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MODERN TRENDS

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

PLENUM PRESS NEW YORK AND LONDON

Library of Congress Cataloging in Publication Data


Main entry under title:
Modern trends in hypnosis.
"Proceedings of the Ninth International Congress of Hypnosis and Psychosomatic
Medicine, held August 22-27, 1982, in Glasgow, Scotland" - T.p. verso.
Includes bibliographies and index.
1. Hypnotism- Therapeutic use-Congresses. 2. Hypnotism-Congresses. I. Waxman, David. II. International Congress of Hypnosis and Psychosomatic Medicine (9th:
1982: Glasgow, Strathclyde) [DNLM: 1. Hypnosis-congresses. W3 IN415 9th 19821
WM 4151612 1982n]
616.89'162
84-26432
RC490.5.M6 1985

ISBN-13: 978-1-4684-4915-0
DOl: 10.1007/978-1-4684-4913-6

e-ISBN-13: 978-1-4684-4913-6

Proceedings of the Ninth International Congress of Hypnosis


and Psychosomatic Medicine, held August 22-27, 1982,
in Glasgow, Scotland
1985 Plenum Press. New York
Softcover reprint of the hardcover 1st edition 1985
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013

(C)

All rights reserved


No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher

To Eric Wookey, MC, LDS, Honorary Consultant Dental


Surgeon of the Royal Free Hospital, First President of
the London Dental and Medical Society for the Study of
Hypnosis. He imparted his enthusiasm and knowledge of
hypnosis widely, and thus played a prominent part in
securing the acceptance of hypnosis by professional
colleagues throughout the United Kingdom.

FOREWORD

The 9th International Congress of Hypnosis and Psychosomatic


Medicine expresses the continuity in the effort to gain scientific
knowledge of hypnosis and scientific status for it, ever since the
1st International Congress for Experimental and Therapeutic Hypnotism
was held in Paris in 1889, attended by many of the best-remembered
psychiatrists and psychologists of the day - men such as Babinski,
Bernheim, Binet, Delboeuf, Freud, James, Lombroso, F.W.H. Myers,
Ribot, and many others. The continuity was broken by the period of
reduced interest in hypnosis between the time of the 2nd International Congress for Hypnotism in Paris in 1900, and the revival of
interest shown by the 3rd International Congress for Hypnosis and
Psychosomatic Medicine in Paris in 1965. Since then, the Congresses
have met more regularly, making the one of which this is the report,
the 9th.
The programs of these Congresses have become increasingly rich
through the years, with many of the older problems still with us but
now studied more dispassionately in the light of new knowledge and
new scientific methods in the design of investigations and the validation of scientific findings.

An examination of the titles of the papers and the places from


which their authors come shows how diverse and widespread the
interests in hypnosis have become, both in the effort to define the
nature of hypnosis and its boundaries in relation to other categories
of behavior and experience, and to explore its potential service in
psychotherapy and other social applications, as in forensic medicine.
On the side of understanding hypnosis itself, there are the
papers on the nature of hypnotic responsiveness and its physiological
vii

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

Practitioners whose interests extend over the entire spectrum of


the healing disciplines assembled in Glasgow from August 22nd to the
27th 1982 to attend the 9th International Congress of Hypnosis and
Psychosomatic Medicine. They came to listen to learned addresses,
to present papers, often the culmination of many years of research
and clinical experience, to participate in workshops and generally
to mark, learn and teach a subject as old as mankind and yet amongst
the most recent and sophisticated of psychotherapies in the multidisciplinary field of the treatment of psychological illness.
The excellent of the ambiance, the impressive array of speakers
and the high quality of the lectures culminated in a meeting which
was without doubt a considerable academic success. As a result the
9th Congress proved an outstanding event, and it is hoped, made a
real contribution to the practice of hypnotherapy. The significance
of the occasion was additionally marked by the joint sponsorship of
the University of Glasgow and the Royal Society of Medicine, as well
as the warm support of the City of Glasgow.
In these proceedings appear some of the papers which were presented at this meeting. Although there were over 100 speakers, it
is regretted that in view of the restrictions of space, only a very
carefully selected number of these papers could ultimately be
included in the publication.
Each paper was rated independently by a panel of referees and
the final selection represents a wide cross-section of the subject
matter outlined in the program.

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

constructed laboratory investigation, coupled with the clinical


experiences so ably reported by so many devoted therapists, that the
meeting was such a success. Perhaps it was the Scotch mist, the
warmth and generosity of the hosting society or some magnetic influence, but somehow the purple cloak of Mesmer which had hung over the
city of Glasgow that August week seemed to have been lifted to allow
bright sunshine to penetrate a subject that had been shrouded in
myth, mystery and misunderstanding for so many years.
As a result it is hoped that Modern Trends in Hypnosis will
influence many to explore further the psychological and neurophysiological understanding of the hypnotic state and that it will
advance the therapeutic skills of all who read it for the ultimate
benefit of the suffering.
D.W.
P.C.M.
M.G.
M.A.B.

ACKNOWLEDGMENTS

The editors wish to express their thanks to the Principal and


Court of the University of Glasgow and to the President and Council
of the Royal Society of Medicine for their sponsorship of this
Congress. Also to the President. Council and Members of the British
Society of Medical and Dental Hypnosis and the British Society of
Experimental and Clinical Hypnosis. to Professor M.R. Bond. 9th
Congress Chairman. to Professor F.H. Frankel. President of the
International Society of Hypnosis. to Professor M.T. Orne and Mrs
Emily Carota Orne for their invaluable help in assembling the program
as well as to all Members of the Committee of the 9th Congress.
Thanks are particularly due to those hundreds of participants who
made this meeting such a success.

xiii

CONTENTS

SPECIAL ADDRESSES

Scottish Contributions to the Development of


Hypnosis and Psychosomatic Medicine
M. R. Bond, Chairman, 9th Congress of Hypnosis
and Psychosomatic Medicine

Hypnosis - Both Poetry and Science


F. H. Frankel, President, International
Society of Hypnosis

15

Conscious and Unconscious Processes in Hypnosis


E. R. Hilgard, Founding President, International
Society of Hypnosis

29

The Clinical Relevance of Hypnotizability in


Psychosis: With Reference to Thinking
Processes and Sample Variances
G.F. Lavoie, President Elect, International
Society of Hypnosis
II

41

BEHAVIOR IN HYPNOSIS

In Search of Hypnosis
A. M. Weitzenhoffer

67

The Relevance of Hypnotizability in Clinical


Behavior
F. H. Frankel

89

Interaction Between Hypnotist and Subject:


Social Psychophysiological Approach
E. I. Banyai, I. Meszaros and L. Csokay

97

Non-Volition and Hypnosis


S. J. Lynn, M. Nash, J. Rhue, V. Carlson,
C. Sweeney, D. Frauman and D. Givens

xv

109

CONTENTS
Visual Memory Processing During Hypnosis:
it Differ From Waking?
H. J. Crawford and S. N. Allen

Does

A Study on the Hypnotic Susceptibility of


Persons Attempting Suicide: Some
Therapeutic Considerations
I. Boncz, L. P. Pallag and J. Fodor

III

119

131

ELECTROPHYSIOLOGICAL STUDIES

EEG Evoked Potential, Hypnotic Anosmia, and Transient


Olfactory Stimulation in High and Low Susceptible
Subjects
A. P. Barabasz and C. Lonsdale

139

Depth EEG Recordings in Epileptic Patients During


Hypnotic and Non-Hypnotic States
G. De Benedittis and V. Sironi

149

Evoked Potential Correlates of Verbal Versus Imagery


Coding in Hypnosis
I. Meszaros, E. I. Banyai and A. C. Greguss

161

Hemispheric Specificity and Hypnotizability: An


Overview of Ongoing EEG Research in South
Australia
C. MacLeod-Morgan
Some Neuromuscular Phenomena in Hypnosis
M. Pajntar, E. Roskar and L. Vodovnik
IV

169
181

SELF HYPNOSIS

The Essential Aspects of Self-Hypnosis


E. Fromm

209

Representations of Self-Hypnosis in Personal


Narratives
E. Fromm, A. M. Boxer and D. P. Brown

215

An Investigation into Audiotaped Self-Hypnosis


Training in Pregnancy and Labor
G. P. Davidson, N. D. Garbett and S. G. Tozer

223

Change in Subjective Experiences During


Therapeutic Self-Hypnosis
R. Van Dyck, P. Spinhoven and J. Commandeur

235

CONTENTS

xvii
V HYPNOSIS AND THE ALLEVIATION OF PAIN

Why is Hypnosis Effective in Pain Control?


P. Sacerdote

249

Hypnosis and Plasmatic Beta-Endorphins


G. Guerra, G. Guantieri and F. Tagliaro

259

VI

HYPNOSIS AND ADDICTIVE BEHAVIOR

Hypnosis in the Alleviation of the Smoking Habit


M. A. Basker
The Treatment of Alcohol and Drug Addiction:
Overview
D. Waxman
VII

An

269

277

HYPNOSIS AND PSYCHOSEXUAL PROBLEMS

Hypnosis and Sexual Disorders


P. C. Misra

291

Hypnotherapy in Male Impotence


K. Fuchs, I. Zaidise, B. A. Peretz and E. Paldi

297

VIII

THE USE OF HYPNOSIS IN CRIMINOLOGY

Hypnosis, Coercive Persuasion and the Law: A


Historical Perspective
J.-R. Laurence and C. Perry

309

Hypnosis in Criminal Investigation - Ethical and


Practical Implications
M. Kleinhauz and B. Beran

317

An Examination of the Effects of Forensic Hypnosis


H. W. Timm
Hypnosis and the Law:
Witness Recall
G. F. Wagstaff

327

The Role of Induction in


345

IX

HYPNOSIS AND ANXIETY

Effects of Hypnosis on State Anxiety and Stress


in Male and Female Intercollegiate Athletes
E. W. Krenz, R. Gordin and S. W. Edwards

359

CONTENTS

xviii
Results of Anxiety Control Training in the
Treatment of Compulsive Disorders
R. P. Snaith

371

X CASE HISTORIES

On a Case of Urinary Retention Treated by Means


of Hypnosis
A. Bottoli, G. Guantieri and V. Azzini

379

Hypnosis in the Treatment of a Case of


Guillain-Barre's Disease
A. Gambacciani and G. Guantieri

385

Hypnoanalytic Treatment of Severe Borderline


,
Neurosis by Means of Spontaneous Multiple
Personalities: A Case Report
R. Kampman, R. Hirvenoja and H. Karlsson
XI

391

SOME USES OF HYPNOSIS IN DENTISTRY

The Treatment of Dental Phobia with a Meditational


and Behavioral Reorientation Self-Hypnosis
G. W. F. Smith

401

The Difficult Dental Patient


J. Gall

409

Index

421

SPECIAL ADDRESSES

SCOTTISH CONTRIBUTIONS TO THE DEVELOPMENT OF


HYPNOSIS AND PSYCHOSOMATIC MEDICINE
M. R. Bond
University of Glasgow
6 Whittinghame Gardens
Glasgow. Scotland
Abstract
Scots have made very significant contributions to both
the understanding and practice of hypnosis and psychosomatic
medicine.
Most believe that the development of animal magnetism by the
Austrian. Franz Mesmer in the 18th century. represented the beginning
of interest in trance states. but his work was influenced by earlier
thoughts of a Scot. William Maxwell. author of 'De Medicina
Magnetica'.
Perhaps the most well known of all Scots involved in the development of hypnosis was James Braid. a Scottish Surgeon working in
Manchester. Though a great sceptic of Mesmerism at first. he changed
his attitude completely in 1841 after attending a demonstration by 'a
magnetiser' Monsieur Lafontaine. It was Braid who concluded that the
trance state was not due to magnetic fluids but to heightened suggestibility on the part of the subject and introduced the term 'neurohypnotism' to describe the state or condition of nervous sleep that
this represented. A year later he shortened this term to 'hypnotism'. Scots. especially James Esdaile. were involved in the development of clinical uses of hypnosis. especially in surgery. throughout
the remainder of the 19th century.
The place of hypnosis in medicine in the 20th century has been
no less ambiguous than in the previous one. but during the 1914-18
war another Scot. McDougall. demonstrated that it could make a positive contribution in the treatment of 'shell-shock' and began a
further revival of the medical use of hypnosis which has persisted
since that time.
3

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.

*Inaugural address by the Chairman of the 9th International Congress.

SCOTTISH CONTRIBUTIONS

Returning to the 17th century, there were four groups of men


involved in the care of the sick. First, and most prestigious of
all, were the physicians. Although the smallest group they were
distinguished by their wealthy backgrounds, continental University
training, and the large fees they demanded. Astrology, which had
been central to the practice of their work for a long time, faded
from use at this period, but in its place they substituted uroscopy diagnosis by examination of the urine. This method of diagnosis
eased their professional life considerably as they did not need to
examine the patient. In fact, they were prepared to treat by post!
Their remedies were complex, often involving the use of animal and
plant extracts and some chemicals. However, they did not administer
or deliver these personally but left matters to more lowly beings the apothecaries and surgeons. One point of interest and significance to those interested in hypnosis and psychosomatic medicine was
their interest in, and search for, a single powder or agent to cure
disease, wherein lies the germ of the later development of mesmerism
and then hypnosis.
The second group of healers were the apothecaries and it only
remains to say that they made considerable incomes but, when they
began to challenge physicians for patients they were, with some
difficulty, excluded from the training of doctors and the full practice of medicine by laws which were promoted by the physicians.
Surgeons were regarded as lesser men than physicians, though not
to such a great extent in Scotland as in England. They were seen as
craftsmen and learned their trade by apprenticeship, a method of
education which lasted until the first half of the 19th century when
University degrees and the Medical Act of 1858 regularised all medical training.
Barbers were also involved in surgery, but regarded as inferior
to surgeons. Nevertheless, at the inception of certain Colleges they
were admitted and their activities were controlled. For example,
Robert Haries was admitted to the Faculty, later the Royal College of
Physicians and Surgeons of Glasgow, in 1645 with the strict ruling
that he should be allowed "only to meddle with simple wounds and not
to meddle with physic, tumors, ulcers, dislocations and fractures",
(Hamilton 1981). Eventually the barbers were forbidden to enter the
Colleges and to take up any form of medical or surgical practice.
This bar took place in Edinburgh in 1648, but not until 1722 in
Glasgow.
The dreadful standards of care given to the sick in the 16th
century by all manner of people, including physicians, led eventually
to the formation of bodies or corporations which were established to
maintain standards of skill and patient care and, of course, the
financial interest of those who had medical training. Three Colleges
were formed and, in order of foundation, they were the Royal College

M. R. BOND

of Surgeons of Edinburgh in 1505, the Royal College of Physicians and


Surgeons of Glasgow in 1599, and the Royal College of Physicians of
Edinburgh in 1681. This order is rather curious bearing in mind that
physicians had the highest status, and that Glasgow in the 16th
century was a much smaller town than Edinburgh. The origins of the
corporations were very different and worth mentioning.
The incorporation of surgeons and barbers in Edinburgh took
place in 1505 and the terms under which the craft was founded was
similar to that of others, in other words a body for the protection
of its members and regulation of their training and conduct.
Hamilton tells us that after apprenticeship the potential surgeon was
examined in anatomy, had to prove he was able to read and write, and
that he understood the signs of the zodiac necessary for the prognosis of disease by astrology. Entry was limited to the sons and
sons-in-law of craftsmen, sons of the nobility, or those marrying the
daughter of a surgeon - provided she was a clean virgin! The
Edinburgh surgeons were given a monopoly to sell aqua vitae, an early
form of whisky, a drink which had not become popular and which was
only considered to be a medicine at that time.
In 1599 Glasgow was not a major town. Nevertheless an important
medical corporation was established at that date, even though there
was only one physician, six surgeons, one apothecary, and two midwives, in Glasgow. The corporation's jurisdiction, unlike that of
the Surgeons' College in Edinburgh, covered a wide geographical area,
including much of West and Central Scotland. In addition to powers
to regulate medical training and practice it was also empowered to
inspect the sellers of drugs.
The reason for the establishment of the College in Glasgow at
all lies in the stature of the person who was the driving force
behind its birth. He was Master Peter Lowe, a Scot, medically
trained in France and almost certainly connected with the political
activities of James I in that country. Why he chose to live in
Glasgow is not known but his early awareness of the medical problems
of the area, and his close relationship with the king, led to his
gaining a charter for the establishment of the College. The king was
interested in medical matters, apart from his well known dislike of
smoking, which be banned at Court.
It is interesting to note that the College was prepared to admit
physicians without examination, but not surgeons!
The College of Physicians in Edinburgh was the last corporation
to be established, and then only with considerable difficulty.
Undoubtedly the physicians sought to control their own numbers, which
were increasing quite rapidly, and.if possible to gain power over the
surgeons and apothecaries., as had happened in London. The surgeons
were outraged, the Faculty in Glasgow felt threatened, and King's

SCOTTISH CONTRIBUTIONS

College in Aberdeen stated that the restrictions proposed would apply


to their trainees who wished to practice in Edinburgh and thus contravened their charter. Even the Town COuncil of Edinburgh were
opposed, no doubt because of the number of surgeons who were members
of it, but perhaps their real fear was that the training of physicians would move away from Edinburgh University, which they controlled. Eventually, having made several attempts to found the College
from 1621 onwards, a charter was granted in 1681, probably because
one of the backers had close connections with the Royal Court and
also because the apothecaries were engaged in a dispute with the
surgeons and thus supported the proposals for the first time.
Hamilton makes the interesting and rather amusing point that, at the
time of the first application of the physicians, which was to Oliver
Cromwell, there was a certain lack of subtlety on their part in the
framing of their request. Thus, a College was needed because of "the
frequent murders committed universally, and in all parts, by quacks,
women, gardeners, and others grossly ignorant and the unlimited
and unaccountable practice of surgeons, apothecaries and empirics
pretending to medicine all these undertaking the cure of all
diseases without the advice and assistance of physicians".
By the 18th century Scotland had a wide reputation for the
training of doctors and was especially famous for surgery. The
influence of Scottish Colleges and Universities was such that at the
beginning of the 19th century 95% of doctors in Britain with a medical degree trained in Scotland, which had a virtual monopoly in
medical education. For example, in 1815 there were more than a
thousand doctors in training in Scotland. It is not surprising
therefore that much of English medical practice was in the hands of
Scotsmen or men trained in Scotland and, therefore, that these men
were at the center of events surrounding the birth of hypnosis.
However, the general public was not over impressed with medical care
and at the end of the 18th century doctors were, with good reason,
regarded with fear and suspicion. They were still making great use
of the practices of bleeding and purging and surgery was barbaric.
In addition there was evidence of the practice of the new mysterious
cults of phrenology (Millingen 1837) mesmerism and homeopathy.
Little wonder that home remedies abounded and that a self-help movement centered on the use of 'spa' therapy developed. Thus, at the
turn of the 19th century the practice of medicine left much to be
desired and, apart from external criticisms, there were many internal
controversies and rivals, not least in relation to mesmerism, and it
was here that Scots were at the center of the debate and the vitriolic exchanges that abounded.
THE RISE OF MESMERISM
For centuries there was a belief that certain substances and
man-made objects like amulets possessed curative powers, especially

M. R. BOND

when made under the influence of magic. The mysterious attractive


powers of magnets led to the belief that they could affect the body
by virtue of imperceptible emanations and. in fact. a Scot. William
Maxwell. author of De Medicina Magnetica. was hounded by academic.
religious and medical men for his theories in this area. In a similar way electricity. which could actually be seen passing from a
generator to the human body. was also held to have curative properties. However. in the late 18th century these matters were of relatively little interest until the dramatic appearance on the medical
scene of Franz Anton Mesmer.
It was Mesmer who was at the center of heated disputes that
raged over his theory of animal magnetism which stimulated James
Braid. a Scot. to examine its various aspects. to define hypnotism
and to establish the practice of medical hypnosis on an acceptable
basis.
Mesmer was a Swiss, born in 1734. He took a medical training in
Vienna and in 1766 wrote a treatise based on his interest in astrology entitled 'The Influence of The Planets on the Human Body'. This
was far from being a new topic and the work was greeted with amusement. Mesmer was heartily ridiculed and. as a result. became much
more secretive and mystical in his interests and works thereafter - a
fact which probably contributed further to his condemnation. His
theory was founded upon the assumption of the existence of a subtle
element or essence prevading all nature. or what Newton called 'the
ether'. At first Mesmer thought this might be electricity but later
rejected the idea in favor of magnetic emanations. This idea he may
have taken from the Jesuit Professor of Astronomy in Vienna.
Maximilian Hell.
Using magnetised rods Mesmer put theory into practice. travelling widely in Europe and effecting a number of miraculous cures.
Later he gave up the use of rods believing that the fluid they conducted from his body to the patient could be transferred equally well
by repeatedly passing his hands from the patient's head to his legs
just in front of the body. Believing his power to be due to transmission of a magnetic fluid he coined the term 'animal magnetism' to
differentiate it from mineral magnetism. In medical circles Mesmer
was regarded as an imposter and continued criticism was heaped upon
him. At last he reached Paris where he generated great emotions.
large numbers of patients. a great deal of money. and the wrath of
the scientific and medical establishment. The latter eventually set
up a commission. the first of three. to investigate Mesmer's work.
It was headed by Benjamin Franklin and included Lavoisier and Dr.
Guillotin. Its report of 1784 made two important points. First.
that imagination played an important part in the cures achieved. and
second that evidence for a magnetic fluid was lacking. It did not
damn Mesmer's work out of hand but the comments were loudly acclaimed
as a rejection of all that Mesmer stood for. Although increasing

SCOTTISH CONTRIBUTIONS

pressure forced Mesmer to leave Paris his work was carried on by


numerous pupils, including D'Eslon, who was the first of many mesmerists to visit Britain in the late 18th, and early 19th century.
However, mesmerism was overshadowed for several years at the beginning of the 19th century by interest in phrenology - them method of
relating mental and moral attributes to the shape and contours of the
heat and proposed by the German, Franz Gall, and his pupil and disciple, Johann Spurzheim (Critchley 1979). Apparently Dr. Gall was a
brilliant anatomist and dissector who, despite the failure of his
system of phrenology, contributed very significantly to understanding
of the anatomy of the brain and cranial nerves and who was a forerunner of those who have since sought to localise brain functions in
what might be termed, a new sort of phrenology. In its heyday the
cult of phrenology was represented by no fewer than 29 societies in
Britain. One of those who was an avowed phrenologist was the Scot,
Dr. John Elliotson of University College, London. He was editor of
the Zoist, a periodical which commented upon phrenology and which
will be mentioned later. He was also first President of the London
Phrenological Society and a number of other famous people were also
supporters of the cult, including Thomas Wakely, Editor of the
Lancet.
Elliotson, also interested in mesmerism, was regarded as an
overactive eccentric. In fact, one of his eccentricities was the use
of the stethoscope which he introduced into British medical practice!
Nevertheless, he held the Chair of Practical Medicine at University
College, London, and was President of the Royal Medical and
Chirurgical Society there. In 1837 his interest in mesmerism was
raised to fever pitch by the visit of a famous French mesmerist,
Baron du Potete, and, as in everything else he did, Elliotson plunged
into experiments and treatments with a certain lack of caution,
characteristic of him. Wakely, Editor of the Lancet, was violently
opposed to mesmerism and in an effort to convince him of its worth
Elliotson made the fatal mistake of attempting early experiments at
Wakely's house using two girls, the Okey sisters, who were unstable,
highly suggestible young women, prone to petty fraud and considerably
exhibitionism. The experiments failed miserably and the full venom
of Wakely fell upon Elliotson who later, because of his many unorthodoxies, became discredited and was removed from his professorial
post. However, he remained in private practice, continued his interest in mesmerism and remained an active editor of the quarterly
magazine, The Zoist, from its first publication in 1843 until he died
in 1856. This journal served to collect and diffuse an enormous
volume of information about mesmerism and cerebral physiology and was
very influential, especially amongst lay people.
A second Scot, not a doctor but a lawyer, J. C. Colquhoun
(1836). made a more reasoned approach to the nature of mesmerism in
his two volume work 'Isis Revelata - An Inquiry into the Origins,
Progress and Present State of Animal Magnetism.' With a clarity of

10

M. R. BOND

mind possessed by the best legal brains he constructed a positive


case for the reality of the phenomena associated with animal magnetism. He criticised sceptics for ignoring the huge mass of facts
available to them and commended the subject for scientific investigation. He was unconvinced by the arguments for a magnetic process
or fluid but much impressed by the powerful effects the mind could
have on the body and vice versa.
The practical value of mesmerism was clearly demonstrated by a
pragmatic Scot in the Indian part of the Colonial Service. Dr. James
Esdaile (1846) appalled by the pain and suffering of his patients and
impressed by the powers of mesmerism to induce trance, used it in
many successful surgical operations, mostly of a minor nature. It
should be borne in mind that the sentiments of the day regarding pain
differed from our own. They were summed up in Esdaile's quote from a
Dr. Copland who stated that, "pain is a wise provision of nature, and
patients ought to suffer pain while their surgeon is operating; they
are all the better for it and recover better". In one period of
eight months Esdaile operated upon 73 patients and in the same period
treated 18 medical cases, most having neurological or what we would
call psychiatric disorders. Pragmatism, a strong feature of the
Scottish personality even today, led him to several basic conclusions
which were, first, the operator should not put too much emphasis on
careful selection of subjects; second, failure to respond to mesmerism in healthy people did not mean that when possessed by the
desire to overcome an illness they would remain resistant to it and,
last, that the effects of mesmerism were similar to certain native
mystical treatments for illness, an effect commented upon by others,
notably Colquhoun and Braid.
The Scot who made the greatest and most lasting contribution to
the debate on mesmerism was James Braid (Dingwall 1968). He was born
in 1795, son of a landowner in Fife, and was educated at Edinburgh
University. He reconciled many of the conflicts surrounding mesmerism by careful experimentation and thoughtful literary contributions, of which the best known is 'Neurypnology or the Rationale of
Nervous Sleep considered in relation with Animal Magnetism' (Waite
1899). The work, hypnotism, is his own shortened form of the term,
neurophypnotism which he derived from neurypnology.
Braid regarded mesmerism, or hypnotism, as a serious subject and
believed that its use in the treatment of illness should be confined
to doctors. He proved to his own satisfaction and that of others
that magnetic fluid was non-existent and emphasized that hypnotism
involved the use of considerable powers of suggestion by the hypnotist, together with a need for suggestibility on the part of the
patient. He concluded, in his own words, that "all I claim for
hypnotism is now willingly admitted by the great majority of scientific men who have investigated the subject without previous prejudice in favor of mesmerism". In addition to his work on hypnosis

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

the practitioners of hypnosis. The Commission concluded that it had


a useful role in pain control and psychotherapy and that it should be
taught to medical and dental students. At the same time Dr. David
Fisher. both a doctor and dentist. established several hypnotherapy
clinics in Glasgow and was also the moving force behind the foundation of the Scottish Division of the British Medical and Dental
Hypnosis Society - the parent body of which had been founded by the
fusion of the Medical and Dental Societies in 1952. Much more recently the British Society of Experimental and Clinical Hypnosis was
founded and has two branches in Scotland. Thus. in the last 30 years
there has been increasing interest in hypnosis in Scotland and. at
present. its practice is both flourishing and expanding.
Psychosomatics is a term covering interest in the relation
between physical and emotional aspects of disease. This has a long
history and the term. psychosomatic, appears to have been used first
at the beginning of the 19th century in Germany by Heinroth. However, formal study of diseases, regarded as specifically psychosomatic, did not begin until the early part of the 20th century when
pupils of Freud firmly established the study of psychosomatic disorders linking certain conditions of the mind with particular physical symptoms or diseases.
The most outstanding contribution in Scotland to this field of
medicine was made by Dr. John Halliday, an epidemiologist and Medical
Officer of Health in Glasgow. In the 1930s and 40s Dr. Halliday
became impressed by, and studied the effects of, social factors upon
illness. In his book. 'Psychosocial Medicine', published in 1948 he
refined the concept of a psychosomatic disorder as follows: "A psychosomatic affection is a disease which complies with the psychosomatic formula and whose prevalence rises or falls in accordance with
the rise or fall of communal upsetting events, that is, in accordance
with the pressure of environment in its psychological aspects". This
seems to have been a forerunner of later interest in the subject of
life events and their relation to emotional distress and mental
illness. Dr. Halliday's investigations revealed that disorders
fitting this pattern. included peptic ulceration and gastritis.
exopthalmic goitre, hypertensive disorders including hypertension,
coronary thrombosis. angina and cerebrovascular disorders. and psychoneuroses. including anxiety states and hysteria. There are many
others detailed in his book and his work was warmly received. especially in the United States where one of the founders of the psychosomatic school in that country. Dr. Flanders Dunbar (1946) acknowledged his contribution at length in her book. 'Emotions and Bodily
Change. a literature survey of 1910-1945'. Dr. Halliday was the
first President of the Glasgow Psychosomatic Society. which remains
one of only two in Britain and which was founded in 1959 at the
instigation of the late Drs. David Kissen and Astor Sclare. This
Society continues to flourish.

