.B. l-eap.
:u.& tE b
I H1i~ IN A
~ r-"-I-tI
:..] ~
Fig. 16.
~ !
1-
i i I I I I-!
ftil
"h'~DI
1-'"
I-
H' fplol
I.B
ii
'\
\
\I
o_ ~+~ BQ'
II~_~
I
I
I
I
.
~
I !
o-
1,L
I ; I!WN;
- , I I I5tI
K.A l-e1lP
199
K.B.-2-c p .
Fig. 17.
excitability and changes in the wave shape and H-responses are clearly seen.
All the above changes in the EMG responses under the influence
of hypnotic suggestions are most probably due to a facilitatory
influx from supraspinal motor centers.
C. MUSCLE FATIGUE
1. Voluntary contractions
The problem of muscle fatigue exists in many fields of human
activity, for example, in sportsmen. In our research, we were interested in this problem from the point of view of helping patients with
various kinds of damage of the locomotor system. (Jeglic et al.,
1975; Jeglic et al., 1980).
The influence of hypnotic suggestions was first analyzed in
cases of maximal voluntary contraction of nonhandicapped experimental
subjects. At voluntary maximal dorsiflexion of the foot in the awake
state, the isometric moment of muscle force was reduced after 50
seconds to one half of its initial value. On the hypnotic suggestion
of competition and of no fatigue however, the isometric moment remained unchanged after eighty seconds and the experiment had to be
interrupted. In the second trace of both records, the EMG is represented. The records show a gradual decrease of the EMG activity in
the awake state and an unchanged or even intensified EMG activity
towards the end of the experiment under hypnosis (see Figure 20).
200
M. PAJNTAR ET AL.
Al/AKE
1000mV/5mV
Fig. 18.
Fig. 19.
201
it did not decrease to half of its initial value. On the other hand
under suggestion of strong fatigue, the isometric moment was reduced
to one half in thirteen seconds. The suggestion of no muscle fatigue
resulted in a hundred and fifty per cent increase of the isometric
moment, which persisted in this increased intensity for three and a
half minutes. The electrical stimulation had then to be interrupted
as there existed a danger that the muscle or the tendons might be
damaged.
Similar results were obtained also in hemiparetic patients, but
of course in a more limited scope. By way of precaution, in these
cases we did not use the suggestion of no fatigue. In Figure 22 it
may be seen that in hypnosis, the fatigue occurs much slower. While
in the awake state the isometric moment decreased to one half in
eighty-six seconds and in the state of hypnotic relaxation it decreased to one half only after a hundred and fourteen seconds.
We are of the opinion that the slower fatigue under the influence of hypnotic suggestion may be ascribed primarily to the occurrence of a reflex response induced by the suggestion of no fatigue.
These reflex responses are shown by an EMG record in Figure 23. The
upper recording is for the awake state and the three lower recordings
are for the hypnotic suggestion of no fatigue. The reflex responses
increase as the experiment progresses.
202
M. PAJNTAR ET AL.
1\ Hl P'<n.IS - m AU<N'HUOr't
ef t:Gn1p'-'Uunn
Fig. 20.
CONCLUSION
203
11;,
2,5
2,0
r\
1,5
5,8N~,__________ 5,2 __ ._ __
__
/'-1's'
S?_ _ ______ _
0,5
'AWAKE----'
Fig. 21.
Fig. 22.
,,
,,
,
relaxed
,_________________________
I(min)
1
1 P.J.
I 20.3.75
IN HYPNOSIS
204
M. PAJNTAR ET AL.
agonistantagonl.stin h}pno
Me u ru ,
a,
- no
r-r-r-r-r
Fig. 23.
205
Jeglic, A., Roskar, E., Pajntar, M., Vodovnik, I., Drugovic, M.,
Stefancic, M., and Zajec, J., 1977, Hypnosis in the rehabilitation of peripheral nerve lesion II, Zdrav.Vestn.,
46:225-228.
Jeglic, A., Roskar E., Pajntar, M., and Vodovnik, L., 1980, The influence of hyper-suggestion on the fatigue of electrically
stimulated muscles, in: "Hypnosis in Psychosomatic Medicine,"
M. Pajntar, E. Roskar, and M. Lavric, eds., Slov.soc.clin.exp.
hypn.,Kranj, 127-132.
Pajntar, M., Jeglic, A., Stefancic, M., Vodovnik, L., Zajec, J.,
Roskar, E., and Drugovic, M., 1977, Restoration of peripheral
nerve lesions by hypnosis, Zdrav.Vestn., 46:159-162.
Pajntar, M., Roskar, E., Vodovnik, L., and Gros, N., 1978, Hypnosis
in the rehabilitation of hemiparetic patients. Report, 1st
European Congress of hypnosis in Psychotherapy and Psychosomatic Medicine, Malmo, Abstracts.
Pajntar, M., Jeglic, A., Stefancic, M., and Vodovnik, L., 1980a,
Improvements of motor response by means of hypnosis in
patients with peripheral nerve lesions, J.clin.exp.Hypnosis,
28:16-26.
Pajntar, M., Roskar, E., Vodovnik, L., Gros, N., and Rudel, D.,
1980b, Further experiences with hypnosis in hemiparetic
patients, in: "Hypnosis in Psychotherapy and Psychosomatic
Medicine,"M. Pajntar, E. Roskar, and M. Lavric, eds.,
Sov.soc.clin.exp.hypn.,Kranj, 242-248.
Pajntar, M., Roskar, E., Gros, N., Valencic, V., and Malezic, M.,
1980c, The evaluation of hemiparetic gait pattern in hypnosis,
in: "Hypnosis in Psychotherapy and Psychosomatic medicine," M.
Pajntar, E. Roskar, and M. Lavric, eds., Slov.soc.clin.exp.
hypn.,Kranj, 133-138.
Roskar, E., Pajntar, M., Vodovnik, L., and Gros, N., 1977, Improvements of motor response in hemiplegic patients by means of
hypnosis, 1st Mediter.Conf.on Med. Biol. Engn. ,Sorento, Italy,
Digest of papers, 1-85, 1-88.
Roskar, .E., Pajntar, M., Vodovnik, L., and Gros, N., 1978a, Neuromuscular activity of hemiparetic extremity in hypnosis,
Report, 1st European Cogr. of Hypnosis in Psychotherapy and
Psychosom. Med., Malmo, Abstracts, 35-36.
Roskar, E., Pajntar, M., Vodovnik, L., and Gros, N., 1978b, Improved
neuromuscular activity of hemiparetic extremity due to hypnosis, in: "Advances in External Control of Human Extremities, "Belgrade, 257-268.
Roskar, E., 1978c, Influence of hyper-suggestion on motor functions
of electrically stimulated muscles, M.Sc.thesis, University of
Ljubljana, Faculty of Electrical Eng.
Roskar, E., Vodovnik, L., Pajntar, M., Stefancic, M., Rudel, D., and
Zrimec, T., 1980, The influence of hypnotic suggestion on
motor excitation in man, in: "Hypnosis in Psychotherapy and
Psychosomatic Medicine," Me Pajntar, E. Roskar. and M. Lavric,
eds., Slov.soc.clin.exp.hypn.,Kranj, 119-126.
206
M. PAJNTAR ET AL.
Erika Fromm
University of Chicago
Department of Behavioral Sciences
5848S University Avenue. Chicago. Illinois 60637. USA
Abstract
In an extensive research study in my Laboratory the similarities
and differences between self-hypnosis and hetero-hypnosis were investigated as well as the phenomena of self-hypnosis when practiced
regularly over some time. Our results showed that the essential
characteristics of self-hypnosis are:
1.
2.
3.
4.
210
E. FROMM
Absorption
The Fading of the General Reality Orientation ( GRO)
Attention and Concentration
Trance Depth
Ego Receptivity to sensations. emotions. imagery,
memories and thoughts arising from within.
211
1981). Without the shift from the awareness of the world around us
to a stronger sense of and absorption in the inner world, hypnotic
trance, whether self-induced or induced by another, simply does not
occur. Hypnotic trance essentially requires a shift away from the
awareness of the external world to a greater sense of engagement with
the events of one's inner world.
However, structurally, hetero-hypnosis and self-hypnosis are not
entirely identical. Our 33 volunteer subjects - all highly hypnotizable in hetero-hypnosis, reported differences in the use of attention
and concentration between hetero-hypnosis and self-hypnosis, differences in ego receptivity, and differences in depth of trance. More
than two-thirds of our subjects felt that while in hetero-hypnosis
they were very receptive to thoughts and ideas coming from the hypnotist, i.e., from one outside object; in self-hypnosis their ego
receptivity turned ~stimuli from within. In addition, they reported that while in hetero-hypnosis their attention was concentrated
(on the hypnotist), focused and steady; in self-hypnosis at times it
was concentrated (on suggestions they gave to themselves); at other
times in the same hour it would be relaxed and expansive. They would
then do what William James has described for other altered states as
watching the stream of consciousness flow by.
After the first week of practice with self-hypnosis, more of the
time was spent in states of focused attention than during the first
week when subjects explored the phenomena of self-hypnosis by "letting themselves go." In the beginning of self-hypnosis practice most
subjects will allow their minds to roam and wander, and let as much
material as possible enter their attentional field. Once our Ss had
become accustomed to the altered state of self-hypnosis, their attention began to focus more often. It became more selective and concentrative. Thus in the beginning stages of self-hypnosis practice, the
stance of attention is very different from that in hetero-hypnosis
where it is focused and concentrated. But as time goes on, it vacillates between expansion and concentration. A significantly greater
amount of time is spent in expanding attention in self-hypnosis than
in laboratory-run hetero-hypnosis.
In our comparison of hetero-hypnosis and self-hypnosis, we used
the Stanford Hypnotic Susceptibility Scales, laboratory scales. Had
we, as a comparison, run a hetero-hypnosis session such as one might
do in hypno-analysis, perhaps we might have found that in heterohypnosis too, there can be a good deal of expansive attention, such
as, when the hypnoanalyst asks the patient to free-associate, i.e.,
to say whatever happens to come up in his mind.
Trance depth undergoes greater fluctuation in self-hypnosis than
in hetero-hypnosis. Our subjects reported that particularly in the
first week of self-hypnosis, they experienced fluctuations in trance
depth much more frequently than in hetero-hypnosis. They also had
212
E. FROMM
greater trouble in the first week to get into trance than they had
when there was an outside hypnotist to help them. The latter is
probably due to scepticism. Many subjects doubt that they will be
able to go into self-hypnosis and it takes about a week of practice
before they can trust their own ability to induce trance.
Among the content categories. heightened vivid imagery for
self-hypnosis stands out above all from other content categories such
as memories spontaneously experienced or intentionally explored.
working on one' problems. age regression. and feelings of scepticism
as to whether one would be able to reach a "deep enough" hypnotic
state.
Self-hypnosis is characterized by a very vivid. realistic
imagery both in story-like sequences and in segmented. unconnected
flashes. Geometric shapes also were often seen in self-hypnosis.
Subjects were struck by the richness of the imagery experienced in
self-hypnosis. It is much more vivid than the imagery induced in
hetero-hypnosis in the laboratory without therapeutic intent. The
imagery in self-hypnosis tends to be orientated towards personally
important experiences and fantasies. It is personally meaningful.
While there was a good deal of self-doubt about being able" to
achieve deep stages of trance in self-hypnosis. particularly in the
first week of practice. subjects report much less self-consciousness
during self-hypnosis than during hetero-hypnosis. Self-consciousness
occurs when one is embarassed or doubts oneself in the presence of
somebody else. Our subjects were alone in a room, on one was with
them, and thus there was less self-consciousness.
As stated before. our subjects practiced self-hypnosis for a
month daily. As time went on, they became better acquainted with the
self-hypnotic state. felt more "at home" with it, spent less time
worrying about occasional failures in self-suggestions, and needed no
longer to give themselves detailed self-suggestions. In order to go
into a self-hypnotic trance. often our "highly successful" and "successful" subjects after a week or two needed to do no more than sit
in a chair and close their eyes. The self-hypnotic trance state
became more comfortable and more natural. The ease of entering
trance increased, the time required to do so decreased. and focussing
attention when one wanted to do so became easier. Reality awareness
(GRO) faded more and more. feelings of absorption increased. as did
the ability to enter deeper states of trance quickly. But we did
find that not all subjects who are deeply hypnotizable by someone
else can hypnotize themselves deeply. One of the main criteria in
our process of selecting subjects had been that they be deeply hypnotizable in hetero-hypnosis. However. three of our subjects.
throughout the whole month of practice could induce only very light
states of self-hypnosis. Twenty-one achieved medium and sometimes
deep state~nd only three went into very deep stages of trance
practically every day.
213
214
E. FROMM
216
E. FROMM ET AL.
217
Ego Inactivity
Trance Depth
Vacillation of Trance Depth
GRO (General Reality Orientation)
Absorption
The Content Categories we established on the basis of the analyses of
the diaries were as follows:
Imagery
Age Regression
Personal Memories
Dreams (usually induced by self-suggestion)
Strong Affect
Working on Problems
Suggestion of Motor Phenomena
Suggestion of Sensory Phenomena
To our surprise diary entries which could be scored as GRO or
Absorption, were very rare. In the Questionnaires which had been
given at the end of four weeks of self-hypnosis, we asked our subjects specific qustions about these areas. Their answers showed that
the GRO and Absorption were very important structural factors. But
only a few subjects spontaneously mentioned in their diaries that
they were so absorbed in the experiment that the General Reality
orientation seemed to fade into the background. We felt that to
become spontaneously aware of Absorption and the GRO requires a good
deal of psychological sophistication, more than our naive Ss had. In
their diaries they tended to report what they had done each day
(g~ving themselves suggestions, working on their own problems, etc.)
or the content of what they had experienced such as vivid imagery,
strong affect, or an age regression. They reported Absorption and
the GRO, but only when specifically asked about them after the month
long experiment was over.
Having presented a short overview of our method and findings,
let us now sample three diaries, and note the differences we have
observed between our Very Successful, our Successful, and our
Unsuccessful Ss. We shall start with an S from our largest group (28
out of a total of 33 Ss), the Successful Ss; then proceed to the Very
Successful, and last to the Unsuccessful group.
Subject 108, a Successful S, developed a great deal of imagery,
particularly between the 7th and 23rd day. He also made a task for
himself to dream a dream everyday, that is, to suggest to himself
that he dream a dream.
Already on the second day S 108 experienced vacillations between
Ego Activity and Ego Receptivity, as well as between Attention
Concentration and Expansive Attention:
218
E. FROMM ET AL.
"I closed my eyes and continued to observe the colors and
patterns on my eyelids. I was able to suggest seeing various
colors especially blue and magenta. I also observed several
patterns and shapes moving and changing against the color background. Oddly. the more I tried to focus my attention on these
patterns the fewer and less interesting the patterns became. I
continued to watch the patterns but without paying strict attention to them. In general. most of the shapes were abstract or
geometric. but occasionally I would recognize a person's face or
body or some other object. These images continued to appear. as
if they were being generated effortlessly by my mind. I found
this stream of images and patterns intriguing and satisfying."
219
220
E. FROMM ET AL.
pacing, touching the walls and doors nervously. I became quite
upset. I sat down and dreamed I was in a dungeon with bread and
water being thrown in to me.
Then I was no longer a prisoner in my room or in a dungeon.
I was in a harem. Just lying around lazily doing nothing except
draw, bathe, munch, talk, and was sitting tn total lUXUry. Then
it appeared that some of my friends were in it. Then I was in a
tent in the desert by myself. The dry cool wind was blowing
over my body. I was a dancer; I was tired but cool after a hot
day. Then I became wounded, a dying person on a battlefield
with dead and dying bodies around me. It was so very awful and
hideous that I quickly changed before I fully took on the suggestion. At this point a deck of cards was shuffled right
before me. An old woman was telling my fortune. I didn't want
to hear it, however, so I picked up the cards. Also today my
back hurt; so I suggested this pain wasn't there, and it felt
better.
The highlights today were being in a harem and lying in
the tent just because I found if pleasurable. However, being in
prison made me very upset and I almost cried. It was terrible
to think of being completely alone in the room for a year. I
also disliked being a dying person today on a battlefield and
I'm glad I didn't get into it (although I think I should have). It.
On
221
and then suddenly I'm that person. I get more and more into the
role as time goes on. When I have no character in mind I count
and then just start talking. Soon I realize what person I am,
and it seems natural. I can then just slide into new roles each
as real as the last. My feelings become those of the new person. I laugh, think, cry, gossip over my new character's concerns. I suddenly know all sorts of different people involved
in her life. It's really interesting, and I enjoy doing it."
Of our two Low SH subjects, one (S 091) was too cerebral. He
constantly observed himself, analyzing what he was doing or not able
to do, and tried to find a computer-like system that would enable him
to be both ego-active (giving himself instructions) and able to let
go and be ego receptive. The other, S 045, did nothing else but give
himself suggestions, most of them the same that he had received in
hetero-hypnosis and often noting for each one in his diary whether it
was successful of unsuccessful. By a "plus" he indicated that he was
successful; by a "minus" he indicated that with this particular task
he had been unsuccessful. Here are some typical excerpts from S
045's diary. Day 4:
222
E. FROMM ET AL.
224
G. P. DAVIDSON ET AL.
225
226
G. P. DAVIDSON ET AL.
METHOD
Fifty primigravidae were invited by their obstetricians to
participate in the study in using self-hypnosis training as a relaxation and pain reduction technique, to be used in addition to their
other antenatal preparation. After each woman agreed, she was randomly assigned into an experimental or control group, the former
being offered by their obstetrician an audiotape cassette to take
home, for self-hypnosis training. The control group women proceded
through their antenatal preparation and delivery in the same manner
as the experimental group, differing only in their not being offered
the training cassette. Both groups were interviewed after delivery
by a researcher whose voice was not that on the training cassette.
227
After delivery, subjects were invited to complete a questionnaire in which among other questions, they rated on linear analogue
scales their responses to four questions:
1.
2.
3.
4.
In the first stage of your labor, how much pain did you feel?
(Answers were recorded as distance along a 10 cm line from 'no
pain' to 'severe pain').
In the second stage of your labor, how much pain did you feel?
('no pain' to 'severe pain').
Overall, would you say your experience of labor was ('very
unpleasant' to 'very pleasant')?
As regards having more children, are you ('definitely against
it' to 'very keen')?
3.
4.
228
G. P. DAVIDSON ET AL.
RESULTS
The labors of the 25 trained subjects were compared with the
labors of the 25 controls, and the following results obtained (Tables
1-6). An analysis of variance does not reveal any significant difference between the groups, although the size of the variance indicates greater spread in the experimental distribution. The average
of the experimental group was increased considerably by observations
of 17, 17.5 and 22 hours which had no parallel in the control group.
However, it must be concluded from these results that no significant
difference in duration of first stage labor was found for women who
used the audiotaped self-hypnosis training, compared with the control
group. No significant difference was found between the duration of
second stage of labor for women who used the audiotaped self-hypnosis
training, compared with controls. A significant difference (p <0.01)
was found between the self-reports of pain in the first stage of
labor for the group of subjects who used the audio taped self-hypnosis
training, compared with the control group, with the hypnotically
prepared subjects experiencing less pain. No significant difference
was found between the groups on self-reported pain in the second
stage of labor. A significant difference (p <0.05) was found between
the attitude towards labor ratings by subjects who used the audiotaped self-hypnosis training compared with controls. A significant
difference (p <0.01) was found between the attitude towards having
more children as expressed by subjects who used the audiotaped selfhypnosis training, compared with controls.
Variables intercorrelating significantly in the experimental
group data are as follows:
1.
2.
Group
Average
duration
Experimental
9.08 hours
30.78
Control
8.27 hours
16.73
Variance
Analysis of Variance
F = 0.3388
pF >.3388 = 0.5633
Table 3.
Group
Average
duration
Experimenta I
0.62 hours
.24
Control
1.05 hours
1.66
Analysis of Variance
F = 2.5
pF > 2.5
= 0.12
Table 4.
229
Average
rating
3.85
6.28
Variance
8.38
Analysis of Variance
F = 8.9985
pF > 8.9985
0.0043
7.94
'Average
rating
Variance
Experimental
4.59
13.13
Control
5.54
10.14
Analysis of Variance
F = 0.8988
pF > 0.8988 = 0.3482
ing was very useful for general relaxation, and for facilitating
sleeping, in addition to analgesia, and 3 subjects reported that they
had tried it successfully, of their own initiative, to combat the
pain of post-partum contractions.
were:
1)
2)
3)
4)
5)
6)
7)
8)
9)
230
G. P. DAVIDSON ET AL.
Table 5.
Variance
Exper:mental
6.32
9.22
Control
4.67
3.49
Group
Table 6.
Analysis of Variance
F = 5.3632
pF > 5.3632
= 0.0249
Variance
Experimental
8.50
4.20
Control
5.90
7.13
Group
Analysis of Variance
F = 11.7
pF> 11.7
= 0.0015
DISCUSSION
Earlier studies of hypnosis in childbirth have concentrated on
its function in reducing the duration of labor, minimizing pain and
consequent analgesic requirement, and in enhancing the psychological
experience of the mother and baby. Of these studies, most were
conducted by obstetricians who hypnotized directly their own
patients. The 'success rates' obtained no doubt reflect in some
measure the emotionally changed relationship between a parturient
woman and her obstetrician. It is not surprising that almost every
study laments the cost-effectiveness aspect as prohibitive, since
antenatal preparation by the obstetrician is time consuming and
expensive (Abramson and Heron, 1950; Gross and Posner, 1963;
Winkelstein, 1958).