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

Waite, A. E., 1899, Braid on hypnotism, in: "Neurypnology or the


Rationale of Nervous Sleep etc.,"Redway, London.

HYPNOSIS - BOTH POETRY AND SCIENCE*

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.

* Presidential Address by the President of the International Society


of Hypnosis.
15

16

F. H. FRANKEL

If it were to follow the theme currently predominant in most


institutions in the United States including hospitals and academic
centers, it would be like an address to the shareholders - a business
report that would be filled with fiscally relevant statements and an
eloquent bottom line.
I mean no disrespect to politics, to the presidency of my
adopted country, or to big business. I believe I recognize the
importance of all three. However, in the hope that there are other
prerogatives open to the president of a society such as ours, I will
choose yet another format. With your indulgence I will use the
occasion, unashamedly, to elaborate on a personal perspective on
hypnosis that is admittedly neither wholly original nor unique. I
wish at the outset to acknowledge the many contributions of my colleagues, some of whom are in this audience or on this podium. I
will, I fear, have to depend, in my presentation, on those contributions, and will try to avoid shaping their findings to my own ends.
I come not as a theorist, grappling with formulae to relate the
psychological to the physiological, although I might wish that I
were. I come not as an experimentalist with a keen insight into
methodology and that enviable ease with statistics that resembles the
skills of the trapeze artist grabbing supports out of nowhere,
although I might wish that I did. I come rather as a clinician and
clinical teacher who has travelled the highways and byways of clinical and academic psychiatry on two continents for more than three
decades. It seemed to me that if I did not use this opportunity to
confront some of what I have gathered along the way, I probably never
would lay claim openly to my own ambivalence. Having spent most a of
my time as a clinician, and some as an investigator, I believe I am
generally regarded as a clinical investigator. On the other hand, I
might also qualify as an investigative clinician, or even as a
curious one. Which all somewhat resembles the conflict that many of
us seem to have as we grow older. Initially having preferred to see
ourselves as liberals with a conservative leaning, we now find that
we are really conservatives with, perhaps, a liberal bent.
I believe the essence of what I wish to address is the unavoidable complexity, uncertainty, and ambiguity in our field as I see it,
and the need for us to tolerate the situation while we still struggle
to understand what it is that we accomplish with the use of hypnosis.
As we well know, close vision while vital to the pursuit of any
details, tends to blind us to the view of the whole. In our
impatience to foster ideas that we personally cherish, our nemesis
lurks in a tendency to be cavalier about what others do.
As a clinical psychiatrist I am no stranger to complexity and
ambiguity. Doubts, uncertain meanings, and the need to live with a
combination of interpretations are a way of life in the field that
has nurtured me for most of my professional life. How else can one

HYPNOSIS - BOTH POETRY AND SCIENCE

17

be of help, for example, to a patient torn by angry feelings toward


an elderly parent, or a dying spouse? Moral and psychodynamic absolutes are of little value. Directed by the moral imperative, I could
say to him, "How can you be so vicious or unkind toward someone who
is dying?" Or will I help him psychodynamically, do you think, i f I
tell him that he has every right to be angered by the fact that his
life is being eroded by the demands and the needs of his suffering
relative? Should I say then, "You go ahead, and let them know?"
Perhaps what I might ultimately do that might be more useful, is to
sit sympathetically, saying little, but making it clear that I, too,
know the human condition to be a tough one, and that I will try to
help him cope with whatever irreconcilable and irrational feelings
arise in him.
How should I best respond to the needs of a patient who recites
a list of physical complaints for which her physicians can uncover no
physiological cause. As she recounts them, I detect a hint of sadness in her voice. On an invitation to her to share her feelings
with me, she describes a series of deep personal losses, the deaths
of close family members that immediately preceded the onset of her
symptoms. Should I treat her be encouraging her to talk about the
hurt of her grief, or should I prescribe medication that is aimed at
helping to lift her depression? Will I be wiser yet to use a combination of both methods; have her first recall her feelings and then
wait for an opportune time to introduce medication in addition.
Perhaps I will select that path. but it should be noted that there is
a literature and a body of professional opinion in favor of each
position. preferring either one approach or the other, rather than a
combination. How should I regard physical symptoms that respond to
biological remedies, but that nevertheless originate in the emotions
- in the anguish of that curious mixture of physical and psychological discomforts that Lindemann (1945) described as the "grief reaction".
Although on more solid ground in some areas than we were twentyfive years ago. psychiatry still has more questions than answers but we offer no apologies. We have a growing body of knowledge
derived from our clinical experience and our laboratory studies; some
of our dearest concepts have stood the test of time. In moments of
crisis our colleagues, even those who are critical, know that they
must calIon us because. limited though we might be, we still know
more about the management and treatment of distressed and psychotic
behavior and suicidal depressions than they do. When their patients
on the medical and surgical floors and in the emergency wards behave
irrationally they calIon us. Both burdened and armed with knowing
how ambiguous is our trade, we go forth. Because our data are for
the most part soft. not hard. and because we cannot rely on an
impressive battery of unequivocal laboratory tests, we have to rely
on a modicum of good sense and a demonstration of good manners. We
aim to be receptive but not passive. cautious but not cowered, and

18

F. H. FRANKEL

realistic but not cavalier. We know that the final solution to


disturbed behavior has yet to be written. But we have learned that
we are more likely to be successful if we remain flexible, nonjudgmental, and open to suggestion as we proceed with our interviews
and our treatment plans. Subsequent events are often open to various
interpretations as we struggle to balance the demands of the psychological and the physical, of the rational and the emotional. We
learn when to prescribe a pill, when to explore feelings, and when to
offer reassurance. Sometimes we prudently wait to discover the
course of action that is best. I have said we go forth both burdened
and armed with the knowledge of the ambiguities inherent in our
calling. Burdened, because it is bothersome not to know many of the
answers, but armed because without being aware of the uncertainties
in our work we might well do more harm than good.
Unexpected though it might seem, tolerating uncertainty is not
peculiar to only those of us who toil in the behavioral sciences.
Closer examination of the hard sciences impresses us with the fact
that even there, beyond a certain point, assertions are less finite.
The Albert Einsteins and the Niels Bohrs provide us with notable
examples. What should be clearcut is frequently not so. Those
illustrious individuals had the ability to acknowledge the value of
more than one theory of light. Theirs is a sober reminder of how the
great learn to live with ambiguity. Einstein (1924) wrote, "We now
have two theories of light, both indispensable, but, it must be
admitted, without any logical connection between them, despite twenty
years of colossal effort by theoretical physicists." Bohr (1934) in
his evaluation of the apparently contradictory wave and particle
theories to explain the propagation of light, suggested more directly
that opposite viewpoints under the circumstances are not only indispensable, they are complementary. In other words, rather than being
mutually exclusive, they can be mutually enhancing.
Hypnosis in Mesmer's Time
Moving now closer to home, to our own field of endeavor, we
might ponder how Franz Anton Mesmer. the acknowledged father of
hypnosis. might have felt had he sensed the potential and the complexity of what he bequeathed to us. To what extent could he have
appreciated that his practices would. on the one hand. contribute to
the development of an important religious institution (Podmore. 1963)
and on the other lead to some of the most sophisticated methodology
in the study of the behavioral sciences? To what extent could he
have been aware that his work heralded a new perspective - that it
lay on the threshold of a dialogue between the psyche and the soma and that it would pave the way to sweeping psychological theories
(Ellenberger. 1910) that would initially reveal more questions than
answers. Could he have even vaguely recognized that among those who
showed an interest in his work would be some dedicated to the accumu-

HYPNOSIS - BOTH POETRY AND SCIENCE

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

20

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

HYPNOSIS - BOTH POETRY AND SCIENCE

21

student population in a friendly but very prosaic manner compared


with that in the clinical situations, investigators have shown that
hypnotizability is not universally distributed, that women are not on
average more hypnotizable than men, and that the level of general
education has no effect on the degree of responsiveness. They have
demonstrated these facts, and many more (Hilgard, 1965).
A major consequence of this intellectual and determined pursuit
of the phenomenon of hypnosis has been the distillation of what is
believed to be its essence - the alteration of perception. This
might be associated with altered cognition and even altered memory,
but within this conceptual framework the altered state of awareness
measured primarily in terms of the subjective experience of the
hypnotized individual is the hallmark of hypnosis.
For some clinicians deeply invested in the use of hypnosis,
immersed in the rich metaphors in frequent use, and involved in the
intense relationships that mark the therapeutic encounter, this
simple explanation is somewhat dull and not altogether relevant. It
is seen at best as a disappointment, and at worst as a betrayal.
They regard it as leaving little justification for the imaginative
practices and intense relationships that surround their use of hypnosis. Although the relationship between the hypnotizer and the
subject, and the subject's consenting participation are seen as
necessary for the development in the laboratory of the altered perception or altered awareness, the phrase itself "altered perception"
by its very nature diminishes the importance of the overtones so dear
to the hearts of clinicians who prefer more colorful practice and
phraseology. The creative style and the imaginative terms they use
add to the psychological impact of the procedure. Perhaps because
the words are often purposefully obscure and the content rich in
metaphor, the whole lends stature to the clinician and enhances his
procedures. He says: "I am about to make contact with your deeply
unconscious mind, to help you communicate with a part of you that has
been hidden from you until now. Deeply unconscious pathways will
lead you to the psychological forces within you that will enable you
to resist the urge to reach for a cigarette."
Despite the reservations of these who criticize the laboratory
definition, this ornate phraseology leads precisely to the experience
of an altered perception. The hypnotizer, with the aid of importantsounding language, encourages the patient to experience what he, the
patient, perceives to be deeply hidden strengths. Even though they
might not be so deeply hidden that only the therapist can provide
access to them, they can be made to seem so inaccessible in order to
have them be that much more influential when they emerge.
What is not immediately conveyed by the brief phrase, "altered
perception", perhaps, is the artistry, the poetry. and the tendency
clinically to encourage the impression that things in hypnosis are

22

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

HYPNOSIS - BOTH POETRY AND SCIENCE

23

lives of the two people involved. Something ineffable, it is yet


crucial to, the calibre of the therapy and of the hypnotic experience.
The relatively lacklustre outcome with self hypnosis learned from
books confirms this view. The phenomenon has, however, thus far
defied measurement, and in the laboratory publications is given
little attention.
It will come as no surprise to you now to hear that the scientist in me often succumbs to this other'very clinical side of the
ambivalence. I am, however, reassured in my surrender by the fact
that the role of imagination in hypnosis was dealt with only
cursorily in investigative work until the importance of imaginative
involvement emerged from clinical observation (Hi1gard, 1970). I
submit that the affect in hypnosis is also an idea whose time in the
laboratory has come. Although the less fastidious have regarded
every aspect of the hypnotic interaction as hypnosis, others among us
have differentiated between the essence of hypnosis - the altered
perception - and the other forces in the hypnotic situation. It is
time now to turn our attention to the latter, to examine them, to try
to measure them if we dare, and to learn to live with them.
Even though this serious dialogue between the poetry and the
science is only now about to dawn, a glimmer has been seen for some
time. We might fashion discussions in the future on the format of
those currently in vogue. Two examples immediately come to mind:
hypnotizability in both the laboratory and clinical contexts, and the
value of memories recalled in hypnosis. Perhaps a brief review of
these two areas and of how the varying viewpoints can be and have
been thus far reconciled, will remind us that contradictory viewpoints are not necessarily mutually exclusive; they can in fact
complement each other.
Hypnotizability Measure
As already indicated by me, clinicians have often been inclined
to disregard the laboratory measurements as inapplicable to the
clinical scene. Contrasting the populations, one young and healthy,
the other suffering and representing several age groups, they conclude that laboratory hypnosis and clinical hypnosis are not comparable entities. When requested to apply to measures developed in the
laboratory to patients, these critics demur on the grounds that the
tests are lengthy and intrusive (Sacerdote, 1982), or that they would
interfere with the course of treatment were they to be introduced
into the clinical situation. There is evidence to the contrary
(Frankel et al., 1979), indicating that the laboratory scales can
indeed be applied to patients without creating the havoc that has
been prophesied by the critics; furthermore studies reveal interesting correlations between high scores and specific types of psychiatric disorders (Frankel and Orne, 1976). But that is not the focus
of this presentation.

24

F. H. FRANKEL

What is at stake here is the apparent contradiction between the


extent of the hypnotic response on the hypnotizability scales and the
degree to which patients respond symptomatically to therapy involving
hypnotic procedures. While these individual reactions are related in
several ways, they are not identical. The response to a hypnotic
induction procedure is not equivalent to the response to a therapeutic procedure. In fact, patients who are highly hypnotizable
might show no therapeutic response to a treatment involving hypnosis
if the secondary gain from their symptoms is such that they are loath
to give them up. Secondary gain is a vital force in the perpetuation
of symptoms. We know well the extent to which attentive and sympathetic relatives can unwittingly prolong the behavior of illness. Pain
clinics have a remarkable accumulation of data to support that.
Furthermore, and in contrast, patients who respond poorly to tests of
hypnotizability might yet show a positive therapeutic response to
procedures involving hypnosis, for the simple reason that they
respond to the setting in which hypnosis takes place even though they
might not be hypnotizable. They respond to the therapeutic influence
of the ambience, the encouragement, and the relaxation that contribute to the situation in which the hypnosis is encouraged to take
place, even when the hypnosis per se fails to occur.
We are here again talking about the hypnotic situation. It is,
in truth, inescapable, and we come full circle. The poor hypnotic
subjects gain relief from their symptoms very often from the reassurance, the trust, and the expectations that are inherent in all
acknowledged clinical procedures. The mystique surrounding hypnosis,
unreliable though it be, might well add to the effects. The benefits
thus stem from the poetry which lies here appropriately juxtaposed to
the measurements of science.
Memory
Yet another conspicuous example in which science and poetry,
measurement and metaphor have intersected recently, is that of
memory. To what extent is it enhanced by hypnosis?
How many in this audience have encouraged patients to turn their
attention to the deep levels of the unconscious mind, to orientate
themselves to events in the past, and to allow themselves to remember, in detail, hidden past experiences. At times the affect-laden
response is dramatic. It affects the quality of a patient's feelings
and contributes in a major way to the development of his insight.
What we sometimes lose sight of, however, is that what is recalled
might well be the feelings of the past, but not necessarily the
facts. Clinically whether they are facts, or feelings, or pure
fantasy, is not relevant. For instance, it matters little clinically
whether one's father was a stern man, or whether one imagines him to
have been such. What is of importance is that one should be able to

HYPNOSIS - BOTH POETRY AND SCIENCE

25

sense, examine, and discuss such feelings in the light of increased


experience and maturity.
Whereas an individual might start out in hypnosis being unsure
of the details he recalls, he can be encouraged to believe that the
procedure itself is capable of producing accurate memories from the
far distant past - even from the moment of his birth and before.
Such claims are not unknown, and taken to the absurdly logical conclusion he might, if prepared for it by his beliefs and attitudes; be
encouraged to recall in detail a former life or incarnation. He
might even project himself into the future, and depending on his
familiarity with science-fiction provide a view of the world in the
twenty-first century that can be as vivid and convincing as his
account of the past. The results of his recall if interpreted
psychodynamically are useful in the course of psychotherapy, the
procedure thus being regarded as a projective technique. Much like
dreams, such fantasies have value in leading to an uncovering of the
unconscious. In this way the poetry is persuasive. It moves to
another realm, however, when the product of the process is presented
as proof of the nature of the birth experience or as verification of
a previous incarnation.
Careful studies of recall in hypnosis have revealed the importance of suggestibility. They have demonstrated that a hypnotized
subject will create memories that mesh with the expectations of the
examiner. It has been shown (O'Connell et al., 1970), that if a
hypnotized individual cannot recall, on request, the name of his
teacher in a specific grade, he will in all probability, convinced
and convincingly, offer you the name of a teacher in another grade if
that is the one teacher's name that comes to mind. Similarly, he
will confabulate in other ways in order to meet what he sees as the
expectations of the individual who asks for the information. The
distinction between fact and fiction is perhaps academic in the
clinical context. In the forensic use of hypnosis, however, it is
crucial, and is at the heart of the controversy that currently predominates the admissibility of evidence from witnesses or victims who
have been questioned in hypnosis about specific events in the past.
Furthermore, we have learned from careful studies of recall that
while the presence of hypnosis leads to a greater number of items, it
also leads to a greater number of inaccuracies among those items
(Stalnaker and Riddle, 1932). These stem from the circumstances of
the interview, the nature of the questions, the relationship between
the interviewer and the subject, and what the subject believes hypnosis will enable him to do. Are we not here again in the embrace,
or the grip, of the hypnotic situation, caught up in the magic and
imagination of the moment? While careful studies illustrate the
limitations of recall in hypnosis, enthusiastic clinical use encourages quite the opposite viewpoint. One is science, the other poetry
- but both are in the practice of hypnosis.

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

HYPNOSIS - BOTH POETRY AND SCIENCE

27

animal magnetism, 1779. Translated by V.R. Myers, Published


with G. Frankau, Introductory Monograph, London, MacDonald.
O'Connell, D. N., Shor, R. E., and Orne, M. T., 1970, Hypnotic age
regression: An empirical and methodological analysis,
J.abnorm.Psychol., 76:(Monogr.Suppl. No.3) 1-32.
Orne, M. T., 1959, The nature of hypnosis: Artifact and essence,
J.abnorm.soc.Psychol., 58:277-299.
Podmore, F., 1963, "From Mesmer to Christian Science: A Short History
of Mental Healing," University Books, New Hyde Park, New York.
Sacerdote, P., 1932, A non-statistical dissertation about hypnotizability scales and clinical goals: Comparison with individualized induction and deepening procedures, Int.J.clin.exp.
Hypnosis., 30:354-376.
Shor, R. E., 1962, Three dimensions of hypnotic depth, Int.J.clin.
exp.Hypnosis., 10:23-38.
Stalnaker, J. M., and Riddle, E. E., 1932, The effect of hypnosis on
long-delayed recall, J.gen.Psychol., 6:429-440.

CONSCIOUS AND UNCONSCIOUS PROCESS IN HYPNOSIS*

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.

For an American psychologist whose primary identification has


been with experimental psychology to speak on conscious processes a
few years ago would have seemed somewhat surprising in view of the
commitment of American psychologists to beh~viorism or related forms
of operationism or positivism. However, the fact that I am speaking
on consciousness results from no conversion experience of my own, for
I was one of the many American psychologists who never were committed
to behaviorism. and I am pleased to report that the hold of behaviorism has been so weakened in America. now that cognitive psychology
has been embraced. that I no longer felt that I am rowing upstream
against the current. This is important for hypnosis. because its
*Invited Address by the Founding President of the International
Society of Hypnosis.
29

E. R. HILGARD

30

essence lies in modification of consciousness, and hypnosis finds a


more central place in psychological science now that serious discussions of consciousness have again become respectable. I should
offer a caveat. When old views are overthrown, and there is a new
freedom, that freedom is readily abused. We learned a good deal
through the discipline of behaviorism, and the return of consciousness does not mean that just anything is acceptable. The problems of
understanding conscious processes were always difficult, and they
still are. Furthermore, the cognitive psychology that has replaced
behaviorism is not ipso facto a consciousness psychology. Ulric
Neisser, for example, whose book by that title (Neisser, 1967) helped
recognize the maturing of cognitive psychology, still feels that we
are not quite ready to bring back consciousness, particularly states
of consciousness as explanatory concepts. Still, the opening up of
psychology has made it much easier for the phenomena of hypnosis to
be integrated into general psychology, and, indeed to contribute to
general psychological theory.
A dynamic unconscious has had greater difficulty in gaining
acceptance among American psychologists than the facts of consciousness. The currently popular cognitive psychology turned away from
Freud as it turned away from affective and motivational influences
upon thought. This was represented in developmental psychology by
moving from Freud toward Piaget. As I have noted elsewhere, one
finds no reference to sibling rivalry in Piaget's conception of the
cognitive growth of children. Correctives are being offered within
cognitive psychology itself to bring back more emphasis on the other
parts of the old trilogy of cognition, affection, and conation, once
so popular in Great Britain under the influence of Stout and
McDougall. Because hypnosis gets at many central problems of the
personality if well researched it may contribute substantially to
keeping psychologists aware of these problems in all their richness,
and help to avoid a certain faddishness with which psychology is
plagued.
Turning now more specifically to hypnotic theorizing, I wish
first to mention briefly the residues from the earlier period in
which subjective states were to be avoided and then go on to consider
two positions with respect to conscious and unconscious processes.

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-

CONSCIOUS AND UNCONSCIOUS PROCESS IN HYPNOSIS

31

ences, but weak on some of the basic characteristics of hypnosis such


as the production of hallucinations. Hallucinations were not congenial to an objectivist. Twenty years later, in the spirit of the
time, Weitzenhoffer, to whom I owe my introduction to hypnosis,
summarized the literature in his book entitled,
"Hypnotism: an
objective study in suggestibility" (1953). Again the emphasis on
suggestibility. T. X. Barber's first scale was called the Barber
Suggestibility Scale (Barber, 1969).
Of course, the suggestibility doctrine was already familiar. It
was the doctrine of the Nancy School in France in the late 19th
century, with Bernheim as its distinguished spokesman, as he countered the neurological disease theory of the Salpetriere School of
Charcot. The suggestibility theory naturally appealed to American
experimenters who like to think in terms of stimulus and response,
for the suggestion was a stimulus and what the hypnotized person did
was a response.
This tradition has been carried on, despite the weakening of
stimulus-response theory in psychology in the meantime, by Barber,
who at first developed what was clearly an input-output theory of
hypnosis, with a trenchant attack on anything resembling a state of
hypnosis, dramatized by always writing hypnosis in quotation marks.
Lately he has modified his position somewhat through the recognition
of some familiar characteristics of the highly hypnotizable person,
including imagery and fantasy. But imagery as he conceives it is
carefully guided so that there is little room for creativity in
ordinary hypnotic practice as his subjects think along with the
hypnotist in a newer scale, developed with Sheryl Wilson, and rather
inappropriately named by them the Creative Imagination Scale (Barber
and Wilson, 1979). Any major alteration in Barber's position is
quite recent because he repeated the chapter which appeared in the
earlier Fromm-Shor volume in essentially the same form in the revision of 1979 (Barber, 1979). Barber's most faithful and highly
productive disciple is now Nicholas Spanos.
Not to be confused in its details with Barber's position is the
role-enactment theory of Sarbin and Coe, enlarged upon in their book
of 1972 entitled, "Hypnosis: a social-psychological analysis of
influence communication," and reiterated frequently since. The
social psychological implications of their approach came by way of
their espousal of the role theory developed by sociologists such as
George Herbert Mead; the influence communication part is merely a new
name for suggestion. When one gets a little distance from the two
positions - that of Barber and that of Sarbin and Coe, they appear
very similar in their impact, despite their differences in vocabulary
and orientation. At least they attack the same people who seem to
find more psychological reality than they do in the familiar phenomena of hypnosis.

32

E. R. HILGARD

Heightened suggestibility or social response to influence by


another person is present in hypnosis, but as the sole criterion of
hypnosis, it is not entirely satisfactory. The suggestibility that
is relevant is of a restricted kind, working within certain boundaries, as shown by the work of Rosemarie Moore (1964), in which many
forms of responses to suggestion, defined by social persuasibility or
acquiescence showed very low correlations with measured hypnotizability. A distinction between primary and secondary suggestibility
has also been recognized for a long time, with only primary suggestibility closely related to hypnosis (Eysenck and Furneaux, 1945;
StukAt, 1958).
I wish to turn now to two conceptions that relate more directly
to the conscious-unconscious distinction: one deriving from psychoanalysis and one deriving from Janet's theory of dissociation. I
shall start first with psychoanalysis, because it has been better
represented in the hypnosis literature since mid-century.
Psychoanalysis and Hypnosis
There are two main aspects to the Freudian theory of the unconscious and the dynamics of hypnosis, the first the principle of
repression, the second, the principle of regression. Limiting discussion to these two concepts is to simplify greatly. The origin of
the unconscious is said to be by way of the repression of socially
unacceptable impulses, sexual and aggressive, into an unconscious
reservoir, where they remain active but express themselves only
indirectly. Psychoanalytic theory is designed to derive a useful
picture of the unconscious through free associations and their interpretations. In addition to free associations, the unconscious may
find expression through slips of speech, mannerisms, dreams, or
symptoms of illness, such as the conversion symptoms of hysteria. I
am here disregarding the Jungian interpretations, which allow for a
racial unconscious, but I wish to note one aspect in common: The
unconscious to both Freud and Jung is never directly accessibl;:-but
is known only by inference from symbolic manifestations in one form
or another. We shall return to this aspect later.
The concept of regression has been brought most clearly from
psychoanalysis into the interpretation of hypnosis. In this context
we are not talking about age-regression as familiarly studied in
hypnosis, but rather regression as an alteration in thought processes
within hypnosis in the direction of a more infantile or primitive
mode of thought.
The conception of hypnosis as a regressed state was implied in
some earlier writings, but came to prominence as the psychoanalytic
ego-psychology was developed under the influence of Anna Freud (1936)
and Heinz Hartmann (1958), as later interpreted by David Rapaport

CONSCIOUS AND UNCONSCIOUS PROCESS IN HYPNOSIS

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

34

E. R. HILGARD

hypnotized may be at any point on the spectrum from quiescence to


high activation. To be sure, when presented with Rorschach cards to
interpret, the patient is doing something, but how typical is that
something? Why not study what he or she was ~ while being tested
for hypnosis: experiencing age regression, having a dream, hallucinating an odour or hallucinating a voice? There is little justification for making inferences about the adaptive responses from a
limited set of demands when a richer set of demands can be studied
through the hypnotic behaviors and experiences themselves.
I made a small excursion into this area twenty years ago in a
paper on the primary-secondary type of thinking, and noted, with
examples from hypnosis, that the ideas could not be applied very
simply to the phenomena of hypnosis (Hilgard, 1962). For example,
sometimes the two types of thinking went on quite independently,
while sometimes they were fused in a single experience.
Let me illustrate by a pair of responses to a hypnotic test item
with which we had had a good deal of experience. The hypnotized
subject is told that he or she is soon to be told a joke, and will
find it amusing. Then the hypnotist says, "The whale is undoubtedly
one of the largest mammals alive today." Two subjects who responded
characteristically to the suggestion each laughed uproariously.
Asked why the joke was funny, the first subject said it wasn't funny
at all. "I just had a laughing fit." Here there was no integration
between the response to the affective suggestion, illustrating the
involuntariness of hypnotic responses, while the ordinary meaning of
the statement about the whale as a large mammal was interpreted in
secondary-process thinking as a simple proposition about a whale.
The second subject said, however, "You should have seen the funny
whale I pictured, with a long snout and tiny legs. It sure was
funny I " Here the primary process affect was integrated with the
cognitive process of hallucinatory transformation. I suppose that
there would be a higher primary process score here than in the first
case, but note that, while hypnotized, even this subject could communicate in a discriminating way how the humor was created by the
distortion.
The mixture between primary process and secondary process is
evident throughout hypnosis. This has been described for many years
as a preservation of the normal observing ego, while part of the ego
has been transformed. For example, when an arm has been paralyzed as
the result of suggestion, the subject perceives the arm in the same
way as an arm paralyzed by a stroke would be perceived. "When I try
to bend it, I am unable to bend it no matter how hard I try." The
contracture was produced involuntarily, but the voluntary trying may
be perfectly normal and genuine, often accompanied by a normal surprise that the arm does not bend. This is one reason that I am
troubled by the concept that hypnosis can be described simply as a
particular altered state of consciousness.