The present study tested a technique which makes little or no
demands on specialist or staff time. The methodology was designed to
test not merely the technique of hypnosis, or even of audiotaped
self-hypnosis training in an unsupervised self-management program,
but rather the random and nonselective introduction of the technique
into an existing context of general practitioner, specialist obstetrician, and hospital staff, with any or all of its hostile aspects
unchanged and unchallenged by the technique.
The authors suggest that this study reveals the technique to be
enough to justify present clinical deployment and future
research on larger patient numbers. It is unfortunate that unlike
other investigators who found a typical 3-7 hour reduction in the
effe~tive
231
232
G. P. DAVIDSON ET AL.
233
2~
236
INTRODUCTION
The precise procedure that was investigated is based on "futureorientated imagery" (Van Dyck. 1980). It starts with a trainingperiod of two weeks during which the patient is familiarized with
self-induction of trance. relaxation and imagery. First. one of the
traditional induction and deepening procedures is demonstrated to the
patient. relaxation instructions are given and a pleasant imagery
scene of his own choice is evoked. The patient's reactions to this
procedure are discussed with him. and if necessary trial sessions are
repeated until they fit to his personal style of responding. The
patient is provided with tape-recording of this session for further
daily training at home with the purpose of improving his skills in
relaxation and imagery. It is presumed that a training period like
this will increase the patient's capacity to experience trance and
consequently make the procedure useful to patients initially having a
low or moderate hypnotizability (Diamond. 1974).
The second stage is problem-orientated: the patient is given
the task to prepare a description of a day in the future which illustrates that his problem is solved or improved. For example: a
woman who came into therapy because of a phobia for hospitals was
asked to describe a successful and relatively comfortable visit to
the hospital. A man with a phobia for highway bridges and tunnels
was asked to describe himself while driving his car over a bridge and
through a tunnel without great discomfort. Usually patients need
considerable assistance in elaborating concrete and realistic scenes
which can be used as therapeutic imagery. As soon as this therapeutic scene is completed, a new hypnosis session is recorded and
this tape is again handed to the patient for further daily exercises
on his own. Because of the importance of the patient's personal
activities and his considerable contributions in giving information
and stylizing, the procedure was called "self-hypnotic". Taking into
account the definitions that were used by Fromm et al. (1981),
"pseudo-self hypnosis", would be a more appropriate name.
The present method was derived from Erickson's (1954) "Pseudo
Orientation in Time"; however the central element of future orientated imagery can be found in many hypnotherapeutic and behavior
therapeutic procedures. (Singer. 1974; Spinhoven and Commandeur,
1981).
In this study the central question was whether any of the variables presumed to be active in this procedure and in hypnosis in
general. did indeed show a relation to success or failure in therapy.
In other words, does improvement indeed relate to (an increase in)
the skills of imagery (Sheehan. 1979) and relaxation (Wolpe. 1958).
as well as to a number of other variables which are important for the
process of hypnotherapy according to the literature. These include.
positive expectations (Lazarus. 1973). task orientation (Sachs and
237
238
RESULTS
At the post-test after 7 weeks three patients (patients 1, 3 and
5) showed a clear improvement on the relevant subscales of the FSS
III (Table 1). This corresponded with their subjective appreciation
and the impresSion they made clinically. On the average, these
changes were maintained at the follow-up inquiry: consequently, we
feel justified in considering them to be the "successful" subgroup
including patient (3), whose score improvement on the FSS III subscale did not reach statistical significance at the .05 level. The
two other patients (patient 2 and 4) failed to show any significant
improvement on the relevant anxiety measures, either after the 6 week
period or at the follow-up. Their personal opinion about the usefulness of the procedure was negative and they can be considered to be
the subgroup of the "unsuccessful" patients.
When looking for common features of the successful vs the unsuccessful group the following pattern emerges:
1.
2.
3.
3.2
Vividness of the imagery (Figure 1) was low for both the most
successful and the least successful patients and did not show
any positive trend during therapy for either group. This was
the general finding. No training effects on the vividness of
imagery were recorded during the period under study.
Degree of relaxation (Figure 2) was consistently higher for
patient (1) than for patient (4). However this cannot be associated with success or lack of it, because the other unsuccessful patient (2) obtained higher scores than patient (3) and
239
posttest
d-s=re
patient 1: factor 3
32
23
-9**
patient 2: factor 2
31
27
-4
patient 3: factor 3
17
12
-5*
patient 4: factor 1
64
59
-5
patient 5: factor 2
39
24
-15**
Factor 1 or subscale 1
= social
anxiety; factor 2
3.3
3.4
**
<::.05
~.1
(5) who profited from therapy. Not only did degree of relaxation fail to show any clear relation to outcome, it also failed
to increase overtime.
Task orientation (Figure 3) was not different for the successful
or unsuccessful patients.
Involvement in the imagery (Figure 4) was high with the successful patient (1) but the level of involvement showed no difference among the other patients. A negative trend did not preclude a successful outcome.
3.6
3.7
3.8
240
max.
therapy-period
(-:patient(l) )
( .... --:patient (4
min.
23456
Fig. 1.
weeks
.,,
,,,
min. 1
Fig. 2.
'Neeks
Degree of relaxation.
max.5 therapy-period
4
3r-------------__
__
--------------------
max. 1
2
Fig. 3.
Task orientation.
DISCUSSION
The intensive design type of study precludes generalization. We
will limit our comments to attempts to understand what happened in
the 5 patients we studied. An important common feature of these
patients is that they scored low to zero on hypnotizability. This
means that any tentative conclusions about therapeutic changes during
hypnotherapy must be limited to this subgroup. Very different re-
241
therapy-period
4
3~
____________________
2 _______________________ _
min.l
4
weeks
Fig. 4.
ll'aX.5
- - - - -----. - - - - - - - - - - - -
min.l
4
weeks
Fig. 5.
Awareness of phobia.
suIts probably would have been found with moderately or highly hypnotizable persons.
Our findings are in agreement with the opinion that exposure to
an hypnotic procedure is therapeutic only for those patients that
manifest (at least minimal) hypnotizability. This would underline
the rationality of using clinical scales or tests of hypnotizability
as it has been advocated by researchers and clinicians (Weitz enhoffer, 1957; Hilgard, 1965; Spiegel and Spiegel, 1978).
In the sample of patients that participated in our study, the
number of negative findings is rather impressive. Therapeutic results did not seem to require very vivid imagery or more than fair
relaxation. A good task orientation was by no means a guarantee to
success, while neither distraction nor awareness of phobic thoughts
during the session appeared to be serious obstacles to positive
results. Even the degree of involvement was not related to therapeutic outcome. If one understands hypnosis as a phenomenon characterized by a loss of the Generalized Reality Orientation (Shor, 1959)
and a high level of involvement (J. Hilgard, 1970) it seems fair to
conclude that specific hypnotic phenomena occurred in our patients
242
max.s
- -- -
min. I
Fig. 6.
weeks
Goal-directed fantasies.
max.s
4
3
2~
__-::-::-:
___:-:-::-:__ _
~~~
1:..=.:-----
min. I
Fig. 7.
weeks
243
max. 5
min.l--------------------2
Fig. 8.
4 weeks
244
245
Spiegel, H., and Speigel, D., 1978, Trance and treatment: clinical
uses of hypnosis, Basic Books, New York.
Spinhoven, Ph., and Commandeur, J., 1981, Illusie, van Fantasie tot
Werkelijkheid, Department of Clinical Psychology, Leiden.
Van Nuys, D., 1973, Meditation, attention and hypnotic susceptibility: a correlational study, Int.J.clin.exp.Hypnosis,
21:59-69.
Weitzenhoffer, A. M., 1957, General Techniques of Hypnotism, Grune
and Stratton, New York.
Wolpe, J., 1958, Psychotherapy by reciprocal inhibition, Stanford
University Press, Stanford, California.
Wolpe, J., and Lang, P. J., 1964, A fear survey schedule for use in
behavior therapy, Behav.Res.Ther., 2:27-30.
Paul Sacerdote
Montefoire Hospital and Medical Center
and Albert Einstein College of Medicine
New York, NY, USA
Abstract
The author briefly reviews the concepts of "pain" and the distinctions between pain and suffering. He then reviews some of the
theoretical constructs that have been advanced to explain the effectiveness of hypnosis in pain control. These include psychological
abstractions, psycho-social observations and generalizations, analysis of communications between patient and hypnotizer, anatomic,
neuro-physiologic and bio-chemical conjectures, behavioral principles, and psycho-analytical theories, among others.
He sees little or no contradiction between the different view
points which simply examine different facets of the same phenomena
from distinct frames of reference. Within the general conceptualization of learning theory it can be hypothesized that hypnosis
facilitates certain learning processes: the translation of every-day
language (verbal, numerical, visual, audial, etc.) into neurophysiological, bio-chemical, anatomical language which the unconscious
areas of our nervous system can understand, activate and communicate
to other organs, systems, and individual cells. Concepts of learning, of different languages do not seem so outlandish since the
discovery of the genetic code.
250
P. SACERDOTE
251
252
P. SACERDOTE
253
conceive the state of hypnosis as one where they are under the power
of another person. In fact, this particular issue of control, probably, constitutes the main cause of conscious and subconscious
resistance to hypnosis, thereby interfering with the achievement of
positive results. Among the patients who reach a satisfactory hypnotic level, additional obstacles can prevent the reaching and maintenance of tangible results. Extrapolating from hundreds of clinical
cases, I can tentatively conclude that in many cases of severe pain
connected with serious injury or illness, the patient, most often
subconsciously, perceives and interprets his illness and pain as
punishment, retribution, and expiation for real or imagined sins.
Such conceptions may trap him into subborn1y holding on to his pain.
In many cases of injury or illness the pain is a thinly disguised cry
for help, attention, and sympathy from the health professionals, and
close members of the family. A person who has long felt rejected,
ignored or under-appreciated, unwittingly uses his suffering as a
means for attracting sympathy and attention, changing from a nonentity to a hero and a martyr.
Other factors that can influence the attempt to achieve hypnotic
pain control are the words and ideas expressed by the physician when
he refers the patient for hypnotic pain control. His words and
behavior may promise or imply totally miraculous success by hypnosis,
even in situations where all other methods have proved inadequate.
In such cases the patient expects instant total relief and tends to
react over-pessimistically if the improvement is limited. On the
other hand, the referring doctor may, in different ways, convey the
idea that he is very sceptical about the effectiveness of hypnotic
intervention. In such cases the patient can well absorb this negative attitude and fail to respond. Similar reactions occur when the
suggestion for hypnotic control comes from members of the family or
friends. Very often the atmosphere in the hospital or clinic tends
to be doubtful if not overtly hostile, rather than favorable to the
use of hypnosis.
Another obstacle to pain-control may result from survivor's
guilt. This can occur when one or more close friends or family
members have succumbed to illness and died. The sick surviving
patient may feel that he has no right to continue to live.
More difficult to uncover is another important factor; a patient
with an advanced, almost terminal, illness often functions at two
different levels of awareness. At one level he is using every kind
of rationalization and reassurance to sustain his faith in an optimistic outcome, while at another level he has some awareness that
further suffering, disability, and death are inevitable. In such a
situation, upon reaching a level of hypnosis that could lead to some
relief, he also has a clearer perception of the inevitable end. This
may result in the patient stubbornly refusing further hypnosis, even
when some degree of success had already been obtained.
254
P. SACERDOTE
As soon as possible after we have assessed the degree of hypnotic talent of the patient. either by observing his responses to our
induction and deepening procedures. or. if so inclined, by testing
him with standard hypnotizability scales. we must decide which type
of ideas and suggestions we should attempt to convey. We may work
with direct suggestions of relief, with the expectations that, as
explained before, by having reached an adequate level of hypnosis,
the patient's ability to translate the intentions of stopping the
pain will quickly be translated into biochemical or bio-electric
changes at various synaptic levels, sufficient to inhibit pain perception. In about 15 per cent of very talented subjects, direct
suggestion may work very well, if none of the psychological interfer-
255
Dissociation
This usually requires a sufficiently deep trance so that the
patient, although aware at one level of his condition, at another
level, becomes an observer of what is happening to his body, without
perceiving subjective painful sensations. Or the patient may imagine
himself, or even hallucinate the self in a different pleasant setting. If the pleasant setting reproduces some enjoyable experience
from the past, he will be making use of body memories that guide him
into an age-regression. Alternatively he may be guided to ageprogression, to a time in the future where pain and illness will have
been left behind.
256
P. SACERDOTE
257
258
P. SACERDOTE
260
G. GUERRA ET AL.
261
262
G. GUERRA ET AL.
263
264
G. GUERRA ET AL.
Table 1.
naJlle
before
H.F.
F.H.
P.G.
lO p
S.C.
3.6
6.3
6.7
7.5
during
mo1/1
3.4
7.9
5.4
l.5.3
C.L.
G.H.
H.B.
B.H.
E.Q.
6.l.
6
5.93
2.53
Average
D.S.
4.8 p mol/1
8.l
mo1/l
"
7.06
3.46
mol./1
"
A..ENDORPHIN
1- "--IL
15
10
BEFORE
DURING
Fig. 1.
though connected with neuronal mechanisms requiring further investigation. There is certainly more than one reservation to be made:
our work is only the beginning of a line of research which we intend
to pursue more extensively and in greater depth, studying a larger
number of patients, with careful attention to the interpersonal
relationship. We would use control groups and include the use of an
authoritarian technique of hypnosis, studying the influences which
hypnosis training over many years may have, and including the carrying out of numerous and complex intra and extra-hypnotic tasks. We
265
266
G. GUERRA ET AI..
Lazzari. C Di Monda. E and Pelliccioli. G., 1981. Elettrostimolazione transcutanea cerebrale e dosaggio endorfinico. Rivista
sperimentale di freniatria. 105:97-102.
Levine. S. E Gordon, N. C., and Fields, H. L., 1978, The mechanism
of placebo analgesia, Lancet. 2:654-657.
Pert. C. B and Snyder. S. A 1973. Opiate receptor: demonstration
in nervous tissue, Science. 179:1011.
Plescia. M Guerra, G Tagliaro. F and Luisetto. G 1981.
Livelli plasmatici di beta-endorfine nelle tossicodipendenze.
Giornale di Medicina Militaire. 3:7-12.
Pomeranz. D 1978. Do endorphins mediate acupuncture analgesia.
Adv.Biochem.Psychopharm 18:351.
Preje. E., Puty. E and Arudt, J. 0 1978. Neurochemical Mechanism
of opiates and endophins. Excerpta Medica T.C.S 451:234-262.
Salar, G and Job, I 1978. Modification de l'action antalgique de
l'electrotherapie transcutanee apres traitement avec Naloxone.
Note preliminaire. Neurochirurgie. 24(6):415-417.
Scarcelli, C 1981, Terapia antalgica con morfina somministrata per
via endorachides. Unpublished Graduations's dissertation.
Universita degli Studi di Milano.
Sicuteri. F., Anselmi. V Corradi. C Micheloni, S and Sassi, A
1978. Morphin-like factors in CSF of headache patients, Adv.
Biochem.Psychopharm., 18:363.
Simon, E. S., Hiller. S. M., and Edelman. I 1973, Stereo-specific
binding of the potent narcotic analgesia (3H) etorphine to rat
brain homogenate, Proc.Natl.Acad.Sci USA, 70:1947-9.
Snyder. S. H., 1977, I recettori degli oppiati e gli oppiati interni,
Le Scienze. 107:26-39.
Terenius, L 1973. Characteristics of the "receptor" for narcotic
analgesics in synaptic plasma membrane fraction from rat
brain. Acta Pharmacol.Tox., 33:377.
Terenius. L., 1978, Significance of endorphins in endogenous antinociception. Adv.Biochem.Psychopharm., 18:321.
Willer, J. C Dehen. H., and Cambier. J., 1980. Stress - induced
analgesia in humans: endogenous opioids and Naloxone reversible depression of pain reflexes. Science. 212:689.
M. Anthony Basker
95 The Ridgeway
Westcliff On Sea
Essex. SSO 8PX. England
Abstract
An approach to alleviating the smoking habit is outlined when
emphasis is placed on motivation in the employment of hypnobehavioral
methods. Creative Imagination and hypnotic susceptibility and their
influence on results are discussed.
INTRODUCTION
The treatment of tobacco addiction and in particular cigarette
smoking is an area of hypnosis most known to the public. Many hypnotists feel frustrated with poor results. Reports from many world
wide authorities of both cardiovascular and pulmonary risks have
maintained interest in the problem.
A summary of the
smoking over the last
Previous to this. the
International Journal
270
M. A. BASKER
Nuland and Field (1970) introduced through trial and error what
they considered the best features for the treatment of smoking, based
on transforming the patient's intellectual reasons for wishing to
stop into an act of quitting based on emotional conviction and
heightened by imagery. The newer technique involved obtaining a high
degree of individualization to obtain the commitment to give up
smoking as soon as possible without using a gradualistic approach,
setting a "quitting day", or switching brands. The patient's own
motives for quitting were amplified and vivified, and fed back and he
was taught self-relaxation or self-hypnosis during the withdrawal
period. The authors found that the new methods resulted in 60%
success rate in 84 patients over a 6 month period, compared to only
25% in 97 patients over the same period, using older methods.
Imagery has been used by hypnotists to treat maladaptive behavior, and Cautela (1975) considers successful hypnosis as being partly
due to covert conditioning and he believes that further use for
covert conditioning techniques within hypnosis would increase the
success rate. He describes four procedures of which three have been
most used in the treatment of smoking.
These are Covert Sensitization (Punishment), Covert Positive
Reinforcement, and Covert Negative Reinforcement. In the first, the
patient imagines a scene in which he is committing the act he wishes
to eliminate, i.e. smoking. In Covert Positive Reinforcement the
patient is asked to imagine a response completely opposed to his
usual maladaptive one (smoking), and then he rewards himself for the
appropriate response by imagining a pleasant scene. In Covert Negative Reinforcement, the patient in rewarded for an appropriate
response by being allowed to imagine escaping from and terminating a
very unpleasant situation.
Kroger and Fezler (1976) recommend covert sensitization using
one of their standard images, or in association with role playing.
The author believes it is necessary to use all known helpful
factors to attain cure. It is important to find out details of each
individual's smoking habits and his fears about smoking. These can
then be used for tailoring covert sensitization procedures for individual patients. The author also believes it is important to stress
to the patient that he can stop smoking soon and foster expectation
to this. Previous personal experience has led to the gradualistic
approach being discarded as quitting day seldom comes. To assist
in relinquishing the old habit, suitable suggestions are given to
develop greater capacity for self reinforcement, and self hypnosis
is taught in further sessions along with the covert conditioning
methods.
It was decided to treat and follow up cigarette smokers over a 6
month period with these concepts in mind. Results were assessed on
271
2.
3.
272
M. A. BASKER
273
SUBSEQUENT SESSIONS
At further sessions it is usual to review the first and congratulate the patient on progress so far. A second appointment is
made only a few days after the initial session and any further
explanations may be given about hypnosis if required. It may be that
the reasons for continued smoking such as various anxieties become
known and these can be treated or at least discussed.
Ego-enhancing and specific post hypnotic suggestions for not
smoking are repeated each time, and imagery again employed to reinforce the avoidance response. The type of technique preferred is
chosen. Many patients responded well to role-playing doctor-patient
interview, and this was found helpful when the patient came to treatment specifically because of fear of illness. Self-hypnosis was
taught and the patient expected to practice this daily until withdrawal effects had passed and then twice weekly until he had
abstained for 6 months.
RESULTS
Sixty patients were treated and followed up over a period of 6
months. Although many patients smoked less as a result of treatment,
and others could not be followed up, 30 patients (50%) stopped
smoking completely.
Score distributions for the clinical scale, SHCS: Adult, are
given in Table 1.
The relation of hypnotic responsiveness to cessation of smoking
is shown in Table 2.
Table 1.
Suscepti oili ty
Raw
NU7!1ber
Level
Scores
Cases
High
5
l!
11ediuIJ
-'
Low
2
1
0
Cases
of
Percentae:e
of cases
7
21
9
12
35
15
11
18
9
3
15
5
60
100;;!
274
M. A. BASKER
Table 2.
Susceptibility
Level
High
Raw
Scores
t;umber of
Cases
Iiumber ceased
smoking
21
11
Medium
11
Low
60
30
% cures
per class
64
45
25
50%
Table 3.
Fear of specific
Illness
Number abstaining
still smoking
of symptoms
of ill health, other
't/orry
26
10
20
DISCUSSION
The poor results obtained by the author in the past in the
treatment of smoking led to the adoption of covert conditioning with
hypnosis. Overall results were better, from less than a 20% to over
50% over a six months period.
Nevertheless, motivation was the most important factor for
success, and the greatest number of successful results were with
those motivated by fear of a specific illness, e.g. lung cancer.