CONSCIOUS AND UNCONSCIOUS PROCESS IN HYPNOSIS

35

Is the Relationship Between the Hypnotist and the Patient a


Regressive Transference?
There is another aspect of the concept of regression as related
to the hypnotic state that is emphasized by Gill and Brenman, referred to by them as a regressive transference. What this means is that
the hypnotic setting stirs up the early emotional attachments to a
parent-like figure, and therefore shares, as psychoanalysis does, in
a regressive transference which also affects the thought processes
within the hypnotic session. The late Ronald Shor in his characterization of hypnosis referred to archaic involvement, and felt it to
be an important aspect of the phenomena (Shor, 1962). He noted,
however, that it had to be encouraged by the hypnotist, so that it
might be a product of the hypnotist's manipulations instead of something essential to the hypnotic condition.
Many conjectures about hypnosis are contaminated by the uses to
which hypnosis is being put. If hypnotic treatment of a neurotic
condition is long-continued and repeated, as in a hypno-analysis, it
may be expected that a transference relationship will develop. Such
transference may belong to the therapeutic relationship rather than
to hypnosis itself.
My wife, Josephine Hilgard, a trained psychoanalyst and member
of the Freudian American Psychoanalytic Association, conducted a
large number of depth interviews with our laboratory subjects who had
shown high involvement in their hypnotic experiences (J. Hilgard,
1965; 1979). They all demonstrated success in experiencing a variety
of responses to suggestion indicative of hypnosis as conventionally
conceived. The characteristic response to the hypnotist did not
reflect regressive transference or archaic involvement. The role of
the hypnotist was more frequently that of a guide, described in the
subjects' words as a tour guide, leading the subject but he or she
did not have to go where the hypnotist directed if they didn't wish
to; or the hypnotist was a catalyst a facilitator helping the
person to experience hypnosis, an aide rather than a director or
manager. Even subjects who had experienced hypnosis for ten or more
times did not alter their picture of the hypnotist. The personality
of the hypnotist seemed to have very little to do with it; in fact,
one common assertion was that the hypnotist was mostly a voice that
could guide the person's own experiences. If this interpretation is
correct, transference is not an essential feature of hypnosis itself,
though it may develop in longer continued therapy using hypnosis.
The Preconscious and the Unconscious.

An older psychoanalytic position is commonly reflected in the


hypnotic conception of layers of consciousness and unconsciousness.
For Freud there were in the topographic view of the conscious, the
preconscious and the unconscious.

36

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

CONSCIOUS AND UNCONSCIOUS PROCESS IN HYPNOSIS

37

hysteria or other forms of psychic weakness. Hence in offering a


modern form of his theory, that rejects the pathological roots, I
have used the expression neodissociation theory (Hilgard, 1977). I
am also sidestepping some of the negatives created by those such as
Hull (1933) and White and Shevach (1942) who dismissed dissociation
because it could be shown to be incomplete. The very advantage of
dissociation as related to hypnotic phenomena is that it can be
partial of incomplete, and hence account for the degrees of responsiveness to hypnosis, manifested in the differences in hypnotic talent
by the less and more hypnotizable, and by the differences in response
in waking hypnosis and following a hypnotic induction. Dissociation
has the advantage that the early writers such as Morton Prince, Hart
and McDougall saw in it, that the dissociated experiences are there
to be examined for what they are, not (as in psychoanalytic theory)
for what they may be inferred to be. I find amnesia to be one of the
clearest features of hypnosis. Amnesia is a model for dissociation
as the dream is a model for primary-process thinking. In amnesia a
once-conscious set of memories is temporarily forgotten as a consequence of suggestion, overt or covert, within hypnosis, and the fact
that the memory was not destroyed is evident because it can be recovered. There are gradations to this: not everything that the
subject is told to forget is forgotten, and not everything is always
recovered when the signal is given for its return. These are experimentable problems, and much attention is being devoted to them.
Amnesia, not only posthypnotic amnesia, but amnesia suggested within
hypnosis, is genuine, and it well illustrates what is meant by dissociation, including partial dissociation.
A few years ago I chanced upon a phenomenon within hypnosis that
I described according to the metaphor of a hidden observer. I wish
to say a few words about this, so that my findings are not generalized too far from the context in which they were studied. I found
that failure under hypnotic suggestion to hear sounds usually heard
or to feel pain normally felt, could be reversed later on, even
though the subject while hypnotized was not aware of them. In this
the parallel with amnesia is evident: something known is now no
longer known, until the release signal is given. In the hearing and
pain experiments, something that registered unknowingly is later
found to have been registered and stored in memory. The difference
from posthypnotic amnesia is that the registration itself under
hypnosis, took place without awareness. That is what made the recovery more puzzling. I therefore called attention to this registration without awareness as a cognitive process that could be conceptualized metaphorically as a hidden observer. I might have been
wiser to refer to it as a cognitive substructure that did the registration, for the information in this neutral statement would have
corresponded to speaking of a hidden observer without calling up the
picture of a homunculus within the head, watching what is going on.
At the level of experimentation, the phenomenon was limited to a very
highly hypnotizable subjects, and not all of them yielded what I

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-

CONSCIOUS AND UNCONSCIOUS PROCESS IN HYPNOSIS

39

opments in research and new perspectives, E. Fromm and R. E.


Shor (eds.), Aldine-Atherton, Chicago.
Barber, T. X., and Wilson, S. C., 1979, The Barber suggestibility
scale and the creative imagination scale: Experimental and
clinical application, Am.J.clin.Hypnosis, 21:84-108.
Cheek, D. B., and LeCron, L. M., 1968, Clinical hypnotherapy, Grune
and Stratton, New York.
Edmonston, W. E., Jr., 1981, Hypnosis and relaxation: Verification of
an old equation, Wiley, New York.
Eysenck, H. J., and Furneaux, W. D., 1945 Primary and secondary
suggestibility: An experimental and statistical study, J.exp.
Psychol., 35:485-503.
Freud, A., 1946, The ego and the mechanisms of defense, International
Universities Press, New York.
Fromm, E., Oberlander, M. I., and Gruenewald, D., 1970, Perceptual
and cognitive processes in different states of consciousness:
The waking state and hypnosis, J.Proj.Tech.Pers.Assess.,
34:375-387.
Gill, M., (ed.) 1967, The collected papers of David Rapaport, Basic
Books, New York.
Gill, M., and Brenman, M., 1959, Hypnosis and related states: Psychoanalytic studies in regression, International Universities
Press, New York.
Hartmann, H., 1958, Ego psychology and the problem of adaptation,
International Universities Press, New York.
Hilgard, E. R., 1962, Impulsive vs. realistic thinking: An examination of the distinction between primary and secondary processes in thought, Psychol.Bull., 59:447-448.
Hilgard, E. R., 1977, Divided consciousness: Multiple controls in
human thought and action, Wiley, New York.
Hilgard, J. R., 1965, Personality and hypnotizability: Inferences
from case studies, in: "E. R. Hilgard, Hypnotic Susceptibility," Harcourt,Brace and World, New York.
Hilgard, J. R. 1979 Personality and hypnosis: A study of imaginative
involvement (2nd ed.), University of Chicago Press, Chicago
and London.
Hold, R. R., 1963 Manual for the scoring of primary process
manifestations in Rorschach responses (9th ed.). Research
Center for Mental Health, New York University (Mimeographed),
New York.
Hull, C. L., 1933, Hypnosis and suggestibility: An experimental
approach, Appleton-Century, New York.
Kris, E., 1952, Psychoanalytic explorations in art, International
Universities Press, New York.
Moore, R. K., 1964, Susceptibility to hypnosis and susceptibility to
social influence, J.abnorm.Soc.Psychol., 68:282-294.
Neisser, U., 1967, Cognitive psychology, Appleton-Century-Crofts, New
York.
.
Sarbin, T. R., and Coe, W. C., 1972, Hypnosis: A social-psychological
analysis of influence communication, Hold, Rhinehart, and
Winston, New York.

40

E. R. HILGARD

Shor, R. E., 1962. Three dimensions of hypnotic depth. Int.J.clin.


exp.Hypnosis. 10:183-202.
StukAt. K.-G 1958. Suggestibility: A factorial and experimental
analysis. Almqvist and Wiksell. Stockholm.
Weitzenhoffer. A. M 1953. Hypnotism: An objective study in
suggestibility. John Wiley and Sons. New York.
White. R. W and Shevach. B. J 1942. Hypnosis and the concept of
dissociation. J.abnorm.Psychol 37:309-328.

THE CLINICAL RELEVANCE OF HYPNOTIZABILITY IN PSYCHOSIS:


WITH REFERENCE TO THINKING PROCESSES AND SAMPLE VARIANCES*
Germain Lavoie and Robert Elie
Hopital Louis-H. Lafontaine & Universite de Montreal
7401, rue Hochelaga
Montreal, H1N 3M5, Canada
Abstract
This paper reviews the relationships between hypnosis and psychosis from the point of view of psychoanalytic theory, cognitive
psychology and neodissociation theory, and the implications of these
in the diagnosis, prognosis and therapy of psychotic patients.
Psychoanalytic concepts of thing and word presentations, of primary
and secondary processes, and ego psychology concepts, are examined in
relation to both hypnosis and psychosis. The contribution of
Piaget's theory in understanding the nature of cognitive deficits is
discussed. Neodissociation concept of the hidden observer in hypnosis is compared with Freud's concept of the hidden observer in psychosis. The hypnotic assessment situation is viewed as a focalized
encounter providing many cues regarding cognitive fluency, attentional flexibility, interpersonal involvement, imaginative potentials,
motivation which are all of importance in establishing a prognosis
and a treatment plan with or without hypnosis. Major psychoses such
as schizophrenia and manic-depressive disorders are considered. The
history and stage of the psychoses are examined as major variables
impinging on the course of hypnotic investigation and treatment.
Some data and experiments are reported and the implications of these
for theories of hypnosis and of psychosis are discussed.

*Invited Address presented by the President-Elect of the


International Society of Hypnosis.
41

42

G. LAVOIE AND R. ELIE

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

the attractive ashtray offered by his girlfriend, he was employing


metaphorical thinking.
The hypnotist might say you will sleep - but hypnosis is not
sleep; that you will sleep deeply - but nobody knows what depth is,
and nonetheless the subject goes deeper; that you will have a dream but it is not like a nocturnal dream; that you will be unable to open
your eyes, or move a hand, a foot, a finger, or say your name - but
somehow, you could if you wished; that there are two experimenters
when there is only one - but you can distinguish who the real one is,
even when you see two of them that you can transport yourself anywhere you wish - but you know that this can be only metaphoric.
Somehow, the hypnotic subject is a party of these inexactitudes which
actually introduce him into the field of imagination, hypnosis, and
meaning.
Consider the "trance-logic" concept introduced by M. T. Orne
(1959). THe S sees two Dr. X when there can be only one. Three
elements of condensation are present: (1) vivid hallucination of a
second Dr. X; (2) multiple use of the same material (Dr. X) and (3)
double meaning. Displacement also occurs in the sense that the Scan
be said to have displaced his belief in the reality of the percept to
the hallucinated image. WHile the highly hypnotizable can experience
this as if it were for real in a very convincing way, he is also able
to demonstrate upon explicit or cued request, his access to the other
side of the coin: that is, not only to the figurative meaning of Dr.
X, but to the unique aspect of Dr. X as well. He testifies that
while he is actually hallucinating, he is also able to discriminate
the realms of imagination and of reality.
Another example could be taken from Hilgard's "hidden observer"
experiment: the subject is told that there is a hidden part of himself that knows about what really happened during hypnosis, while the
hypnotized part of the subject does not know. The evidence of dissociation revealed with this procedure is convincing (Hebb, 1975).
However, as Hilgard (1977) clearly stated, the hidden observer is a
structuralized methaphor, that has the power to produce, in half of
th highly hypnotizable subjects and in standard conditions, a distinctive dissociation of consciousness. Here again, the S testifies,
through his very adoption of the metaphor, that he has full mastery
of the borderlines of reality and imagination.
Finally, the work of Erickson (Erickson et al., 1976; Rossi,
1980; Zeig, 1980) provides the largest available sample of clinical
uses of condensation and displacement in hypnosis: analogies, puns,
metaphor, jokes, folk language, apposition of opposites, idiosyncratic signalling, displacement of resistance, confusion, converting
a response into another, reverse set, non sequitur, double dissociation, time distortion, a whole catalogue of anecdotes, etc. These
techniques clearly illustrate a deliberate triggering of the many

44

G. LAVOIE AND R. ELIE

form-varieties of primary process as described by Gill (1967) and


Holt (1970).*
Among the specific manifestations of primary process, Gill
(1967) reported the following: formation of composite words, multiple
use of the same material, double meaning, collective figure, composite figures, "intermediate" cOllDDOn entity acting as bridge between
thoughts, "unification" (where new and unexpected unities are set
up), linking thoughts by similarity, consonance, the possession of
cOllDDOn attributes, allusion (real or apparent), faulty reasoning and
absurdity, indirect representation, symbolization, plus some more
manifestations of a list initially proposed by Fliess (1959): picturization, representation of a whole through a part, concretization
(when the word is treated like the object), representations through
opposites, displacement and manifest content against affect, transformation of one affect into another, and suppression of affect.
In this paper, Gill followed closely Freud's writings in an
attempt to demonstrate that all the specific primary-process phenomena described in dream work, joke work, and symptom formation were
reductible as phenotypes of the more basic processes of condensation
and displacement, regarded as the economic genotypes (Gill, 1967).
Similar account of Freud's concepts of condensation and displacement
could be found in the French Vocabulaire de la psychanalyse
(Laplanche et Pontalis, 1967, 1973), where displacement was seen as
being at work in "every" unconscious formation, condensation was seen
as "one of the essential modes of the functioning of the unconscious
processes", especially responsible for the exceptional intensity of
certain images. Primary process was then characterized not so much
by an absence of meaning, but by a "constant sliding of meaning"
through the mechanisms of displacement and condensation.
According to this view, displacement was present "whenever one
psychical element is linked with another by an objectionable or
superficial association" (Freud, 1953). Condensation generally
*The puzzling problem is how so much deliberate inexactness can lead
to secure knowledge, a question of prime importance for the semeiotician: "There are metaphors and metonymies in which the multiple
meanings, inherent in the displacements, do result from a calculated
inexactness and ambiguity This fact leads to a better understanding of the nature of a speaker's competence in matters of
semantic traits It is a certain tact, an adroitness that
enables him to decide which train he will emphasize whether he
intends, at this moment and in this circumstance, to be exact but
hardly heard, or easily heard though little exact, or fairly exact
and fairly heard It is this permanent approximation which constitutes the strength and paradoxically, the exactness of human signification." (Van Lier, 1980).

HYPNOTIZABILITY IN PSYCHOSIS

45

implied: (1) formation of composite words or images; (2) multiple use


of the same material, and (3) double meaning (Freud, 1960). Primary
process along with exemption from mutual contradiction, timelessness,
and replacement of external by psychical reality, were seen as the
characteristics of the Unconscious (Freud, 1957).
This conception led the linguist Roman Jakobson (1956) to relate
condensation and displacement with the rhetorical processes of metaphor and metonymy, which he himself considered as the basic polarities of language. This view was further developed by Jacques Lacan
(1957). Displacement and replacement at distance have also been
presented by Van Lier (1980), as the defining characteristics of
human signification: "Signification is ceaseless displacement and
replacement, always involving flexibility and approximation."
Such manipulation and displacement of meanings presumably involve, on the part of the S, and possibly of the hypnotist, both a
lifting of censorship and an imposition of censorship (Gill, 1967,
Lap1anche and Ponta1is, 1973,) and not only, as is sometimes asserted, a lifting of censorship or critical thinking. Orne's (1959)
"trance-logic" concept, and Hilgard's analysis of the monitoring
function in hypnosis (Hilgard, 1977) do imply such an interplay of
selected inhibition and release mediated by words.
Psychosis
During active phases of psychosis, there are delusions and
hallucinations, and metaphoric and figurative thinking is often
greatly impaired. This is well illustrated in the autobiography of
the Schreber case who, at some point, believed he was entering into
sexual relationships with God, and in the following contemporary
example of schizophrenia, quoted from Neal and Oltmanns (1980).
D.
P.
D.
P.
D.
P.

Have you been nervous or tense lately?


No, I got a head of lettuce.
You got a head of lettuce? I don't understand.
Well, it's just a head of lettuce.
Tell me about lettuce. What do you mean?
Well lettuce is a transformation of a dead cougar that
suffered a relapse on the lion's toe. And he swallowed the
lion and something happened. The see, the Gloria and
Tomy, they're two head and they're not whales. But they
escaped with herds of vomit and things like that.
(passage omitted)
D. - What does all that mean?
P. - Well, you see, I have to leave the hospital. I'm supposed to
have an operation on my legs, you know. And it comes to me
pretty sickly that I don't want to keep my legs
D. - You want to have your legs taken off?

46

G. LAVOIE AND R. ELIE


P. - It's possible, you know.
D. - Why would you want to do that?
P. - I didn't have any legs to begin with. So I would imagine that
if I was a fast runner, I'd be scared to be a wife, because I
had a plinter inside of my head of lettuce.

It has been said that schizophrenic language is metaphoric.


Actually the sample just reported rather indicates, at this stage, a
failure of metaphoric thinking. The full range of meanings of the
"head of lettuce" does not seem to be available to the patient. In
schizophrenic delusions and hallucinations, some meanings are abol
ished and the patient is imprisoned into a closed network of associations classically diagnosed as autistic thinking. In contrast, if a
hypnotized S happens to have the experience that "he has a head of
lettuce", the other meanings of "head of lettuce" would not be abolished or repudiated as in actual psychosis (Lacan, 1981) but only
temporarily put aside or suspended, as is the case with metaphor.
There is another stage or type of schizophrenia when the
patient, though he is still hallucinating and deluded at times, is
also able to challenge the "reality" of these hallucinations and
delusions. The most hypnotizable schizophrenic the senior author
(G.L.) ever met was at such a stage when he experienced hypnosis for
the first time. He suggested with a smile that he was feeling better
now because "he had finally met his father" (that is G.L.). This in
his mind was a metaphor, and was intended to mean, as revealed in the
transcript of the interview, that he was experiencing with G. L., at
that time, some of the characteristics of the ideal father: trustful,
permissive, caring, interested in his difficulties, holding position
in the hospital, and above all, having as family name "Lavoie" (from
the Latin "via"), literally in English "the route", "the way", "the
path", which he was kind enough to express in the following image:
"Germain the Path, the right path, the path leading to the right
harbor"
Yet, in this same interview, the patient reported having hallucinated G.L. in the Chapel, after the Holy Communion, in the form
of an air pilot. He and the air pilot "looked at each other", and
from then on, he "knew" it was G.L. In this case, we have an instance
where two levels of handling images and symbols appear in communication. The hallucination indicates that the autistic forms of
thinking are still active, though they appear in a more sporadic
fashion. The same interview also provided some gems of a more
socialized deliberate use of images and symbols. Certainly, the
"father" metaphor and the sliding of meaning from "Lavoie" to "the
path" and finally, "the path leading to the right harbor" indicate in
that man a capacity to handle signification in a rich way, a capacity
to convey deep meanings. Even if you find here and there some autistic processes whose concealed meaning can be elucidated, however,
in the therapeutic relationship.

HYPNOTIZABILITY IN PSYCHOSIS

47

In a third type or stage of schizophrenia, you find patients who


don't present autistic thinking and language for long periods of
time. These are active, quite flexible in their use of images and
symbols, sometimes creative people. They might be depressed at
times, but still, there is a meaning to it, that can be worked
through in metaphoric terms.
A fourth type of patients would rather appear rigid, stereotyped, little talkative, matter-or-fact, isolated, with a certain
flatness of affect. These patients are difficult to interview, and
do not manifest much of the liberate and socially shared manipulations of images and symbols which characterize metaphoric thinking.
A Measure of Socialized versus Autistic Use of Primary Process
From these sets of clinical examples, three relevant measures of
form-varieties of primary process can be developed: a measure of
autistic use of images and symbols, to be represented here by AF; a
measure of socialized and readily meaningful use of images and symbols, to be represented here by SF; a measure of the rapport between
these two scores, represented here by SF ratio, that is the proportion of socialized use of images and symbols, on the total observed
production of such formal mechanisms, whether autistic or socialized.
These scores were derived from Holt's (1963, 1970) system for gauging
primary and secondary processes manifestations in the Rorschach test.
Holt (1963, 1970) suggested, for each of 40 categories of formvarieties of primary process, a weighed score ("Defense demand") on a
5 point-scale. The more socialized and readily meaningful formal
mechanisms would receive a lower score (e.g. 1, 2 or 3) and the more
autistic ones, a higher score (e.g. 4 or 5). Our SF (socialized
form-varieties) score is the sum of all the weighedlformal scores
ranging from 1 to 3, divided by a number of responses (R). Our AF
(autistic form-varieties) score is the sum of all the weighed formal
scores ranging from 4 to 5, divided by the number of responses (R).
Our SF ratio is defined as SF/(SF + AF). These scores are somewhat
different from Holt's "level 1" and "level 2" formal scores. For
instance, all the explicit instances of symbolism would fall in the
SF ("socialized") score, while the AF ("autistic") score constains
only the most extreme formal deviations of thinking.
The SF ratio does include such figure of speech as metaphor and
metonymy, as well as many other indicators of socialized formvarieties of primary process. In fact, although metaphor was taken
here as the most readily available example of the type of figurative
process involved in hypnosis, the other related form-varieties of
such process are relevant as well. In psychoanalytic thinking,
metaphor belongs with a group of "techniques" representing the more
socialized part of the form-varieties of primary process. Among
these processes listed in Holt's system (1963, 1970) from which our

48

G. LAVOIE AND R. ELIE

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).

*The question whether all these form-varieties of primary process can


be considered as phenotypes of the two basic processes of condensation and displacement is getting right to the heart of a theorica1
controversy. There is plenty of direct Freudian text (Gill. 1967)
that support the position that all formal properties of primary
process are direct or indirect consequences of condensation and
displacement.
Robert Hold (personal communication) does not agree. however.
with such a broad interpretation of condensation and displacement,
which in his view, leaves an ad hoc gap between these hypothetical
constructs and what is actually observed on a phenomenological
level. He alternatively suggested (Holt. 1970) a restricted. though
operational. definition of condensation. displacement and symbolization (i.e. about only one half of his list of form-varieties of
primary process). Holt's (1970) categories of condensation. displacement and symbolization do not. as they stand. pin down more
than a certain proportion of these processes, ad defined by Gill
(1967) and Lap1anche and Ponta1is (1973). These authors would lead
one to consider most, perhaps all form-varieties of primary process
as listed by Holt (1970), as indicating displacement.
At this point, we chose to keep on with the general denomination
"autistic versus socialized form-varieties of primary process".
leaving open the question whether all, or which ones of these processes could be subsumed under the basic mechanisms of condensation
and displacement.

HYPNOTIZABILITY IN PSYCHOSIS

49

DATA ON SOCIALIZED USE OF PRIMARY PROCESS AND HYPNOTIZABILITY


Figure 1 presents the percentage of highly hypnotizable (scores
7-9 on SHSS:A, N = 11) and the percentages of less hypnotizable
patients (scores 1-6 on SHSS:A, N = 45) as a function of autistic
forms of primary process in the Rorschach (AF index). It can be seen
that hypnotizability in schizophrenics is an inverse function of
autistic forms of primary process (r = -.36, p< .01, two-tailed).
This finding, which is a specification of Lavoie et al., (1976) data,
is currently in process of cross-validation on a new sample in our
hospital. Spiegel, et al., (1982) found, with a different method,
that among pathological samples, those with severe thought disorders
had lower scores on the Hypnotic Induction Profile (HIP; Spiegel,
1974).

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)

Autistic form-varieties of primary process (AF)

Fig. 1.

Percentage of more hypnotizable (7-9 on SHSS:A; N = 11) and


less hypnotizable schizophrenics (1-6 on SHSS:A; N = 45) as
function of autistic form-varieties of primary process
(AF).

G. LAVOIE AND R. ELIE

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)

Socialized form-varieties of primary process (SF Ratio)

Fig. 2.

Percentage of more hypnotizable (7-9 on SHSS:A; N = 11) and


less hypnotizable schizophrenics (1-6 on SHSS: A; N = 45) as
a function of socialized form-varieties of primary process
(SF Ratio).

Figure 2 presents the percentage of highly hypnotizable (7-9 on


SHSS:A, N = 11) and the percentage of less hypnotizable schizophrenics (1-6 on SHSS:A, N = 45), as a function of socialized forms of
primary process in the Rorschach (SF ratio). For a given amount of
form-varieties of primary process, the higher the proportion of
socialized use of such imaginative processes, the higher the percentage of hypnotizable ~s. 75% of the highly hypnotizable fall in the
upper third of the distribution of SF ratio, while 71% of less hypnotizable fall in the lower two-thirds of the distribution of SF ration
(r = +.31, p< .05, two-tailed).
The amount of socialized forms of primary process per response
(SF) does not in itself correlate with hypnotizability, and consequently the importance of this specific variable was overlooked in
our 1976 report (Lavoie et al., 1976). The relationship with hypnotizability is mediated by the ability of the patient, in an unstructured situation such as the Rorschach test, to maintain whatever

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

Baker &Copeland (1978)


Gordon (1973)

Obstoj & Sheehan (1982)

Greene (1969)
Lavoie et al. ( 1973)

SHSS:A

:;:

4.81
4.80

4.05
3.99

Lavoie et al. (1978)


Spiegel et al. (1982)

HIP

2.30

Ham et al. (1976)

1.71
1.56

Barber et a1. (1964)


Barber et a1. (1964)

Fig. 3.

BSS

Mean susceptibility score obtained in 12 studies with


schizophrenic patients.

amount of form-varieties of primary process within the limits of what


is considered meaningful from a social point of view. The less this
use of socialized form of primary process is disrupted by autistic
type of material, the higher the hypnotizability.

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

G. LAVOIE AND R. ELIE

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

THE SAMPLE VARIANCES

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).

and the Stanford scales measure somewhat different things (Hilgard,


1982).*
*Pettinati (1982) reported, for 25 schizophrenics tested with SHSS:
C, a mean of 5.76 which was comparable to normal mean. She found,
however. that patients obtained a lower mean score on the HIP when
compared to normals, and suggested that the HIP may have different
properties from the HGSHS:A and SHSS:C. Horne, Pettinati and Orne
(1981) also found that young acute hospitalized schizophrenics (mean
age 29) scored as high as the normative samples on HGSH:A and
SHSS:C. As far as variance is concerned, an examination of
Pettinati (1982) tables reveals a striking agreement with the data
presented here, which shows the very high consistancy of this
"effect" across available schizophrenic samples. Among her clinical
groups, schizophrenics presented the lowest variance (SD 2 = 3.6).
compared to variances of 9.6 and 10.9 for two normal samples. With
the HIP, on the contrary, the variance for schizophrenics (SD 2
8.4) was higher than the variances for the normal samples (SD 2 = 4.8
and 6.3, respectively).

54

Table 1.

G. LAVOIE AND R. ELIE

Mean susceptibility scores (SHSS:A) for 7 samples of


schizophrenics and for 8 samples of normal Ss from Morgan
and Hilgard (1973)
Schizophrenics(l)

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

(1) M=ma1e; F= female; V. volunteer; cv="coerced volunteer".

(2) Comparison of the variances: F = 2.1977. p < .001 .


(3) See Figure 3 for identification of schizophrenic samples. Greene
(1969) sample has not been included in this table. since only 10 of
the 12 SHSS:A items were used in that study.

The striking characteristic of schizophrenic response to SHSS:A


is that, as a group, they tend to cluster around the mean, in the
middle range of susceptibility, while scores of normal Ss are more
evenly distributed over the whole range of susceptibility. This
confirms on a much wider scale our 1973 observation (Lavoie et al.,
1973) stating that two characteristics distinguished schizophrenic
scores from normals: (a) a lower variance and consequently (b) a
difference in the shape of the hypnotic scores distribution.
The left part of Figure 4 shows the means of the seven (7)
samples of patients, totaling 306 psychotics, mainly schizophrenics.
The middle part shows the means of four (4) groups of normal Ss in

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

G. LAVOIE AND R. ELIE

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

important source of bias; (2) the confounding, in the typical "status


questionis", of means obtained with scales having fewer items than
the Stanford Scales, such as the BSS; (3) the prejudice we entertain
towards psychotic and schizophrenics which consists in believing that
they should not be able to obtain normal scores on hypnotic scales;
(4) volunteering bias (Boucher and Hilgard, 1962), illustrated by the
fact that means were lower in coerced volunteer samples and higher in
true volunteer samples, as the selection ratio increases; (5) failure
to recognize, in samples of younger psychotic patients, the interaction of sex and age, as shown in the normative data reported by
Morgan and Hilgard (1973); so-called "high" psychotic means are in
line with the means of normal Ss of the same age and sex; (6) failure
to distinguish clearly what belongs to the means and what belongs to
the variance of susceptibility scores; (7) failure to control for the
patient ability to relate meaningfully with other persons.
Also, it is important to note that the smallness of the hypnotic
variances in schizophrenic samples is independent of the size of the
mean. That is, with less hypnotizable samples (e.g. Lavoie et al.,
1973), the clustering around the mean will result in a greater scarcity of high hypnotic scores, and to a lesser extent, of low hypnotic
scores. With more hypnotizable samples (e.g. Kramer and Brennan,
1964), the clustering around the mean will result in a great scarcity
of low hypnotic scores. This very constant variance factor across
schizophrenic samples tested with SHSS: A still awaits proper explanation. I shall however indicate several areas of research where
controlled studies are needed to deepen our understanding of these
data.*
*There is some indication that this variance factor is not specific
to schizophrenia, but does characterize hypnotic scores with other
clinical groups as well. Frankel and Orne (1976) observed a variance of 4.49 for 24 phobic patients, and a variance of 8.88 for a
matched sample of Ss who applied for help in quitting smoking. All
Ss were tested on either the Stanford Scale Form C (SHSS:C;
Weitzenhoffer and Hilgard, 1962) or the Havard Group Scale (HGS;
Shor and E. Orne, 1962) administered individually. Baker and
Copeland (1978) reported SHSS:A variance of 4.75 for 45 depressed
patients. Pettinati (1982) reported SHSS:C variances of 5.76 for 18
depressed patients, 5.76 for 60 anorexic patients, and 4.0 for 12
alcoholic patients, compared to variances of 10.89 for 87
Pennsylvania students and 9.61 for 58 Stanford students. Such a
constant lowering of SHSS:A and C variance as soon as one deals with
clinical samples from so different sources could possibly find some
element of answer from social and cognitive psychology. Perhaps the
treatment of information and the exploration of meaning is limited
as psychopathology develops, with a resulting conformity and stereotype of the person's behavior on SHSS:A and SHSS:C. The reasons why
the reverse occurs with the HIP are not clear and reveal, from a new
angle, the important differences in the psychometric properties of
the HIP and the Stanford Scales.

58

G. LAVOIE AND R. ELIE

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

Other factors. however, are undoubtedly at work, such as the


item structure of the hypnotic scale. It is now clear that success
on some hypnotic items such as reversible posthypnotic amnesia rests
partly on sophisticated cognitive operations where schizophrenics. as
a group, have been shown less effective than normal controls (Lavoie
and Sabourin, 1980; Lavoie. 1980). In some schizophrenic samples,
other items may generate atypical responses as well. For instance,
in the Lavoie et al., (1973) sample, eye closure, eye catalepsy and
hand movement presented significant difficulty for the patients.
Nobody would interpret the blind's inability to fixate a point, or
the deaf's inability to listen to instructions as indicating low
hypnotizability. These examples suggest that it is risky to test for
hypnotizability with a small number of items whose psychometric
properties, with schizophrenics, are unknown. There is an increased
risk then that specific deficits or behaviors unrelated to hypnotizability will be mistaken as indicating low hypnotizability. A failure of careful examination for response genuineness could lead to
erroneous conclusions.
Another area of investigation would lead to controlled studies
of the relationship between the dissociative processes in psychosis
and in the hypnotic experience, in line with Hilgard's (1977) neodissociation model. Although Freud (1964) contended that a "hidden"
normal appraisal of reality persisted in numerous psychoses (Lavoie
and Sabourin, 1980) and although clinicians consider such an occurrence as extremely significant and useful from a therapeutic point of
view, controlled research in that area is virtually absent.

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

G. LAVOIE AND R. ELIE

Finally, a genuine semeiotic theory of hypnosis is a task for


the future. The human being is basically characterized by his
mastery of signs, images and symbols, whether one uses analogical or
digital languages (Van Lier, 1980). The hypnotist has always been
placed by his subject in a position where he had just a sign or a few
signs to make in order to throw both parties into the gear of the
hypnotic realm of meaning. James Braid (1846) had discovered just
that, when he demonstrated to his fellow physicians that passes and
magnets were no more than signs, and that the most simple signs and
figures of speech, when shared, could have a tremendous symbolic
power.
Meanwhile, the clinician of whatever allegiance should be alert
to variables that are in the core of his practice: highly susceptible schizophrenics are mainly recruited among those patients who are
able to use form-varieties of primary process, including condensation
and displacement - and hence metaphors, images and symbols - in a
meaningful way, and whose process of metaphoric and symbolic thinking
is minimally disturbed by impenetrable autistic deviations in the
formal aspects of thinking and language. And he is likely to find
more among younger patients, especially women, than among older
patients, and more if he respects the genuine volunteering, choice
and interest of his patients than if he tends to be coercive. Under
these conditions, many schizophrenic patients can reveal, in the
hypnotic relationship, their ability for exploration of meaning and
human relationships.
REFERENCES
Baker, E. L., 1981, An hypnotherapeutic approach to enhance object
relatedness in psychotic patients, Int.J.clin.exp.Hypnosis,
24: 136-147.
Baker, E. L., and Copeland, D. R., 1978, Hypnotic susceptibility of
psychotic patients: a comparison of schizophrenics and psychotic depressives. Unpublished manuscript. Research
Institute of Mental Sciences, Houston, Texas.
Barber, T. X., Karacan, 1., and .Calverley, D. S., 1964, "Hypnotizability" and suggestibility in chronic schizophrenics,
Archs.gen.Psychiat., 11:439-451.
Barber, T. X., 1969, Hypnosis: A scientific approach, Van Nostrand,
New York.
Boucher, R. G., and Hilgard, E. R., 1962, Volunteer bias in hypnotic
experimentation, Am.J.clin.Hypnosis, 5:49-51.
Braid, J., 1846. The power of the mind over the body: An experimental inquiry into the nature and cause of the phenomena
attributed by Reichenbach and others to a "new imponderable".
John Churchill, London. Adam and Charles Black, Edinburgh.
This phamphlet is a slightly revised reproduction of three
papers published in the Medical Times, June 13, 20 and 23,

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,
Standard Edition, 8. Hogarth Press, London.
Freud, S., 1964, Splitting of the ego in the process of defence,
Standard Edition, 23, Hogarth Press, London.
Gill, M. M., 1967, The primary process, in: "Psychological Issues,"
18, 19. International UniversitieS-Press, New York. 276. 286.
Gill. M. M and Brenman. M 1959. Hypnosis and related states:
Psychoanalytic studies in regression, International Universities Press, New York. 217.
Gordon. M. C., 1973. Suggestibility of chronic szhizophrenic and
normal males matched for age. Int.J.clin.exp.Hypnosis.
21:284-288.
Greene. J. T. 1969. Hypnotizability of hospitalized psychotics,
Int.J.clin.exp.Hypnosis, 17:103-108.
Gruenewald, D., Fromm, E., and Oberlander, M. I., 1972, Hypnosis and
adaptive regression: An ego-psychological inquiry, in:
"Hypnosis: Research Developments and Perspectives,"E. Fromm
and R. E. Shor, (eds.), Chicago, Aldine-Atherton, Chicago,
pp.495-509.
Ham, W. M., Spanos, N. P., and Barber, T. X., 1976, Suggestibility
in hospitalized schizophrenics, J.abnorm.Psychol., 85:550-557.
Hebb, D.O., 1975, Science and the world of imagination,
Canad.Psychol.Dev., 16:4-11.
Hilgard, E. R., 1977, Divided consciousness, multiple controls in
human thought and action, Wiley, New York, 195, 188, 204, 221,
230-236.
Hilgard, E. R., 1982, Hypnotic susceptibility and implications for
measurement, Int.J.clin.exp.Hypnosis, 30:4, 394-403.

62

G. LAVOIE AND R. ELIE

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
Mental Health, New York University, New York.
Holt, R. R., Manual for scoring of primary process manifestations in
Rorschach responses, (Rev. 10th ed.)., Research Center for
Mental Health, New York University, New York.
Horne, R. L., Pettinati, H. M., and Orne, M. T., Hypnotizability of
schizophrenic patients. Paper presented at the meeting of the
Society for Clinical and Experimental Hypnosis, Portland,
Oregon, October, 1981.
Jakob son , R., 1956, Two aspects of language and two types of aphasic
disturbances, In the fundamentals of language, Mouton, The
Hague, p.81.
Kramer, E., and Brennan, E. P., 1964, Hypnotic susceptibility of
schizophrenic patients, J.abnorm.soc.Psychol., 69:657-659.
Lacan, J., 1957, L'instance de la lettre dans l'inconscient ou la
raison depuis Freud, in: "La psychanalyse," 3:47-81. (Reprinted in Lacan, J. Ecrits, Editions du Seuil, Paris, 1966.
English translation, The insistence of the letter, Yale French
Studies, 1966, 36-37, 112-147. Reprinted in Ehrmann, J.
(ed.): Structuralism, Doubleday Anchor Books, New York, 1970.
Lacan, J., 1981, Le seminaire, livre III: Les psychoses,
Jacques-Alain Miller, (ed.)., Editions du Seuil, Paris, 47-50.
Laplanche, J., and Pontalis, J. B., 1967, Vocabulaire de la psychanalyse, Presses Universitaires de France, Paris.
Laplanche, J., and Pontalis, J. B., 1973, The language of
psychoanalysis (D. Nicholson-Smith, trans.)., Hogarth Press,
London, 121,82,83 and 339, 123, 166, 168.
Lavoie, G., 1980, Posthypnotic amnesia and retrieval in
schizophrenia, Paper presented at, Annual Convention of the
American Psychological Association, Montreal.
Lavoie, G., and Sabourin, M., 1980, Hypnosis and schizophrenia: a
review of experimental and clinical studies, in: "Handbook of
Hypnosis and Psychosomatic Medicine," G. D. Burrows and L.
Dennerstein (eds.), North Holland Biomedical Press, Elsevier,
pp.377-420.
Lavoie, G., Sabourin, M., and Langlois, J., 1973, Hypnotic susceptibility, amnesia and I.Q. in chronic schizophrenia,
Int.J.clin.exp.Hypnosis, 21:157-168.
Lavoie, G., Sabourin, M., Ally, G., and Langlois, J., 1976, Hypnotizability as a function of adaptive regression among chronic
psychotic patients, Int.J.clin.exp.Hypnosis, 24:3, 238-257.
Lavoie, G., Lieberman, J., Sabourin, M., and Brisson, A., 1978,
Individual and group assessment of hypnotic responsivity in
coerced volunteer chronic schizophrenics, in: "Hypnosis at its
Bicentennial: Selected papers," F. H. Frankel and H. S.
Zamansky (eds.), Plenum, New York, pp. 109-124.

HYPNOTIZABILITY IN PSYCHOSIS

63

Lieberman, J., 1975, Suggested posthypnotic amnesia under active and


passive learning conditions in chronic schizophrenia: A quantitative and qualitative analysis, Unpublished master's thesis, Universite de Montreal.
Lieberman, J., Lavoie, G., and Brisson, A., 1978, Suggested amnesia
and order of recall as a function of hypnotic susceptibility
and learning conditions in chronic schizophrenic patients,
Int.J.clin.exp.Hypnosis, 26:4, 268-280.
Morgan, A. H., and Hilgard, E. R., 1973, Age differences in susceptibility to hypnosis, Int.J.clin.exp.Hypnosis, 21:78-85.
Neal, J. N., and Oltmanns, T. F., 1980, Schizophrenia, Wiley, New
York, 102.
Obstoj, I., and Sheehan, P., 1982, Posthypnotic amnesia and the
cognitive efficiency of schizophrenics, Unpublished manuscript, University of Queensland, Australia.
Orne, M. T., 1959, The nature of hypnosis, Artifact and essence,
J.abnorm.Soc.Psychol., 58:277-299.
Orne, M. T., 1962, On the social psychology of the psychological
experiment: With particular reference to demand characteristics and their implications, Am.Psychol., 17:776-783.
Orne, M. T., 1969, Demand characteristics and the concept of
quasi-controls, in: "Artifact in Behavioral Research," R.
Rosenthal and R.~. Rosnow, (eds.), Academic Press, New York.
Orne, M. T., On the simulating subject as a quasi-control group in
hypnosis research: What, why and how, in: "Hypnosis: Research
Development and Perspectives," E. FromDland R. E. Shor (eds.),
Aldine-Atherton, Chicago, 399-443.
Orne, M. T., 1982, Affidavit (April 28) in the People vs Donald Lee
Shirley Hearing, Supreme Court of the State of California.
Pettinati, H. M., 1982, The capacity of hypnosis in clinical populations. Paper presented at 9th International congress of
hypnosis and psychosomatic medicine, Glasgow, Scotland,
August.
Podvoll. E. M 1979. Psychosis and the mystic path. Psychoanl.Rev
66:4,571-590.
Rossi, E., (ed.). 1980, The collected papers of Milton H. Erickson.
(4 volumes). Irvington, New York.
Schreber. D. P., 1847. Memoirs of my nervous illness, Dawson, London.
1955.
Short R. E., and Orne. E. C 1962. Harvard Group Scale of Hypnotic
Susceptibility. Form A., Consulting Psychologists Press. Palo
Alto, Calif.
Speigel. H 1974. Manual for the hypnotic induction profile, Soni
Medica. New York.
Spiegel, H., Detrick. D and Frischholz, E 1982, Hypnotizability
and psychopathology. Am.J.Psychiat 139:4.431-437.
Van Lier. H 1980, L'animal signe, Belgique. Rhode St. Genese.
Visscher. 25. 64.
Vingoe, F. J and Kramer. E 1966. Hypnotic susceptibility of
hospitalized psychotic patients: a pilot study.
Int.J.clin.exp.Hypnosis. 14:47-54.

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Weitzenhoffer, A. M., and Hilgard, E. R., 1959, Stanford hypnotic


susceptibility scale, Forms A and B, Consulting Psychologists
Press, Palo Alto, Calif.
Weitzenhoffer, A. M., and Hilgard, E. R., 1962, Stanford hypnotic
susceptibility scale, Form C., Consulting Psychologists Press,
Palo Alto, Calif.
Zeig, J., 1980, Erickson's use of anecdotes, in: "Teaching Seminar
with Milton H. Erickson, M.D.," J. Zeig-(ed.), Brunner/Mazel.
New York, pp. 3-29.

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

68

A. M. WEITZENHOFFER

In 1841 James Braid witnessed two demonstrations of mesmerism.


More specifically, he saw demonstrations of so-called magnetic or
artificial somnambulism, a condition discovered by de Puysegur in
1782. Shortly thereafter, Braid renamed the condition hypnotism or
nervous sleep. He also showed it could be brought about in some
individuals by merely asking them to focus their eyes and attention
on a small, bright object held in front of them. Braid researched
and utilized hypnotism therapeutically for some twenty years, until
his death in 1861.
Braid's (1841) view of hypnotism can be summed up as follows:
(1) It is a state of monoideism, i.e., of concentrated attention to
an idea. (2) It can be brought about in five minutes or less in the
fashion already described. (3) It is an all-or-none condition,
i.e., without degrees. (4) It is usually associated with the outward appearance of sleep. (5) It is a condition in which a person
is frequently found to be most readily influenced by verbal communications. (6) Although initially appearing asleep, such a person is
capable of being active in this state. Most important, (7) it is
always accompanied by a spontaneous amnesia for all events transpiring during its presence. Braid viewed this last feature as a sine
qua non for its presence. Regardless of whatever else unusual or
different might be observed, he held there is no hypnosis without
amnesia. Also to be noted is that the deliberate, direct, use of
what was later to be called suggestion appears to have been minimally
used by Braid.
My own first experience with hypnotism was as an observer some
50 years ago. I then witnessed a demonstration of the postural sway
test as prescribed by mesmerists and an induction of hypnosis by
means of mesmeric passes. This was the start of my interest in
hypnotic phenomena. I was then about 12 years old and it was quite a
while before I became actively involved as a hypnotist. By the time
I did, around 1947, the practice and subject matter of hypnotism had
suffered some changes since Braid's time. The term "hypnosis" had
replaced the term "hypnotism" to denote the state in question.
"Hypnotism" was now used to denote the use of the hypnotic state and
all of its attendant phenomenology. Authoritarian overt suggestion
now played a dominant part in the production of all hypnotic phenomena, including the hypnotic state Very much in contrast to Braid's
view, hypnosis was now seen as being on a continuum; i.e., as having
degree or depth. Much of the time, too, post-hypnotic amnesia was
routinely suggested and was no longer considered a necessary sign of
hypnosis. Also, considerable emphasis was placed on the use of
multiple tests of sugg~stibility (or of hypnotizability) prior to
formal inductions of hypnosis. Inductions were usually a combination
of visual or auditory fixation with suggestions of the precursor
signs of sleep. For the most part, hypnotism centered around the use
of suggestion, and hypnosis came into the picture mainly as a way to
enhance suggestibility. Indeed, hypnosis was frequently defined as a
state of enhanced suggestibility (Weitzenhoffer, 1953, 1957).

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

"unconscious." With some authorities it became even a matter of


communicating with not one but many 'unconsciouses' each being
"deeper" or less "deep" than the others. The use of finger movements, so-called ideo-motor signalling, was developed for communicating with the unconscious. This was basically a modification of
traditional automatic writing and the planchette of spiritists. A
whole new and very popular form of hypnotherapy was to grow out of
this. This also gave rise to a popular method for obtaining subjective estimates of hypnotic depth from the subjects themselves. On the
other hand, except for one test, objective tests for suggestibility
and depth of hypnosis were largely eschewed by practitioners. The
one exception, popularized by Erickson, was the so-called arm or hand
catalepsy test for hypnosis. This is not the well-known suggested
effect frequently called the arm rigidity test, but a much more
subtle test which actually had first been described by Braid. Like
Braid, Erickson believed it reflected a non-suggested characteristic
tonic change in the musculature of subjects when they became hypnotized. For both, this tonic change was an intrinsic physiological
characteristic of hypnosis. The possibility that it might be a
non-verbally suggested effect was not considered by Erickson. Be
that as it may, Erickson did eventually combine this test with a very
impressive and effective non-verbal modification of his original hand
levitation induction, a combination he made much use of in demonstrations after the mid-1950's.
The net effect of all this is that, by 1960, not only were many
practitioners of hypnotism holding to the position that all sorts of
everyday changes in awareness were trance or hypnosis, but they were
reducing yoga, meditation, various drug-induced states, brainwashing,
religious healing, voodoo, and even the whole process of formal
education, all to being hypnotism. There was actually nothing new in
this development. The same sort of thing had taken place earlier,
around the last quarter of the 19th Century (Barrucand 1967).
In view of the current interest in so-called "Ericksonian hyp~
notism," let me say a little more about Erickson. His work with
hypnotism seems to me to fall into three phases. Until the middle
1940's he seems to have functioned largely in the framework of traditional hypnotism, working with traditional somnambulists and other
highly suggestible subjects in a very creative and productive manner.
The second phase is the one I have just described at length, and
which I see as a transition to the final phase of Erickson as primarily the clinician and teacher. It is evident that many of the elements of his so-called "indirect" method of producing hypnotic phenomena were being used by him as early as 1944, but always in a framework where there was a clear-cut, formal, induction of hypnosis. In
the third phase of his work, it became frequently difficult to determine when or where hypnosis had been induced by him, how deep it had
been, the extent to which it had been used, and even whether there
had been any hypnosis present. It became equally difficult at times

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

anything, modern and especially contemporary research have only


further abetted the situation created by the clinicians. Today, some
200 years after the discovery of artificial somnambulism, researchers
are divided on even such basic issues as the veridicality of hypnotic
phenomena and whether or not hypnosis exists as a state. There are
some who even insist it is all a matter of role playing brought about
by appropriately chosen motivating techniques. About the only point
on which there seems to be a general consensus is that, if it exists,
hypnosis is not sleep.
I could go on at this point and share with you my thoughts as to
the reasons why modern research has failed to be more effective. To
do so, however, would take us into methodological questions of rather
a technical nature and into such issues as the nature of science, the
character of American psychology, the personality of American psychologists and health professionals, and the quality of higher education
in America. I think I can more valuably use the space in a more
directly relevant and productive way.
One thing I have tried to do is to bring into focus the fact
that the concept of hypnosis has evolved more as a function of speculations than as a function of scientifically well-established facts.
There is nothing wrong about speculations provided they are recognized to be just that and are not confused with facts. Additionally,
to be productive, speculations should be based on the proper use of
logic and should at least be consistent with such facts as are available. It is in this context that I have already discussed the validity of certain early speculations such as the relation of suggestibility to hypnotic depth. There are a number of other speculations
I have touched upon which have played and continue to play an important part in hypnotism and which bear further scrutiny.
For a start, there is the question of whether or not the state
of hypnosis exists. Let me first say that it is not possible to
disprove its existence, as Barber and Sarbin have tried, by showing
that something labelled otherwise can be associated with the same
kinds of behaviors. From the proposition that A and B are each
associated with, or even cause, C," it does not follow that A is B,
or that only one can exist. Heat causes blisters, so does cold, but
heat and cold are not the same. Indeed, they are the opposite.
Quite apart from this issue, there are other fundamental weaknesses,
such as those created in this context by the substitution of motivation and role-playing for hypnosis and hypnotic behavior. The
existence and presence of these substitutes are no more objectively
demonstrable than is that of hypnosis. To state that procedure A has
motivated John to behave in a certain way implies a change in his
state of being. I defy any of you to show me how I can detect this
motivation by any means other than the kinds I use to detect hypnosis. How, then, is the one better than the other? As for roleplaying, how do you tell when a person is role-playing? As I have

IN SEARCH OF HYPNOSIS

75

pointed out elsewhere (Weitzenhoffer 1973), the Barber and Sarbin


theses are generally quite weak. Furthermore, it needs to be pointed
out that in essence what the Barber-Sarbin school of thinking really
maintains, is that hypnotic behavior is all conscious, voluntary
behavior, whereas the "hypnosis-as-a-state" adherents hold to the
opposite view. That seems to be the real issue, not what might or
should be substituted for hypnosis. To date, this first issue remains an unsettled one, largely because both 'sides have concentrated
on the second one.
Perhaps, indeed, as Barber and Sarbin have maintained, hypnosis
is a chimera, a mere metaphor. Past efforts to detect its physiological counterparts have failed miserably. Some years ago, I spoke
in Malmo (Weitzenhoffer 1978a) at another Congress about this and
other failures to substantiate hypnotic phenomena at a physiological
level. This has been a personal failure of mine, one extending over
a period of ten years. Possibly, this failure is indeed a reflection
that there is no hypnosis, or, and I still maintain this to be a very
strong probability, it reflects that to date, we have gone about the
task in the wrong way. I proposed in Malmo that properly placed deep
electrode implants in the cortex of selected patients undergoing
brain surgery was as yet an untried by highly logical approach.
Although my efforts to find collaborators to do this in the last few
years have been unsuccessful, I still believe it to be a desirable
step. Short of this approach or of some new, revolutionary, alternative technique for studying brain activity becoming available, we may
have to resign ourselves to dealing with the state of hypnosis at a
speculative and inferential level. This is by no means an ideal
situation.
Whether or not there is a state of hypnosis, if not many hypnoses, whether or not we can satisfactorily document its existence,
and whatever we may otherwise call it, there is another side of the
coin we cannot ignore - namely, suggestion. Until Bernheim, the
state of hypnosis was the dominant feature of hypnotism. From
Bernheim on, it has been suggestion. So much so that Bernheim himself proposed that one speaks of suggestion states in lieu of hypnosis. Others, such as Gill and Brennan (1959), and Erickson (1976)
in his latter years, have tended to view hypnosis and suggestion as
synonymous. Indeed, if evoking a suggested response is accessing
unconscious processes and hypnosis is the attendant condition when
evoked unconscious processes dominate, then there is some merit to
this view. For my part, as many of you are aware, I have always held
suggestion to be central to traditional hypnotism. How else could it
be - being the entire modus operandi? By far and large, the study of
hypnotic phenomena has been the study of suggested phenomena, and to
that extent the issue of whether there is or is not a state of hypnosis has been an unfortunate distraction. If we hypnotise, it is
only because we believe, first, that it enhances suggestibility.
Additionally, there are some who believe certain processes and func-

76

A. M. WEITZENHOFFER

tions become more accessible because of the presumed change in state,


i.e., quite apart from increased suggestibility. In any event, the
bulk of the research that has gone on since Bernheim has centered on
the effects of suggestions.
This is not to minimize hypnosis. As an enhancer of suggestibility, it is obviously important for both the study of suggested
effects and the applications of suggestion. Furthermore, a better
understanding of hypnosis may also mean a better understanding of
suggestion. I am inclined to believe that there are a number of
enhancing processes, possibly states, both from theory as well as
practice. Around 1954, when I was exploring topics for my doctoral
dissertation, I collected certain preliminary data which when plotted
appeared as in Figure 2a. There are several ways of looking at these
points. One can assume that a curvilinear relationship, reflecting a
single process at work, is the best fit. One can also assume that a
polygonal line with two discontinuities at A and B is the best fit.
Such a fit is consistent with the presence of three processes activated at different times being associated with the enhancement. (See
Figure 2c). At the time, I opted for this alternative. Unfortunately, the necessary statistical tests for the existence of such discontinuities were not available then. Therefore, I abandoned this
line of investigation and never returned to it. As it happened, I
did not encounter any somnambulists in the de Puysegurian sense in my
pilot study. I am inclined to believe that a different kind of
discontinuity must be considered for such cases possibly leading to
the results seen in Figure 2d. Thus, the discontinuity at C is
somewhat like a quantum jump.
Be that as it may, let me now add that if hypnosis exists as a
state, it is unlikely it can be viewed merely or purely as a "state
of concentration" or a "state of relaxation," these being two rather
popular views of hypnosis.
If it is a state of concentration, what is the nature of this
concentration? Presumably, it is one of attention. This notion goes
back to Braid and perhaps was fairly appropriate to the condition he
provoked. Its appropriateness to the condition induced from Bernheim
onwards is another matter. For modern inductions of hypnosis more
often than not require the subject to shift his attention from one
point of his body to another and from one experience to another.
Furthermore, once hypnosis is presumably induced, the subject can be
asked to expand and shift his attention in a variety of ways in order
to carry out various activities, with hypnosis presumably still
continuing to be present. None of this seems consistent with a
strict monoideism. At best, we can describe hypnosis as involving
selective control of the span and focus of attention.