275
277
278
D. WAXMAN
INTRODUCTION
The problem of alcoholism has now reached major proportions.
Once a music hall joke - "work," said Oscar Wilde, "is the curse of
the drinking classes" - or even a medical joke - an alcoholic is
someone who drinks more than his doctor - today it is estimated that
the number of people with a significant drinking problem in England
and Wales alone has reached three quarters of a million. According
to a recent report issued by the Northampton Council on Alcoholism
this is costing industry more than a thousand million pounds a year
through absenteeism.
A report published by the Scottish Council of Alcoholism showed
that in that area the problem is costing industry around 100 million
pounds a year and a Senate Standing Committee found that 250,000
Australians could be classified as alcoholics. It accused the
country of being a nation of alcoholics, tobacco addicts, pot smokers
and pill takers.
Therefore not only has an effective treatment of the resulting
medical conditions become an increasing necessity, but ideally some
prophylactic measures must be devised in order to attempt to contain
and to prevent the problem from spreading further. Sadly the pressures of the alcohol and the drug industries, and the ambivalent
attitude of governments encouraging a considerable source of revenue,
not only ensures continuous exposure of patients to the origin of
their dependency but also encourages susceptible personalities to
initial experimentation and repeated modelling on peer groups and
adult hero archetypes.
Moreover, the problem is not only of the harm which is selfinflicted, but so often also of the suffering which is visited upon
others, spouse, families and the innocent.
In the year after the Road Safety Act of 1967 the proportion of
drivers in the 20-40 age groups killed in road accidents in Britain
and found with excess alcohol in the blood fell from just under 40%
to 20%. By 1974 it had risen to nearly 50%. Road accidents now
account for more than 40% of all male deaths between the ages of 15
and 24 in England and Wales.
279
280
3.
D. WAXMAN
The World Health Organization Expert Committee on Drug Dependence defined the following types of drug dependence:
Table 1.
1.
2.
4.
5.
6.
7.
Drugs of dependence.
Morphine type
) that is the narcotics
Barbiturate and alcohol type ) and sedatives
Amphetamine type
)) that is the stimulants
Cocaine type
Cannabis type
Hallucinogenic type
Khat type
ETIOLOGY
Drug dependence may occur in certain vulnerable individuals.
It could often follow a critical period in a person's life or it may
have a more chronic background resulting from a series of personal,
social or psychological forces, the total of which exceed the threshold of the subject's tolerance.
It must be remembered that the presenting personality of the
addict may not be his true personality, as this may have been modified by the psychic effects of the drug.
It is essential to look into the history, the family history and
the early environment of the patient whose addiction is more than
likely just one manifestation of a much greater personality problem.
It should also be noted that whilst other drug addiction is one which
will be encountered in youth, alcoholism, because it takes some time
to become established, will more commonly be found in middle age and
thus in personalities which have become reinforced with the passage
of years. Unfortunately, the average age of the alcoholic is latterly becoming reduced. Most youthful addicts are immature, inadequate and insecure. At this formative period of development the
emerging adolescent, neither child nor adult will question his identity and may well discover a less threatening world and relief from
anxiety within a drug-taking sub-culture.
Earlier environmental circumstances may have been deprived but
this is not necessarily so. It is how the individual has interpreted
his upbringing which is important and not how the facts may have
proved it to be.
281
282
2.
D. WAXMAN
Drug Replacement Therapy. Chlormethiazole or heminevrin is used
in the case of the alcoholic. Short term therapy with this drug
has been emphasized by Glatt (1977) who suggests that it should
be given for about 6 days only whilst the patient is institutionalized because of the risk of the dependence upon this
drug in place of, or additional to alcohol after his discharge.
The phenothiazines, particularly chlorpromazine are often used,
as well as other tranquillizers.
In treating barbiturate addiction, extra care must be taken as
fits and even death may occur during and after withdrawal. The
amphetamines may be withdrawn immediately, but in the case of
heroin, gradual withdrawal or the substitution of methadone is
common practice.
3.
4.
5.
6.
Aversion Therapy. This has long been a favorite form of treatment and the two drugs, citrated calcium carbimide or abstem and
disulfiram or antabuse are still in use. Each result in flushing, dyspnoea, tachycardia and vomiting if alcohol is additionally taken. Recently, subcutaneous implantation has been advocated for the non-compliant patient. Other forms of behavioral
modification such as the pairing of an electric shock with
drinking are used but these will not be considered in this
paper.
283
284
D. WAXMAN
Beahrs and Hill (1971) studied as a new approach to the treatment of alcoholism the use of group therapy with relaxation,
suggestion of social awareness and self-hypnosis followed by group
interaction and spontaneous discussion in the waking state. The idea
was well-intentioned but poor conditions of follow-up rendered the
study incomplete.
Spencer Paterson (1974) dealt briefly with the relationship of
alcoholism to crime and illustrated the use of hypnosis with three
case histories teaching relaxation and self-hypnosis and encouraging
the patient to accept a more credible view of himself.
Cautela (1975) compared covert conditioning and hypnotic induction procedures employing imagery. He felt that hypnotherapists
might increase the effectiveness of treatment by systematically
employing the former.
Miller (1976) described the use of hypnosis to help patients
relive past disagreeable experiences with marked intensity. Thus
every time the drinker subsequently attempts to drink he automatically relives his worst hangover experience. Of 150 patients
treated, 62% still abstained after one year.
Hartman (1976) suggested treatment commencing immediately the
patient leaves the hospital and is "dried out." He claimed that the
use of metronidazole was superior to that of disulfiram. He maintained that once the hypnotherapy had proceeded to the point where
the cause for the compulsion to drink had been determined, then the
compulsion diminished.
Lennox and Bonny (1976) found that hypnotizability of chronic
alcoholics was not significantly lower than of normal adults of the
same age and sex and thus its use need not be excluded in this group
of patients.
Kessel and Walton (1979) maintained that suggestive treatment
using hypnosis had permanently helped few if any alcoholics, but made
no comment regarding other hypnotherapeutic approaches.
Lovern (1980) maintained that the alcoholic was more likely to
listen to his peers than to an authority figure and using indirect
hypnotic suggestion attempted to influence the behavior of entire
groups.
DISCUSSION
The etiology of alcoholism and drug addiction reveals a wide
variety of preCipitating factors and each must be taken into consideration in the treatment of this disease. Principally, there is
285
286
D. WAXMAN
Acknowledgements
The author wishes to express his gratitude to the Librarians of
the Royal Society of Medicine and of the Central Middlesex Hospital
for their tireless assistance in providing numerous refences.
REFERENCES
Beahrs, J. 0., and Hill, M. M., 1971, Treatment of alcoholism by
group-interaction in psychotherapy and hypnosis, Am.J.clin.
Hypnosis, 14:60-62.
Bissell, D., Paton, A., Ritson, B., 1982, ABC of alcohol, Br.med.J.,
284:495-497.
Cautela, J. R., 1975, The use of covert conditioning in hypnotherapy,
Int.J.clin.exp.Hypnosis, 23:15-27.
De Quincey, T., London Magazine 1821, Confessions of an English opium
eater, IV. 293-312.
Edwards, G., 1966, Hypnosis in treatment of alcohol addition:
Controlled trial with analysis of factors affecting outcome,
Q.J.Stud.Alcohol, 27:221-241.
Glatt, M. M., 1977, Place of chlormethiazole in the treatment of
alcoholics, Br.med.J., ii,1088.
Hartman, B. J., 1976, Hypnotherapeutic approaches to the treatment of
alcoholism, J.Natn.med.Ass., 68:101-103 and 147.
Kessel, N., and Walton, H., 1979, "Alcoholism," Penguin, Harmondsworth, England, 145-146.
Kraft, T., 1968, Successful treatment of a case of drinamyl
addiction, Br.J.Psychiat., 114:1363-1364.
Langen, D., 1967, Modern hypnotic treatment of various forms of
addition in particular alcoholism, Br.J.Addict., 62:77-81.
Leading Artical,1967, How important are genetic influences on alcohol
dependence? Br.med.J., 2:1371-1372.
Leading Artical, 1977, Action on alcohol and road accidents,
Br.Med.J., 1.665.
Lenox, J. R., and Bonny, H., 1976, The hypnotizability of chronic
alcoholics, Int.J.clin.exp.Hypnosis, 4:419-425.
Lovern, J. D., Indirect hypnotic communication as a group-therapy
technique in alcoholism treatment, in: "Clinical Hypnosis in
Medicine 1980," H.J. Wain, ed., Symposia Specialists Inc.,
Miami, 1973-191.
Lloyd, G., 1982, The Alcoholics Anonymous method of treatment, Modern
Medicine, 33-37.
McCord, H., 1967, Hypnotic treatment of alcoholism, brief case
history, J.Am.Soc.Psychosom.dent.med., 14:104-105.
Merry, J., Reynolds, C. M., Bailey, J., and Coppen, A., 1976,
Prophylactic treatment of alcoholism by lithium carbonate: A
controlled study, Lancet, 2:481-482.
Moll, A., 1889, "Hypnotism," Scott, London.
287
Prem C. Misra
Duke Street and Gartloch Hospitals and the Royal
Infirmary, Department of Psychological Medicine
University of Glasgow, Rathmore, 21 Victoria Road
Lenzie, Glasgow, Scotland
Abstract
Sex therapy has become increasingly popular and has entered into
the mainstream of the professional world during the past 15 years.
The use of hypnosis for treating sexual disorders is not unknown, but
the texts, particularly those predating Masters and Johnson (1970)
make brief, if any, mention of the treatment of sexual problems by
hypnosis. This paper describes a group of cases involving sexual
disorders which were referred to a psychosexual clinic in the west of
Scotland, and which have been helped by hypnosis.
A statistical account is presented of 358 cases referred to the
author during the years of 1977 to 1980; 134 cases were treated with
hypnosis and only 13 individuals failed to respond. The diagnostic
categories, treatment methods used, including video hypnodesensitization, hypnoconditioning with slides, hypnotic recall, and others
and their respective outcome are described. At our psychosexual
clinic hypnotherapy was successful in 38% of cases in comparison to
other methods of treatment with success rates as follows: a modified
Masters and Johnson's technique - 30%: counselling - 16%: marital
therapy and drugs, etc. - 16%. In view of these promising results,
psychosexual hypnotherapy needs to be evaluated further. It is less
time consuming than commonly thought and success can occur with as
few as 3 sessions of hypnosis lasting for about 1 hour each over a
period of 3 weeks. A further advantage in using this method of
treatment is that no cotherapist is required.
291
292
P. C. MISRA
INTRODUCTION
Hypnosis has been used for the treatment of various psychosomatic disorders since 1771 when Mesmer called it "animal magnetism." Dr J. Braid (1889) a Scottish physician working in England
coined the term "hypnotism" from the Greek work "Hypnos." The use of
hypnosis for the treatment of sexual disorders is not unknown
although most text books on sexology do not mention this method of
treatment. Some books on hypnosis make brief, if any, mention of the
treatment of sexual problems by hypnosis; for example Wolberg's
Medical Hypnosis (1948), Hartland's Medical and Dental Hypnosis
(1966), Ulett and Peterson's Applied Hypnosis and Positive Suggestions (1965) and Schneck's Hypnosis in Modern Medicine (1959).
Up to 1955 hypnosis had been used empirically by many therapists
and glowing results were claimed by some. Then the British Medical
Association (1955), having established a commission to look at the
clinical literature, recommended that serious research should be set
up to look into some of these claims.
This paper describes an unselected series of 358 cases referred
to the author at his psychosexual clinic from 1977 to 1980.
Number of cases seen by the author Cases treated with hypnosis -
Ego-strengthening
Video hypno-desensitization
Hypno-conditioning with slides
Hypnotic recall
293
Table 1.
Diagnosis
(N=202)
Impotence
78 (39!O
Loss of interest
64 (32%)
Premature ejaculation
53 (26%)
Increased libido
7 ( 3%)
Loss of interest
83 (53%)
Vaginismus
36 (23%)
Non orgasm
22 (14%)
Dyspareunia
11 ( (%)
~e
(N=156)
Increased libido
4 ( 3%)
The treatment methods used at our psychosexual clinic were as follows:Treatment Methods (N=358)
Masters 8< Johnsons (Modified)
112 (31%)
Counselling
53 (1%)
DrugS/Marital therapy
59
Hypnosis
(1~)
134 (37%)
Hypnotherapy was used in 134 (37%) patients; 13 patients discontinued treatment, three of whom failed to respond to hypnosis because
of associated personality and social problems. The other cause for
the failure to continue treatment was due to the non-cooperation of
the sexual partner. The type of sexual disorders and their outcome
in response to hypnosis are given in Table 2. It was quite interesting to see three cases of premature ejaculation and five cases of
loss of interest in females having recovered completely after only
three sessions with an ego-strengthening technique and relaxation.
Fifteen patients had already been to a lay hypnotist and had received
eight to ten sessions of hypnosis but without any benefit.
More detailed analysis of the results suggest that the video
presentation of the desensitization hierarchy is more effective than
st~ndard systematic desensitization under hypnosis.
Similarly hypnoconditioning with slides while a patient is under trance with his
294
P. C. MISRA
Table 2.
Cases treated with hypnosis (N=134)
Mal.e (N=46)
Recovered
Partially Rec.
Dropped out
Impotence
12
Premo Ej.
14
Loss of interest
36
Non-orgasm
23
Vaginismus
10
Dyspareunia
10
Increased 1ibido
295
2.
Mr. B. aged 31 years complained of secondary erectile impotence
and his marriage was non consummated for two years. He regained his
erectile function after 6 sessions of hypnosis and the marriage was
consummated, but he developed premature ejaculation.
Mrs. B. started to complain of feeling frustrated and unsatisfied. The couple were hypnotized together and they both achieved
satisfactory sexual function after another 10 sessions of hypnosis.
3.
Mrs. G. aged 28 years, a comptometer operator, was referred by
her general practitioner for non consummation of marriage for 7
years. She had a phobia of coitus, precipitated by her painful
experience at her first attempt to have intercourse, during her
honeymoon.
The marriage was consummated after only 5 sessions of hypnosis
and she started to enjoy coitus. She is now pregnant and looking
forward to having a baby.
REFERENCES
British Medical Association, 1955, Br.med.J., i:1019.
Hartland, J., 1966, "Medical and Dental Hypnosis and Its
Applications," Bai11iere, Tindall and Cassell, London.
Misra, P. C., 1979, Hypnosis in the management of psychosexual
disorders in a NHS psychiatric OP Clinic, Hypnos, J.Swedish
Soc.c1in.exp.Hypnosis, 5:26-29.
Misra, P. C., 1980, Hypnosis in the management of psychosexual
disorders, in: "Hypnosis in Psychotherapy and Psychosomatic
Medicine," M. Pajntar, E. Roskar and M. Lavric, eds.,
University Press, Ljubljana, Yugoslavia, 192-195.
Schneck, J. M., 1959, "Hypnosis in Modern Medicine," Charles C.
Thomas, Springfield, Illinois.
U1ett, G. A., and Peterson, D. B., 1965, "Applied Hypnosis and
Positive Suggestions," The CV Mosby Co., St. Louis.
Wo1berg, L. R., 1948. "Medical Hypnosis," Grune and Stratton, New
York.
298
K. FUCHS ET AL.
We believe hypno-
INTRODUCTION
Impotence is rapidly being recognized as one of the most common
problems facing the male today. It has always been present but in
the last few decades it has come increasingly to the attention of
clinicians and researchers. There appear to be two basis reasons in
the growing awareness and incidence of impotence:
1.
2.
Definition
Impotence can be defined simply as the inability to execute the
sexual act despite the presence of a conscious desire to do so. It
may be described as the inability to obtain or maintain an erection
sufficient for penetration into the vagina and perform the sexual act
(Nuland, 1978). Some authors include premature ejaculation in their
definition of impotence (Rothman, 1972; Crasilneck and Hall, 1975;
Kroger, 1976). Masters and Johnson (1970) broaden the definition and
also include partial impotent men whose rate of failure at successfu:
coital connection exceeds 25% of their opportunities. Impotence can
be primary, meaning that the patient had never been successful in
obtaining an erection during sexual intercourse, or secondary, meaning that impotence appeared after a variable period (even many years)
of adequate sexual behavior. This paper deals only with secondary
impotence without including premature ejaculation.
Almost every man encounters a few episodes in inability to
achieve an erection despite his will. These episodes occur in different situations like physical or emotional exhaustion, states of
anxiety, after alcohol or drug abuse, etc. These are not considered
as true impotence. - Situations like decreased libido toward the wife
due to an extramaritial affair, or unconventional sexual behavior
like excessive masterbation or homosexual relations are not considered impotence.
The exact incidence of impotence is unknown mainly because of
insufficient published data. Kinsey et ale (1948) report an incidence of 1.5% of impotence in adult males. In this series there were
very few young people suffering from impotence but the numbers grew
with age, achieving 20% at the age of 60. It is difficult to accept
these figures as being valid nowadays; and this for two main reasons.
Modern living became much more stressful than 35 years ago and people
299
are now more open to discuss and admit their sexual inadequacies
(Ward, 1980).
Etiology: only a few of the patients with secondary impotence
demonstrate any relevant organic disorder. The etiology in most of
the patients is purely psychogenic. Such problems as unsolved
oedipal conflicts (Kaplan, 1974), disharmony between parent with
either maternal or paternal predominance (Masters and Johnson, 1970)
and latent homosexuality were found in patients suffering fromoimpo~ence and revealed in psychoanalysis.
The following factors are the main causes of impotence:
a)
Environmental factors such as excessive tiredness or other
physical depressive upsetting circumstances, frequently a fear of
interruption by children or relatives, mixed motivation in which the
man may be attempting intercourse with an unsuitable partner to whom
he has no real emotional attraction, and chronic alcohol or drug
ingestion.
b)
Interpersonal relation: an impaired relation with the usual
sexual partner. A divorce can change the whole way of living causing
a loss of security and self-confidence and lead to impotence. However, even a temporary declination in family life can cause the same
symptoms. Sometimes a lack of understanding of the husband's physiology and psychology, like teasing the husband about his manhood or
sexual performance, can be a trigger for impotence.
c)
Conversion symptoms: some sexual dysfunctions seem to be conversion symptoms. Conversion implies that a conflict in one area is
expressed in the language of another. Usually a psychological conflict showing itself not in words of feeling but in bodily symptoms.
In a wider sense, sexual conversion symptoms may be expressed in the
language of penile erection, feelings of adequacy and inadequacy that
have their true origin in other non-sexual fields or experience. For
example, a healthy man who is disabled through an accident that
prevents him from returning to his usual work. Such a man may become
withdrawn, experiencing a loss of self-esteem which was previously
based on his work, productivity or earning ability. Such a man also
becomes, not infrequently impotent on a conversion basis, the impotence reflecting feelings of diminished potency in other areas.
d)
Age: Kinsey et ale (1948) found that the rate of impotence
increases with age. Old age in itself is not a reason for impotence.
Many people have been reported to have regular intercourse in their
eighties and nineties. In the Kinsey et a1. (1948) series itself,
45% of men aged 75 were potent. Disabling diseases explain only part
of the cases. It seems that the main reasons of impotence in age are
lack of sexual partners on the one hand and loss of self-confidence
on the other. The general belief that sex is for the young, contributes a lot to the development of the problem. A lot of old people
300
K. FUCHS ET AL.
who do not even try to have intercourse have morning erection or even
masterbate regularly.
Among the many methods of treatment, hypnotherapy as a method of
treatment in secondary impotence is well-established. (Kroger, 1976;
Crasilneck, 1979; Beigel, 1980). In this paper we present a modified
hypnotherapy technique based on relaxation and indirect suggestion as
described and verbalized by Erickson (1979). According to our experience this technique is brief (1-3 sessions) and yields a high
success rate.
MATERIALS, METHODS AND RESULTS
The cases presented are those of nine men * aged 25-55, treated
in the years 1975-80, suffering from secondary impotence. The duration of impotence was 1-6 years and there were no related organic
problems. The immediate causes of impotence were previous myocardial
infarction - two cases, family crisis (separation, threat of divorce)
- two cases, loss of a child with resulting guilt feeling (the child
was killed in a car accident in which the father was the driver) one case, failure in university studies - one case, and in two cases
there was no immediate obvious reason.
The method of treatment was hypnotherapy lasting 1-3 sessions
(45 minutes each) with indirect suggestions according to Milton
Erickson (1979) verbalization. To demonstrate the method we shall
present an illustrative case:
P.M., a 44 year-old man married for 10 years and a father of 3
children, accountant by profession. One and a half years before
consultation, he was hospitalized because of a myocardial infarction.
After recovery he returned to his daily professional occupation.
Following the infarction he suffered from impotence. In the first
interview he stated that he believed that "intercourse can affect him
with another stroke," and for this reason he did not try to act
sexually for half a year. Later when he tried to initiate sexual
intercourse with his wife, he failed to achieve and erection. Since
then, for a further year, he had never obtained an erection except
occasionally early in the morning.