77

IN SEARCH OF HYPNOSIS

(a)
o

(b)

(c)

>>-'

(d)

'"

Fig. 2.

TIME

The growth of suggestibility.

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

act need not involve such an alteration. Think of the multitude of


reflexes and other automatic learned responses that are constantly
taking place within you during your normal waking condition. Is
there any evidence that you are undergoing alterations in consciousness at such times? I mean solid, objective evidence? Of course
not. I am not against speculating that with hypnosis we are dealing
with some kind of alteration of one or more parameters of consciousness, but speculating is all we can do and we need to recognize this.
Furthermore, if such speculation is to be useful or even meaningful,
it needs to be done more carefully.
While I am on this subject of altered state of awareness, let me
speak briefly of the use of the term "trance" in relationship to
hypnotic phenomena. Except for the fact that it gets away from any
associations with the idea of sleep, I see no other advantages in
using this term as a substitute. Certainly not as long as various
authorities go on making such assertions as "almost everyone goes
into a trance in an elevator," or state that one automatically induces " a series of trances" when getting a personal history from a
patient; or, to top this, assert "one person's normal state may be
another person's. trance!" Not only is there no factual basis for any
of these statements, but they take away all meaning from the term,
hence, its usefulness. "Trance" was once a perfectly good term
which, like "hypnosis," evolved for the purpose of distinguishing
certain behaviors from others. While I will concede that there are
similarities between traditional trances and traditional hypnosis, I
believe that there also are sufficient differences to support a
continued distinction of sorts. A more scientifically tenable position than making the two one and the same would be to view hypnosis
as a potential element of a class of trances, itself to be viewed as
a sub-class of a broader class of so-called altered states of awareness. This is explicated further in Figures 3 and 4. 1 In this
context, one might then specifically speak of a hypnotic trance in
distinction to, say, a "yoga trance." If by nothing else, hypnosis
can be distinguished from other trances on the basis of its dyadic
interactional character.
The next issue I wish to examine with you is that of the socalled "unconscious" in relation to hypnotic phenomena. In 1947,
when I began working actively with hypnotism, it was generally believed that somehow or other hypnosis freed unconscious material or
processes from some of the restraints that kept them in the unconscious. There was little question that we were then speaking of the
Freudian unconscious (or system USC). Hypnotic techniques used to
facilitate the outflow of unconscious material tended to make use of
non-hypnotic conditions known to facilitate unconscious manifestations. Hypnotic techniques were also used to implant behavior
segments which were to function outside of the subject's awareness.

80

A. M. WEITZENHOFFER

This process was generally viewed along the lines of setting up a


complex conditioned-reflex-like response. Attempts at an interactive
communication with the unconscious, in which the latter was treated
like a personality, was not the usual approach. Although earlier
investigators of hypnotic phenomena such as Janet and Grasset had
seen similarities between hypnotism and spontaneously occurring
multiple personalities, I believe the general view in 1947 had moved
away from this position. In fact, multiple personalities had been
artificially produced by hypnotic techniques, and the resulting
entities were not generally viewed as being identifiable with the
system USC of Freud.
As pointed out earlier in this presentation, hypnotism today is
being increasingly viewed and utilized in the context of an interactional communication with an unconscious. For some practitioners,
such as Erickson, getting responses from this kind of mental apparatus is the essence of hypnosis. But what kind of sense is one to
make out of a hypnotist saying to the hypnotized subject, "I want
your unconscious to show ~ which finger it will move to answer 'yes'
to my questions"? To whom is this statement being directed? It
would seem it is to the subject's conscious. However, if we accept
the Ericksonian model much in vogue today, hypnosis, in its most
complete form, is nothing more than full, direct communication with
the subject's unconscious. If so, we are then faced with the hypnotist presumably telling the subject's unconscious to allow its unconscious to do something! But even if we ignore this implication, we
still have to contend with another practice, with its own implications. These same hypnotists will usually go on to ask the subject's unconscious to enter into a dialogue with, say, "that part of
you which is responsible for your overeating." Later, a dialogue may
be set up between the unconscious and the patient's "creative part,"
and even between the two parts just referred to, not to mention other
"parts" that may be brought into the picture. Presumably, these
so-called parts function outside the patient's normal awareness and
hence meet one condition for being considered to belong to the domain
of the unconscious. Does this mean the unconscious is fractionated?
Or are there a number of unconsciouses? If so, is there a hierarchy,
as it seems there might be? If so, how does it all fit into the
concept of hypnosis merely being a condition where the unconscious
takes precedence over the conscious? There are a number of variations of this theme, each confusing more, rather than clearing up the
situation.
It seems clear that we are no longer speaking here of the unconscious in the Freudian sense. I am not sure that we are speaking
of any kind of unconscious. A more appropriate label would seem to
be "co-conscious" or "alternate'conscious" for whatever it is with
which it is being intet'acted. As I have pointed out elsewhere
(Weitzenhoffer, 1960), the behavior of the so-called unconscious (and
now of these various parts) is essentially that of a conscious

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.

Altered states of consciousness.

NATURAL
SOMNAMBULISM

NON-REM
SLEEP

Fig. 4.

REM
SLEEP

ARTIFICIAL
SOMNAMBULISM

Altered states of consciousness (alternative view).

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

(Weitzenhoffer, 1957). A more accurate labelling might be selfinduced heterogenic hypnosis.


The big stumbling block that the concept of self-hypnosis faces
is in the utilization phase of heterohypnosis. In my opinion, the
very nature of heterohypnotic behavior rules out the possibility of a
truly comparable autohypnotic behavior. Let me explicate. There is
no problem regarding the production of limited non-hypnotic selfsuggested action. This possibility is well documented. The problem
centers around the fact that the traditional heterohypnotic state
calls for and seems to elicit what I have referred to as an abdication of volitional control (Weitzenhoffer, 1963). At best, the
subject's volitional participation seems highly circumscribed. Put
another way, if traditional heterohypnotism is viewed as a situation
in which there is a separate director and a separate directee, then a
comparable autohypnosis calls for one person being both a director
and directee, being both active and passive. Any theoretical resolution of this paradox that I can come up with leads to a situation
which cannot be said to be fully comparable with heterohypnosis. As
for the practical end, I do not know of anyone who has successfully
duplicated heterohypnosis at its best with autohypnosis.
Lastly, let me return to the topic of suggestion. Even this
term, so central to hypnotism, has been greatly misused and abused.
It, too, has been used with great linguistic carelessness. So much
so that Grasset (1904) was complaining of its having become essentially meaningless. What, indeed, is a suggestion? Whether verbal or
non-verbal, it can be agreed it is a communication made by one party
to another. But what distinguishes it qua communication as being a
suggestion rather than being, say, a request, a transmission of
information, or even a command? Is it just anything the hypnotist
says to the subject? Hypnotists, even those engaged in research,
seem rarely to have taken time out to consider this question. ,Yet,
obviously it is a very important crucial question for modern hypnotism. The answer ought to make some differences for research as
well as practice.
I think Bernheim made it pretty clear that for him suggestion
was any communication which elicited an automatism, i.e., nonvolitional activity. In my opinion, this view agreed well with that
of his contemporaries, as well as with many of his successors. In
more recent times, this view has again been made more or less explicit by Erickson and some of his students under the guise of suggestion being communications eliciting responses from the subject's
unconscious. Erickson's view, however, does appear to differ from
Bernheim's in an important aspect; namely, the Ericksonian unconscious seems frequently to exhibit a volitional apparatus of its own.
Thus, while the subject's usual volitional apparatus may not be

84

A. M. WEITZENHOFFER

involved, one cannot say the Ericksonian suggestion involves acts


fully devoid of volitional activity. Therefore, they. are not automatisms in quite the sense Bernheim used this term.
Be that as it may, as I have pointed out previously
(Weitzenhoffer 1974), either position implies that a communication
cannot be stated to be a suggestion de facto, but to have been one
only post facto, i.e., after the response has resulted and shown
itself to be non-voluntary. It is, of course, permissible to speak
of a communication as being a suggestion by intent prior to the
occurrence of a response. But this must be clearly understood.
Failure to do so can obviously readily lead to improperly crediting a
subject's suggestibility and hypnotizability. There is more than
this to a proper definition of suggestion. For instance, suggestions
always evoke responses which are an actualization or realization of
their main ideational content. But we need not get into this aspect
at this time.
I hope this discussion had made it clear that much of the speculation behind past conceptual changes relating to hypnosis and
hypnotic phenomena does not meet the criteria for being considered
scientifically acceptable. Where does this leave us? Where do we go
from here?
I believe the time has come to take serious stock of the situation and to realize that we have strayed far and wide in our search
for hypnosis and its magic. We ought to discard all these wild
speculations. As least we ought to stop acting as if they were
facts. If we are able to speculate, we ought to be more-moderate.
We should be especially careful not to build speculations upon ot ..e.:poorly founded speculations such as psychology offers us in abundance. Undoubtedly hypnotism belongs to the domain of psychology. It
might be better, however, if one were to make less effort to fit
hypnotism into the existing body of psychology. In this connection,
we ought to be more careful with regard to the use of vague, poorly
defined psychological concepts and constructs to describe, define, or
explain hypnotism. Above all, I think we need to get back to basics.
Get back to and start allover from certain basic observations.
There is the facts of suggestibility. That is, some individuals
respond to communications in such a way as to allow us to differentiate the latter specifically as suggestions. There is the fact of a
Braid-type or de Puys~gurian-type of hypnosis. That is, certain
well-defined procedures are associated with behavior satisfying
criteria for being labelled hypnotic in that sense. I believe we
would do well to go back to these facts and re-examine them with the
following additionally in mind:

IN SEARCH OF HYPNOSIS
1)
2)
3)
4)

5)

6)
7)

8)
9)

10)
11)

12)

13)

85

Clearly distinguish between communications that are effective


suggestions and those which are intended to be so but are not.
Cease the unfounded practice of assuming that suggestibility is
a measure of a presumed hypnotic depth.
Consider se~iously that hypnosis may be an all-or-none
condition.
Stop the unfounded practice of assuming hypnosis is present
whenever an appropriate response to an intended suggestion is
obtained after an induction of hypnosis procedure has been
completed.
Consider that "hypnotic suggestibility" may appreciably differ
processwise from "non-hypnotic suggestibility." For instance,
the former may be a combination of the latter with added, new
elements promoting a broader kind of influencability.
Be more stringent with regard to what we accept as being
necessary and sufficient behavior to be labelled "hypnotic."
Consider that there is a strong possibility that everyone cannot
be hypnotized in the traditional sense, maybe only a handful.
If so, more often than not we see only evidence of varying
degrees of suggestibility when we think we see varying depths of
hypnosis.
Consider that there is a possibility that not everyone who is
hypnotized knows he is; hence, can give an accurate self-report
of depth, if hypnosis has depth (Weitzenhoffer, 1963).
There may be more to some of the traditional signs of hypnosis
than they have been credited with. These signs include decreased occulomotor activity and blinking (so-called "trance
stare"), lack of spontaneity and initiative, tonic immobility
(disinclination to move), psychomotor retardation, decreased
reactivity, demonstrated hypersuggestibility, and rapport
(selective responsiveness).
The process of inducing and utilizing hypnosis can shape it in
ways which mask some to all of its essential, i.e., intrinsic
characteristic features.
Hypnosis is basically a human experience centered around
communication. It does not follow, however, that there are
special "magic" forms or ways of using communication which
promote hypnotic behavior.
Hypnotic behavior is always induced in the context of a dyadic
relationship which is anything but trivial. Stated another way,
hypnotic phenomena are always defined within a tran~actional or
interpersonal context.
Hypnotic behavior appears to have affective and regressive
elements, as well as elements of compulsivity, or acquiescence
(or compliance), of a childlike belief, which Bernheim
(Weitzenhoffer 1980) called "credivite". These have too often
been ignored.

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.

Maybe if we do these things, 200 years from now there will no


longer be authorities in this field still admitting as they do today
that "We do not know what hypnosis is", or that "The domain of hypnosis is obscure." Maybe our successors will at last be able truly
to speak of scientific hypnotism.
REFERENCES
Bandler, R., and Grinder, J, 1979, Frogs into Princes. Moab, Utah,
Real People Press.
Barrucand, D, 1967, Histoire de l'Hypnose en France, Presses Universitaires de France, Paris.
Braid, J, 1841, Neurypnology, John Churchill, London.
Erickson, M. H., Rossi, E. L., and Rossi, S. I., 1976, Hypnotic realities, in: "The Induction of Clinical Hypnosis and Forms of
IndirectSuggestion," Irvington Publishers, Inc., New York.
Gill, M. M., and Brennan, M., 1959, Hypnosis and Related States,
International University Press, New York.
Grasset, P., 1904, L'hypnotisme et la suggestion, O. Doin, Paris.
Weitzenhoffer, A. M., 1953, Hypnotism: an objective study in suggestibility, John Wiley & Sons, Inc., New York.
Weitzenhoffer, A. M., 1957, General Techniques of Hypnotism, Grune
and Stratton, Inc, New York.
Weitzenhoffer, A. M., 1960, Unconscious or Co-conscious? Am.J.clin.
Hypnosis, 2:177-196.
Weitzenhoffer, A. M., 1963, The nature of hypnosis, part III, Am.J.
clin. Hypnosis , 6:40-72.
---Weitzenhoffer, A. M., 1973, Hypnosis and hypnotherapy, six lectures
on cassettes, Fort Lee, New Jersey, Behavioral Science Tape
Library.
Weitzenhoffer, A. M., 1974, When is an instruction an "instruction?",
.
Int.J.clin.exp.Hypnosis, 22:258-269.
Weitzenhoffer, A. M., 1978a, The physiology of hypnotism. Methodological and conceptual aspects, Svensk Tidskrift for Hypnos,
5:15-20.

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87

Weitzenhoffer, A. M., 1978b, Hypnosis and altered states of


consciousness, in: "Expanding Dimensions of Consciousness," A.
A. Sugarman andlR. E. Tarter, eds., Springer Publications, New
York.
Weitzenhoffer, A. M., 1980, What did he (Bernheim) say? An addendum
and a postscript, Int.J.clin.exp.Hypnosis, 28:252-260.

THE RELEVANCE OF HYPNOTIZABILITY IN CLINICAL BEHAVIOR

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.

to draw attention to the clinical methods in use. some for more


than a century. to test the hypnotic responsiveness of patients;
to describe the importance of the hypnotic situation and to
emphasize the value of hypnotic techniques even in the absence
of recognizable hypnotizability;
to stress the importance of the investigative use of the laboratory scales in the clinical context. in order to examine clinical experience in the light of the laboratory findings; and
to indicate the relevance of the laboratory scales to clinical
events.

CLINICAL ASSESSMENT OF HYPNOTIZABILITY


From the earliest clinical records of the use of hypnosis it is
apparent that experienced clinicians have recognized the difference
in the extent to which individual patients seemed able to respond to
hypnosis. While using the concept of "depth". doctors in the nineteenth century literature did indeed refer to criteria whereby they
believed they could determine whether their patients were in a light
trance. a medium trance. or in an even deeper state of hypnosis.
Inability to open the eyes. catalepsy. degree of response to suggestions. negative hallucinations. and posthypnotic amnesia were some of
the behaviors used to determine the depth of trance. For thirty
years. from the early 1930's to the early 1960's. these criteria were
studied and refined and then incorporated in the laboratory scales
already referred to.

HYPNOTIZABILITY IN CLINICAL BEHAVIOR

91

Contemporary clinicians in the western world use criteria in


their measurement of hypnosis that are not dissimilar. However,
encouraged by the prevailing social customs, the permissive nature of
the therapeutic relationship, and the modern tendency to demystify
hypnosis, they do so in a less structured and more flexible manner.
Sensitive to the need to protect the illusion in hypnosis, they map
out the strategy as they proceed, careful not to present demands or
suggestions that are beyond the capacity of the patient. They
usually avoid creating a sense of failure by conducting their suggestions in terms such as "You will probably feel" or "You might experience", or "I do not know exactly when or how, but you will begin to
notice ". They then wait for signals, verbal or otherwise, that
some change is taking place, or they specifically request the
patients to communicate whether or not they are experiencing the
suggested events, and in what way. "The muscles in your eyelids are
relaxed beyond the point where they will be able to work - you might
test their strength when you are ready, but be sure they are too
relaxed to work before you test them." This statement is followed
by close observation of the eyelids to determine the extent of the
response.
Suggestions for anesthesia or analgesia are offered in a similar
vein, if the purpose of the hypnosis is to relieve pain or discomfort. If the purpose is to aid in the recall of events from a
meaningful period in his past as vividly as he can, the patient is
encouraged to turn his mind toward the past to make contact with any
events that have to do with the situation under examination. His
response under such circumstances is likely to be a valid indicator
of his ability in hypnosis to recall past events. It is probably
more dependable than his response to the request to regress to an
unrelated and emotionally neutral event as part of a standardized
rating scale.
The open-ended suggestion, so often in use in the current clinical context, encourages responses which reflect the individual's
capacity. There can be little question that such responses are
entirely adequate for the purposes of therapy for that particular
patient. Because, however, neither the suggestions nor the responses
are standardized, they can add little to any generalizations that the
therapist might wish to make about the patient population, the symptoms, or the use of hypnosis.
THE ROLE OF HYPNOTIZABILITY VERSUS THE HYPNOTIC SITUATION,
IN CLINICAL PRACTICE
Clinicians by and large have been challenged by the concept of
hypnotizability as it has emerged from the experimental studies and
have tended to turn away from it. This could have been a mixed
blessing, with both benefits and disadvantages. Of benefit because

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

HYPNOTIZABILITY IN CLINICAL BEHAVIOR

93

the placebo effect. By our having no standardized rating of the


hypnotizability of most of those patients, we are denied a full
understanding of the role of hypnosis when compared with the other
therapeutic factors in those cases.
Were even the most unsophisticated literature not constantly
reminding us of the fact that some patients are better at hypnosis
than others, we might wonder whether this idea of different capacities for hypnosis was not just a figment of laboratory investigations. We need, however, to remind ourselves of the fact that
hypnosis originated and developed in the clinical context. Experimentalists who explored the aspect of differing hypnotizabilities
took their cue from conventional clinical wisdom.

EXAMINING CLINICAL EXPERIENCE IN THE LIGHT OF THE


LABORATORY FINDINGS
The most compelling evidence for acknowledging the study of
hypnosis as a serious academic pursuit has accumulated in the reports
of experimental studies. These could not have been conducted had the
hypnotizability scales not been invented. Repeated comparisons
between the behavior of highly hypnotizable subjects has led to a
substantial body of information on the events of hypnosis. For
example, studies like those of imaginative capacity (Hi1gard, 1970)
and personal experiences (Shor et a1., 1962) and how these differ
among individuals of varying hypnotic abilities, have added not only
to our knowledge of hypnosis, but also to our understanding of human
behavior. Furthermore the ways in which highly hypnotizable individuals pay attention in hypnosis or remember nonsense syllables in
hypnosis tells us about hypnosis, about memory, and about paying
attention.
The knowledge about hypnosis in the healthy population studied
in the laboratory is considerable. There are those who argue that
you cannot extrapolate from one context to another - you cannot
conclude that what occurs in the laboratory will necessarily apply in
the clinic. I believe we do not yet have a definite answer to that
challenge and any judgments about the likely correlations are premature and arbitrary. We do, however, have the opportunity to test
hypotheses and to find out what the correlations are. We need to
examine the clinical population in the light of the knowledge already
accumulated in the laboratory, and in order to do this effectively we
should stay with the same y~rdstick. In this way we can determine to
what extent, if any, the findings in the one correlate with those in
the other.
There is clearly a host of clinical events that awaits further
study. For example:

94

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

HYPNOTIZABILITY IN CLINICAL BEHAVIOR

95

hypnotizability of a series of phobic patients by means of the


Stanford Scales and their derivatives. We then compared the results
with the hypnotizability ratings of other patients, namely smokers.
The mean rating among the phobic patients was significantly higher
than the mean among the smokers. Although phobic behavior is an
essentially clinical phenomenon, patients displaying such behavior
achieve scores on the laboratory scales that were significantly
higher than the scores achieved by patients who have other problems.
Gerschman et al. (1979) in a study of patients with dental
phobic illness, reported a significantly higher mean hypnotizability
rating in their group than in the normal population, thus supporting
our findings.
Frischholz et al. (1982) failed to confirm a correlation between
phobic behavior and high hypnotizability. This might be explained
by their use of an entirely different technique to measure hypnotizability.
In our second study (Apfel et al., in preparation) women with
hyperemesis gravidarum tested on the Stanford Scales have shown a
higher mean hypnotizability score than women who do not have this
pathological degree of nausea and vomiting during pregnancy. Here
again the scales have demonstrated their relevance to clinical
events. I believe this all confirms the potential value of the
measurement of hypnotizability in clinical practice. If offers
exciting possibilities.
Some believe that measurement of hypnotizability can help in
planning treatment strategy. Others see the rating scales as providing a useful rehearsal or preparation for patients who then become
familiar with hypnosis before their exposure to the clinical application. While not in disagreement with wither of these views, I
personally see the major value of such measurement in the information
it will yield. It can enrich not only our knowledge of hypnosis, but
also our understanding of the clinical events we try to treat.
Acknowledgement
Aspects of this paper were addressed in a Symposium on "Clinical
Implications of Assessed Hypnotizability" presented at the American
Psychiatric Association Annual Meeting in Toronto, Canada, in May,
1982.
REFERENCES
Apfel, R. J., Kelly, S. F., and Frankel, F. H., (in preparation).
Collison, D. R., 1978, Hypnotherapy in asthmatic patients and the
importance of trance depth, in: "Hypnosis at its

96

F. H. FRANKEL

Bicentennial," F.H. Frankel and H.S. Zamansky, eds Plenum


Press, New York, 261-273.
Frankel, F. H., and Orne, M. T., 1976, Hypnotizability and phobic
behavior, Arch.gen.Psychiat 33:1259-1261.
Frischholz, E. J., Spiegel, D., Spiegel, H., Balma, D. L., and
Markell, C. S., 1982, Differential hypnotic responsivity of
smokers, phobics, and chronic-pain control patients: A failure
to confirm, J.abnorm.Psychol., 91:269-272.
Gerschman, J., Burrows, G. D., Reade, P., and Foenander, G., 1979,
Hypnotizability and the treatment of dental phobic illness,
in: "Hypnosis 1979," G.D. Burrows, D.R. Collison and L.
Dennerstein, eds., Elsevier/North Holland Biomedical Press,
Amsterdam, 33-39.
Hilgard, E. R., 1965, "Hypnotic Susceptibility," Harcourt, Brace and
World, New York.
Hilgard, J. R., 1970, "Personality and Hypnosis: A Study of
Imaginative Involvement," Univer. of Chicago Press, Chicago.
Morgan, A. H., and Hilgard, J. R., 1975, Stanford Hypnotic Scale
(SHCS). in: "Hypnosis in the Relief of Pain," E.R. Hilgard and
J.R. Hilgard, eds., Kaufman, Los Altos, Calif 209-221,
Appendix A.
Nace, E. P., Warwick, A. M., Kelley, R. L and Evans, F. J., 1982,
Hypnotizability and outcome in brief psychotherapy, J.Clin.
Psychiatry, 43:129-133.
Orne, M. T., 1959, The nature of hypnosis: Artifact and essence,
J.abnorm.soc.Psychol., 58:277-299.
Sacerdote. P 1982, A non-statistical dissertation about hypnotizability scales and clinical goals: Comparison with individualized induction and deepening procedures, Int.J.clin.exp.
Hypnosis, 30:354-376.
Shor, R. E Orne. M. T and O'Connell, D. N., 1962, Validation and
cross-validation of a scale of self-reported personal experiences which predicts hypnotizability, J.Psychol 53:55-75.
Spiegel. H., 1978, "Manual for the Hypnotic Induction Profile, (IV
Rev.)," Basic Books, New York.
Weitzenhoffer. A. M., and Hilgard, E. R., 1959, "Stanford Hypnotic
Susceptibility Scale, Forms A and B," Consulting Psychologists
Press, Palo Alto. Calif.
Weitzenhher. A. M., and Hilgard, E. R 1962, Stanford Hypnotic
Susceptibility Scale, Form C," Consulting Psychologists Press,
Palo Alto. Calif.

INTERACTION BETWEEN HYPNOTIST AND SUBJECT:

A SOCIAL

PSYCHOPHYSIOLOGICAL APPROACH (PRELIMINARY REPORT)


Eva I. Banyai. Istvan Meszaros. Laszl6 Cs6kay
Department of Comparative Physiology
Eotvos Lorand University
Muzeum Krt 4/A
Budapest. Hungary
Abstract
There is a vast amount of literature demonstrating that hypnotic
susceptibility is a stable personality trait. In the course of our
practice of teaching beginners to hypnotize. however. it occurred to
us that hypnotists without sufficient previous training frequently
measured a lower level of hypnotic susceptibility than the true
score. It has to be emphasized that hypnosis is a special altered
state of consciousness which develops as a result of an interaction
between a hypnotist and a subject. The failure of beginners to
induce hypnosis could be explained by considering an insufficient
participation of the hypnotist in this interaction.
The purpose of the present study was to analyze the necessary
and sufficient subjective. behavioral and physiological alterations
in both participants of the hypnotic interaction. During successful
and unsuccessful hypnotic inductions the subjective experiences.
behavioral manifestations and physiological indicators including
respiration. ECG. EMG. EOG. GSR and bilateral fronto-occipital EEG
leads. were recorded simultaneously in the hypnotists and the hypnotized subjects.
The results indicate that hypnotic induction is successful if a
mutual "tuning in" of the other person occurs not only on the subjective and behavioral levels. but first of all on the psychophysiological level.

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).

INTERACTION BETWEEN HYPNOTIST AND SUBJECT

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)

eye closure (as part of induction).


hand lowering. left hand (SHSS:A).
arm rigidity. left arm (SHSS:A).
dream: topic unspecified (Revised Stanford Profile Scale of
Hypnotic Susceptibility. Form I; Weitzenhoffer and Hilgard.
1967)
arm immobilization. right arm (SHSS:A).
eye catalepsy (SHSS:A).
dehypnosis and suggestion of posthypnotic amnesia (SHSS:B)
and.
posthypnotic suggestion (Harvard Group Scale of Hypnotic
Susceptibility Form A; Shor and Orne. 1962).

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

Electrophysiological indicators of the hypnotists and subjects


were recorded simultaneously. An 8-channel Beckman Dynograph type
R411 was used for recording vegetative indices: tonic and phasic
changes of skin conductance (recorded from the thenar area vs. the
back of the right hand by chlorided silver cup electrodes), respiration and heart rate. An 8-channel Medicor EEG was used for recording F -0 1 and F 2-02 EEGs according to the international 10-20
system, and for electromyograms (EMG) from the chin of both participants and horizontal eye movements and left biceps-triceps EMG activity of the subject. EEGs and heart rates were simultaneously
recorded on a Philips Ana-Log 7 tape recorder for further computer
analysis. The left and right fronto-occipital EEGs were analyzed by
Berg's method in the range of 0-16 Hertz using an OTE Biomedical
Firenzeltype Fourier-Bert analyzer.
A signal marking time facilitated the later identification of
the sequences of the experiment.
Procedure
A total of 12 hypnotic sessions were conducted: each subject was
hypnotized twice, once by a male, once by a female hypnotist. Each
experimental session began with the fixing of the silver cup electrodes to the appropriate recording places with the use of collodium.
This was followed by a check of the different leads, by the establishment of a rapport between hypnotist and subject, by hypnosis
itself and finally by the interviews. The entire procedure took
approximately 3 hours.
RESULTS
Considering the preliminary character of this report, only those
results are mentioned which, shoWing characteristic differences as a
function of hypnotic depth, seem relevant to our goal of determining
methods which help to detect the important metacommunicative elements
within the hypnotic interaction.
In spite of the identical hypnotizability of the subjects and
the fully standardized verbal communication, the hypnotic interactions showed marked differences from one session to the other
(Figure 1).
On the basis of the number of test suggestions performed positively, the hypnotic sessions could be divided into 3 groups:
- in 4 sessions a mean score of 6 was achieved and cognitive
distortions, changes in body scheme also occurred; i.e. a deep
hypnosis was induced;

INTERACTION BETWEEN HYPNOTIST AND SUBJECT

101

10

Fig. 1.

Differences in hypnotic depth according to objective and


subjective criteria. A: means and SD values of objective
scores. B: means and SD values of subjective depth of
hypnosis. C: means and SD values of the degree of "tuning
in" to each other. D: means and SD values of the
differences in positive and negative comments of the
subjects regarding the hypnotist. Vertically striped
columns: deep hypnosis; Diagonally striped columns: moderate
hypnosis; Empty columns: light hypnosis. Grouping is based
on objective behavioral scores.

- in 3 cases only the 2 easiest test suggestions were carried out


positively, thus the hypnotic depth was moderate.
The subjective depth of hypnosis and the degree of "tuning in"
to each other (i.e. the degree of focussing their attention on the
other person) also showed marked differences correlating with the
objective scores.
Spontaneous comments, concerning the hypnotist, made by the
subjects also reflected these differences in the depth of hypnosis.
While after deep hypnosis the positive comments dominated, after
moderate and light hypnosis the subjects mainly criticized the technique of the hypnotist.
A part of the differences of scores in hypnotic depth and in
"tuning in" to each other can be explained by overt behavioral differences. One of the most important factors seemed to be the hypnotist's turning toward the subject, while maintaining a total visual
focus with the situation, even during the 2-minute silent period of
the dream suggestion. The amount of the loss of eye contact proved

E. 1. BANYAI ET AL.

102
DEEP HYPNOSIS

LI GHT HYPNOS I S

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'JUST REW'

Electromyographic activity during arm rigidity suggestion.


1. Biceps-triceps electromyographic (EMG) activity of a
subject in deep (left side) and in light (right side)
hypnosis. 2. Chin EMB-activity of two different hypnotists
inducing deep (left side) or light (right side) hypnosis.
Texts under the EMG pairs: cue words of test suggestion.
Note that the muscular activity of the subject is higher in
deep hypnosis according to the more intensive chin EMG of
the hypnotist.

to be a valuable index of concentration on the subject necessary to


detect subtle reactions such as closing or opening of the eyes,
horizontal eye movements in the dream situation, changes in relaxation, etc.
These overt behavioral changes were transmitted to the subjects
by covert signs.
The subjects emphasized that their hypnotic state was deepened
if they sensed from his voice that the hypnotist perceived their
actual state. This change of voice was a powerful feedback to the
subjects.
The muscular tension of both the hypnotist and the subject
played an important role in the iateraction. When the subject relaxed during the eye closure period of the induction a marked de-

INTERACTION BETWEEN HYPNOTIST AND SUBJECT


HYPNOTIST
Left Fronto Occipit..

Fig. 3.

Right Fr.a. Occipita'

103
SUBJECT

Left Fronto Occlplhll

Right Fronto Occipital

Power spectra of the left and right hemispheres of hypnotist


and subject when deep hypnosis was induced. Berg's analysis
of fronto-occipital leads in the range of 0-16 Hertz. One
curve: average power of 30 sec's activity. Time of
experiment in minutes: scale going from the bottom to the
top.

crease of the initial tension of the hypnotist was observed, as


reflected in the EMG of the chin and in the muscular artifacts of the
occipital EEG leads. As a result of this the subject had the feeling
that the hypnotist was closely following the changes in his internal
events, even if the hypnotist delayed in giving any verbal feedback
about noticing eye closure.
The increase in muscular tension of the hypnotist's chin - seen
at the administration of the challenge suggestions (Figure 2) which
required an intensive muscular activity from the subject - proved to
be effective in increasing the amount of muscular contractions reflected in the appropriate EMGs of the subject. In cases of seemingly identical positive performances to the challenge suggestions on
the behavioral level, the above-mentioned increased contractions made
the subjects feel different subjective depths of hypnosis.
Characteristic differences were found in the EEG activity reflecting the differences of the hypnotic depth.
As is illustrated in Figure 3 by a typical record, when deep
hypnosis was achieved, a marked dominance of the left hemisphere's
activity could be observed in the power spectra of the right handed
hypnotists, while in the hypnotized persons a right hemispheric
dominance appeared.

104

E. 1. BANYAI ET AL.
Q

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Fig. 4.

DEHYPNOSIS

Relation between lateral difference in total power and


hypnotic depth. (Two sessions of the same subject). Solid
line: deep hypnosis; Broken line: light hypnosis; Lx: mean
total power of left fronto-occipital EEG; RX: mean total
power of right fronto-occipital EEG.

The power spectra of the hypnotized subjects, however, showed a


significantly different pattern, if only light hypnosis could be
induced. As is seen in Figure 4, although a quotient of the total
power of the left and right hemispheric activity demonstrated a right
hemispheric dominance if the subject entered deep hypnosis, it showed
a marked left hemispheric dominance when only a light hypnotic state
could be reached.
The group-averaged changes of alpha and beta powers (see Figure
5) indicate that the lateral difference in hemispheric activation
might be a reliable indicator of the achieved hypnotic depth. While
in deep hypnosis the increment of the alpha power is generally more
pronounced in the right cerebral hemisphere than in the left, in
light hypnosis the change shows an inverse lateralization. The same
lateral difference appears in the changes of beta power: in deep
hypnosis the decrease in the power is less expressed in the right
hemisphere while in light hypnosis the left hemisphere shows practically no change.

INTERACTION BETWEEN HYPNOTIST AND SUBJECT

R L

Hypnosis

fj

Fig. 5.

100

105

R L

After
dehypnosis

R L

R L

Change of power spectra in alpha and beta bands. 100%:


Group-averaged powers in the initial waking period of the
experiment. Dark columns: deep hypnosis; Empty columns:
light hypnosis: R: right side change; L: left side change.

As a result of these changes. as is demonstrated in Figure 6.


the EEG activity of the subjects achieving deep hypnosis is generally
characterized by a right hemispheric dominance. while the activity of
the left hemisphere is more dominant in light hypnosis.

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.

Relation between lateral difference of powers (alpha, beta)


and hypnotic depth. 1: initial waking period; 2: under
hypnosis; 3: after dehypnosis; Dark columns: deep hypnosis;
Empty columns: light hypnosis; LX: group-averaged power of
left fronto-occipital EEG; aX: group-averaged power of right
fronto-occipital EEG.

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

INTERACTION BETWEEN HYPNOTIST AND SUBJECT

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.

Weitzenhoffer, A. M., and Hilgard, E. R., 1959, Stanford hypnotic


susceptibility scale, Forms A and B, Consulting Psychologists
Press, Palo Alto, Calif.
Weitzenhoffer, A. M., and Hilgard, E. R., 1967, Revised Stanford
profile scales of hypnotic susceptibility, Forms I and II.,
Consulting Psychologists Press, Palo Alto, Calif.

NON-VOLITION AND HYPNOSIS. REALS vs. SIMULATORS:


EXPERIENTIAL AND BEHAVIORAL DIFFERENCES IN RESPONSE
TO CONFLICTING SUGGESTIONS DURING HYPNOSIS
S. J. Lynn. M. R. Nash. J. W. Rhue. V. Carlson.
C. Sweeney. D. Frauman and D. Givens
Psychology Department. Ohio University
Athens. Ohio. 45701. USA
Abstract
Susceptible real and low susceptible simulating subjects were
instructed to attend to. imagine. and think about described actions.
but not to engage in movements while hypnotized. Susceptible imagination subjects received identical instructions but no prior induction. Testing occurred in small groups where observers rated movement responses to five motoric suggestions. As predicted. reals
responded behaviorally following their experiential involvement in
suggestions more than did simulators. Simulators moved more at one
extreme or the other (movement or no movement) than reals. as predicted. Reals coded testimony reflected more conflict. sensations.
imaginative involvement, and lack of volition than simulators.
Although the imagination group behaved like simulators. their testimony paralleled the reals. with the exception that more volitional
control was reported. In a second replication of real-simulator
movement differences with a separate group of subjects. even when
simulators were not released from their role plays when subjective
reports were collected, they continued to differ on all subjective
scales with the exception that they appreciated the conflict inherent
in the situation. as did the reals. This second study demonstrated
that real-simulator differences are still evident when simulators
role play.
INTRODUCTION
Hypnosis theorists are in sharp disagreement about the inferences that can be made from subjects' reports that their responses
to suggestions are often experienced as involuntary. Magda Arnold
109

110

S. J LYNN ET AL.

(1946), for example, has emphasized the importance of imaginative


processes in determining the subject's experience of nonvolition.
Sustained uncontradicted imagining of a suggested behavior is posited
to lead automatically to the occurrence of that behavior. Subjects'
reports of nonvolition are viewed as accurate reflections of the
supposed automatic nature of ideomotor action. Hence, only if
subjects interrupt their imaginings are they able easily to resist
suggested behavior. Spanos and his colleagues (e.g., Spanos et al.,
1977: Spanos, 1981) have consistently argued that hypnotizable
subjects, despite their reports of nonvolition, retain control over
their suggested responses. Subjects come to interpret their imaginings as happenings which are a function of such variables as preconceptions concerning hypnosis and expectations of effortless
responding elicited by the wording of hypnotic inductions and test
suggestions. While imaginings may legitimate and reinforce the
interpretation of effortless responding, they are not a direct cause
of actions during hypnosis. Finally, Hilgard (1977) and Kihlstrom et
al., (1980) have advocated the position that hypnotizable subjects
actually do lose conscious control over their behavior because control over movements may be dissociated from normal consciousness
during hypnosis. Reports of nonvolition, then, accurately reflect
the fact that behavior normally under conscious control is no longer
under such control.
The research that I shall describe today summarizes two studies
that were conducted as part of a research programme designed to
generate findings relevant to the major theories of nonvolition. In
the first study, hypnotic, simulating, and imagination control subjects were instructed to attend to, imagine and think about described
actions, but resist engaging in movements. We hypnothesized that
hypnotic subjects will continue to respond to suggestions when faced
with a conflict between resisting suggestions and fully experiencing
the suggestions. This prediction is consistent with each of the
theories of nonvolition. Subjects' responses were categorized on the
basis of the degree of compliance with suggestions. Further, subjects' reports were analyzed to determine whether differences among
groups were evident in the number of sensations experienced (Spanos
et al., 1977) conflict about responding, experienced nonvolition and
imaginative involvement. In the first study, simulators were
released from their role-plays prior to completing their subjective
reports. In the second study, the hypnotic-simulating conditions
were repeated, but simulators continued to role-play while they
reported their experiences. In the second study subjects were asked
not only about how much they moved in response to the suggestions,
but also about how other "good" subjects respond in the experimental
context. In addition, during the susceptibility screening phase of
the second study, subjects completed questionnaires regarding their
experience of hypnosis. This permitted an evaluation of the relationship between subjects' movements in response to countersuggestion and their prior experience of hypnosis.

NON-VOLITION AND HYPNOSIS

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.

deepening instructions were read. The imagining subjects received


the instructions shortly after they were comfortably seated with
their eyes closed. All subjects received the instructions which
follow: "Please listen very carefully. It is important that you
listen very carefully. For each of the following five suggestions,
just listen as carefully and intently as you can, but be sure not to
act on any of the suggestions. So, even if I suggest that you do
something, you will not do it. Just think and imagine along with the
suggestions, but do not actually take any actions or engage in any of
the behaviors that I suggest until I give you instructions to come
out of you hypnotic trance. The important thing for you to remember
is that you can think and imagine along with what I suggest, but do
not actually do anything I suggest to you. O.K., now we will begin
with the first suggestion with you listening and imagining to the
greatest extent you are capable of."
After the instructions were read, raters quietly entered the
room and positioned themselves about three feet in front of a subject
who was sitting with eyes closed. The raters were carefully trained
to record each subject's responses on a scale ranging form no movement, to some movement, to full compliance with the suggestion.
Adequate interrater reliabilities were obtained on this three point
continuous movement dimension. Following the reading of the instructions, the hypnotist read five motoric suggestions (head falling,
hand lowering, arm rigidity, moving hands together, hand levitation).
None of the subjects had prior exposure to the suggestion which
involved hand levitation and balloon imagery.
Following the experimental procedure, subjects were instructed
to write an essay of at least one hundred words, describing their
thoughts, feelings, and actions during the experimental procedure.
Subjects in the second study also indicated how many suggestions they
moved in response to, on a scale which ranged from 0 to 5; they also
completed a corresponding scale which required them to indicate how
many suggestions good hypnotic subjects respond to. These questions
were embedded in a larger questionnaire which tapped the experience
of hypnosis in order to reduce the salience of the key items.
RESULTS AND DISCUSSION
The major analyses are summarized in Table 1. In both studies,
hypnotic subjects moved more than simulating subjects. In Study I,
the hypnotic group moved more than both simulating and imagining
subjects. The finding that hypnotic subjects move more than simulating subjects, provides strong support for the hypotheses that,
when faced with a conflict between experiencing suggestions and
responding behaviorally, hypnotized susceptibles resolve the conflict
by following the hypnotist's suggestions. An inspection of the table
also reveals that hypnotic subjects expressed more sensations, im-

NON-VOLITION AND HYPNOSIS


Table 1.

Means of Behavioral and Subjective Report Data

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"

Note: Newman-Keuls Post Tests


a.
b.
c.
d.
e.

nypnotic> imagining and


hypnotic and imagining>
hypnotic and imagining>
hypnotic and imagining>
hypnotic> imagining and

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

NON-VOLITION AND HYPNOSIS

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.

Hilgard, E. R., 1977, Divided consciousness: Multiple controls in


human thought and action, Wiley, New York.
Hilgard, E. R., 1979 Divided consciousness in hypnosis: The implications of the hidden observer, in: "Hypnosis: Developments in
Research and New Perspectives," (2nd Ed.)., E. Fromm and R.
E. Shor, eds., Aldine, New York.
Kihlstrom, J. F., Evans, F. J., Orne, E. C., and Orne, M. T., 1980,
Attempting to breach posthypnotic amnesia, J.abnorm.Psychol.,
89:603-616.
McConkey, K. M., 1979, Conflict in hypnosis: Reality versus suggestion, in: "Hypnosis, 1979", G. D. Burrows, D. R. Collison, and
L. Dennerstein, eds., Elseiver/North Holland Biomedical Press,
Amsterdam.
Orne, M. T., 1959, The nature of hypnosis: Artifact and essence,
J.abnorm.soc. Psychol., 58:277-299.
Orne, M. T., Sheehan, P. W., and Evans, F. J., 1968, Occurrence of
posthypnotic behavior outside of the experimental setting,
J.Person.soc.Psychol., 9:189-196.
Peters, J. E., 1973, Trance Logic: Artifact or essence in hypnosis,
Unpublished doctoral dissertation, Pennsylvania State
University.
Radtke-Bodorik, H. L., Spanos, N. P., and Haddad, M. C., 1979, The
effects of spoken versus written recall on suggested amnesia
in hypnotic and task-motivated subjects, Amer.J.clin.Hypnosis, 22:8-16.
Sheehan, P. W., 1971, Countering preconceptions about hypnosis: an
objective index of involvement with the hypnotist, J.abnorm.
Psychol., 78:299-322, (Monograph).
Sheehan, P. W., 1977, Incongruity intrance behavior: a defining
property of hypnosis? Annals of the New York Academy of
Sciences, 296:194-207.
Sheehan, P. W., 1980, Factors influencing rapport in hypnosis,
J.abnorm.Psychol., 89:263-281.
Sheehan, P. W., and Dolby, R. M., 1975, Hypnosis and the influence
of most recently perceived events, J.abnorm.Psychol., 84:
331-345.
Sheehan, P. W., and Dolby, R. M., 1979, Motivated involvement in
hypnosis: The illustration of clinical rapport through hypnotic dreams, J.abnorm.Psychol., 88:573-583.
Sheehan, P. W., and Perry, C. W., 1976, Methodologies of hypnosis: A
critical appraisal of contemporary paradigms of hypnosis,
Hillsdale, N. J.: Erlbaum.
Shore, R. E., and Orne, E. C., 1962, The Harvard group scale of
hypnotic susceptibility (Form A), Consulting Psychologists
Press, Palo Alto, Ca.
Spanos, N. P. Hypnotic responding: automatic dissociation of situation-relevant cognizing? in: "Imagery: volume 2, Concepts,
Results, and Applications,"E. Klinger, ed., Plenum Press, New
York.

NON-VOLITION AND HYPNOSIS

ll7

Spanos, N. P., 1982, Hypnotic behavior: A cognitive, social


psychological perspective, Research Communications in Psychology, Psychiatry, and Behavior, 7:199-213.
Spanos, N. P., and Bodorik, H. L., 1977, Suggested amnesia and
disorganized recall in hypnotic and task-motivated subjects,
J.abnorm.Psychol., 86:295-305.
Spanos, N. P., Rivers, S. M., and Ross, S., 1977, Experienced
involuntariness and response to hypnotic suggestions, in:
"Conceptual and Investigative Approaches to Hypnosis and
Hypnotic Phenomena," W.E. Edmonston Jr., ed., Annals of the
New York Academy of Science, 296:208-221.
Weitzenhoffer, A. M., and Hilgard, E. R., 1967, Revised Stanford
profile scales of hypnotic susceptibility (Form 2).
Consulting Psychologists Press, Palo Alto, Ca.

VISUAL MEMORY PROCESSING DURING HYPNOSIS:


DOES IT DIFFER FROM WAKING?
Helen J. Crawford and Steven N. Allen
Department of Psychology
University of Wyoming
Laramie. Wyoming. 82071. USA
Abstract
Cognitive processing differences in waking and hypnotic states
have been suggested by several studies. While previous studies have
examined self-reports of imagery vividness (Coe et al 1980;
Sanders. 1967). this paper presents a series of investigations using
more objective visual memory tasks to investigate the hypothesis that
hypnosis can facilitate imagery processing such that either visual
memory is better encoded or the preferred mode of scanning visual
information is shifted within the highly hypnotizable individual.
Two studies. using low hypnotizables (6 and 10 Ss) and high
hypnotizables (6 and 10). as assessed by the Standford Hypnotic
Susceptibility Scale. Form C. studied visual memory processing in
counterbalanced conditions of waking and hypnosis. Based on the
methodology of Gur and Hilgard (1975). subjects were presented Meier
Art Design (Meier. 1940) pictures successively. such that subjects
viewed one picture for 10 seconds. saw nothing for 10 seconds. and
then were given a second picture with one object changed from the
first. In both studies the lows and highs did not differ in the
waking state, but during hypnosis the highs were able to identify
significantly more often the object difference in the picture than
were the lows. Self reports of visual memory strategy used indicated
that both lows and highs reported a predominant detail memory encoding strategy during the waking state. During hypnosis the lows
continued doing the same strategy, but the highs reported a shift to
a predominant holistic image memory encoding strategy.
A third study, now in progress, investigates the full range of
hypnotizability with conditions of task motivation instructions and
simulating subjects. Similar tasks are being used.
119

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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

VISUAL MEMORY PROCESSING

121

successfully produce eidetic imagery, using the nonfakable Julesz


(1971) seterograms, during the hypnosis state even though they cannot
during the waking state, although Spanos et ale (1979) were unable to
obtain eidetic imagery in their subjects. Since it was only selfreported childhood eidetikers who exhibited eidetic imagery during
hypnosis, and then only a few of them, this research suggests that
hypnosis allows some individuals to access the "lost" ability to
image eidetically, possibly through a shift in cognitive strategies.
Crawford et ale (1981) found no significant differences between
low and high hypnotizables across waking and hypnosis conditions on a
timed spatial memory test. When postexperimental inquiries about
strategies were analyzed, they found that those subjects who reported
a significant shift from a detail-orientated strategy during waking
to a more holistic-orientated strategy during hypnosis showed a
significantly higher spatial memory mean enhancement score than those
who did not report such a shift. Thus, in such research it is important to assess individual differences in self-reported information
processing strategies.
The research we shall report on in this paper is an extension of
previous work by Crawford (1979). She examined waking and hypnotic
performance on a visual memory discrimination task, which had been
developed from the Meier Art Judgement Tests (Meier, 1940) by Gur and
Hilgard (1975). Subjects were shown one of a pair of pictures for 10
seconds. They then closed their eyes for five or 10 seconds. Upon
opening their eyes, they were presented a second picture of the pair
which was changed so that the shade or perspective was different or a
detail was missing, added, or changed. Subjects were instructed to
indicate as quickly and as accurately as possible the change they
saw. Reaction time was not significantly different across low and
high hypnotizables, either in waking or hypnosis counterbalanced
conditions. While lows and highs showed no significant difference in
the number correct during the waking condition, high hypnotizables
showed a significant increase in their mean number correct during
hypnosis while lows showed no change or a significant reduction in
performance. As Berger and Guanitz (1979) have pointed out in the
same task, there were two main strategies reported: (I) a detail
memory encoding strategy, and (2) a holistic imagery strategy. Low
hypnotizables reported maintaining a predominantly detail-orientated
strategy during both waking and hypnosis conditions. Highs reported
a significant shift from a predominantly detail-orientated strategy
during waking, which did not differ significantly from lows, to a
predominantly image-orientated strategy during hypnosis.
In the present study we examined the whole range of hypnotic
responsiveness. So that a "holding back" phenomena would not occur
due to expectations (Zamansky et al., 1964), groups of low, medium
and high hypnotizables were tested in either waking - waking or
waking - hypnosis groups, without their knowing that hypnosis might

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-

VISUAL MEMORY PROCESSING

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.

Visual Memory Mean and Change Scores

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

treatment, there were no significant differences across the three


hypnotic levels. Hypnotic susceptibility did not correlate with
performance level in the waking condition, ~ = .03.
In the hypnosis - hypnosis group, subjects did not differ significantly across the two testing times, ~(9)
1.25.
Influence of Hypnosis on Performance
The mean scores on the visual memory discrimination task was
essentially the same for the high hypnotizables in the waking hypnosis and hypnosis - waking conditions, indicating that there was
no order effect. Thus, the two groups have been combined for further
analyses. Due to the large within group variances [see Hilgard
(1965) for a discussion of within vs. between group comparisons in
hypnosis research], reported analyses are limited to mean change
scores, as presented in Table 1.
An ANOVA of the mean enhancement scores for the hypnotic condition in comparison to the waking condition indicated that there
were significant differences across the low, medium and high hypnotizable levels, K(2, 37) = 9.31, ~<.001. Subsequent Newman-Keuls
mean comparisons ~<.05) indicated that while the mediums did not
differ significantly from either the low or high hypnotizables, the
high hypnotizables showed a hypnosis mean enhancement that was significantly greater than the low hypnotizables.
Paired t-tests indicated that the lows did not differ between
the two conditions, ~(9) = .30. Both the mediums, t(9) = 2.90,

VISUAL MEMORY PROCESSING

125

and the highs, t(19)


6.23, ~<.001, showed significant enhancements in the mean number correct on the visual memory discrimination task during hypnosis in comparison to the waking condition.

~<.02,

The degree of enhancement during hypnosis correlated quite


significantly with SHSS:C hypnotic scores, = .52, ~<.005, ~ = 40.
Thus, we find strong support for our hypothesis that tasks which
may involve imagery in their mediation, here a visual memory task,
show enhanced performance during hypnosis when individuals are moderately to highly responsive to hypnosis. Low hypnotizables actually
showed a slight, although nonsignificant, decrease in overall performance during hypnosis.
Let us now examine the self-reported strategies in hopes of
shedding further light on individual differences in performance
during hypnosis.
Reported Information Processing Strategies
Table 2 summarizes the data for the reported percentage of
holistic information processing strategy used by subjects in the
different groups.
For those groups where the conditions remained the same (waking
- waking and hypnosis - hypnosis), none of the hypnotic levels showed
a significant shift in the estimated percentage of holstic strategy
across the two times.
Let us now turn to the waking - hypnosis groups. The low hypnotizables showed no significant shift between the two conditions.
Both the mediums, ~(9) = 2.64, ~<.05, and the highs, ~(19) = 3.62,
~<.01, showed significant strategy shifts:
they reported significantly more holistic information processing during hypnosis than
during waking. A common theme was "I looked around at all the details in the picture during the waking condition, trying to remember
how many objects there were, where they were located, shading, etc.
During hypnosis, I just looked at the whole picture and I was not as
concerned with numbers and details." Once again, there were no order
effects for the two order presentations within the high hypnotizabIes.
Subjects were categorized into two groups: (1) those who reported no change or a decrease in holistic information processing
during hypnosis in comparison with waking, and (2) those who reported
an increase in holistic strategies during hypnosis. The mean enhancement scores for the hypnosis conditions for subjects in each of
these two categories across the three hypnotic levels are given in
Table 3. Within the low hypnotizables, those subjects who reported

126

H. J. CRAWFORD ET AL.
Table 2.

Mean Percentage of Estimated Holistic Strategy


Means

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

an enhanced holistic strategy during hypnosis showed a trend towards


poorer performance. With the mediums there is no significant difference between the two groups. Within the highs, those subjects who
reported an increase in holistic strategy showed a significantly
higher mean enhancement on the visual memory discrimination task than
did those who reported no change or a decrease in holistic processing
during hypnosis. These relationships are also expressed in the
accompanying biserial correlations.
DISCUSSION
This research indicates that during hypnosis responsive individuals perform significantly better on tasks which seem to require
imagery in their mediation. While hypnotic susceptibility did not
correlate with performance on the visual memory discrimination task
during the waking condition, it did correlate significantly (.52)
with the amount of mean enhancement during hypnosis. Both medium and
high hypnotizables showed a significant enhancement during hypnosis
over their waking performance. but low hypnotizables did not.
To investigate this relationship further we asked subjects to
estimate how much detail vs. holistic information processing strategies they used in the conditions. In the waking condition there was
a significantly positive correlation (r = .34) between the number
correct and the percentage of holistic strategy reported. but this
relationship did not continue during hypnosis.

VISUAL MEMORY PROCESSING


Table 3.

127

Visual Memory Mean Enhancement Scores during Hypnosis:


Relationships to Holistic Strategy Changes
No change or
decrease in
holistic strategy

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

Forty percent of the low hypnotizables, 80% of the mediums, and


80% of the highs reported an increase in holistic strategies during
hypnosis. Among the lows, those who reported an increase tended to
show a decrease in performance, whereas among the highs those who
reported an increase in holistic strategy showed a significant visual
memory increase over those who did not. The mediums showed no differences.
These shifts may be characterized by a shift away from a more
verbal, analytic, detail-orientated strategy during waking to a more
imaginal, non-analytic, holistic-orientated strategy during hypnosis.
Such phenomenological shifts accompanied objective score enhancements
among the high hypnotizables and did the opposite among the low
hypnotizables. In the past we have come across some low hypnotizabIes who show shifts toward more holistic processing during hypnosis
but show dramatic decreases in performance. In discussion they
cannot explain their shifts. Among the highs we find some subjects
who are quite comfortable with the shifts, and sometimes even surprised by them, and a few who try to shift back to a more detailorientated strategy because they are not comfortable with what they
are doing. Expectations cannot explain away the results.