Therapy technique: induction was achieved by arm levitation
technique, and this for the simple reason that arm levitation is a
symbolic expression of an elevated and erected organ. Then we
started with verbalization, as suggested by Erickson (1979):
301
"As you wer~ a little child at the age of one year, you have
known you couldn't stand up {indirect statement of impotence) ..
(Pause) And now you know you can't (challenge), try it! You
can't (Pause) And now you truly know how an idea can take
possession of you .. (Long pause). And now I would like you to
enjoy an experience. One or the other or both of your hands will
lift up towards your face. (Long pause). And no matter how hard you
try to press down, it is going to lift up toward your face.
And you can't stop it .. (Pause)
There is nothing you can do to stop it .. A little bit
higher .
There is nothing you can do to stop your hand from feeling hair,
the feeling of hair and feeling of warm body .. (Pause)
And you can't stop your hand from doing that ... (Pause)
And now you know that whenever you wish, your penis can stand up
and feel hair. (Pause)
And you can enjoy it .. (Pause)
It won't be your hair. It will be that feeling of her. And you
can't lower your hand until you've enjoyed sensing the feeling of
hair sensing a warm body. (Pause) An nothing can tell you that your
penis won't stand up. Nothing can tell you that.
And nothing can prevent it from feeling hair and a vagina for as
long as you want. (Long pause).
And I want you to have the surprise of your life because sometime today or tomorrow, your hand will touch the hair on her head,
and you'll find what your penis will insist on doing. (Pause). And
you're going to let that be a surprise.
And I would like to tell you that sometime in your lifetime you
are going to lose your erection . (Pause). And what you don't
know. That this is a sign that your conscious mind is telling you
that the beauty of your wife's body is overwhelming.
Enjoy this fact because that is the greatest possible compliment
you can both receive (Pause)
And then think of your elevated arm, that nobody can prevent you
from lifting it up toward your face, and you will immediately experience the feeling that your penis is elevating like your stiff arm."
302
K. FUCHS ET AL.
COMMENTS
Most cases of impotence have and emotional and psychological
background. Therefore, psychotherapy of any kind should be the
treatment of choice after ruling out the possibility of organic
disturbance.
The psychodynamics of secondary impotence consist of two main
elements. The first is deep trauma in childhood which affected the
psychosexual structure of the patient. This trauma can be repressed
over a long period of time leaving the patient with an adequate
sexual function for years. At a certain point, mainly as a result of
another trauma, which can be of various kinds either physical, such
as myocardial infarction, road accident, etc., or emotional, such as
crisis in family life, failure at work and even an accidental failure
in sexual performance. The first deep trauma and its effect on
personality structure reveals itself either consciously or unconsciously. The patient enters into a situation of stress, anxiety and
lack of self-confidence, expressed as impotence. The sexual failure
itself (sometimes even a solitary event) increases anxiety, stress
and fear and creates a vicious circle. It is quite common initially
to note sporadic failures which in time become more and more frequent
until complete impotence ensues. At this stage the patient discards
the task of being an emotional participant in his own sexual act and
turns to being a "spectator" thus intensifying even more the dissociation between positive emotions necessary for normal satisfying
sexual relations and the physiological sexual act. Sexual impotence
projects itself over other areas of life, such as family relationship, social life and decreased performance at work, studies, etc.
Many methods of psychological treatment have been described.
Basically they can be divided into two groups:
a)
Radical reconstruction insight therapy with the purpose of
solving the deep conflicts and changing the entire psychosexual
structure of the patient. The classic form of these methods is
psychoanalysis as presented in the basis works of Freud (1979)
and Stekel (1965)
303
304
K. FUCHS ET AL.
305
310
The idea of using hypnosis for investigative purposes is certainly not a novel one; it goes back in fact to the early beginnings
of animal magnetism. In Quebec. for example. the history of animal
magnetism as a method of eliciting meaningful information can be
traced back to the late 1830's. According to Dr. Olivier Robitaille.
a Qubec physician. animal magnetism was introduced in Quebec by
Edward Gibbon Wakefield in 1838. Wakefield was one of Lord Durham's
associates and co-author of the famous Durham report. He was a
well-known magnetizer and used his talents in a peculiar way. In
order to get acquainted with the Canadian population. he would visit
different families and entertain them on the topic of animal magnetism. He would then propose to magnetize a few persons. Following
his feat. he would converse and inquire about the political climate
and opinions in the country and report to Lord Durham (Drolet. 1970).
The last few decades of the-nineteenth century have justly been
regarded as one of the major epochs of the history of hypnosis.
particularly in France. This is a period in which the schools of La
Sa1petriere and Nancy were in major conflict about the nature of
hypnosis. with Charcot arguing for a neuro-physio10gica1 viewpoint.
and Bernheim ultimately winning out and laying the foundation for a
more psychological pOSition; the effects of -this conflict continue to
be felt.
This was also a period in which there was considerable debate
about the forensic uses of hypnosis. It is extremely rare to find a
book of this period that did not underline the dangers of hypnosis.
and in particular its coercive power. Medico-legal jurists. many of
them working in conjunction with either La Sa1p~triere or Nancy
schools. were numerous and although the debate took place particularly in France. the fallout trom it extended throughout most of
Europe. By the end of the century. legislation had been passed in
the majority of European countries limiting the practice of hypnosis
to professionally trained individuals (Ellenberger. 1970). It is
worth noting that the legislations limiting the practice of hypnosis
were well-known to the American judicial system by the end of the
19th century although they were not supported. An extensive commentary on the uses and abuses of hypnosis can be found in the August
1897 issue of the Lawyers Annotated Report (FHB. 1897) following the
Ebanks case in California.
The basic questions that were asked at this time were similar to
those asked today: Can hypnosis be used to coerce individuals? Can
a hypnotized person be forced to commit a crime? Can we believe a
legal testimony e1icted while a person is hypnotized? Who should
practice hypnosis? Can public demonstrations and stage hypnosis be
dangerous to the participants? This paper takes up two of these
issues; namely. (1) the issue of coercion by hypnosis. and (2) the
forensic use of hypnosis to "refresh memory" of victims of crime.
311
312
313
her to recall the events of the previous session in which the "crime"
had been suggested. This led to some interesting results. Upon
rehypnotization, some subjects confess to the crime, but implicate
the hypnotist as the sole reason for his or her commission of it.
Others would admit that they had done what the hypnotist had
required, but would go on to state that they had done what the hypnotist asked because they had realized that there was no real danger
(Janet, 1889). This led such investigators as Janet to condemn such
experiments as superficial, since they could be artifactual of all
sorts of unacknowledged contextual cues. Nevertheless, Courts of
this period recognized, sometimes, that spontaneous hypnosis, with
spontaneous amnesia, could occur.
For example, in a case reported by Mottet in 1881 (Bottey, 1884;
Morand, 1889), a young man, D., was arrested at 8.30 in the evening
for gross indecency. He was seen spending more than half an hour in
a public toilet. He was condemned to 3 months in jail. Visiting the
jail, Mottet recognized the man as a former patient of Dr. Mesnet.
Knowing that he had frequently been hypnotized by Mesnet, Mottet
suspected that D. could be a "spontaneous sleeper". After talking to
him, he became convinced that D. had experienced an attack of spontaneous somnambulism in the toilet, and could not recall what had
happened because of spontaneous amnesia. Mottet obtained a retrial
where he demonstrated before the judges how hypnotizable D. was. The
court reversed its previous decision and set D. free by reason of
both spontaneous somnambulism and amnesia. In general 19th century
investigators were very cautious when writing on the coercive power
of hypnosis and most of them expressed the opinion that each case
should be studied independently and extremely carefully (Bottey,
1884; Morand, 1889).
But when it came to the issues of confabulation, simulation,
biased questioning and false testimony under hypnosis, these same
investigators were quite sophisticated. Binet and Fere (1888)
provide one of the most comprehensive discussions of these problems.
They start their discussion with the following question; "How can we
convince judges of the reality of a state in which all the phenomena
may be stimulated?" They point out that when testimony is elicited
hypnotically, the hypnotized person may be telling the truth. But as
equally, any of three other alternatives are possible, and all need
to be checked out. (1) The subject may be simulating; (2) the subject may be hallucinating, which is their term for confabulation, and
(3) a suggested memory may be created as the result of a biased
suggestion from the hypnotist. A number of authors of this time gave
particular emphasis to the danger of confabluation in legal cases,
because the hypnotized person comes to see these fabricated memories
as being true. Bernheim (1888 and 1973) called such memories "retroactive hallucinations". Forel (1906) called them "illusory retroactive memories". Both provided numerous examples of subjects incorporating suggested facts during hypnosis into their normal memories,
314
and Bernheim (1891 and 1980) warned the legal system against those
witnesses who would furnish a "false testimony given in good faith".
Perhaps the best way to illustrate these points is to conclude
by describing a case reported by Ladame in 1882 and referred to by
Morand (1889). The trial involved a young woman, Maria F., who had
allegedly been raped by a male friend of hers, who also used to
magnetize her. For nine months she did not recall the rape, or
whatever sexual relationship it was, and regarded her pregnancy as a
very strange thing. After the birth of the child, a doctor hypnotized her, and she proceeded to recall (if that is the word) the
details of becoming pregnant. What is of interest here are the
conclusions of the report submitted to the Court by the experts that
were asked to testify. It concluded that under the circumstances
rape would have been possible. There was a close relationship
between the two young people and the dates of birth and the alleged
rape were correct. The delay in the hypnotic inquiry, however, made
it impossible to state with certainty that it really happened that
way. The Court conceded that hypnosis was a permissible method for
investigating inaccessible memories, but argued that the dangers of
confabulation were too great. It stated: "It could be easy to
obtain a detailed description of what happened by hypnotizing Maria
F.; but that experiment would be difficult and could be misleading.
During hypnotic sleep we could suggest, voluntarily or involuntarily
to the hypnotized subject's dreams and hallucinations that she will
describe with an astonishing precision. Because of the vividness of
the descriptions, one may be tempted to see them as being real"
(Morand, 1889). Stressing the issue of simulation the experts then
stated that although they could show that Maria was hypnotizable, the
results of that type of information "could not be in any case a
sufficient testimony to justify a decisive and certain judgement".
Based on this report, and the impossibility of ruling out the issue
of simulation, the young man was acquitted and set free.
Overall, we think it is clear that 19th century investigators
rejected in general the idea of using hypnosis to coerce an individual into the commission of a crime. But as to the possibility of
abusing a hypnotized subject, they were at the same point that we are
still today. In each case, the best they could do was to make an
"educated guess" based on the knowledge of the time. At the same
time, it is also clear that many 19th century investigators showed a
much more acute awareness of the dangers of simulation, confabulation
and cued testimony than is quite often observed today. The awareness
of those problems left the judicial authorities little choice but to
adopt severe legislations towards the use of hypnosis. In light of
the literature of forensic hypnosis that has recently burgeoned in
North America and especially the rising popularity of hypnotic techniques within police departments, it may be worthwhile to refresh our
memory and look at what our predecessors have proposed and done to
minimize the impact of misusing hypnosis.
315
Note
Following the judgement of Judge Searls on the Ebanks case, an
individual (F.H.B.) wrote an extensive note on hypnosis. at the
request of the court. Its purpose was to inform judicial opinion on
hypnosis, which was quite deficient at this time. Unfortunately,
F.H.B. cannot be identified with certainty. even now.
REFERENCES
Bernheim, H., 1973, "Hypnosis and Suggestion in Psychotherapy."
Aronson, New York, (Orig. Publ. 1888).
Bernheim, H., 1980, "New Studies in Hypnotism," International
Universities Press, New York, (Orig. Publ. 1891), 92.
Binet, A., and Fen~, C., 1888, "Animal Magnetism," Appleton, New
York, 36a.
Bottey, F., 1884, "Le Magnetisme Animal: Etude Critique et
Experimentale sur I'Hypnotisme ou Sommeil Nerveux," (Animal
Magnetism: A Critical and Experimental Study on Hypnotism or
Nervous Sleep), PIon., Nourie et Cie., Paris.
Drolet, A., 1970, Le 'Magnetisme Animal' Chez Lord Durham, (Animal
Magnetism and Lord Durham), in: "Les Cahiers d'histoire: Trois
Siecles de Medicine Quebecoise," (Historical Notes: Three
Centuries of Medicine in Quebec), Quebec, La societe
historique de Quebec, 22:145-153.
Ellenberger. H. F., 1970, "The Discovery of the Unconscious," Basic
Books, New York.
F.H.B. 1897, Lawy.Annot.Rep., 40:269-280.
Forel, A., 1906, "Hypnotism or Suggestion and Psychotherapy: A Study
of the Psychological, Psychophysiological and Therapeutic
Aspects of Hypnotism," H.W. Armit. trans. Rebman, New York.
Franklin, B., et al. 1965, Secret report on Mesmerism, or animal
magnetism, (Orig. Pub!. 1784), in: "The Nature of Hypnosis:
Selected Basic Readings," R.E. Shor and M.T. Orne, eds., Holt,
Rinehart and Winston, New York, 3-7.
Janet, P., 1889, "L'Automatisme Psychologique," (Psychological
Automatism), Alcan, Paris.
Lafontaine, C., 1843, L'Art de Magnetiser ou Ie Magnetisme Animal
Sous Ie Point de Vue Therorique, Practique et Therapeutique,"
(The Art of Magnetism or a Theoretical, Practical and Therapeutic Approach to Animal Magnetism), Balliere, Paris, (Reprinted in 1960).
Morand, J. S., 1889, "Le Magnetisme Animal: Etude Historique et
Critique," (Animal Magnetism: A Critical and Historical
Study), Garmer et Freres, Paris, 47 and 481-487.
Stephen, J. F., 1883, "History of the Criminal Law in England,"
Macmillan, London, 442.
Unsigned article, 1828-1829, Lancet, 11:303,384.
Wheless, J., 1897, Note: The case of Spurgeon Young, 31 American
Law Review, 440-441.
318
319
320
PSYCHOLOGICAL IMPLICATIONS
The hypnotist eliciting information needed by the police must
also be careful to function as a clinician responsible for the
present and future well-being of the subject. Particularly because
of the psychological implications of amnesia itself as a defence
mechanism, the clinician must be alert to the possibility that removing or overcoming amnesia may create problems for the subject.
Unlike the police, whose task it is to uncover useful facts, the
hypnotist must function both as an investigator and as a clinician.
Amnesia following a crime may stem from three major psychological factors. First, the experience itself may cause the individual
involved acute emotional trauma, especially if he was the victim.
Second, the experience may take on a symbolic meaning for the individual, in the context of a long-standing prior psychodynamic conflict. Lastly, recall of material criminal evidence may place the
witness in acute conflict, since it may have ramifications for his
321
322
the car. He noted that the men were neighbors and known to him and
named them. On awakening from hypnosis, however, he became nervous
about having identified the men and stated that he feared that they
might take revenge by killing him, since they were members of the
criminal underworld. Thus, in this instance, hypnotic hypermnesia
removed the defensive amnesia and, in fact, may have put the subject's life in danger. Although consciously he had wanted to cooperate, his amnesia had been protecting him from the conflict
between cooperation and fear for his own safety. Hypnotic recall
made this solution untenable.
In this situation, which is by no means unique, the responsibility of the hypnotist is not a clear clinical matter. The risk to
the subject is real and has been heightened by the hypnotist by
stimulating recall. Not only the subject, but the hypnotist as well,
is placed in conflict. For the hypnotist the conflict is an ethical
one: To whom does he own responsibility, and how should he balance
these conflicting responsibilities? Asked to perform a specific task
for the police, the facts he uncovers are the "property" of the
police. Even should the hypnotist claim "medical confidentiality" in
an attempt to protect the subject, the police would be justified in
suspecting that important evidence has been uncovered. Indeed, they
may even suspect that the hypnotist is withholding information
incriminatory to the subject, and the investigation may take an
unwarranted turn. This type of dilemma has no easy solution, and
leads the reader conveniently to the next section.
ETHICAL, LEGAL AND CIVIL RIGHTS IMPLICATIONS
Hypnotically induced recall produces many ethically complicated
issues. Following on the example just cited, there are other times
when the clinical hypnotist is placed in a situation of seemingly
insoluble conflict.
For example, according to accepted procedure, hypnotism should
not be used with an accused person without his agreement or in the
absence of his lawyer. This is obviously designed to protect the
witness from any situation in which he might unknowingly incriminate
himself. However, the line between witness and suspect is not always
well defined, especially in the early stages of investigation. In
one murder case, a person reported to the police that he may well
have been the last person to see the victim alive. The police
requested that he be placed under hypnosis to enhance his recall of
the circumstances under which he had seen the victim. Material so
recalled by the subject seemed to implicate him in the crime and
directed the investigation toward this assumption. It is clearly not
the function of the hypnotist to decide when the material being
recalled under hypnosis is, in fact, self-incriminatory. Legal
safeguards must be established to protect the basic right against
323
self-incrimination. It should be the task of the professional hypnotist to alert the legal profession to the need for a law clarifying
the point in time at which a person requires legal counsel during or
prior to hypnotization.
It is clear that a hypnotist participating in a criminal investigation should be protected against any knowledge of the case,
except the minimum necessary to direct recall to the specific areas
in which information is needed by the police. Moreover, the hypnotist must establish a "contract" with his subject so that he raises
no issues extraneous to those specifically requested by the police.
We know of one investigation of a serious crime in which the hypnotist noticed that the subject manifested certain reactions to
stimuli which he interpreted as indicative of homosexual tendencies.
The police had not requested information regarding the subject's
sexual inclination, and the subject did not expect to be examined in
this area. Following the session, in his report to the police, the
hypnotist stated that the subject was probably a homosexual. This
report had unexpected ramifications, given the nature of the crime,
and the gratuitously discovered reactions of the subject as interpreted by the hypnotist proved to be self-incriminatory.
CONCLUSION
In this paper we have discussed a number of practical and
ethical considerations which may arise with the use of hypnosis
during forensic investigations. We have provided illustrations taken
from an extensive clinical background in some of the ways in which
implications so derived can affect both the course of the investigation and the welfare of the patient. It is important that the
effort to develop legal and clinical safeguards be continued
(Kleinhauz et al., 1977; Orne, 1979), and in view of our discussion
we would like to stress the following:
Safeguards to protect the validity of material used in investigations:a.
All material recalled under hypnosis must be regarded as nonfactual unless and until independent corroboration is obtained. The
hypnotist, as a professional, should have primary responsibility for
insuring that police and legal investigators understand this and act
accordingly.
b.
Since the clinical hypnotist is aware of all the ways in which a
subject may interpret and attempt to conform to the hypnotist's
intentions and preconceived notions, he must insist that he receives
only pertinent prior information, limited to the specific goals of
the investigation as it related to his subject.
324
c.
All prior information, and the entire encounter between the
hypnotist and subject, must be recorded to permit independent evaluation (Orne, 1979).
Safeguards to protect the right of the subject's psychological wellbeiog:a.
Since the process of hypnotic recall to overcome amnesia following a crimdnal event may have psychological implications for the
subject, and the psychological dynamics may require immediate professional intervention, the hypnotist participating in forensic
investigations should be a professional psychiatrist or psychologist
trained in hypnosis.
b.
Clinical psychological evaluation of the subject must be provided prior to hypnosis. preferably by the clinician who is to
perform the hypnosis.
c.
Clinical psychological evaluation must be performed after the
hypnotic intervention. Counselling and care services should be
available.
Other ethical safeguards:a.
The clinical hypnotist participating in a forensic investigation
should maintain a direct focus on the subject as a human being and
attempt to guard his human and civil rights.
b.
Hypnosis must be undertaken only with witnesses or victims who
have expressed full and explicit willingness to undergo hypnosis.
c.
Hypnosis must not be induced in any person who is a suspect in
an investigation, except when it is at his request and aimed at the
elicitation of material in his interest (for instance, to help him
establish an alibi).
d.
Hypnosis of a subject who is a suspect should be conducted only
in the presence of his attorney.
e.
The hypnotist must not raise any matters unrelated to the case
with the subject or draw or report any conclusions extraneous to the
information requested by the police investigator.
We believe that hypnosis is an important and useful tool in
forensic investigations. It is for this reason that we encourage the
continuing development of safeguards such as these, which will
enhance its utility while protecting the rights of the individual.
325
REFERENCES
Bartlett, F. C., 1932, "Remembering," Cambridge University Press,
Cambridge.
Hilgard, E. R., and Loftus, E. F., 1979, Effective interrogation of
the eyewitness, Int.J.clin.exp.Hypnosis, 27:342-357.
Kaplan, H., Freedman, A., and Sadock, B., 1974, "Comprehensive
Textbook of Psychiatry III," Williams and Wilkins, Baltimore,
325-326.
Kleinhauz, M., Horowitz, I., and Tobin, Y., 1977, The use of hypnosis
in police investigation: A preliminary communication,
J.Forens.Sci.Soc., 17:77-80.
Orne, M. T., 1979, Use and misuse of hypnosis in court, Int.J.clin.
exp.Hypnosis, 27:311-341.
Worthington, T. S., 1979, The use in court of hypnotically enhanced
testimony, Int.J.clin.exp.Hypnosis, 27:402-416.
328
H. W. TIMM
329
330
H. W. TIMM
An equal number of subjects was assigned to each of two treatment conditions and to each of seven experimenters. Subjects
assigned to Group I received the complete forensic hypnosis procedure. while those assigned to Group II received the same procedure
without a formal hypnotic induction. Due to an apparent misunderstanding a research assistant assigned all highly susceptible subjects (whose HGSHS:A scores ranked in the upper half of those completing the study) to Group I and all subjects with lower levels of
hypnotic susceptibility to Group II. instead of randomly assigning
them to those two treatments controlling for their level of susceptibility. This deviation went undetected until all of the subjects had
completed the treatments. Although this unanticipated change altered
the nature of the study to some extent. it also provided some unique
research opportunities. For example. it permitted certain relationships associated with different levels of hypnotic susceptibility to
be examined in a situation where the experimenters were totally
convinced that the two groups of subjects with whom they were working
were completely homogeneous with respect to that variable. In
addition it probably served to help maximize any of the treatment
differences attributed to hypnosis.
The
females.
score on
standard
subjects
Procedure
The first phase of the study involved administering the HGSHS:A
to the student volunteers. The students were required to complete in
advance and take to the testing site an informed consent form. a
personal data questionnaire and a biographical data sheet. On the
last two forms the subjects were asked questions regarding their
physical description (age. height. weight. etc.). past classes they
had taken at the university. standard mode of local transportation.
and current classes/activities including the times and locations of
those events.
When students first arrived at the testing site. their forms
were collected and they were photographed with a polaroid camera
(model #660). After all of the subjects had been photographed the
investigator administered the HGSHS:A to them. To help standardize
that procedure an audio tape recording of that test was made according to the specifications contained in the HGSHS:A Manual (Shor and
Orne 1962) and that same tape was played during each of those
sessions.
331
A research assistant was assigned the task of soliciting, training, and monitoring a second group of students that served as the
mock offenders in this study. To reduce the chances of those mock
offenders knowing their respective victims, the offenders were
recruited from a political science class (as opposed to another
criminal justice class). In addition the offenders were shown the
pictures and background information that was gathered from those
victims to which they were tentatively assigned. All mock offenders
indicating that they may have had prior contact with their
prospective victims were reassigned to different victims, whom they
did not recognize.
In an attempt to standardize to some extent the actions of the
offenders, the research assistant overseeing them held several
offender training sessions. During those training sessions each of
the offenders present was given a squirt gun and certain materials
about their victims including pictures, current class/activity lists,
and physical descriptions. The offenders were instructed to use the
information they were given to later track down their victims. They
were also told that after locating their victims they should go up
and ask each of them if they were the correct person (i.e. Is your
name
?), which served to eliminate mistaken identifications and
insure that the victims would have at least some opportunity to
observe their offenders. After the prospective victims responded in
the affirmative to that question, the assassins were instructed to
pullout their squirt gun and shoot the victims twice in the abdomen
while simultaneously saying the words "squirt, squirt" loud enough
for the victims to hear them. The offenders were told to then turn
from the victims and walk away at a somewhat brisk pace. To further
increase consistency the research assistant had the mock offenders
role play their parts in the presence of the other offenders attending that session. Finally the offenders were given a blank set of
questionnaires and were instructed to fill them out immediately after
shooting each of their victims. The questions contained on that
instrument addressed the offenders' physical characteristics, what
they were wearing at the time of the shooting, and other details
about the incident that the victim would be asked about later.
In all. 26 offenders both completed the training and shot at
least one person. Out of those 26 volunteers, 5 shot 1 victim a
piece, 12 shot 2 victims, 5 shot 3 victims, and 3 of the offenders
shot 4 victims.
To prevent biasing the experimenters, the assistant in charge
of the offenders did not inform them who was serving as the mock
assassins, nor were the experimenters permitted to see the questionnaires completed by them until all pf the subjects had been tested.
Thus, none of the experimenters had prior knowledge concerning the
identity of the offenders whom their assigned victims were attempting
tn n~Rcribe.
332
H. W. TIMM
333
"What sex was the offender. what race was the offender." etc.). The
subjects were also requested to note their level of certainty on a
six point scale ranging from "positive" to "no idea." After they had
completed all those questions. the subjects were shown a photo line
up consisting of eight different pictures and told that the offender
might. or might not. be included among them. Once again the subjects' level of certainty was recorded along with their responses.
Next the experimenters told the subjects in step-by-step fashion
how they would induce hypnosis and what procedures they would employ
afterward. After answering the subjects' questions concerning those
procedures. the experimenters proceeded to hypnotize the subjects
using an eye fixation approach. That induction procedure was
followed by both deepening and hand closure suggestions. (For a
description of the eye fixation induction method. deepening. and hand
closure suggestions see Weitzenhoffer. 1957). The hand closure
suggestion was incorporated into the procedure to demonstrate to the
subjects that by focusing their concentration and imagination as
directed they could produce. what probably most of them perceived to
be. a somewhat amazing effect. As a result. it was anticipated that
the demonstration would serve to increase the subjects' expectations
that the memory assistance procedures to follow would also result in
positive outcomes.
Next the subjects were given time regression suggestions. during
which they were asked to use their mental image of one of their
calendars to help "go back into time" (Timm. 1981). In addition.
subjects were given suggestions that they would be able to observe
what had transpired on the day of the mock offense by visualizing
those events being replayed on an imagined television (Timm. 1981).
They were also told that the actions on the television screen could
be replayed. played in slow motion. frozen. and that any part of the
projected image could be enlarged or clarified.
The subjects were asked to inform the experimenters what they
were doing. feeling. smelling. tasting. and so on from a point one
hour before the mock crime took place until after it had occurred.
During periods of silence the experimenters would ask the subjects.
"What are you doing now?" or "Where are you at now?" If the subjects
were describing a particular situation in which one or more of their
senses would have been particularly affected. the experimenter would
ask how it felt, smelt, tasted, and so forth. Constant reference to
sensory images was made in an attempt further to assist the subject's
recall by trying to recreate the same emotional and sensory state the
subjects were in when the information was originally processed and
encoded.
After the subjects had described both the events occurring the
hour before the mock crime and the incident itself, the experimenters
pruceeded tv ask tham qucsti~nG ~bcut the meek cr!~e ~sing th~ 9~~~
334
H. W. TIMM
questions and procedures used earlier in the session. Once again the
experimenters started with the free narrative procedure, followed by
the directed narrative, ending with the more specific questions.
After all 21 of the specific questions had been asked, the subjects
were told to open their eyes, but to remain deeply hypnotized and to
determine whether or not their offender was included among the 8
pictures shown to them earlier. The subjects' answer to each of the
questions and their level of certainty were again recorded by the
experimenter in writing. After completing this question phase the
subjects were finally dehypnotized, asked to complete a brief followup questionnaire, and thanked for their participation.
Subjects assigned to the second treatment condition received
almost an identical procedure. The only differences were that when
they first arrived they were told about the memory assistance procedure they were going to receive and the theory behind it, as
opposed to the discussion about hypnosis; and the experimenters did
not perform the formal hypnotic inductions, nor the deepening suggestions. However, the hand clasp, calendar and television suggestions,
as well as the sensory imagery questions previously noted were administered to the subjects in both groups. During that portion of the
session where Group I subjects had been hypnotized (following the
formal hypnotic induction), the subjects in the second group were
asked to close their eyes and attempt to visualize the images they
saw on the day of the mock crime.
RESULTS
Eighteen questions asked to all subjects during each of the
three interview sessions were selected to serve as the instrument
used to measure recall performance. The questions were selected on
the basis of their pertinence to both offender characteristics typically asked about during police interviews and to details the subjects should have had an opportunity to observe. Eight of the questions related to the offenders' physical characteristics (e.g. race,
height, eye color, etc.), while the other questions addressed the
offenders' clothing and accessories (e.g. shirt color, shoe style,
gun color, etc.).
Each of the responses to the eighteen questions were scored as
either correct, incorrect, or do not know. Subjects were given a 2
inch margin of error for the offender's height, a 2 year margin for
age, and a ID pound margin of error with respect to the offender's
weight. To reduce the possibility that the results on certain questions might be overly affected by individual differences in categorizing or choice of nomenclature, mutually exclusive categories were
established by incorporating both the subjects' and offenders'
responses to those questions before they were compared to determine
recall accuracy. For example, it was decided to score subjects'
335
336
H. W. TIMM
Table 1.
Type of
Tvpe of Interview
Si ... lated Pol ice!X)
Res~onse
Initial
Ex~erimenter!Y)
Oneway
Forensic H~~nosisa(Z)
it.)' Subjects C[Group
Anava
F Ratio
Tukey Post-Hoc
Prob.
Com~ari sons b
10.500(1. 953}
10.393(2.025)
11.036(2.117)
.804
.451
Don1t Know
3.679(1.982}
3.179(2.389)
1.929(1.804)
5.295
.007
Incorrect
3.821 (1.847)
4.429(1.989)
5.036(2.365)
2.392
.098
N/A
X
yz
N/A
10.893(2.455}
11.536(2.317)
11.857(2.415}
1. 175
.3141
N/A
Doni t Know
3.714(1.960}
2.536(1.575}
1.214(1.524)
15.199
.000
X- V I
Incorrect
3.393(1.423}
3.929(1.884}
4.929(2.292)
4.715
.012
XY'L
Note.
~.
bSymbols under the same line indicate those row means do not differ by Tukey. P > .05.
cn =28
337
Type of Interview
Type of
Forensic Hypnosisa(l)
FRates
Tukey Post-Hoc
Prob.
Compari sons
Response
Correct
1.6525(.328)
1. 7046(.294)
1.4930( .351)
3.219
.0452
Incorrect
2.3399(.985)
2.3209(.942)
1. 9568(.757)
1.611
.2060
N/A
Corr.ect
1.5472(.273 )
1.7001 (.437)
1.6019(.368)
1. 258
.2898
N/A
Incorrect
2.4357 ( .869)
2.7807(1.031)
2.3313(.605)
2.127
.1258
N/A
x-v
Note. Numbers in parentheses indicate the SO for the preceeding M. The higher the mean value. the lower the
subjects' certainty.
- ,
dSubjects in Group II were not given a formal hypnotic induction procedure.
bsymbols under the same line indicate those row means do not differ by Tukey, P > .05.
cn =28
338
H. W. TIMM
susceptibility/treatment groups.
presented in Table 3.
Table 3.
Type of
Response
Correct
Simulated Pol ice Interview
Initial Experimenter Interview
Memory Assistance Interview
.0697
-.3243*
.0400
.0771
.1958
.1021
-.2329
.3215*
- .0565
Incorrect
Simulated Police Interview
-.1717
-.0527
-.1022
-.0672
-.1203
-.2417*
-.1331
-.2491
-.3224**
-.4088*
.1626
-.1070
.0611
.0518
-.3955*
-.0086
-.0564
Note.
*.
**!
<.05
<.01
339
Degrees
One-Tail
of
Correct
Incorrect
Value
Group la
1.6525{.328)
2.3399{ .985)
-3.504
54
.0005
Group lib
1.5472{.273)
2.4357{ .869)
-5.162
54
.0000
Group la
1. 7046 (. 294)
2.3209{.942)
-3.305
54
.0008
Group lib
1. 7001 (.437)
2.7807{1.031)
-5.106
54
.0000
Group Ia ,c
1.4930{ .351)
1.9568{.757)
-2.941
54
.0024
Group IIb,c
1.6019{ .368)
2.3313{.605)
-3.420
54
.0006
Freedom
Probabil ity
Note.
340
H. W. TIMM
341
originally encoded bits
342
H. W. TIMM
to be far more judicious in their note taking, but it is also possible that the absence of the video taping may have slightly affected
the subjects' responses.
While the generalizability of the study appears to be limited to
some extent by the preceding factors, the experiment also incorporated several positive features into its design. Having people actually commit what was probably a fairly surprising act, seems to offer
certain advantages over basing the subjects' recollections on details
presented during a film shown as part of an announced eyewitness
recall experiment. In addition, while there was tremendous fluctuation regarding the scheduling of the testing, the time lags appear
more consistent in this study with field procedures than they did in
certain other studies. Perhaps most important, the experimenters did
not know in advance the identity of the offenders. nor were they able
to figure it out since numerous mock assassins were used. The experimenters were also not informed about any of the details pertaining
to the incident by the assistant who served as the "police investigator," which might have biased both their questioning procedures and
the subjects' responses to them. By using both mUltiple offenders
and experimenters, the chances of the results being significantly
affected by one person possessing peculiar characteristics was also
substantially reduced. Finally, collecting the data on each person
at several questioning points made it possible better to examine
certain changes that occurred within the subjects between those
sessions.
Taking into account both the experiment's positive features and
its limitations, the study appears to provide several useful insights
regarding the application of forensic hypnosis. Perhaps its greatest
contribution is that it demonstrates that the benefits and problems
typically associated with forensic hypnosis techniques are by no
means limited exclusively to those procedures. The results indicate
that forensic hypnosis offers little or no advantages or disadvantages over similar guided memory assistance procedures conducted in
the waking state in terms of the amount of information recalled. It
also indicates that whenever subtle methods of pressuring witnesses
to answer questions are employed, the witnesses will provide more
answers, but a greater number of them will be incorrect. In
addition. as subjects are repeatedly questioned over time, they
appear less able to differentiate between their original recollections and those bits of information they acquired through either
speculation or directly from others after the fact. Thus the study
indicates that forensic hypnosis or other related procedures might
prove helpful in certain situations, but only when sound questioning
procedures are utilized and acquiring possible leads seems more
important to solving the case than the necessity for that witness
being as accurate and untainted as possible.
343
Acknowledgements
The author wishes to acknowledge the valuable assistance of the
following people, without whom this project could have never been
completed: Dennis Anderson, Sara Anderson, Robert Lorinskas, Michael
Moore, Gail Peterson, and Eugene Ringuette who served as experimenters; Bryan Bledsoe who assisted with the mock assassins; D.T.M.
Senarath who served as the "Police Investigator," and Paul Davidson,
Mary Joiner, Stephen Lounsbury, James Mullins, and Ann Puckett who
helped in several ways during the analysis of the data and preparation of the manuscript.
REFERENCES
Griffin, G. R., 1980, Hypnosis: Towards a logical approach in using
hypnosis in law enforcement agencies, J.Pol.Sci.Admin.,
8:385-389.
Hilgard, E. R., and Loftus, E. G., 1979, Effective interrogation of
the eyewitness, Int.J.clin.exp.Hypnosis, 27:342-357.
Kroger, W. S., and Douce, R. G., 1979, Hypnosis in criminal investigation, Int.J.clin.exp.Hypnosis, 27:358-374.
Loftus, E. F., 1979, "Eyewitness Testimony," Harvard University
Press, Cambridge, Mass., 54-78.
Malpass, R. S., and Devine, P. G., 1981, Guided memory in eyewitness
identification, J.appl.Psychol., 66:343-350(a).
Orne, M. T., 1959, The nature of hypnosis: Artifact and essence,
J.abnorm.soc.Psychol., 58:277-299.
Orne, M. T., 1962, Antisocial behavior and hypnosis: Problems of
control and validation in empirical studies, in: "Hypnosis:
Current Problems," G.H. Estabrooks, (ed.), Harper & Row, New
York.
Orne, M. T., 1979, The use and misuse of hypnosis in court,
Int.J.clin.exp.Hypnosis, 27:311-341.
Putnam, W. H., 1979, Hypnosis and distortions in eyewitness memory,
Int.J.clin.exp.Hypnosis., 27:437-448.
Reiser, M., and Nielson, M., 1980, Investigative hypnosis: A
developing speciality, Amer.J.clin.Hypnosis, 23:75-84.
Schafer, D. W., and Rubio, R., 1978, Hypnosis to aid the recall of
witnesses, Int.J.clin.exp.Hypnosis, 26:81-91.
Shor, R. E., and Orne, E. C., 1962, "Harvard Group Scale of Hypnotic
Susceptibility Manual, Form A," Consulting Psychologist Press,
Palo Alto, Ca.
Smith, S. M., 1979, Remembering in and out of context: Human learning
and memory, J.exp.Psychol., 5:460-471.
Timm, H. W., 1981, The effects of forensic hypnosis techniques of
eyewitness recall and recognition, J.Pol.Sci.Admin.,
9:188-194.
Weitzenhoffer, A. M., 1957, "General Techniques of Hypnotism," Grune
and Stratton, New York.
Zelig, M., and Beidleman, W. B., 1981, The investigative use of hypnosis: A word of caution, Int.J.clin.exp.Hypnosis, 29:401-412.
THE ROLE OF
346
G. F. WAGSTAFF
347
348
G. F. WAGSTAFF
crime has been committed. or who are not emotionally involved with
the episode. It is hoped therefore that the results to be presented
may bear some relevance to such cases. Furthermore. De Piano and
Salzberg (1981) have reported that in the experimental context at
least. the level of retrieval under hypnosis does not vary with the
level of subject arousal at the time of stimulus presentation.
EYE-CLOSU~
349
and subjects had to pick one out of five possible responses. Typical
questions were "In which direction was the vehicle travelling?" "What
time did the clock say?" "What was the car's numberplate?" and "How
many people were standing by the car?" The subjects were randomly
assigned to three groups: Hypnosis, relaxation and control and all
groups were tested in the same room. All subjects received the
slides for the same duration (5 seconds per slide) and were tested in
groups. Subjects assigned to the hypnosis group were then given the
induction procedure for the Barber Suggestibility Scale (1969), after
which they were asked to indicate their state of hypnotic depth in
writing by means of Tart's (1970) Long Stanford Scale adapted for
group application. Following this they were given a suggestion that
hypnosis would help them remember the slides before being required to
open their eyes, whilst remaining in hypnosis, to fill out the questionnaire. After all subjects had finished they were instructed to
close their eyes and the hypnosis termination instructions were
given. The subjects in the relaxation group were given a taped
relaxation procedure followed by the questionnaire, and the control
group were given a tape of rather loud, unrelaxing popular music
before receiving the same questionnaire. In order to control for
experimenter bias all instructions were issued on tape, and temporal
factors were held constant, i.e. the questionnaire was presented 9
minutes after the stimulus presentation for all groups.
For analysis of the results the subjects in the hypnosis treatment were divided into two groups according to their LSS reports.
Those scoring 0-1 were classified as 'not hypnotized', and those
scoring 2 or more, 'Hypnotized'; the mean LSS score for the latter
group was 4, approximating to 'quite strongly and deeply hypnotized'.
As the LSS is a standardized and reliable measure of 'trance depth'
which correlates highly and significantly with other more lengthy and
complex measures of hypnotic susceptibility, a mean score of 4 would
reflect that the subjects concerned were adequately 'hypnotized' to
make comparisons meaningful.
Data analysis by means of an ANOVA following by planned t-tests
revealed that the low susceptibility subjects given hypnotic induction scored significantly lower than the other three groups. The
mean recognition scores were: hypnosis 1 (low susceptibility), 10.58
(n = 12); hypnosis 2 (high susceptibility), 13.00 (n = 8); relaxation, 13.33 (n = 12); control, 14.09 (n = 11). None of the other
comparisons was statistically significant.
The results of this experiment appeared to indicate that neither
hypnosis nor relaxation facilitated memory for meaningful material;
indeed the effect of hypnotic induction on subjects of low susceptibility was to impair memory. This finding contradicts that of De
Piano and Salzberg (1981) who used a shorter induction and failed to
test their subjects for hypnotic susceptibility.
G. F. WAGSTAFF
350
351
352
G. F. WAGSTAFF
353
(1981), it is not at all clear whether it was hypnosis per se, or the
good sense, ingenuity and social skills of the hypnotist concerned,
which were responsible for the alleged improvements in memory. A
variety of techniques were employed on different witnesses including
getting the witness to sketch, reassurance that testifying would not
create a danger to safety, adopting a non-authoritarian manner,
assurance that recall of an unhappy memory would not be required for
long, and allowing a rape victim to describe her ordeal in the third
person.
To summarize, it cannot be concluded on the basis of the results
presented in this paper that hypnosis is of no use on facilitating
witness memory as it may be the case that when hyperempiric suggestions are used, or hypnotic suggestions are administered as an
adjunct to the kinds of practical techniques, just described that
memory improvement is possible. Nevertheless, the role of induction
as a causative agent in witness memory facilitation has yet to be
definitively demonstrated, and the possibility remains that if hypnosis is applied indiscriminately, it may sometimes have a misleading
and inhibiting effect. However, the hypnotic 'supermemory' claims
adopted by so many proponents of forensic hypnosis may actually be
unnecessary as a justification for the use of some of the techniques
employed by forensic hypnotists. Instead, the true value of these
techniques may derive from their capacity to create a social situation in which witnesses may feel able to divulge distressing or
embarrassing information.
Notes
Fuller details of these experiments are available in the following manuscripts from the Department of Psychology, University of
Liverpool.
1.
2.
3.
REFERENCES
Barber, T. X., 1962, Hypnotic age regression: A critical review,
Psychosomatic Medicine, 20:286-299.
Barber, T. X., 1965, The effects of 'hypnosis' on learning and
recall: A methodological critique, J.abnorm.Psychol., 21:19-25.