128

H. J. CRAWFORD ET AL.

How hypnosis influences the shift in cognitive strategies is not


known at this time. We feel the decrease in generalized reality
orientation (Shor, 1970) permits more non-analytic processing of
information and enhanced imagery. Whether or not there are underlying physiological changes in brain functioning is now known at this
time and requires further investigation. We do not know if there are
hemispheric dominance shifts. Frumkin et al. (1978) reported a
decrease in left hemisphere activation, as assessed in dichotic
listening, but Crawford et al. (1980) were unable to replicate the
findings. Macleod-Morgan (1979) and Karlin et al. (1981) have reported that highs may be able to shift from right to left hemispheric
tasks more than low hypnotizables. Such research may indicate a
greater flexibility in cognitive processing in high hypnotizables.
The present study does continue to provide support for Hilgard's
(1977) neodissociation theory: during hypnosis, responsive individuals may show shifts in hierarchical control systems with subsequent
changes in cognitive functioning. The results also appear to provide
support for Paivio's (1971) dual-coding theory, which hypothesizes
that there are both visual and verbal coding systems which may be
either separate or may interact with one another in the encoding of
information. While previous research (e.g., Paivio, 1971; Berger and
Gaunitz, 1979; Richardson, 1980) has shown that there are individual
differences in the predominant use of the two encoding systems across
individuals, the present research provides further evidence that
within the same individual and with the same task, the state the
individual is experiencing at the time has an influence upon the
degree to which one or the other of the two encoding systems is being
used.
Our laboratory is continuing research in this area. Hypnosis,
and its interaction with hypnotic susceptibility levels, provides us
with an excellent tool to investigate individual differences in
cognitive styles and cognitive flexibility.
Acknowledgements
This research was supported by a grant from the Spencer
Foundation, Chicago, Illinois, USA, to Helen J. Crawford.
REFERENCES
Berger, G. H., and Gaunitz, S. C. B., 1979, Self-rated imagery and
encoding strategies in visual memory, Br.J.Psychol., 70:21-24.
Bowers, K. S., 1968, Hypnosis and creativity: A preliminary
investigation, Int.J.clin.exp.Hypnosis, 16:38-52.
Coe, W.C., St. Jean, R. L., and Burger, J. M., 1980, Hypnosis and the
enhancement of visual imagery, Int.J.clin.exp.Hypnosis,
28:225-243.

VISUAL MEMORY PROCESSING

129

Crawford, H. J., Can hypnosis enhance visual imagery processing


and memory? Paper presented at national meeting of The Society
for Clinical and Experimental Hypnosis, Denver, Colorado,
October, 1979.
Crawford, H. J., Crawford, K., and Koperski, B., Does hemispheric
lateralization change during hypnosis? Paper presented at
national meeting of The Society for Clinical and Experimental
Hypnosis, Chicago, October, 1980.
Crawford, H. J., Nomura, K., and Slater H., Spatial memory
processing: Enhancement during hypnosis. Paper presented at
national meeting of the American Association for the Study of
Mental Imagery, Yale University, New Haven, Conn., June, 1981.
DiVesta, F. J., Ingersoll, G., and Sunshine, P., 1971, A factor
analysis of imagery tests, J.of Verbal Learning and Verbal
Behavior, 10:471-479.
Fromm, E., Oberlander, M. I., and Gruenewald, D., 1970, Perceptual
and cognitive processes in different states of consciousness:
The waking state and hypnosis, J.of Projective Techniques and
Personality Assessment, 34:375-387.
Frumkin, L. R., Ripley, H. S., and Cox, G. B., 1978, Changes in
cerebral hemispheric lateralization with hypnosis,
Biol.Psychiat., 13:741-750.
Gur, R., and Reyher, J., 1976, The enhancement of creativity via free
imagery and hypnosis, Am.J.clin.Hypnosis, 18:237-249.
Gur, R. C., and Hilgard, E. R., 1975, Visual imagery and the
discrimination of differences between altered pictures simultaneously and successively presented, Br.J.Psychol., 66:341-345.
Hilgard, E. R., 1965, Hypnotic Susceptibility, N.Y., Harcourt, Brace,
and Janovitch.
Hilgard, E. R., 1977, Divided consciousness: Multiple control in
human thought and action, N.Y., John Wiley and Sons.
Julesz, G., 1971, Foundations of cyclopean perception, Chicago, Ill.,
University of Chicago Press.
Karlin, R. A., Goldstein, L., Cohen, A., Morgan, D., and Berman, A.,
Attention, imagination and brain function. Paper presented at
national meeting of the American Association for the Study of
Mental Imagery, Yale University, New Haven, Conn., June 1981.
Levin, L. A., and Harrison, R. H., 1976, Hypnosis and regression in
the service of the ego, Int.J.clin.exp.Hypnosis, 24:400-418.
MacLeod-Morgan, C., 1979, Hypnotic susceptibility, EEG Theta and
Alpha waves, and hemispheric specificity, in: "Hypnosis 1979,"
G. D. Burrows, D. R. Collison, and L. Dennerstein, eds.,
Holland, Ellsevier/North Holland Biomedical Press.
Meier, N. C., 1940, The Meier Art Tests I. Art Judgment, Iowa City,
Iowa, Bureau of Educational Research and Service, University of
Iowa.
Nomura, K., Crawford, H. J., and Slater, H., Eidetic imagery: Can it
be reinstated during hypnotic age regression? Paper presented
at the annual meeting of the Rocky Mountain Psychological
Association, Denver, Colorado, May 1981.

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.

A STUDY ON THE HYPNOTIC SUSCEPTIBILITY OF PERSONS


ATTEMPTING SUICIDE: SOME THERAPEUTIC CONSIDERATIONS
Istvan Boncz, Lajos P. Pallag and Judit Fodor
Department of Neurology and Psychistry
Medical University Szeged
Hungary, 6701 PF. 397
Abstract
Hungary is one of the leading countries in the 1968 international suicide rate listed by the'World Health Organization. Until
now, only the social factors underlying suicides have been studied
rather than psychodynamic factors. As it was reported in one of our
previous works in 40 per cent of attempted suicide cases an example
of suicide could be found in the immediate social environment. It
occurred to us that suicide in the subculture might have a direct
and/or indirect suggestive effect on the personal resolving pattern
of crisis situations. The purpose of the present study was to investigate whether there is a relationship between suggestibility and the
effect of suicide examples in the social environment. In order to
judge the suggestibility of persons attempting suicide hypnotic
susceptibility was measured by standardized scales. The measures of
hypnotic susceptibility were compared in four groups; (1) attempted
suicide with suicide example in the immediate social environment, (2)
attempted suicide without suicide example in the immediate social
environment, (3) no attempted suicide (neurotic patients and normal
students) with suicide example in the immediate social environment
and (4) no attempted suicide without suicide example in the immediate
social environment. The hypnotic susceptibility of group (1) was
higher than average. Our results suggest that high hypnotic susceptibility - as an indicator of strong suggestibility - might mediate
social environmental effects and thus may facilitate the occurrence
of suicide attempts in crisis situations. Due to high hypnotic
susceptibility hypnotherapy seems to be indicated in the after-care
of persons who have attempted suicide.

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-

HYPNOTIC SUSCEPTIBILITY OF PERSONS ATTEMPTING SUICIDE

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!

Average Susceptibility by SHSS:A.

134

1. BONez ET AL.
-

SUICidal oItempts N-37


_. cOl'trol
N-IS
- - Hungaroan standard Nof16

",
100

/sudtnls/

90

80
70
60
50

'0

~'i

30

11,.."

......

.. ..,

20
10
1 2 3 ,

Fig. 2.

',.

S 6 7 6

sUIcidal al\ernpls N=37


NoI78

.. 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.

- !Uicidal alle"1'15 N-37


.... - control
1+-15

p < 0.001
100

30
,0

SHSS:A ~ems

Performance of SHSS:A. items in per cent.

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

Comparison of Frequency Distribution of SHSS:A. items


(x 2 test)

consideration that susceptibility is a stable characteristic feature.


in our opinion these cognitive factors must play an important role in
the process of socialization towards suicide. By this we mean that
in the course of personality development the idea of suicide as the
final solution for human problems might develop due to environmental
effects. It is in this peculiarly changed state of consciousness
(the pre-suicidal syndrome) occurring in hypnotizable people that
effective outside cognitive factors precipitate the idea. result in
the intention and finally the act. In Figure 4 the percentage distribution of those who have suicidal examples in the environment and
those who have not are demonstrated. It can be seen that the two
curves are almost identical.

HYPNOTIC SUSCEPTIBILITY OF PERSONS ATTEMPTING SUICIDE


%

------ with suICidal examples

100

135

N- 15
N- 22

without suicidal examples

90
80

70
60
50
40
30

20
10
1 2 ]

Fig. 4.

I,

5 6

8 910 11 12 SHSS .A ,tems

Performance of SHSS:A, items in per cent.

In our opinion the hypothesis that other effects such as verbal


and non-verbal communication, as well as some immediate example, are
equally important. Suggestions through various channels of massmedia have an equally important, mostly negative effect. It is
generally accepted, that highly hypnotizable people, even when awake,
react well to suggestions (Meszaros, 1978). Thus suggestions of the
mass-media could have a positive effect on them, were they portraying
events which appeared to be hopeless, but which were shown to be
solved in the end. While relating such events it would be important
to mention possible solutions, the help obtainable etc., so that
these could have an equally suggestive effect.
Following the susceptibility-test, hypnotic treatment was used
in the case of 6 of our patients as a part of psychotherapy. Except
for one all of them had attempted suicide previously. Those who
already attempted suicide are considered by many to be in a more
dangerous situation, since in them the motivation and image structure
in connection with suicide is developed and the series of acts has
been carried out. The aim of hypnotic treatment, besides strengthening the ego, was to correct the defective or underdeveloped ways of
behavior. We tried to build up the realistic possibility of a solution in the patients with their active participation in life situations preceding suicide and similar ~ituations - in hypnosis.
In this process, beside using cognitive elements, an important role
was devoted to the application of post-hypnotic suggestions. Further
hypnosis proved to be successful in eliminating numerous secondary
symptoms such as anxiety, fear, insomnia etc. During the subsequent
period of one-to-two years none of these patients attempted suicide
again.

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.

EEG EVOKED POTENTIAL, HYPNOTIC ANOSMIA, AND TRANSIENT OLFACTORY


STIMULATION IN HIGH AND LOW SUSCEPTIBLE SUBJECTS
A. F. Barabasz* and C. Lonsdale**
*Harvard Medical School & Massachusetts General Hospital
16 Blossom St., Boston, Mass. 02114, USA
**University of Canterbury, New Zealand
Abstract
The Stanford Hypnotic Susceptibility Scale Form C (SHSS:C) was
administered to 93 University of Canterbury (New Zealand) students.
High susceptibility Ss (N=4) consisted of those who scored above 10
on the SHSS:C. Low susceptibility Ss (N=5) consisted of those who
scored 0 or 1 on the SHSS:C. Ss were seated in an olfactorium and
exposed to a waking condition and a hypnotic induction condition
which included an eye catalepsy test and a suggestion for anosmia to
all odors. Low susceptibility subjects were instructed to simulate
hypnotic response so that the experienced hypnotist remained blind
with respect to SiS susceptibility status. A strong odor (6.615 mg/L
eugenol), weak odor (4.525 mg/L of eugenol) or no odor (air puff
only) was administered to each subject in random sequence (lsec.
duration each) by PDP 11/10 computer using a continuous flow bypass
olfactometer. Throughout the experiment Ss breathed only by nose.
Respiration was measured by a bellows transducer amplified and
recorded on a Lafayette datagraph. Respiration data was sampled at
10Hz by the PDP 11/10 computer which used inhaling as a pre-condition
for stimulus presentation. EEG data from left and right hemispheres
(temporal and occipital sites) were amplified via a San-Ei
electroencephalograph. Statistical analysis of the P300 (300msec
latency) positive wave demonstrated amplitude increases for weak and
strong odors for high hypnotizable Ss in hypnosis but not for these
Ss in the waking condition. No such amplitude increases were found
for the low hypnotizable simulator subjects in waking or hypnosis
exposure conditions.
This investigation was concerned with the generic problem of
objectifying alterations in the subjective experience which con139

140

A. F. BARABASZ AND C. LONSDALE

stitutes hypnotic responsiveness. Orne (1979) noted that the most


satisfying proof of the reality of hypnosis is to demonstrate abilities of the hypnotized individual that are present only in that
state. If it can be demonstrated that the hypnotized S can do things
that the waking individual cannot, there is little need to worry
about the reality of the phenomena.
Orne (1979) also presented evidence that the search for characteristics of hypnosis that are "intrinsic" is exceedingly difficult.
Experimental demand characteristics (Orne, 1959), e.g. cues in the
procedure which might influence S's performance, might be unwittingly
communicated before or during the hypnotic procedure by the hypnotist. Orne (1971) developed the use of simulating subjects as a
quasi-control group. The procedure aids recognition of aspects of an
S's response, if any, that were due to hypnosis, as opposed to those
that were the result of S's prior knowledge, expectations and experimental demand characteristics.
Hi1gard (1979b) noted that while deep hypnosis may be accepted
as a genuine change in state, we need more research to specify exactly how the state should be characterized. The search for specific
EEG patterns characteristic of hypnosis has not been successful (Beck
and Baro1in, 1965; Tebecis et a1., 1975; U1ett et a1., 1972). However, recent preliminary investigations, focussed on EEG evoked
potentials, have suggested that this more precise form of EEG methodology may be helpful in defining the hypnotic state for highly hypnotizable subjects (Deehan and Robertson, 1980; Javanovic, 1979;
Mesz4ros et a1., 1980; Zakrzewski and Sze1enberger, 1981). Most
notable was the finding of increased amplitudes of the late components of visual evoked potentials (N-250&P300) in hypnosis when contrasted with a waking condition.
EEG evoked potentials have also been recorded in response to
olfactory stimulation (Barabasz and Gregson, 1979). Men who wintered
over in Antarctica showed significant increases in hypnotizability
(Barabasz, 1980). These Ss also demonstrated increased olfactory
evoked potential amplitudes in the late components for suggested
odors following winter over isolation (Barabasz and Gregson, 1979).
Unfortunately, evoked potential scoring was crude and experimental
constraints precluded clear differentiation between waking and hypnosis conditions or comparisons with control subjects.
The investigations noted above suggest that hypnosis might be
uniquely characterized by amplitude increases in the late components
of EEG evoked potentials. To date, however, no investigation of this
type has provided adequate controls for situational variables or
experimental demand characteristics which could account for these
early findings. The purpose of this investigation was to determine
whether or not olfactory evoked potential late component amplitude
responses can be modified by hypnotically induced anosmia, while

HIGH AND LOW SUSCEPTIBLE SUBJECTS

141

controlling for important experimental factors not considered in


previous investigations.
METHOD
Subjects
The Stanford Hypnotic Susceptibility Scale Form C (SHSS:C)
(Weitzenhoffer and Hilgard, 1962) was administered to 93 University
of Canterbury (New Zealand) students. Shor et al., (1962) demonstrated the importance of establishing subjects' plateau susceptibility by repeated hypnosis. Nineteen of the Ss, scoring below 3 or
above 9 on the SHSS:C, agreed to an average of 8 additional hypnosis
sessions conducted by 3 advanced graduate students using a variety of
induction techniques.* These subjects had an opportunity to ask
questions about hypnosis both before and after sessions. Following
the plateau sessions the final sample was drawn after SHSS:C retesting. High susceptibility Ss (N=4) consisted of those Ss who scored
10 or higher. Low susceptibility Ss (N=5) consisted of those who
scored 0 or 1.
Procedure
Low susceptibility subjects served as a quasi-control group and
were asked to simulate hypnosis. Consistent with Orne (1965, 1971,
1979), these Ss were instructed as follows:
"Your task will be to work with Dr. Barabasz and to convince him
that you are an excellent hypnotic subject, and become deeply
hypnotized. Dr. Barabasz will no know that you are simulating
hypnosis but he does know that some of the subjects are faking.
I cannot tell you anything about how a hypnotized individual
might act in this situation. Use your own judgement and do the
best you can. This is a difficult task but we have found subjects like you have been able to carry it out successfully.
Your data are just as important as that from the highly hypnotizable subjects. Your participation is a very important aspect
of the experiment."
As recommended by Orne (1979), high hypnotizable Ss were not
told about the simulator group since it could cast doubt on their own
performances and, thereby, disrupt the concentration required to
reach significant hypnotic depth.
Ss were seated in the olfactorium cubicle. S's chin rested on a
U-shaped padded brace designed to eliminate head movement and to
standardize proximity of S's nose to the olfactometer outlet (approx.
10 cm). All odor and no odor stimuli were presented to Ss in both
waking and hypnosis exposure conditions.

142

A. F. BARABASZ AND C. LONSDALE

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

HIGH AND LOW SUSCEPTIBLE SUBJECTS

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

A. F. BARABASZ AND C. LONSDALE

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

HIGH AND LOW SUSCEPTIBLE SUBJECTS

145

P300 amplitudes in response to weak and strong odors than those


elicited in a waking state. Furthermore, these P300 amplitudes were
higher than those elicited from Ss known to have little or no hypnotic talent under either waking or hypnosis exposure conditions. It
appears that enhanced P300 amplitudes may represent a unique characteristic of the hypnotic state.
Under waking conditions high and low hypnotizables emitted
similar P300 amplitudes. Both groups, however, showed greater amplitudes for the no odor/air puff only versus the weak or strong odor
stimuli. This later finding is also of particular interest when
considered with the low susceptibility Ss' demonstration of higher
P300 amplitudes for the no odor air puff only versus the weak or
strong odor after exposure to the hypnosis conditions. Evoked potential late components may reflect increasingly complex levels of
psychological processing. Perhaps the observed P300 amplitude increases represent a surprise effect. The research in auditory evoked
potentials seems relevant. In studies (Hassett, 1978) where S concentrates on a regularly timed series of tones, omitted tones (averaged from the point where the stimulus should have occurred), elicit
a surprise effect by an increase in P450 wave amplitude. In the
hypnosis condition Ss were told they would be anosmic to all odors.
Ss received air puffs with weak, strong or no odor. Perhaps high
hypnotizables register their surprise at anosmic responding with an
increased amplitude of the P300 while the low hypnotizables, who do
not respond anosmically to the suggestions, are only surprised by the
no odor air puff. These Ss expect to detect an odor after an air
puff. This speculation might be elucidated if additional research
can address the technical problems attendant with the evaluation of
the early components of olfactory evoked potentials.
The finding of no apparent significant difference between electrode placement sites should be viewed with caution because amplitude
measures may have been confounded by overlap (Donchin et al., 1975;
Donchin and Heffley, 1978). Further research considering potential
hemispherical laterality is needed.

* 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

A. F. BARABASZ AND C. LONSDALE

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

HIGH AND LOW SUSCEPTIBLE SUBJECTS

147

real life: The importance of quasi-controls. Paper presented


at the American Psychological Association Convention, Chicago,
September.
Orne, M. T., 1971, The simulation of hypnosis: Why, how and what it
means, Int.J.clin.exp.Hypnosis, 19:183-210.
Orne, M. T., 1979, On the simulating subject as a quasi-control group
in hypnosis research: What, why and how, in: "Hypnosis: Developments in Research and New Perspectives,~ E. Fromm and R.
Shor, eds., Aldine, New York, 519-565.
Ottoson, D., 1971, The electro-olfactogram, in: "Handbook of Sensory
Physiology," Vol. IV: Chemical Senses-r: Olfaction, S. M.
Beidler, ed., Springer, Berlin.
Ough, C. S., and Stone, H., 1961,An olfactometer for rapid and critical measurement, J.food Sci., 26:452-456.
Overall, J. E., and Klett, C. J., 1972, Applied Multivariate Analysis, McGraw Hill, New York.
Sandusky, A., and Parducci, A., 1963, Pleasantness of odor as a
function of the immediate stimulus context, Psychon.Sci.,
3:231.
Shor, R. E., Orne, M. T., and O'Connell, D. N., 1966 Validation and
cross-validation of a scale of self-reported personal experiences which predicts hypnotizability. J.Psychol., 3:80-95.
Tebecis, A. K., Provins, K. A., Franbach, R. W., and Pentany, P.,
1975, Hypnosis and the EEG: A quantitative investigation,
J.nerv.ment.dis., 161:1-17.
Ulett, G. A., Akpinar, S., and Itil, T. M., 1972, Quantitative EEG
analysis during hypnosis, Electroenceph clin. Neurophys.,
33:361-368.
Weitzenhoffer, A. M., and Hilgard, E. R., 1962, Stanford Hypnotic
Susceptibility Scale, Form C. Consulting Psychologists Press,
Palo Alto, California.
Zakrzewski, K., and Szelenberger, W., 1981, Visual evoked potentials
in hypnosis: A longitudinal approach, Int.J.clin.exp.Hypnosis,
29:77-86.

DEPTH EEG RECORDINGS IN EPILEPTIC PATIENTS


DURING HYPNOTIC AND NON-HYPNOTIC STATES
G. De Benedittis and V.A. Sironi
Institute of Neurosurgery, University of Milan
Policlinico, 35, via F. Sforza, 20123
Milano, Italy
Abstract
In the study of epileptic patients medically resistant, who are
potential candidates for surgical treatment, depth EEG recording has
been used for many years for the exact delimitation of the epileptogenic lesion. To our knowledge, hypnosis has never been induced in
epileptic patients during EEG study. This neurosurgical diagnostic
procedure offers a unique opportunity of obtaining fundamental information on the possible neurophysiological mechanisms implied in human
hypnosis.
Observations were carried out on 3 consecutive patients affected
by medically resistant partial seizures with elementary and/or complex symptomatology. Chronic deep electrode study explored rhinencephalic structures as well as specific target areas of the cerebral
cortex.
Background electrical activity during the hypnotic state showed
a significant decrease of slow and increase of alpha and beta rhythm,
with a constant increase of amplitude, as compared with the nonhypnotic state. Focal interictal abnormalities were dramatically
reduced by the hypnotic trance. Moreover depth EEG study during
sleep in one patient indicated that the EEG patterns during hypnosis
and sleep are basically different, confirming that there is no convincing evidence of physiological similarities between the two
states.

149

150

G. DE BENEDITTIS AND V. A. SIRONI

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.

DEPTH EEG RECORDINGS IN EPILEPTIC PATIENTS

151

MATERIAL AND METHOD


Observations were carried out on three consecutive epileptic
patients admitted at the Institute of Neurosurgery of the University
of Milan. Two patients were males and one female. their age ranging
from 21 to 35 years. They all were affected by medically resistant
partial seizures. with elementary and/or complex symptomatology. On
scalp-EEG recording. two cases proved to have a unilateral temporal
focus. whereas one exhibited a right parietal focus.
Neurological examinations and psychic evaluations were normal in
all cases. A comprehensive neuroradiological study (including CTscan) showed normal findings in the two temporal lobe epilepsies.
whereas a focal parietal atrophy was observed at CT-scan in the
patient with right parietal focus.
Chronic DEEG study was carried out in these patients in order to
acquire the most detailed information on the topography of the
lesional-functional epileptogenic complex. in view of surgical treatment. In each patient 8 multilead stainless electrodes were stereotactically implanted using the Talairach's apparatus and technique
(Talairach et al., 1974). Each electrode had two groups of leads:
three deep leads recording the activity of the mesial cortex and of
deep structures (limbic structures and thalamic nuclei) and three
superficial leads recording the activity of convexity cortex (Figure
1)

The following structures were explored: in all cases limbic


structures (amygdala in both sides and Ammon's horn on the side of
the epileptogenic lesion) and anterior. posterior and mesial cortices. In two cases fusiform gyrus, frontal and fronto-orbital
cortices, and the temporo-parietal-occipital junction were electrically recorded. In one case the VL thalamic nucleus, the parietal
cortex and the supplementary motor area were explored. Clinical and
DEEG data are summarized in Figure 2. Antiepileptic therapy was
discontinued three days before the hypnotic sessions.
Experimental Design and Procedure
Hypnotic susceptibility of the Ss was assessed by two observers
using the Barber Suggestibility Scale (Barber and Calverley, 1963) in
order to test hypnotic-like behaviors without prior attempted induction of hypnosis. Two Ss scored 4-5 (medium susceptibility) in this
scale, whereas one patient proved to be highly susceptible to hypnosis (score 7).
All the Ss were hypnotized with a standard induction procedure
using task motivational instructions described by Barber and
Calverley (1963). The experimental protocol involved the following

152

G. DE BENEDITTIS AND V. A. SIRON!

-==~~= A .

~
L

Fig. 1.

PATIENTS

TYPE & FREQUENCY


OF

N.

35y - F

Depth EEG-Explored Structures

DEPTH

EEG

FOCUS

SEIZURES

Psychomotor &

Left Temporal Focus

Secondarily General. with rare controla15-20 weekly

EXPLORED

STRUCTURES

Right

Left

A.

teral inter ictal

T 1
F .0.

2ly - M

Psychomotor &

Right Temporal Focu s

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.

Clinical and DEEG Data

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.

DEPTH EEG RECORDINGS IN EPILEPTIC PATIENTS

IS3

For purposes of data analysis, background electrical activity


and focal interictal abnormalities of each explored structure were
hand-scored. Two methods of scoring were used: (1) the number of
seconds/minute of alpha (8-12 Hz), theta (4-8 Hz), delta (0-4 Hz) and
beta (12-30 Hz) was tabulated for each S-minute period. (2) the
number of spikes/minute (%) was scored during IS-five minute segments
by hand counting numbers of spikes per minute (three periods for each
condition).
Physiological responses were monitored continuously throughout
each session. The following parameters were taken into consideration: a) heart rate (beats per minute); b) respiratory rate
(breaths per minute); c) mean blood pressure.
The patients' eyes were closed during all recording periods.
Resting - Baseline. Patients were allowed a IS-minute resting
recording in order to adapt to the laboratory. The Ss were asked to
relax in the normal waking state.
Waking suggestions - Imagination instructions. During a ISminute test of mental imagery, 5s were told: "the better you can
imagine and the harder you try, the more you'll respond; try as hard
as you can to concentrate and to imagine the things I tell you."
(Barber and Glass, 1962).
Hypnosis. The hypnotic procedure involved the following: a)
elicit cooperation; b) progressive relaxation; c) dissociation; d)
amnesia; e) arousal.
Post-Hypnosis. The trance was terminated by telling the S that
he/she would be waking up shortly and that he/she would be wide awake
and alert after hypnotic trance. The S was also told to keep his/her
eyes open for S minutes and become fully alert. He/she was then
asked to close his/her eyes, but to remain awake and alert. After
his/her eyes had been closed for S minutes, a IS-minute recording was
taken to provide the post-treatment waking baseline.
RESULTS
Background electrical activity
Background electrical activity (BA) during baseline and imagination instructions periods was characterized by a rare alpha activity
with slow theta waves on the temporal cortices and limbic structures.
During the trance period a decrease of slow activity was observed, concomitant with an increase of alpha waves. The predominance of alpha rhythm was accompanied by a constant increase in amp li-

154

G. DE BENEDITTIS AND V. A. SIRONI

tude, particularly on the frontal and the temporal cortex. Moreover


a relatively high frequency beta activity (i.e. 14-16 Hz, the socalled sensorimotor rhythm, SMR) was observed.
During the post-hypnotic period BA was similar to that recorded
in pre-trance periods.
Data reductions are shown in Figure 3.
Interictal activity
Focal interictal activity (IA) changes during hypnosis are shown
in Figure 4.
Statistically significant reductions (p<.001) of focal IA were
observed during trance period as compared with non-hypnotic states.
Physiological responses (heart and respiratory rate, mean blood
pressure) indicated that hypnotized Ss exhibited significantly decreased rates during trance as compared to pre and post-induction
levels.
Sleep DEEG and Hypnosis
During sleep, DEEG activity was basically different from that
recorded during hypnosis. BA was characterized by typical modifications of sleep stages, whereas IA increased significantly and
constantly (Figure 5).
DISCUSSION AND CONCLUSIONS
Although "hypnosis is at the crossroads for all levels of
physiological and psychological organization" (Kubie, 1961), very
little is known of neurophysiological and neuropsychological correlates underlying hypnotic behavior.
With regard to EEG, despite intensive investigations in the
past, contradictory results have been reported concerning scalp-EEG
alterations during the hypnotic trance (Evans, 1979). This is not
surprising, since hypnosis is likely to be "both a state and an
operation, by which an individual can change his perception of his
own control of internal and external responses or his attributional
system The state characteristics are partially defined by the
EEG. With more specificity the EEG could come a refined criterion .
variable." (Engstrom, 1976).
The introduction of DEEG has added more specificity to EEG
studies, representing a real breakthrough in the understanding of
neurophysiological events of the trance experience.