354
G. F. WAGSTAFF
355
360
E. W. KRENZ ET AL.
INTRODUCTION
Traditionally, the training of athletes has emphasized the
development and refinement of fine and gross motor skills. Though
many hours of practice are utilized for the perfection Qf movements
necessary for optimal performance in a competitive situation, little
attention has been given to the mental preparation of athletes for
competition. When placed in a stressful competitive situation,
athletes experience varying amounts of stress and anxiety. These
heightened states of stress and state anxiety may sometimes enhance
performance. However, increased amounts of stress and state anxiety
are most often detrimental to performance. Therefore, it is important to control this psychological aspect of preparation for and
participation during competitive performance. Sarason (1961) has
reported a direct relationship between stress and anxiety and poor
performance in complex motor skills. Martens (1977) reported that as
stress and state anxiety (or arousal) increased to an optimal point,
performance was enhanced. However, increases in state anxiety beyond
this point had a detrimental effect on performance. Similarly,
research by Castaneda et al., (1956), and Sarason and Palola (1960),
also have supported this theory that high levels of stress and
anxiety have negative effects upon the performance of complex motor
skills.
Post-hypnotic suggestion has been utilized in a variety of
settings to reduce or control excessive levels of stress and anxiety.
Researchers have investigate the enhancement of motor performance
through the use of post-hypnotic suggestion (Pulos, 1969; Johnson and
Kramer, 1961). Likewise, other studies have been conducted to investigate the positive effects of post-hypnotic suggestion on stress
and anxiety in fine motor performance (London et al., 1968; DeMers,
1980).
Research has indicated that males and females respond to stress
and anxiety differently. Researchers in the area of sex differences
have reported that females exhibited a higher fear of success while
males exhibited a greater fear of failure (Patty and Safford, 1977).
Studies by Hill and Sarason (1966), and Lehanczyk and Hill (1969)
indicated that males are more defensive, that is to say, less willing
to admit to weakness.
HYPNOSIS IN ATHLETES
361
362
E. W. KRENZ ET AL.
Procedure
After consent was obtained from the Review Committee for Research with Human Subjects, all subjects were given a pre-test assessment during the initial meeting with the researcher. During this
introductory period, course credit and any previous experience with
the pursuit rotor was discussed. Only those athletes who had never
performed this fine motor task with the pursuit rotor were used as
subjects in the experiment. While the subject listened to an audio
cassette tape which briefly explained the study and the role of each
subject in the experiment, he or she was asked to read and sign a
consent form and to fill out a data card. During this time, the
researcher attached all the necessary equipment in order to measure
heart rate. The subject was then instructed concerning her or his
upcoming performance with the pursuit rotor.
The stressor used in this study consisted of a previously prepared statement that implied a false relationship about the subject's
performance on the pursuit rotor and overall athletic ability, as
well as suggesting competition between subjects. Each subject was
then given 15 trials of 30 seconds duration interspersed by rest
intervals of 30 seconds on the pursuit rotor. Total time on target
was recorded for each trial. At the conclusion of the pursuit rotor
task, each subject was asked to complete the state anxiety portion of
the STAl.
Each subject's percentile rank on the STAl was determined and
then each subject was assigned to either the experimental or control
group so that approximately the same number of low (1st to 35th
percentile), medium (36th to 65th percentile) and high (66th and
above) subjects were in each group.
The treatment used in this study was applied during three
sessions per week for 6 weeks. The post-hypnotic suggestion treatment consisted of an initial session of 30 minutes during which time
the subject was assured by the researcher about the use of hypnosis
and the researcher answered questions concerning it's myths. At that
time, the subject signed a second consent form and a personalized
tape for each experimental subject was made. The post-hypnotic
suggestion treatment was designed to allow each subject to attain the
proper level of nontightness during a stressful situation. Sessions
two through eighteen were of 20 minutes duration when the subject
listened to his or her personal tape in the laboratory. The control
group returned to the laboratory three times a week, 20 minutes per
visit, for 6 weeks to read unrelated material. During the treatment
stage of this study, two male experimental subjects and two male
control group subjects withdrew from the study and were not replaced.
No female subjects withdrew. A post-test assessment was administered
to all subjects during the 8th week which was identical to the pretest assessment. At this time all subjects were debriefed and the
stressor was disavowed.
HYPNOSIS IN ATHLETES
363
RESULTS
A three-way repeated measures analysis of variance was used to
analyze the data statistically. Two grouping factors were used:
Group (hypnosis or control) and Sex (male or female); and, one trial
factor was used: Time (pre or post). This analysis permitted testing the main effects of Group, Sex, and Time as well as the two-way
and single three-way interaction effects (Keppel, 1973).
Pre-test means and standard deviations for the variables of
interest in each of the four comparison groups are presented in
Table 1. Similarly, post-test data are presented in Table 2.
The pursuit rotor variable represents the average of trials
number 13, 14, and 15. The STAI variable is the percentile rank
obtained from the norms presented for the test. The heart rate
variables are the average of the minute by minute heart rates obtained during each of the three phases of the data collection: 7
minutes of baseline, 3 minutes during introduction of the verbal
stressor, and 15 minutes during the performance on the pursuit rotor.
Pursuit Rotor Results
Table 3 presents the repeated measures analysis of variance
results for the pursuit rotor data. There are two significant main
effects: one for Sex and one for Time. The males (X = 20.07) performed significantly higher than the females (X = 17.80) in the
overall experiment. Regarding the main effect of Time, post-test
performance (X
20.53) was significantly greater than pre-test
performance (X = 17.19) for the total group in the study.
Table 1.
Variable
Control/Male
Control/Female
Pursuit Rotor
18.04
4.53
16.21
4.26
3.59
18.42
16.37
4.84
STAl
66.40
21 .81
73.67
'24.54
75.50
20.49
80.91
25.53
Heart RateBaseline
68.41
:tll.69
71.49
12.42
73.67
:t16.33
70.47
1O.58
78.07
:t13.65
79.08
:t12.62
82.53
15.60
80.06
16.03
82.40
13.38
83.48
11 .99
88.14
13.99
88.16
18.80
10
12
10
11
E.
364
w.
KRENZ ET AL.
Table 2.
Control/Male Control/Female
Hypnosis/Male
Hypnosis/Female
Pursuit Rotor
22.20
:t 2.99
18.87
:t 4.39
21.63
:t 3.48
3.25
STAl
37.40
27.90
38.58
:t24.86
59.40
:t26.13
58.82
23.45
Heart RateBaseline
74.89
:t12.19
6.91
73.63
69.28
1O.96
71.38
13.77
79.16
12.42
79.11
8.24
75.93
8.28
80.03
19.68
82.52
:t14.56
81.03
7.43
78.77
8.22
83.43
15.78
Variable
Table 3.
10
12
10
19.81
11
Source
Group
Sex
Group X Sex
MS
1.10
1.10
.04
108.90
108.90
2.24
2.24
SS
OF
4.07*
.08
Error
1044.66
Time
242.54
242.54
.04
.04
.01
Time X Sex
2.12
2.12
.42
4.06
4.06
.80
Time X Group
39
Error
196.91
39
Total
1602.57
85
*p
**p
<
<
26.77
48.04**
5.05
.05
.01
HYPNOSIS IN ATHLETES
365
STAI Results
Table 4 presents the repeated measures analysis of variance
results for the performance on the STAle There are two significant
main effects: one for Group and one for Time. The hypnosis group (X
= 54.20) had significantly lower STAI scores than the control group
(X = 68.71) for the overall experiment. Regarding the main effect of
Time, post-test scores (X = 48.33) were significantly lower than the
pre-test scores (X = 74.26) for the total group in the study.
A significant two-way interaction, Time X Group, was also noted
in Table 4. A Newman-Keuls Sequential Range Test was used to compare
the means for the four cells in this interaction: hypnosis group
pre-test, hypnosis group post-test, control group pre-test, and
control group post-test. In the hypnosis group, the post-test mean
(X = 38.04) was significantly lower than the pre-test mean (X 70.36).
Similarly, in the control group the post-test mean (X = 59.10) was
significantly lower than the pre-test mean (X = 78.33). Though the
hypnosis and control group means were not significantly different at
the pre-test, the post-test means were significantly different from
one another.
Table 4.
Source
Group
Sex
Group X Sex
DF
SS
~lS
4584.32
4584.32
5.27**
235.52
235.52
.27
17.53
17.53
.02
39
870.17
Error
33936.47
Time
13974.93
13974.93
Time X Group
895.70
895.70
2.86*
Time X Sex
194.78
194.78
.62
.01
.01
.00
12207.36
39
Total
66046.62
85
*p
**p
<
<
.10
.05
313.01
44.65**
E. W. KRENZ ET AL.
366
Heart Rate Results
MS
110.22
110.22
.40
Sex
24.19
24.19
.09
Group X Sex
34.55
34.55
.13
Source
Group
Error
SS
10666.03
39
273.49
Time
360.50
360.50
4.09*
Time X Group
185.09
185.09
2.10
5.76
5.76
.07
69.56
69.56
.79
Time X Sex
Time X Group X Sex
Error
3437.01
39
Total
14892.91
85
*p
<
.05
88.13
HYPNOSIS IN ATHLETES
367
E. W. KRENZ ET AL.
368
A decrease of 4.04 beats per minute was noted from the pre-test to
the post-test for the total group of subjects. Table 6 below helps
clarify the importance of this finding. Because of this decrease in
heart rate, the stress due to motor performance was deemed to be less
effective in manifesting a physiological response, an increase in
heart rate. Familiarity with the testing situation was the probable
cause for this decrease across all subjects. It should be noted that
significant differences did exist among all three phases at the
pre-test and among all but the last two phases at the post-test.
Design of the Study
This study has shown conclusively that a verbal stressor can be
used in a laboratory setting to create stress as measured by increased heart rate. Also, since state anxiety was remediated by
post-hypnotic suggestion and, for the most part, increased levels of
stress were maintained, it can be concluded that stress and state
anxiety as they were measured in this context were independent
phenomena. Authorities disagree on the independence of stress and
anxiety but these findings suggest that they are indeed two independent characteristics when viewed in a motor performance context
(Eliot, 1979; Selye, 1974).
SUMMARY
Table 6.
Time
Verbal Stressor
Pursuit Rotor
Pre-test
71.02
79.90
85.50
Post-test
72.33
78.62
81.47
HYPNOSIS IN ATHLETES
369
REFERENCES
Castaneda, A., McCandless, B., and Palermo, D., 1956, Complex learning and performance as a function of anxiety in children and
task difficulty, Child Dev., 27:327-332.
DeMers, G. E., 1980, Effects of post-hypnotic suggestion on the
performance of a fine motor skill under stress (Doctoral
dissertation, University of Utah, 1979), Dissertation
Abstracts Int., 40(9):4955-4956A. (University Microfilms No.
8005315).
Eliot, R. S., 1979, Stress and major cardiovascular disorders, Futura
Publishing Company, Mount Kisco, N.Y.
Hill, K. T., and Sarason, S. B., 1966, The relation of test anxiety
and defensiveness to test and school performance over the
elementary-school years, Monogr.Soc.Res.Child Dev., 31:104.
Johnson, W., and Kramer, G., 1961, Effects of stereotyped nonhypnotic, hypnotic and post-hypnotic suggestions upon strength,
power and endurance, Res.Quarterly, 32:522-529.
Keppel, G., 1973, Design and analysis: A researcher's handbook,
Prentice-Hall Inc., Englewood Cliffs.
Lekarczyk, D. T., and Hill, K. T., 1969, Self-esteem, test anxiety,
stress and verbal learning, Dev.Psychol., 1:147-154.
London, P., Ogle, M., and Unikel, I., 1968, The effects of hypnosis
and motivation on resistance to heat stress, J.abnorm.
Psychol., 73:532-541.
Martens, R., 1977, Sport Competition Anxiety Test, Human Kinetics
Publishers, Champaign, Ill.
Patty, R. A., and Safford, S. F., 1977, Motive to avoid success,
motive to avoid failure, state-trait anxiety, and performance,
in: "Stress and Anxiety," (Vo1.4). C. D. Spielberger and I.
~ Sarason (eds.), Hemisphere Publishing Corporation,
Washington, D.C.
Pulos, L., 1969, Hypnosis and think training with athletes, Paper
presented at the 12th Annual Scientific Meeting, American
Society of Clinical Hypnosis, San Francisco, California.
Sarason, I. G., 1961, The effects of anxiety and threat on the
solution of a difficult task, J.abnorm.soc.Psychol., 62:
165-168.
Sarason, I. G., and Palola, E., 1960, The relationship of test and
general anxiety, difficulty of task, and experimental instructions to task performance, J.exp.Psychol., 59:186-191.
Selye, H., 1974, Stress without distress, J. B. Lippinncott Company,
New York.
Spielberger, C. D., Gorsuch, R. L., and Lushene, R. E., 1970, STAI
manual, Consulting Psychologists Press, Inc., Palo Alto, Ca.,
Abstract
The development of behavior therapy has gradually evolved from
strict behavioral tenets to a cognitive psychotherapy in which emphasis is placed upon increased self-control and confidence in situations which previously provoked anxiety or other emotional malaise.
A particular development of this type of cognitive-behavioral
therapy, incorporating hypnotic and autohypnotic techniques, Anxiety
Control Training (ACT), has been described by Snaith (1981a). There
is an increasing therapeutic expertise in the treatment of anxiety
based disorders but the treatment of impulse control disorders has
been less thoroughly explored and psychotherapists have, in general,
less expertise in the treatment of such disorders. An account was
published (Snaith and Collins, 1981) of the treatment of one form of
impulse-control disorder, namely, exhibitionism, by an adaptation of
Anxiety Control Training. Results were sufficiently encouraging to
explore the use of the technique in other disorders of impulse control, and particularly compulsive eating of the morbid degree known
as bulimia.
The immediate results and follow-up of the therapeutic intervention are described.
INTRODUCTION
The treatment of obsessional neurosis, whether by behavior
therapy or other psychotherapeutic methods, has for long been recognized to be a difficult undertaking. Apart from those cases in which
obsessional symptoms occur in the setting of a depressive illness and
371
372
R. P. SNAITH
373
sequently the patient rehearses confrontation of his anxietyproducing situations and practices control in daily autohypnotic
sessions at home and in this he is helped by a clear instruction
pamphlet and discussions with the therapist at the weekly sessions.
The value of suggestion of anxiety producing situations in the
trance, as opposed to the waking state is the clarlty of the imagery
and the patient's experience of its reality so that he feels as if he
had been really present in the situation suggested to him and had
experienced the attendant emotional discomfort. Through continuous
rehearsal of exposure to anxiety and self-control over the anxiety in
the daily autohypnotic exercises the patient's self-confidence in his
skill in anxiety control in real life situations gradually increases.
In a preliminary attempt to determine whether the technique of
ACT could be adapted for the treatment of obsessional phenomena, a
series of five exhibitionists were treated and the results reported
(Snaith & Collins, 1981). The adaptation of the ACT technique consisted of presenting the patient, in the trance state, with the image
that he was in a situation where loss of control and exposure was
inevitable and then suggesting that he was gaining self-control by
one or other of the usual coping mechanisms, such as taking a few
deep breaths. The outcome was sufficiently encouraging to suggest
that further experience should be obtained with the method.
METHOD
The definition of an obsessional phenomenon proposed by
Schneider (1925) will be followed here: "Contents of consciousness
which are accompanied by the experience of subjective compulsion and
which cannot be got rid of, though in quiet reflection they are
recognized as senseless." Patients were accepted tor the trial of
the therapeutic technique if, (a) they suffered from an obsessional
disorder without evidence of other gross psychopathology, and (b)
they were well-motivated to overcome their disorder and prepared to
follow the demands of the therapeutic technique in order to do so.
Three patients were selected:
Patient A. A thirty-five year old married woman who had a
five-year history of a classic obsessional neurosis; any approximation to a dead person, or a person who might have been in contact
with a dead person (such as passing a funeral cortege in the street,
or meeting and being spoken to by someone who was recently bereaved)
would cause her, on returning to her home to engage in prolonged
washing, changing and cleaning of her clothes and destroying
articles which she had been carrying at the time of the noxious
contact. There had been no period of remission of the obsessional
disorder since its onset.
374
R. P. SNAITH
Patient B. A married woman, aged thirty three years, who suffered from compulsive eating of vast quantities of food followed by
self-induced vomiting; this behavior had persisted for three years
without remission. The phenomenon, now described as bulimia, is a
frequent accompaniment of anorexia nervosa but it has been described
(Russell, 1979) as an isolated neurotic entity: 'bulimia nervosa'.
The patient had at no time suffered from any of the features of
anorexia nervosa. The compulsive quality of the abnormal eating and
her recognition of the behavior as senseless and disgusting justified
the inclusion of the disorder as an obsessional phenomenon.
Patient C. This young married man, aged twenty two years, was
an exhibitionist. For three years he had engaged in repetitive acts
of genital exposure to passing women. Although he exhibited an erect
penis he did not request sexual contact with the women nor engage in
masturbation; he denied that he held any wish to shock or insult
women. His marital relationship was satisfactory with a normal
sexual relationship. He was at a loss to understand why he felt
compelled to behave in this offensive manner and stated that he
wished to stop the behavior. The argument for including some cases
of exhibitionism among the obsessional disorders has been set out by
Snaith (1981a) and this patient's disorder certainly justified
classification as an obsessional phenomenon.
Before commencement of the therapeutic program the severity of
the obsessional phenomenon was assessed by the self-assessment method
of the Personal Questionnaire Rapid Scaling Technique - PQRST (Mulhall, 1976, 1978). This is ideally suited to the assessment of
phenomena which are highly individual and which, therefore, could not
be assessed by the standard questionnaires of obsessional symptoms
(Snaith, 1981b).
THE TREATMENT AND RESULTS
All three patients undertook to follow the demands of the ACT
program, i.e. to carry out twice daily autohypnotic exercises and to
attend for sessions with the therapist, initially weekly and then at
increasing intervals, according to the progress. The patients all
complied with these requirements.
Early in her treatment the first patient remarked that she felt
that the best technique of controlling her compulsion to engage in
the washing ritual, both in the session with the therapist and in her
homework sessions, was to switch her thoughts and 'see herself'
engaging in alternative non-neurotic activity. This suggestion was
followed by the therapist both for that patient and the other two
patients. As a result a typical suggestion given in the trance state
was: "You now feel yourself in the situation where you are just
about to indulge in (your compulsive behavior) you pause,
375
get control by taking a few deep breaths and now you switch to
alternative, sensible activity and you feel yourself to have
gained control over your impulse."
The therapy with the first patient extended over a period of
five months with regular weekly therapy for the first 10 weeks. She
continued to apply herself to the regular practice of the homework
autohypnotic practice throughout the follow up period of a further
one year. Her PQRST score for her main obsessional symptom before
therapy commenced was 9 (maximum), falling to 3 (minor discomfort
only) at the end of regular sessions and to 1 at the end of the
follow-up period.
The second patient had a similar duration of time in active
therapy and follow-up period. The only difference to the first
patient was her stated preference to engage in autohypnotic practice
on a single, rather than twice, daily session. Her PQRST rating for
Timpiuse to indulge in 'binge' eating was 8 (maximum 9) at the commencement of therapy, falling to 4 at the end of regular weekly
sessions and to 0 at the end of the follow-up period.
The third patient was in regular weekly therapeutic contact for
a shorter period of time, i.e. only six weeks. It was accepted by
the therapist that his work and the distance at which he lived was a
valid reason for the shorter period of therapeutic time. However he
continued to carry out the autohypnotic homework sessions throughout
the therapeutic and the follow-up period. The initial PQRST rating
was 9 (maximum 9) at the commencement of therapy, falling to 5 at the
end of the regular therapeutic contact and to 0 at the end of the
follow-up period.
DISCUSSION
The presentation of the therapeutic technique and its outcome in
these three patients suggests that it may be a valid method of brief
psychotherapeutic intervention for the management of otherwise intractable obsessional disorders. The requirements for a successful
outcome are (a) strong motivation toward self-control and (b) the
absence of other major psychopathology.
REFERENCES
Beech, H. R., and Vaughan, M., 1978, "Behavioral Treatment of
Obsessional States," Wiley, London.
Cautela, J. R., 1967 ,Covert sensitization, Psycho1.Rep., 20:459-468.
Cautela, J. R., 1970, Covert reinforcement, Behav.Ther., 1:33-50.
376
R. P. SNAITH
380
A. BOTTOLI ET AL.
381
A. BOTTOLI ET AL.
382
1000
900
800
700
~ 600
~:8 500
s::s::
'~$ 400
;3 ~ 300
200
100
1
2 3 4 5 6 7
Hypnotic sessions
Fig. I.
9 10
383
CONCLUSION
The positive outcome of the case described, was attributable to
a modification of physical responses made possible by the hypnotic
state and the interpersonal relationship established. This was a
basis for carrying out certain suggestions from the therapist, and
for developing positive experiences in the patient's own body. This
seems to us to highlight the considerable importance which hypnosis,
where correctly induced and used on reasoned principles, can assume
in certain situations, not only as a form of therapy but also, in
particular, as a form of diagnosis "ex adiuvantibus".
REFERENCES
Antonelli, F., 1970, Elementi di Psicosomatics, Rizzoli, Milano,
221-222.
Chertok, L., 1966, "Hypnosis," Pergamon Press, Paris, 79-80.
Guantieri, G., 1973, "L'ipnosi come oggetto di studio e mezzo di
impiego in medicina," Rizzoli, Milano.
Haynal, A., and Pasini, W., 1979, "Medicina Psicosomatica," Masson,
Milano, 30-32.
Jonas, U., and Heidler, H., 1979, Ursachen und therapie postoperativen harnverhaltungen, Gynaek.Rdsch, 19: (Suppl.I)97-106.
Jonas, U., and Tanaghe, E. A., 1975, Studies on vesico-urethral
reflexes: Urethral sphincteric responses to detruser stretch,
Invest.Urol., 12:357-377.
Lange, J., Staffeldt, K., and Schwartz, R., 1976, Intra und postoperative urologische komplikationen bei der abdominalen und
vaginalen radikaloperation des kollumkarzinoms, Verh-Ber.Dt.
Ges.Urol., 19-21.
Weiss, E., and English, O. S., 1965, "Medicina Psicosomatica,"
Astrolabio, Roma, 676-678.
385
386
DESCRIPTION OF CASE
The patient is a man aged 35, married with one daughter, and
prior to his illness was a bar-owner. The only important anamnestic
factor was the paralysis of the right arm due to a birth injury.
Following an attack of acute bronchopneumonia. the patient
developed polyneuritis (Gui11ain-Barre's syndrome). diagnosed and
treated first neurologically and subsequently by physiotherapy.
The patient reported periods of improvement alternating with
periods of relapse and aggravation of the condition. The most
serious stage was characterized. apart from the birth injury
paralYSiS, by a considerable atrophy and paresis of all four limbs.
with generalized superficial hypoaesthesia to the distal segments and
apallaesthesia of the lower limbs. difficulty in swallowing and in
articulation of words, difficulty in distinguishing tastes, and acute
crises of urinary retention. Pharmacological treatment and retraining (Levine et al., 1954), achieved a considerable degree of
recovered mobility leaving almost unaltered the superficial and
non-superficial sensory disturbances. The patient heard of the use
of hypnosis in physiotherapy after consulting various specialists. a
chiropractor and a healer. and after undergoing a number of sessions
of acupuncture.
When he was referred to one of us (A.G.), more than three years
after the beginning of the illness, he walked with a stick, having an
ataxic (sensory) type gait and many residual sensory disturbances.
He had to be helped in many everyday actions, did not leave home
unaccompanied. had not attempted any kind of work. and because of
387
these difficulties he felt that the had lost social contact and even
contact with his family (he no longer felt able to act as head of the
family)
The patient claimed that his handicap consisted of a lack of
sensitivity in certain areas of his body and that the only way for
him to "recover his role in society, in the family and as a person
the way it was before" was to recover his sensory function as it had
been prior to the illness (Jores, 1965; Antonelli, 1970).
From what he said, and especially from the way in which it was
said, we thought that the dysthasia represented a screen, albeit real
in itself, behind which the patient was hiding his own sense of
weakness, in the face of his family and social life. Previously,
according to his wife and daughter, the patient had been a notably
authoritarian personality, with a great ability to be decisive at all
moments of choice. What, in fact, is known as "a man who knows his
own mind," with all the positive and negative qualities (Weiss and
English, 1950) that the definition implies.
388
389
390
392
R. KAMPMAN ET AL.
by which the split mechanism between the different multiple personalities was eliminated.
INTRODUCTION
Hypnosis has been used quite successfully in the treatment of
spontaneous secondary personalities (Thigpen and Cleckley, 1957;
Ludwig et al., 1972; Schreiber, 1974; Prince, 1980). Most of the
recent studies have greatly modified our notion of the etiology of
the multiple personality phenomenon. The previous theories on possession by spirits or transmigration of souls have been discarded, as
several phenomena now appear understandable in the light of completely well-known psychological mechanisms. It is possible roughly to
discriminate between three main forms of multiple personality.
Healthy individuals have states resembling multiple personalities and
enriching their ego, which can be evoked in deep hypnosis (Kampman,
1976). The second group consists of neurotic individuals, who produce various multiple personalities as a defence of their neurotic
symptoms; these multiple personalities may symbolically contain the
crucial conflict of the neurosis (Kampman and Hirvenoja, 1976). The
third group might be said to comprise what are called "spontaneous"
multiple personalities, which have been classified as mainly narcissistic disorders in the most recent analytic interpretations
(Gruenewald, 1977). In these cases the splitting mechanism completely separates certain parts of personality, yet so that the
separate multiple personalities formed through dissociation are not
psychotic, but capable of differentiating between internal and
external realities.
Case Report
A 32-year-old woman's husband contacted the first author from
Sweden, because he had read about the multiple personality studies
made by Kampman. He thought that the behavior of his wife might, to
a notable extent, originate from similar phenomena.
The patient is a woman who migrated from Finland to Sweden over
15 years ago and speaks Finnish as her mother tongue. Kampman
promised to see the patient at least to assess the situation, because
he assumed that she would have certain linguistic difficulties in
psychotherapeutic work conducted in a language other than her mother
tongue.
The clinical interview reveals a completely matter-of-fact,
slightly stammering, married woman. The psychic functions are perfectly good. The patient appears intelligent and her ego functions
flexible.
393
394
R. KAMPMAN ET AL.
gave all her love to the new sister. The patient had a feeling that
the mother no longer loved her, and it was then that the Lisa personality entered the scene.
Lisa took the role of an unbeloved daughter who withdrew from
the situation. With the aid of this splitting mechanism the patient
was able to retain her own ego intact: Lisa was the girl who was not
loved, not the patient herself. Even later on, Lisa emerged whenever
the situations emotionally resembled the situation of rejection
experienced by the patient at the time when her youngest sister was
born. Lisa was manifested clincically when the patient was 19 years
old. It was then that she had moved to Sweden and began dating. The
patient's fianc~ was unfaithful, and she re-lived the same feelings
of rejection she had experienced as a child. This was the time of
the patient's first suicidal attempts. The hypnosis revealed the
background of the suicidal attempt: Lisa imagined that by dying she
would be able to show to her mother that she existed, and she all the
time fancied that she would be sitting on a rock, watching her mother
mourn and, once the mother had wept enough, would return. The infantile fantasies were confronted with the realistic parts of the
adult ego in the therapy, and the splitting mechanism thereafter
disappeared very soon. Lisa was the first personality to be treated,
because it was destructive and dangerous to the patient's life.
The second multiple personality calls herself Angry Anneli.
Anneli is very angry and wicked. She has many sadistic features and
is exceedingly selfish. If she does not get what she wants, she
breaks pottery and attacks people in a fit of primitive reaction.
Angry Anneli has caused the greatest breaks in the patient's memory
and also occasioned her most inconvenience, though not in such a
dangerous fashion as Lisa.
Angry Anneli also came about when the patient was 5 years old.
She was very often left at home alone, because the mother was somewhere with the new sister and the father did not take any responsibility for the child, but often went angling, leaving the daughter at
home alone. The patient once took her father's tin of worms and
broke it, in order that the father could not go fishing. This was
the beginning of sadistic treatment of animals. The father treated
the girl sadistically, and the girl, in turn, maltreated animals.
The father occasionally hit the girl in the face so hard that her
face bled. After one such occasion the patient went and stoned to
death her favorite hen. In later life situations, if a male tried to
show hostile feelings to the patient or did not please her, Angry
Anneli entered the scene with violent and raging behavior.
The birth mechanism of Angry Anneli and the sources of her power
were also analyzed and confronted with the patient's adult personality. Angry Anneli disappeared gradually stating, time after time,
that her powers were diminishing and that she was no longer able to
get angry.
395
These were the patient's two most destructive multiple personalities, whose disappearance signified a notable improvement in her
clinical behavior and social adaptation.
The third difficult and troublesome multiple personality was
Rita. Rita came about in the patient's childhood while she observed
her father's and mother's sexual behavior. Rita felt that the father
subjected the mother to his will quite infamously. By channeling all
her feelings of disgust into her Rita personality, the patient was
able to retain her own feminity and sexual desires.
At a later stage of her development the patient came to have
more multiple personalities, into which she channelled her various
feelings. Angelika was a highly romantic and sexual mUltiple
personality, which emerged when the patient became engaged. It was
by means of Angelika that she could be sexually stimulating to her
fiance. Rita was, however, present all the time, causing very difficult situations in the patient's dating relationship. The fiance
wondered how the patient could sometimes behave like a nymphomaniac,
and sometimes be quite derogatory and sexually reluctant.
The Maria personality emerged after a miscarriage by the
patient. Maria loved children and wanted to have a big family.
patient has a lO-year-old child, but cannot have any more. She
places her feelings of thwarted hope in Maria.
The
396
R. KAMPMAN ET AL.
397
the psychodynamics of the neuroses are being analyzed. At a subconscious level the ego channels the conflict ridden material into
the multiple personality. i.e. away from itself.
It seems that the origins of spontaneous multiple personalities
lie in a developmental stage at which the ego is not capable of
compromise formation. If the patient has successfully solved difficult childhood conflicts by using the splitting mechanism. he may
adopt this mechanism into active use. It is probable that the form
which is manifested when the patient becomes clinically ill. i.e. the
spontaneous multiple personality phenomenon. has only come about at a
later stage of personality development. At the time when they
appear. the first multiple personalities are vague. receiving a
definite form of personality only at a later developmental stage.
when the functions even otherwise develop and become more versatile.
When the primary splitting mechanism develops, the patient only has a
subconscious obsession to function in a certain way. When the same
mechanism is readopted later in life, it gradually acquires the form
of a multiple personality, e.g., a name. an occupation. a social
status and other similar distinctive features.
It is probable. and quite obvious. that many of the impulsive
suicidal attempts as well as many other impulsive and destructive
modes of behavior may have the multiple personality phenomenon at the
background much more often than it is perceived today. After such
impulsive behavior the patients are often completely locked up.
humiliated and ashamed and want to get out of the situation as soon
as possible. This means that many aspects capable of being treated
in the patient's situation may go unnoticed. As far as can be seen,
the primary consultation units of the general health-care system
should be prepared to deal with sudden destructive impulsive behavior
better than they are now and should create an atmosphere that would
arouse the patient's motivation and curiosity to discover the background forces of his impulsive behavior. This would often help avoid
misdiagnoses and the possible multiple personalities or states reminiscent of multiple personalities would also be diagnosed. particularly as such states are now relatively easy to treat and have a good
prognostic outcome.
REFERENCES
Gruenewald. D 1977. Multiple personality and splitting phenomena: A
reconceptualization. J.Nerv. and Ment.Dis 164.385-393.
Kampman. R 1976, Hypnotically induced multiple personality. an
experimental study. Int.J.clin.exp.Hypnosis. 24. 3:215-227.
Kampman. R and Hirvenoja. R 1976. The dynamic and relationship of
hypnotically induced multiple personality to the present
personality. Int.J.clin.exp.Hypnosis. 24. 3:335-336.
398
R. KAMPMAN ET AL.
G. W. FAIRFULL SMITH
402
PHILOGENETIC
Fear of pain
Fear of loss of support
Fear of a loud noise (or any extreme sensory stimulus)
2.
a)
b)
403
any population as several studies have shown, (Gale and Ayer, 1969;
Marks, 1969; Kleinknecht et al., 1973 and Kegeles, 1963). Gall
(1965) states that a further 40-50% of the population is dental
phobic to a lesser degree. In this, the milder form, dental phobic
illness prevents optimum attendance and full co-operation of the
patient during treatment, patients only attending for treatment when
there is severe pain associated with their teeth. In the more severe
forms, (16%), the patient totally avoids dental care (Gerschman et
al., 1979).
DISCUSSION
The twenty dental phobics surveyed were a random choice of the
next twenty consecutive referrals to the Hypnosis Clinic. There were
8 males and 12 females of ages ranging from 6 to 42 years old, with
the average age being 20.8. They all had extreme fear of dental
treatment, the 6 year old patient had not been to a dentist for 3
years and that was the shortest period of avoidance. The longest was
27 years. Four patients reported fainting when they had gone to
dental surgeries to make appointments. They all had other neuroses
in conjunction with their dental phobic disease. The dental phobia
is often only one symptom of many, signifying that all is not well.
Fifteen of the twenty intimated to being on regular psychotropic
drugs, the other five from time to time.
Willoughby's personality schedule (Wilkinson and Latif, 1974)
was used to obtain a normality/neuroticism profile.
The Standford Hypnotic Clinical Scale (Morgan and Hilgard, 1975)
was taken and the Glasgow Dental Hospital - Dental Phobia Index
(Fairfull Smith et al 1980) was administered to assess if there was
a connection between hypnotizability and the phobia level. It was of
interest to note that 13 scored "High" on the SHCS; 5, Medium and
only 2 were low. This is a higher than average number scoring
"High".
The phobia profile was obtained by devising a very simple self
evaluation phobia heirarchy-index schedule. This proved to be very
useful as an indication for the forming of specific therapeutic
suggestions for the desensitisation. It was also a very accurate and
a useful subjective measurement of the degree of improvement. A copy
of this schedule is attached (appendix "A").
METHOD
The patients were all induced by the Glasgow Dental Hospital
method (Fairfull Smith, 1976a) then they were taught a system of
self-relaxation in the waking state. The one chosen for its
simplicity was a modification of Stein's "Clenched Fist" technique
(Stein, 1965).
404
G. W. FAIRFULL SMITH
405
RESULTS
17 patients accepted dental treatment normally after their
course of hypnotherapy. Two of these patients managed to control
surgical pain completely and had all their dental treatment without
any form of pharmacological help. The other 15 patients accepted
their dental treatment with LA and GA happily, 10 went back to their
family general dental practitioners and 7 had their treatment carried
out by student operators in the hospital. As measured by the G.D.H.
phobia index the average improvement was 284%; one patient's score
improved from 14 to 56 signifying a 300% improvement.
One girl of 10 years old had a reasonable depth of hypnosis but
still refused LA. She was counted as a failure even though she
subsequently had her treatment with GA. Two boys did not complete
the hypnotherapy course. One of them was non-hypnotizable. All the
concomitant neuroses of the 17 were also resolved with no specific
suggestions given for them. They also reported that they had cut
down their psychotropic drugs immediately, and after 4 years they
were all free from the need to take them regularly, or at all.
A reassessment was made four years later and the 17 patients
were still having dental treatment on a regular basis.
CONCLUSION
This clinical trial gives further proof that the underlying
mental mechanism for creating phobias, and for being a good hypnotic
subject appear to be the same, thus creating the illness and the
cure.
Hypnosis appears to be an effective self-regulation aid and with
other therapies able to re-orientate attitudes, ego-boost, control
stress, anxiety, fear, and degree of pain. Like all other therapies
it has its limitations, but 85% success rate in a random group of
people is reasonably good. Especially so, as these 17 patients on a
follow-up assessment after 4 years were still attending for routine
dental treatment without any stress or fear. As other neuroses were
also spontaneously influenced it would appear that the hypnotherapy
per se regardless of depth helped the patients to integrate their
attitudes and to be well adjusted to cope not only with dental
treatment but with life in general.
REFERENCES
Benson, W., and Klipper, M. Z., 1975, The relaxation response,
Collins, London.
Blofeld, J., 1977, Mantras, Allen and Unwin, London.
406
G. W. FAIRFULL SMITH
407
o.
1.
2.
3.
4.
means
means
means
means
means
1-
2.
3.
4.
1
1
2
2
3
3
4
4
5.
6.
1
1
2
2
3
3
4
4
1
1
2
2
7.
4
4
4
4
8.
9.
3
3
10.
H.
12.
1
1
2
2
3
3
4
4
13.
14.
the dentist?
15.
16.
17.
the dentist?
G. W. FAIRFULL SMITH
408
18.
19.
20.
3
3
4
4
James Gall
Scottish Home and Health Department
St. Andrew's House
Edinburgh, Scotland
Abstract
The acceptance of active dental procedures is not always easy
and this is particularly so with children, some of whom demonstrate
extreme patterns of bad behavior. For the dentist several techniques
are available to deal with this type of child. These include oral
premedication, intra-venous sedation, relative anesthesia, general
anesthesia and hypnotherapy. Whatever technique is selected should,
in addition to meeting the crisis situation, be helpful to promote a
proper attitude and a more ready acceptance of program for maintenance of oral health. An endeavor should be made to elicit the reason
or reasons for the child being difficult. It is important for the
practitioner to be kind, considerate. firm. to have understanding and
an ability to communicate. Formerly. undergraduate dental training
concentrated largely on developing skills to undertake technical
procedures. to meet restorative needs and to consider the mouth in
isolation. Today there is appreciation that treatment is being given
to a person who has a dental problem. There is a requirement to
allay fears. many of which are false, to control anxiety and to reeducate the patient to have a more positive and confident approach to
acceptance of dental care. The use of hypnosis trance is an excellent way in which to conduct desensitization. modelling. contingency
management, and to develop self-confidence.
Before embarking on these therapies it is important to establish
rapport with the patient. This can. of course. mean that the practitioner must be prepared to surrender active dental treatment at the
first visit as an initial investment. in order to receive the reward
in which a dental cripple, (i.e. the difficult patient) will become a
409
410
J. GALL
411
Five
Six
Seven
Eight
Nine
Ten
Eleven
Twelve
Thirteen
Fourteen
Fifteen
Deciduous
teeth
Permanent
teeth
Either
dentiti on
63%
68%
68%
3%
12%
27%
73%
72%
66%
51%
32%
15%
7%
2%
1%
40%
42%
46%
53%
54%
58%
61%
57%
63%
69%
78%
76%
69%
66%
61%
61%
62%
57%
Whether mother
goes wi th child
8+
5+
12+
14+
%
Mother usually goes
Does not
92
8
92
8
78
22
58
42
100
100
100
100
%
Mother went last time
Did not
Base
%
50
50
91
9
88
12
67
100
100
100
100
656
484
435
855
33
J. GALL
412
Table 3.
Things mentioned
as being unpleasant
for chil dren
8+
12+
14+
21%
23%
13%
6%
3%
6%
5%
10%
12%
13%
2%
3%
4%
2%
1%
26%
26%
14%
7%
4%
6%
4%
9%
10%
9%
2%
2%
3%
2%
1%
16%
28%
16%
5%
4%
9%
7%
8%
11%
12%
1%
2%
2%
1%
2%
18%
24%
15%
5%
8ase
922
532
451
886
Nothin~
3~
13%
5%
8%
11%
10%
1%
2%
3%
2%
1%
No fi 11 ings no extractions
Some extracti ons
Some fi 11 i ngs
Base
2%
75%
21 %
115
8+
12+
14+
23%
4%
84%
15%
4%
86%
10%
BJ
84
183
3%
78%
1404
26070
15070
31070
12070
407.
S070
24070
907.
507.
Regular
check-up
444
47070
34070
50070
29070
14070
4607.
4007.
IS070
130{0
Occasional
check-up
1392
5S07o
30070
55070
36070
2807.
56070
48070
2007.
1107.
Only with
trouble
3262
43070
24070
44070
24070
16070
3407.
3607.
15070
907.
All dentate
adults
1376
S07.
907.
3307.
1907.
23%
37070
10070
Edentulous
adults
Comment: It can be seen that fear and dislike were the main reasons that people put off
going to the dentist and it is of particular interest to see that 37% of edentulous adults
were still scared of the dentist.
Base
Table 5.
:=
~
~
t='
1-1
t='
txl
414
J. GALL
Table 6.
'/ put off going to the dentist
because .... '
United Kingdom
England
Wales
Scotland
Age
16-24
25 - 34
35 - 44
45 - 54
55 and ove'r
Base
I'm scared of
the dentist
I can't be
bothered really
4107.
4207.
4407.
3807.
3107.
4639
3007.
3307.
3833
580
4107.
3407.
86()
4707.
4907.
4307.
34070
1420
729
40070
34070
31070
30070
24070
Sex
Male
Female
3407.
4707.
25070
3707.
2176
2463
Social class
I, II, IIIN
IIIM
IV, V
3707.
4407.
4407.
2607.
3407.
3307.
1658
1561
Attendance pattern
Natural teeth only
Partial dentures
Edentulous
4407.
3407.
3207.
2307.
2304
4007.
3707.
785
728
1532
976
958
1376
Extreme or
These
2.
415
(a)
Fear of pain
(b)
(c)
Ontogenetic
(a)
(b)
416
J. GALL
C_unicat<
to
':>E
trananit~
news
'nfo_.U=
feelings
417
communicated. The dentist's choice of words and phrases is importance. The word "plaque" has little meaning for a six year old child
and an eight year old is unlikely to comprehend "anesthetic" with LA
or GA. Also the use of certain emotive words can be upsetting to the
patient e.g. "hurt", "drill", "painful" could be replaced with
"bother or disturb", "clean out", "annoy". Unwittingly some practitioners miscommunicate. A common example of this, is the dentist
saying, "Fine, sit back, take it easy, relax, this won't hurt much."
Very often, the patient does not know how to relax, and the response
is to become very tense, take a tighter hold of the chair rest, and
the hand knuckles become pallid from pressure, and often a bead of
sweat appears on the forehead. A state of heightened anxiety results
which makes communication less easy.
Effective communication requires, Attention, Comprehension,
Acceptance. An ability to communicate well is a prerequisite for
success in hypnotherapy.
With regard to patients selecting dentists, surveys by Kreisberg
and Treimann (1960), McKeithen (1966), and Collett (1969), revealed
that the critical factors from the patients perspective were - the
dentist's personality, his ability to reduce fear and anxiety, and
his technical ability. Another study, (Jenny et al., 1973) reveals
that parents were most satisfied with those dentists who talked to
the children, all the time. Recent research by Linn (1971) seems to
confirm that while patients initially select their dental practitioner, a continuing relationship is dependent upon the dentist's
attitude to the person, and a few patients do move around until a
mutually satisfactory relationship is found.
Stage two of the dental consultation is of paramount importance
with the dentist having a significant and vital role to play in
trying to establish rapport with the patient. Before receiving the
patient into the surgery, the dentist should be knowledgeable about
the name, age and address of the patient, the reason for the visit,
and have any other information which was given to the practice about
the patient. As the patient enters the surgery the dentist should
accord a welcoming greeting. This may take the form of a smile with
an extended hand of friendship as well as indicating to the patient
to be seated in an ordinary chair in the surgery. All this time the
dentist's powers of observation should be contributing to a quick
assessment of the patient's attitude to the visit. In the case of a
child one would note the following points:(a)
(b)
(c)
(d)
(e)
Did
Was
Was
Did
Was
418
J. GALL
"Those of us who keep our eyes open can read volumes into what
we see going on around us" (E.Hall). Children have individual
differences and responses. Most respond to kindness, sincerity,
firmness and honesty, particularly if they believe that an interest
is being taken in them, their interests, even their dress and
appearance. It is worth remembering that every child likes to be a
winner, that every child responds to praise and that everybody likes
to be somebody.
A patient may be classified as difficult, through being noncooperative, non-communicative or disobedient. A few may even demonstrate some pattern of belligerent behavior in the surgery. It is at
this time, stage two of the consultation, that the dentist has to use
his skills of communication, non-verbal and verbal in order to obtain
or provoke a response from the child.
During this stage, there may be a verbal or non-verbal response,
and at this point the dentist must give acknowledgement and praise,
not merely by saying "that is good." It is important to say why it
is good, e.g. "it is good that you are listening to me and now talking to me about , etc." The dentist has to develop meaningful
communication, strengthen rapport, and build up a mutual trust before
proceeding to stages three and four of the consultation. Stage 4 of
the consultation, that of active dental procedures may be left until
a later visit.
419
Relative Analgesia
Inhalation sedation has gained a little in popularity but not
all patients readily accept a nose-piece and in addition, lengthy
exposure to nitrous oxide can be harmful to practitioners and ancillary surgery staff.
(2) Psychological Approach
Desensitization, modelling and contingency management all have
been used with success for managing children's behavior during
initial and subsequent visits. Perhaps the "Tell; Show; Do" technique (Adelson and Goldfried, 1970) is the most popular one used by
dentists with children. The purpose is to accustom the child to each
stage of the procedure, e.g. before a tooth is polished, the child is
told and shown this being done on the fingernail before carrying it
out on the tooth.
Hypnosis and Hypnotherapy
One must remember that hypnosis is not a technique intended here
to alter a patient's behavior. It is the means however, through
which the individual's perception and memory may be altered. When
rapport has been established during stage two of the consultation the
dentist can readily guide the patient into a trance, and carry out
the appropriate therapy. With the difficult or wayward child one
reinforces the ego, confidence, the desire to be a winner, to be like
the sports hero or pop star and have a nice smile. To say that the
choice is yours, to be a winner or loser, to grow up and take
decisions, to state to the patient that you will only carry out
dental care if there is acceptance to have it done, and to point out
that it is in their best personal interest to have a good clean
disease free mouth. With this style of approach, and using hypnotherapy the patient can become a group two, even group one patient
and be able to cope with all future visits to the dentist.
We should remember that with hypnotherapy, the benefits are
remedial, not palliative.
REFERENCES
Adelson, R., and Goldfried, M. R., 1970, Modeling and the fearful
child patient, J.Dent.Child., 37:476-489.
Carpenter, C. H., 1941, What techniques may be used to secure
relaxation in a child patient, J.Dent.Child., 80:233-237.
Cawson, R. A., 1969, Some shortcomings of dental education, Brit.
Dent.J., 127:556-561.
420
J. GALL
INDEX
Absorption in self-hypnosis,
210-211
personal narratives, 217, 220
Aitken, Cairns, 13
Alcohol addiction, treatment,
277-287
definitions, 279
discussion, 284-285
etiology, 281
history and diagnosis, 281
hypnosis, 283-284
statistics, 278
treatment, 281-284
withdrawal, 282
Alphe rhythms, EEG hypnosis, 150
and hemispheric specificity,
169-179
Amnesia, following a crime,
hypnosis, 318-320
and dissociation, 37
post-hypnotic, early
observations, 70
psychological implications,
320-322
Anosmia, hypnotic, and olfactory
evoked potentials,
139-147
Anxiety
control training in compulsive
disorder treatment,
371-376 (see atso
Obsessional neurosis)
hypnosis, athletes, 359-369
discussion, 366-367
electrocardiograph, 361
heart rate results, 366, 368
421
Anxiety (continued)
hypnosis, athletes (continued)
Lafayette Pursuit Rotor Model
30012, 361, 367
method, 361
procedure, 362
results, 363-364
state-trait anxiety
inventory, 361, 363
results, 365-366, 367
Artificial somnambulism,
definition, 68
Athletes, state anxiety and
stress, 359-369
Attention in self-hypnosis, 210,
211, 213
personal narrative, 217, 218,
219, 220
Autistic
form-varieties of primary
process, 49
versus socialized use of
primary process, 47-48
Aversion therapy, 282
Barber Suggestibility Scale
(BSS), 51
Barbers, historical facts, 5
Barbiturate addiction, treatment,
282
Behavior
clinical, and hypnotizability,
89-96
therapy and hypnosis in
impotence, 303
Behaviorism, present status,
29-30
422
Bernheim's interpretations of
suggestion, 69-70, 71-72
Braid, James, 3, 10, 68
description of 'mesmerism', 68
BSS see Barber Suggestibility
Scale
Catalepsy test, 72
Cay, Lorna, 13
Childbirth, audio taped selfhypnosis, 226-232 (see
aLso Obstetric patients)
Chlormethiazole in alcohol
addiction, 282
Civil rights, and hypnosis in
criminal investigation,
322-323
Clinical behavior and
hypnotizability, 89-96
Coercive persuasion and the law,
309-315
America, 311
historical facts. 311-314
magnetism. 312. 314
19th C. investigators. 314
somnambulism. 313
unskilled practitioners. 312
use of hypnosis. 310-314
Colquhoun. J.C 9-10
Concentration in self-hypnosis.
210. 211. 213
Condensation in hypnosis. 43-44.
45
interpretation. 48
Conscious (consciousness). and
unconscious process in
hypnosis. 29-40
altered states. 33-34. 79-83
dissociation as alternative.
36-38
heightened suggestibility.
30-31
and preconscious. relationship.
36
and psychoanalysis. 32-34
registration without awareness.
37
Cost-effectiveness. audio taped
self-hypnosis. obstetric
patients. 224. 227
INDEX
Covert conditioning in smoking
withdrawal, results.
273-274
Criminal investigations. hypnosis
in. 317-325
conclusion. 323-324
ethical, legal and civil
rights, implications,
322-323, 324
examples. 319. 320-322
psychological implications,
320. 324
reliability of recalled
material, 318-320
(see also Forensic hypnosis:
Law)
de Pyusegur, 67
Dental patient. difficult.
409-410
approach to patient. 410-412
classification of patients.
414-416
communication. 416-417
drugs. 419
fear. classification. 414
frightened child. 412-413
hypnosis and hypnotherapy. 419
patient's attitude. 417-418
practitioner's qualities. 416
psychological approach. 419
techniques to eradicate fear.
418-419
Dental phobia, self-hypnosis,
401-407
categories of fear. 402-403
"clenched fist" technique.
403-404
Glasgow Dental Hospital phobia
index. 405, and
appendix A
glove anesthesia. 405
other neuroses. 403
phobia profile. 403
psychotherapies built into
self-hypnosis. 404
results. 405
Displacement in hypnosis. 43-44.
44-45
interpretation, 48
INDEX
Dissociation theory, 36-38
Drug addiction, treatment,
277-287
definitions, 279
etiology, 280
history and diagnosis, 281
main features, 279
treatment, 281-284
withdrawal, 282
Electroencephalography (EEG)
epilepsy, hypnotic, nonhypnotic states, 149-159
evoked potential, hypnotic
anosmia and transient olfactory
stimulation, 139-147
(see aZso Evoked potentials:
Olfactory)
left to right hemispheres, deep
hypnosis, 103-104
Ego
activity in self-hypnosis,
personal narrative, 217,
218, 219
-enhancing and stopping
smoking, 271-272, 273
receptivity in self-hypnosis,
210, 211, 213
personal narrative, 217, 218,
220
Electromyographic activity
during deep hypnosis, 102-103
hemiparesis, 185-187, 195-199
peripheral nerve lesions,
hypnotherapy, 183-185
muscle fatigue, 199-204
urinary incontinence, 189-193
Electro-oculography in olfactory
stimulation, 143
Elliotson, John, 9, 11
Endorphins, beta, plasmatic, and
hypnosis, 259-266
biochemistry, 260-261
blood samples, 262
ACTH and cortisol, 263-264
extraction of beta-endorphin,
263
plasma values, 263
hypnotic analgesia, 262
results, 263-265
role in chronic pain, 261
423
Enhanced suggestibility, 68
Epilepsy, depth EEG, 149-159
background electrical activity,
153-154
Barber Suggestibility Scales,
151
clinical data, 151, 152
depth EEG data, 151, 152
discussion, 154-157
during sleep, 154
hypnosis, 150
interictal activity, 154
material and method, 151
non-hypnotic state, 154
physiological responses, 153
procedure and design, 151-153
Ericksonian hypnosis, 72-73
Esdaile, James, 3, 10
Ethical implications, hypnosis in
criminal investigation,
322-323, 324
Evoked potentials
olfactory and hypnotic anosmia,
139-147
verbal and imagery coding,
161-168
hypnosis, 164-166
recording, 163-164
results, 164-166
waking state, 164-166
Eye-witness recall in criminal
investigation, 327-329
Fisher, David, 12
Forensic hypnosis, effects,
327-343
eyewitness recall, 327-329
discussion, correct and
incorrect answering,
339-342
methods, 329-334
results, 334-339
(see aZso Criminal
investigation: Law)
Freud, Sigmund, 11
General reality orientation in
self-hypnosis, 210, 212,
213
personal narratives, 217, 220
phobias, 241
424
Glasgow Dental Hospital dental
phobia index, 405 and
appendix A
Guided memory and hypnosis in
witness recall, 350-352
Guillain-Barre's disease,
hypnosis, 385-390
case description, 386-387
treatment and results, 387-389
Halliday, John, 12
Hallucinations in schizophrenia
and hypnotizability, 46
Heminevrin in alcohol addiction,
282
Hemiparesis, hypnotherapy,
185-188
electrically stimulated
contractions, 195-199
EMG studies, 185-187, 195-199
results, 187-188
right, and hypnosis
susceptibility, 162-168
evoked potentials, 163-164
hypnosis, 164-166
results, 164-166
waking state, 164-166
right and left, activity,
hypnotist/subject,
103-104
specificity and hypnotizability, 169-179
apparatus, 171
definitions, 170-171
discussion, 176-178
experiments, 172-176
formulae, 170
hypnosis as right hemisphere
task, 175-176
hypnotizability scores, 171
scoring of data, 171
tasks set, 171
conflicted, 172
Hypnosis
concept, 32-33
changing, 19th C.-1950's,
69-71
definition, 67
general background, 15-18
historical aspects, 4-13, 67-73
INDEX
Hypnosis (continued)
in Mesmer's time, 18-19
modern practice, 19-23
origin of term, 3, 10
recall, 25
as state, 74-76
current thoughts, 76-80
other considerations, 76-86
scientific acceptance, 84-85
as self-hypnosis, 83
unconscious in relation to,
80-83
effects on subject of examiner,
25
Hypnotist and patient, relationship, 25
interaction see Interaction
as regressive transference, 35
Hypnotizability
in clinical behavior,
relevance, 89-96
assessment, clinical, 90-91
clinician's question
techniques, 91-93
criteria for hypnosis
measurement, 91
examining clinical
experience, laboratory
findings, 93-94
versus hypnotic situation,
91-93
relevance of laboratory
scales to clinical
events, 94-85
and hemispheric specificity,
169-179
(see atso Hemispheres,
specificity)
measure, 23-24
in psychosis, clinical
relevance, 41-64
discussion, 55-60
SHSS: A scales, 49-50
sample variances, 52-55
and socialized use of primary
process, 49-52
(see atso Psychosis:
Schizophrenia)
statistics, 251-252
INDEX
Imagery
future-orientated. 236. 242
phobias. self-hypnosis. 237,
238-239
in self-hypnosis. 209-210
personal narrative. 217. 218.
219. 220
and verbal commands, 161-168
evoked potentials. 163-164
hypnosis. 164-166
results. 164-166
right cerebral hemisphere and
hypnosis susceptibility.
162-168
SHSS: A and B, 162
waking state, 164-166
Impotence, male. hypnotherapy,
297-305
and behavioral approach, 303
definition, 298-299
etiology, 299-300
age, 299-300
conversion symptoms, 299
environmental factors, 299
interpersonal relations, 299
methods, 300-302
psychological background. 298,
302
psychological treatment,
302-303
results, 302
secondary, 303
therapy. 300-302
Incontinence. urinary see Urinary
incontinence
Interaction between hypnotist and
subject, 97-108
characteristic psychophysiological alterations, 98-100
discussion. 105-107
hypnotists, 99
induction of hypnosis, 99
methods, 98-99
procedure, 100
recording, 99-100
results, 100-105
differences between sessions,
100-102
electromyographic activity,
102-103
425
Interaction between hypnotist and
subject (continued)
results (continued)
relation between power
spectra, 104-105
right and left hemispheric
activity. 103-104
Involuntary responses, 109-117
(see also Nonvolition)
Kissen, David, 13
Labor, self-hypnosis, audiotaped,
226-232
(see also Obstetric patients)
Language, metaphoric, 42-45
(see also Metaphoric language)
Law
coercive persuasion and
hypnosis. 309-315
and hypnosis, criminal
investigations, 322-323
induction in witness recall,
345-355
conclusions, 352-354
design relevance, problems,
347-348
eye closure, 348
hypnosis and guided memory,
350-352
hypnotic induction and
relaxation, 348-349
results, 349
memory studies, 346
age regression, 346
and magnetism, 311-312
McDougall, John, 11
Magnetism
animal, 3
and the law, 311-312
Memory
enhancement by hypnosis. 24-25
in witness recall, criminal
investigation. 346
Mesmer, Franz Anton, 8-9
Mesmerism. rise, 7-11, 18-19
Metaphoric language. 42-45
definition, 42-43
displacement and condensation,
43-45
426
Metaphoric language (continued)
in schizophrenia, example,
45-46
suggestion. 43
trance-logic concept. 43. 45
Metonymy. definition. 42. 44
Multiple personality phenomenon.
391-398
case report and description of
personalities. 392-395
discussion, 396-397
hypoanalytic treatment, 391-392
Muscle fatigue. hypnotherapy,
199-204
electrically stimulated
contractions, 200-204
EMG studies, 199-204
voluntary contractions, 199-200
Neodissociation theory, 37, 59
Neuromuscular phenomena, and
hypnosis, 181-206
electrically stimulated
contractions, 193-199
hemiparesis, 195-199
peripheral lesions, 193
muscle fatigue, 199-204
voluntary contraction of
muscles, 182-193
hemiparesis, 185-188
peripheral motor nerve
lesions, 182-185
urethral sphincter, 188-193
Nonvolition and hypnosis, 109-117
method I: hypnotic, imagination
and stimulation
conditions, 111-112
method II: hypnotic and
simulation conditions
contrasted, 111-112
instructions, 112
results, 112-115
Obsessional neurosis. anxiety
control training, 371-376
definition, 373
discussion, 375
method, 373-374
results, 374-375
treatment, 374-375
INDEX
Obstetric patients
cost-effectiveness, 227
discussion, 230-232
method for audio taped selfhypnosis training,
226-228
questionnaire after delivery,
227
results, 228-230
use of hypnosis, 224-226
cost-effectiveness, 224
mass or group, 224
patient without hypnosis
training in labor,
225-226
Olfactory evoked potential and
hypnotic anosmia, 139-147
EEG measurement, 143-144
electrode position, 144, 145
experimental setting, 142-143
hypnosis versus waking states,
144
hypnotic induction, 141
method, 141
olfactory stimulation, 142-143
procedure, 141
results, 144-145
subjects, 141
Pain control
concept of pain, 249-250
awareness, 253
biochemical activity, 251
compensation, 254
control/hypnosis, paradox,
252-253
distinction from suffering,
252
guilt, 253
physiology, 250-251
talent for hypnosis, 251-252
hypnosis, effectiveness,
249-258
approaches, 255-256
displacement of symptoms, 255
dissociation, 255
indirect suggestions of
relief, 255
substitution of symptoms, 255
time and space distortion,
256-257
INDEX
427
Psychoanalysis and hypnosis,
32-34
Psychosis, clinical relevance to
hypnotizability, 41-64
discussion, 55-60
metaphoric language, 42-44,
45-46
primary process, 44
(see aZso Autistic: Primary
process: Schizophrenia)
Psychosomatic medicine, general
background, 15-18
Psychosomatics, 20th C., 11-13
Psychotherapies built into selfhypnosis, 304
Registration without awareness,
37
Regression, concept, 32
in relationship between
hypnotist and patient, 35
Relaxation
and hypnotic induction in
witness recall, 348-349
as state of hypnosis, 76
Repression, concept, 32
Rodger, Ferguson, 11-12
Schizophrenia, metaphoric
language, 45-47
Barber Suggestibility Scale,
51-52
hypnotizability, 46, 56-59
discussion, 55-60
normal data, 51-52
sample variances, 52-55
SHSS: A score, 49-50, 52-55
structure of scale, 59
Scientific considerations of
hypnosis, 74-85
early terminology and
definition, 69-72
hypnosis as state. 74-76
later terms. suggestion.
trance. suggestibility,
unconscious. 74-85
Scottish contribution, 3-14
Self-hypnosis
audiotaped. obstetric patients.
223-233
(see aZso Obstetric patients)
428
INDEX
Self-hypnosis (continued)
as concept, 82
dental phobia, 401-407
(see a"Lso Dental phobia)"
essential aspects, 209-214
compared with heterohypnosis, 209-210,
211-212
structural factors, 210-213
trance depth, 211-213
personal narratives, 215-222
(see a"Lso specific structural
factors)
therapeutic, phobias, 235-245
"future orientated imagery",
236
(see a"Lso Phobias)
Sexual disorders and hypnosis,
291-295
hypnotherapy, 293-295
and behavior therapy, 294
case histories, 294-295
methods, 292
SF ratio, socialized formvarieties of primary
process, 47, 50
'Shell-shock', use of hypnosis, 3
SHSS see Stanford Scale
Smoking habit. effect of
hypnosis. 269-275
concepts used, 270
aonvert conditioning. 272
discussion, 274-275
ego-enhancing, 271-272
method. 271
results. 273-274
specific post-hypnotic
suggestions. 271-272
subsequent sessions. 273
suggestions for reinforcement,
272
INDEX
Trance (continued)
terminology, 71-73
'trance-logic' concept, 43, 45
Unconscious
and conscious process in
hypnosis, 29-40
dissociation theory, 36-38
registration without
awareness, 37
repression and regression, 32
(see aLso Conscious)
processes, early observations,
71-72
Unconsciousness, Freudian theory,
and dynamics of hypnosis,
32-34
and preconsciousness, 35-36
Urethral sphincter, hypnotherapy,
188-193
Urinary
incontinence, hypnotherapy,
188-193
EMG studies, 189-193
results, 191-193
retention, hypnosis for,
379-383
case description, 380-381
hypnosis treatment, 381-382
results, 382-383
Verbal and imagery commands,
161-168
evoked potentials, 163-164
hypnosis, 164-166
results, 164-166
waking state, 164-166
right cerebral hemisphere and
hypnosis susceptibility,
162-168
SHSS: A and B, 162
Visual memory processing during
hypnosis, 119-130
difference from waking,
studies, 120-128
discussion, 126-128
imagery vividness during
hypnosis, 120-121
influence of hypnosis on
performance, 124-125
429
Visual memory processing during
hypnosis (continued)
method. 122-123
performances when conditions
same. 123-124
procedure. 122-123
reported information processing strategies,
125-126
SHSS: C. 122
subj ects. 122
visual memory discrimination
task. 121. 123-125
Wakely. Thomas. 9
Witness recall. hypnosis and the
law. 345-355
design relevance. problems,
347-348
eye closure. 348
memory studies. 346
age regression. 346
(see aLso Law)
Zoist. 9. 11