DEPTH EEG RECORDINGS IN EPILEPTIC PATIENTS


WAKING
SUGGESTION

%':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

Depth EEG-Background Activity

WAKING
POST
RESTING
SUGGESTION
HYPNOSIS
HYPNOSIS
5'
10' '5' 0 '
5'
'0' '5' 0 '
5'
10'
15' 0 '
5'
'0'
'5'

_-'-_"----'1

1 . - '_ - ' - _ " - - - - "

1.-1_

,.
,.. ..

=100 -----_ ... - ... -

;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

Interictal Depth EEG Activity

30

MIN.

CASE" I

156

G. DE BENEDITTIS AND V. A. SIRONI


SLEEP

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~-------------------------------------------

~:~~, '~t;; =::::- ---:::= ---------------

~---------:===

R-

'0 SO

RHINEN _
CEPHALON

loot
50

----

o ----------- - ----- - ---- -----~-----------

Fig. 5.

__
MESIAL
------------ POSTERIOR

: : : - - - - - ANTERIOR
-~------- INFERIOR

_
AMMON HORN
------------ AMIGOALA

Depth EEG-Sleep Interictal Activity

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

DEPTH EEG RECORDINGS IN EPILEPTIC PATIENTS

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

G. DE BENEDITTIS AND V. A. SIRONI

(3) electrophysiological correlates of hypnotic behavior emphasize


the crucial role of the limbic system in mediating the trance
experience.
(4) hypnosis is effective in reducing focal interictal abnormalities
in epileptic patients and can be considered a promising potential in preventing and/or reducing seizure activity.
We agree that "a complete theory of hypnosis would deal also
with the understanding of events in the brain and nervous system."
(Hilgard, 1970), although further research is needed in these areas.
REFERENCES
Arnold, M.B., 1959, Brain functions in hypnosis, Int.J.clin.exp.
Hypnosis, 7:109-119.
Bancaud, J. and Talairach, J., 1965, La stereo-electroencephalographie dans l'epilepsie. Paris, Masson et Cie.
Barber, T.X. and Calverley, D.S., 1963, "Hypnotic-like" suggestibility in children and adults, J.abn.soc.Psychol.,
66:589-597.
Barber, T.X. and Glass, L.B., 1962, Significant factors in hypnotic
behavior, J.abn.soc.Psychol., 64:222-228.
Crasilneck, H.B., McCranie, E.J. and Jenkins, M.T., 1956, Special
indications for hypnosis as a method of anesthesia, JAMA,
162:1606-1608.
Engstrom, D.R., 1976, Hypnotic susceptibility, EEG-alpha and selfregulation, in: "Consciousness and Self-regulation. Advances
in Research"~G.E. Schwartz and D. Shapiro, eds., Vo1.1,
173-221, London, Wiley.
Evans, F.J., 1972, Hypnosis and sleep: techniques for exploring
cognitive activity during sleep, in: "Hypnosis: research
developments and perspectives", E-.-Fromm and R. E. Shor, eds.,
43-83, Chicago, Aldine.
Evans, F.J., 1979, Hypnosis and sleep: techniques for exploring
cognitive activity during sleep, in: "Hypnosis: developments
in research and new perspectives"-.-2nd ed., E. Fromm and R.E.
Shor, eds., 139-183, Chicago, Aldine.
Goldie, L., 1967, Psychosomatic relations in hypnosis and epilepsy,
in: "Hypnosis and Psychosomatic Medicine", J. Lassner, ed.,
105-125, Berlin-Heidelberg, Springer-Verlag.
Hilgard, J.R., 1970, Personality and hypnosis: a study of imaginative
involvement, Chicago, University of Chicago Press.
Jasper, H.H. and Shagass, C., 1941, Conditioning the occipital alpha
rhythm in man, J.exp.Psychol., 28:373-388.
Kamiya, J., 1968, Conscious control of brain waves. Psychology Today,
Apri1. 57-50.
Kamiya, J., 1969, Operant control of the EEG alpha rhythm and some of
its reported effects on consciousness, in "Altered states of
consciousness: a book of readings", C. Tart, ed., 509-517, New
York, Wiley.

DEPTH EEG RECORDINGS IN EPILEPTIC PATIENTS

159

Kubie, L.S., 1961, Hypnotism: a focus for psychophysiological and


psychoanalytical investigations, Arch.gen.Psychiat., 4:40-54.
McCabe, W.S. and Habovick, J.A., 1963, Thorazine as an epileptogenic
agent. Am.J.Psychiat., 120:595-596.
Miller, N.E., 1969, Learning of visceral and glandular responses,
Science, 163:434-445.
Olton, D.S. and Noonberg, A.R., 1980, Biofeedback. Clinical applications in behavioral medicine, New York, Prentice-Hall,
Englewood Cliffs, 252-283.
Schwab, R.S. and Young, R.R., 1973, Electroencephalography, in:
"Neurological Surgery", Vo1.1, J. R. Youmans, ed., Philadelphia, W.B. Saunders Co., 334-357.
Sterman, M.B., 1973, Neurophysiologic and clinical studies of
sensorimotor EEG biofeedback training: some effects on epilepsy, in: "Biofeedback: behavioral medicine", L. Birk, ed.,
New York, Grune and Stratton, 147-165.
Sterman, M.B., 1977, Effects of sensorimotor EEG feedback training on
sleep and clinical manifestations of epilepsy, in:
"Biofeedback and Behavior", J. Beatty and H. Legewie, eds.,
New York, Plenum Publ. Corp., 167-200.
Talairach, J., Bancaud, J., Szikla, G., Bonis, A., Geier, S. and
Vedrenne, C., 1974, Approche nouvelle de la neurochirurgie de
l'~pilepsie. M~thode st~r~otaxique et r~sultats th~ra
peutiques, Neurochirurgie, 20,suppl.1:1-240.
Ulett, G.A., Akpinar, S., and Itil, T.M., 1972, Quantitative EEG
analysis during hypnosis, Electroenceph.clin.Neurophysiol.,
33:361-368.

EVOKED POTENTIAL CORRELATES OF VERBAL


VERSUS IMAGERY CODING IN HYPNOSIS
Istvan

M~szaros.

Eva I. Banyai and Anna C. Greguss

Department of Comparative Physiology


Eotvos Lorand University
Budapest. Hungary
Abstract
In our previous works it has been demonstrated that late components of midline evoked potentials recorded in the associative cortical areas do reflect significant modifications of selective attention
caused by hypnosis. More and more data can be found in the literature indicating that subdominant hemispheric functions - significant
in imagery coding - are more expressed in hypnosis as compared to the
waking state.
The purpose of the present experiment was to study how the motor
reactions and the bilaterially recorded evoked potentials reflect the
hypnotic modifications in processing visually exposed verbal vs.
imagery commands. A warning tone signal was followed by a tachistoscopically exposed verbal or imagery command to push a button either
by the right or the left hand. according to the content of the command. Correct and incorrect responses and their reaction time were
recorded together with the registration of EEG. EMG. ECG. EOG and
evoked potentials in frontal. central and occipital right and left
monopolar leads. The alterations of the motor responses and of the
negative evoked potential peak appearing with 120 ms latency and of
the positive peaks with 200 and 300 ms latencies showed characteristic differences as functions of verbal vs. imagery task (i.e.
dominant vs. sub dominant hemispheric processing) as a result of
hypnosis.
INTRODUCTION
In the past 15 years interest has become increasingly focused on
the hemispheric specialization of functions. It is generally ac161

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.

EVOKED POTENTIAL CORRELATES

163

<:@~
c

Fig. 1.

The tachistoscopically presented stimuli. a and b:


unambiguous stimuli; c and d: ambiguous stimuli; jobb: right
(in Hungarian); bal: left (in Hungarian); angle of
presentation: 22.

To compare the performances under hypnosis and in the waking


state the subjects constituting their own control group, were presented the stimuli twice in each session: to half of them first
under hypnosis, then in the waking state, to the other half in a
reversed order. Hypnosis was induced by individual induction procedures with deepening instructions sufficient to reach very deep
hypnosis. The depth of hypnosis was checked by asking the subjects
to determine their actual score on a 10 point subjective scale with 0
as the waking state and 10 as the deepest possible hypnosis for them.
The stimuli were presented after the subjects had reached a score of
at least 8. Immediately following the 15 min period of stimulus
presentation under hypnosis the depth of hypnosis was retested. The
waking part of the session was introduced by a musical selection of
12 min duration.
Prior to the stimulus presentation the subjects were given the
following instructions: "Respond to the command by pressing the
button you feel necessary. Choose one of them."
The subjects were shown a command containing a contradiction
between the meaning of the triangle and that of the word in it (see c
and d in Figure 1) exclusively in the experimental series itself.
Recording
The reaction times were calculated and averaged separately by a
computer for the responses of the two hands as a function of the four
different visual stimuli resulting in a total of 8 categories. For
the recording of evoked potentials, chlorided silver cup electrodes
fixed by collodium were applied according to the international 10-20
system. FP1, FP2, C3, C4, 01 and 02 served as active electrodes in
monopolar leads with reference to the earlobes. The evoked poten-

164

1. MESZAROS ET AL.

tials were grouped and averaged off-line by a computer according to


the above-mentioned 8 categories omitting responses containing blinking or muscular artifacts. The evoked potential peaks were determined visually. The amplitude and latency data were calculated
automatically by the computer.
RESULTS

The subjective experiences of the subjects differed markedly in


the hypnotic and waking parts of the sessions. While in the waking
state they considered the 15 min period of stimulus presentation to
be trying, whereas under hypnosis they felt comfortable and sat
still. During the stimulus presentation the depth of hypnosis decreased by 0-3 points on the subjective scales of the subjects.
The triangle as a command seemed to be dominant to the subjects
in the waking state, and became even more so in hypnosis.
The behavioral reactions showed no difference in the cases of
unambiguous stimuli: the subjects reacted correctly in 92.6% of the
cases in the waking state and in 94.1% of the cases under hypnosis.
In accordance with the subjective reports the increased dominance of
the triangle as a command under hypnosis was reflected in the reactions to the ambiguous stimuli: in the waking state 53.5% of the
reactions were in response to the triangle and 43.5% to the words,
while the respective data under hypnosis were 69.3% and 28.8% (x 2 ; p
<0.001). This tendency was independent of the responding hand, as is
illustrated in Figure 2, the subjects responded to the triangle with
significantly higher probability under hypnosis regardless of the
hand used (x 2 ; p <0.01).
The reaction time data are illustrated in Figure 3. In accordance with the complex nature of the task the average reaction time to
the unambigous stimuli was around 500 msec, independent of the state
of the subjects. In the case of ambiguous stimuli this reaction time
was practically the same if the subjects responded to the triangle,
but it increased if they responded to the word under hypnosis. While
in the waking state there was no difference between the reaction
times to the word and the triangle, in hypnosis a significant difference (p <0.05, by Mann-Whitney U test) occurred independent of the
hand used. The reaction time in responding to the triangle was
shortened, in responding to the word this was lengthened (see Figure
4)

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

EVOKED POTENTIAL CORRELATES

165

0,6

0 ,4

0,2

~ ~ [3> ~

stimulus

response ",-

'0

"oro 'r angle triangl

' w"th right left

Fig. 2.

right

word
left

hand

Probability of responding to the ambiguous stimili with left


and right hand. Empty column: waking state; striped column:
hypnotic state.

sec

response

word

r' gni

Fig. 3.

Averaged reaction time.


column: hypnotic state.

~rianqle

Ie t

triangle
right

word
Ie

hand

Empty column: waking state; striped

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

Interaction between state and response-evoking


stimulus-component in cases of ambiguous stimuli. Solid
line: response to the triangle; broken line: response to the
word.

msec latency (P120-N200) decreased when the subjects responded to the


triangle and increased when the subjects responded to the word, in
comparison with the amplitude of this component when unambiguous
stimuli were presented (p <0.05, by Mann-Whitney U test). In the
corresponding N120-P200 amplitude of the left frontal associative
area a tendency to increase occurred, but only in response to the
word and only in the waking state (see Figure 6).
DISCUSSION
The subjective, behavioral, reaction time and evoked potential
data show that the significance of a drawing as a command (triangle)
is greater than that of a verbal command (word) to our highly susceptible subjects. This greater importance of the imagery information becomes even more pronounced in hypnosis. When contradictory
stimuli are presented this is manifested in:
1) the subjective dominance of the triangle,

2) more frequent responses to the triangle,

3) an increased reaction time to the verbal command,


4) an increase in the amplitude of the evoked potentials over the
visual (occipital) cortical area when the subjects respond to
the verbal part of the ambiguous stimuli and its decrease when
they respond to the triangle. As is generally interpreted in
the literature, the greater amplitude of the late components of
the evoked potentials reflect an enhanced attention to the task
(Tecce, 1970; Picton and Hillyard, 1974; Naatanen and Mitchie,
1979). Similarly, the increased reaction time to the verbal

EVOKED POTENTIAL CORRELATES

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

Peak-to-peak evoked potential amplitudes of P120-N200 (group


average) in monopolar 01 lead. Empty column: waking state;
striped column: hypnotic state.

10
B

s imulu

to
response '
' w' h

Fig. 6.

w~rd

,i9',1

+rlangle
left

triangle
ri ht

word
lelt

hand

Peak-to-peak evoked potential amplitudes of N120-P200 (group


average) in monopolar Fpl lead. Empty column: waking state;
striped column: hypnotic state.

168

I. MESZAROS ET AL.

command suggests that for a highly susceptible person, greater


attention is needed to carry out a verbal command that is processed in the left cerebral hemisphere.
Since it is the right cerebral hemisphere that plays the key
role in imagery processing, these results demonstrate that in a
situation where a choice is given, highly susceptible subjects process information more readily with their right hemisphere. This is
in accordance with the results of research using conjugate lateral
eye movements as indicators of right cerebral dominance of highly
hypnotizables (Baker, 1969; Gur and Gur, 1974).
Beyond this correlation between hypnotizability and the readiness to activate the right cerebral hemisphere, our data support the
hypothesis that hypnosis accentuates the preference for right hemisphere use.
REFERENCES
Bakan, P., 1969, Hypnotizability, laterality of eye movements, and
functional brain asymmetry, Percept.Mot.Skills, 28:927-932.
Gazzaniga, M.S. and LeDoux, J.E., 1978, The integrated mind, Plenum
Press, New York.
Gur, R.C. and Gur, R.E., 1974, Handedness, sex, and eyedness as
moderating variables in the relation between hypnotic susceptibility and functional brain asymmetry, J.abnorm. Psychol.,
83:635-643.
Gur. R.E. and Reyher, J., 1973, Relationship between style of
hypnotic induction and direction of lateral eye movement,
J.abnorm.Psychol., 82:499-505.
Moscovitch, M., 1979, Information processing and the cerebral
hemispheres, in: "Handbook of Behavioral Neurobiology," Vo1.2.
Neuropsychology, M.S. Gazzaniga, ed., Plenum Press, New York,
379-446.
N~~t~nen, R. and Michie, P.T., 1979, Different variations of
endogenous negative brain potentials in performance situation:
A review and classification, in: "Human Evoked Potentials," D.
Lehman and E. Callaway, eds.,:Plenum Press, New York, 251-267.
Picton, T.W. and Hillyard, S.A., 1974, Human auditory evoked
potentials, II. the effects of attention, Electroenceph.clin.
Neurophysiol, 36:191-199.
Sperry, R.W., 1974, Lateral specialization in the surgically
separated hemispheres, in: "The Neurosciences: Third Study
Program," F.O. Schmitt and F.G. Worden, eds., The MIT Press,
Cambridge, Mass., 5-19.
Tecce, J.J., 1970, Attention and evoked potentials in man, in:
"Attention: Contemporary Theory and Analysis," D. I. Mostofsky,
ed., Appleton-Century-Crofts, New York, 331-365.

HEMISPHERIC SPECIFICITY AND HYPNOTIZABILITY:


AN OVERVIEW OF ONGOING EEG RESEARCH IN SOUTH AUSTRALIA
C. Macleod-Morgan
Department of Psychology
University of Wyoming
Laramie, Wyoming 82071, USA
Abstract
At the 1979 I.S.H. Conference in Melbourne, it was reported
(MacLeod-Morgan, 1979) that highly hypnotizable subjects show more
specific lateralization during right and left hemisphere tasks than
do low hypnotizables, using the change in alpha ratio when changing
task, as the measure of specificity.
The present paper is a resume of subsequent work, and included
reports on:(a) replication of the 1979 study;
(b) four experiments showing that the specific lateralization of
high hypnotizables does not appear to be disrupted by the
presence of conflicting information during task performance;
and
(c) evidence (also using the hemispheric specificity paradigm)
for regarding hypnosis as a right-hemisphere "task".
The latter is discussed in relation to other theories of hypnosis.

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

hypnotizable subjects (HIs) with low hypnotizables (LOs). rather than


presenting any data as correlations using the complete range of
hypnotizability scores.
Definition of Hemispheric Specificity
Before I begin I also wish to make clear what I mean by my term
"hemispheric specificity". This explanation will seem simplistic to
those who are familiar with EEG experimentation. Broadly speaking. I
use as my raw data EEG alpha waves (8-13 Hz). These might be described as the waves produced by an alert brain in neutral gear. If
one records alpha at a certain scalp location during a resting
period. and then during a task, a drop in the alpha level can be
grossly interpreted as meaning that the brain cells in that region
have been activated by the task. In other words, activation of a
particular cerebral area is accompanied by a decrease in the amount
of alpha produced there.
Taking this a step further, it is possible to compute a gross
measure of which hemisphere of the brain is more active at any particular time, by recording alpha levels on both sides of the head,
and then calculating the ratio between them. In the resting alert
state. most individuals have more alpha in the right hemisphere than
in the left, so the alpha ratio is calculated by the formula:
Right Hemisphere Alpha - Left Hemisphere Alpha
Right hemisphere alpha + Left hemisphere alpha
The more positive the ratio is, the more left-hemisphere bias
the subject is showing (bearing in mind that alpha drops with activation); and so of course, the more negative the ratio, the more
right-hemisphere bias.
However. the resting alpha ratio is fairly idiosyncratic; so I
have evolved a measure called "hemispheric specificity" (HS) which
measures the difference or change in alpha ratio when the task that
the subject is performing changes.
The formula for a subject's hemispheric specificity value is:
R- L
R+L

HS
where

R
L
LH task

=
=
=

RH task ..

(LH task)

R- L
R+L

(RH task)

Right Hemisphere Alpha


Left Hemisphere Alpha
Task empirically found to activate the left
hemisphere preferentially
Task empirically found to activate the right
hemisphere preferentially

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

Histograms showing hemispheric specificity (a) for high and


low hypnotizable groups (b) from four samples.
spec1. f
( a ) Hemi sp h
er1C
1C1ty = R-L
R+L - R-L
R+L
(L: Hem. tasks; R: Hem. tasks)
(b) Differences between high and low groups are all
significant at least at .05 level.

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).

hemisphere. Crawford (1982) has shown that in hypnosis. HIs prefer


to use a Gestalt (right-hemisphere) strategy in preference to a
left-hemisphere one. when both are possible.
I have recorded the EEG alpha of 88 subjects (41 HIs. 47 LOs)
over the last four years or so during resting. eyes-closed baseline
and during the administration of individual hypnotizability testing
with the Stanford C scale. Figure 4 shows that HIs move sharply in a
negative direction when going from baseline to hypnosis (i.e from a
left-hemisphere bias towards a right-hemisphere bias). LOs show no
consistent pattern. As before. hemispheric specificity (in this case
the difference between alpha ratio during baseline. and alpha ratio
during hypnosis) is significantly greater for HIs than for LOs (t
(86) = 2.77. p<.004).
Figure 4 also shows the alpha ratio for each group during the
dream sequence within the SHSS:c. For this right-hemisphere "task-

HEMISPHERIC SPECIFICITY
Low HYPNOT I ZABlES
(N = 47l

177
HIGH HYPNOTl ZABlES
(N = Ill)

15

10

...

co
>-

'"~

...

~
~

...
0

-5

...J

"'"
Fig. 4.

Alpha Ratios* of high and low hypnotizable groups during (B)


Eyes-closed resting baseline, (H) Hypnosis and (D) Dream
within hypnosis.
*NOTE: The more positive the alpha ratio, the more left
hemisphere bias being shown, and vice versa.

within-a-task" it can be seen that the right hemisphere bias of both


groups increases.
DISCUSSION
If hypnosis is indeed a right-hemisphere task, as these results
seem to suggest, then the suggestibility which subjects are liable to
demonstrate, as well as the illogical "trance logic" to which they
are prone (Orne, 1959) become intuitively understandable, since it is
reasonable to assume that the usual reality-testing and 10gica1sequential processing of the left hemisphere are somewhat in abeyance. Hypnotic amnesia is also understandable, since the right
hemisphere does not speak in many subjects, making it difficult to
report available memories until the subject returns to 1efthemisphere mode. Since the good hypnotic subject physiologically
seems to be capable of disregarding conflicting information, as well
as showing task-specific activation, then pain control with hypnotic
analgesia can be explained by this model - the task offered to the
subject asks him to ignore the pain. In Hilgard's (1979) "hidden
observer" phenomenon, where highly hypnotizable subjects disregard
pain until asked to report the "real" state of affairs, the hypnotic
task changes from "disregard pain as conflicting information" to

178

C. MACLEOD-MORGAN

"report on pain". It would not be difficult to investigate whether


EEG alpha changes parallel the apparant change in task demands.
Hypnosis theorists who reject the notion of a special state can
be reconciled with those who embrace the concept of trance. The
highly hypnotizable subject makes task-specific shifts in lateralization. as we have seen. but he is also prone to hypnotic-like
experiences in his everyday life (Shor. 1960; As et al 1968).
Therefore. the lateralization in hypnosis can be c~nceptualized as
merely a particular use of a technique he uses in his everyday experience - perhaps a "special" state, but not a state unique to formal
hypnosis.
Shore (1962) has referred to hypnosis as "the fading of generalized reality orientation", and Bowers (1976) to the cessation of
"triangulation" of reality - both intuitively plausible descriptions
of right-hemisphere functioning, or rather the lessening of lefthemisphere functioning.
In clinical practice. therefore, instead of trying to persuade
clients into cessation of triangulation by getting them to stare at a
spot on the ceiling or lulling them over into their right hemisphere
with music or imagery; or tricking them into ceasing to be logical by
the use of clever and confusing verbiage, nowadays I explain instead
what I feel should be happening. I ask them to shut down all their
"sentry-go" mechanisms such as the muscles for pricking up their
ears, and making their hair stand on end. I ask them to close their
eyes so that they no longer have to work at filtering perceptions. I
ask them to persuade their internal censor, or critical and analytical faculties, to go off duty for a bit. These are task-relevant
instructions and most clients can understand what is required.
It seems possible, at all events, that this line of enquiry may
lead to explanations of many traditional phenomena of hypnosis; nor
is it at odds with definitions of hypnosis that are current amongst
present-day theorists.
REFERENCES
As. A O'Hara, R and Munger. M. P 1968. The measurement of
subjective experiences presumably related to hypnotic susceptibility. Scand.J.Psychol 9:33-38.
Bakan. P and Svorad. D., 1969, Resting EEG alpha and asymmetry of
reflective lateral eye movements, Nature Lond., 223:975-976.
Biederman. I., and Tsao, Y.-C. 1979, On processing Chinese ideographs
and English words: some implications from Stroop-test results.
Cognit.Psychol 11:125-132.
Bowers. K. S 1976. Hypnosis for the seriously curious. Wadsworth
Publishing Co Belmont. Calif.

HEMISPHERIC SPECIFICITY

179

Crawford, H. J., 1982, Cognitive processing during hypnosis: much


unfinished business, Res.Communications Psychol.Psychiat.
Behav., 7:169-179.
Davidof~, 1976, Hemispheric sensitivity differences in the perception of color, Q.J.exp.Psychol., 28:387-394
Doyle, J. C., Ornstein, R., and Galin, D., 1974, Lateral specialization of cognitive mode; 11 EEG frequency analysis, Psychophysiol., 11:567-578.
Frumkin, L. R., Ripley, H. S., and Cox, G. B., 1978, Changes in
cerebral hemispheric lateralization with hypnosis, BioI.
Psychiat., 13:741-750.
-Graham, C., and Evans, F. J., 1977, Hypnotizability and deployment of
waking attention, J.abnorm.Psychol., 86:631-638.
Graham, K. R., 1977, Perceptual processes and hypnosis: support for a
cognitive state theory based on laterality, Ann.NY.Acad.Sci.,
296:274-283.
Gur, R. C., and Gur, R. E., 1974, Handedness, sex and eyedness as
moderating variables in the relation between hypnotic susceptibility and functional brain asymmetry, J.abnorm.Psychol.,
83: 635-643.
Hilgard, E. R., 1979, Divided consciousness in hypnosis: the implications of the hidden observer, in: "Hypnosis: Developments in
Research and New Perspectives," (2nd Edn.), E. Fromm, and R.
E. Shor, eds., Aldine, New York.
Hosek, R. S., and Wilson, A. S., 1973, A technique for accurate
identification of alpha frequency in the EEG. Behav.Res.
Methodol.Instrumentation, 5:405-406.
MacLeod-Morgan, C., 1979, Hypnotic susceptibility, EEG theta and
alpha waves, and hemispheric specificity, in: "Hypnosis 1979,"
G. D. Burrows, D. R. Collinson, and L. Dennerstein, eds.,
Amsterdam, Elsevier, North Holland.
MacLeod-Morgan, C., and Lack, L., Hemispheric specificity - a physiological concomitant of hypnotizability, in press, Psychophysiology.
Morgan, A. H., McDonald, P. J., and MacDonald, H., 1971, Differences
in bilateral alpha activity as a function of experimental
task, with a note on lateral eye movements and hypnotic
ability, Neuropsychologia, 9:459-469.
Orne, M. T., 1959, Hypnosis: artifact and essence, J.abnorm.Psychol.,
58:277-299.
Pennal, B. E., 1977, Human cerebral asymmetry in color discrimination, Neuropsychologia, 15:563-568.
Shor, R. E., 1960, The frequency of naturally occurring "hypnoticlike" experiences in the normal college population, Int.J.
clin.exp.Hypnosis, 8:151-163.
----Shor, R. E., and Orne, E. C., 1962, Harvard Group Scale of Hypnotic
Susceptibility, Consulting Psychologists Press, Palo Alto.
Weitzenhoffer, A. M., and Hilgard, E. R., 1959, Stanford Hypnotic
Susceptibility Scale, Form C, Consulting Psychologists Press,
Palo Alto.

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

Marjan Pajntar,* Egidija Roskar** and Lojze Vodovnik**


*University of Ljubljana and Hospital of Kranj
**Rehabilitation Institute in Ljubljana, 64001 Kranj
Kidriceva 38a, Yugoslavia
Abstract
The study of both voluntary and electrically stimulated activity
of the neuromuscular system of striated muscles in various conditions
of a hypnotic state and under various verbal suggestions in those
states of hypnosis, has shown interesting neuromuscular responses in
normal test subjects, in patients with various lesions of the peripheral nerves as well as in patients with hemiparesis. An increased
EMG response in an electrically stimulated muscle, an increased EMG
response and an increased force of the paretic muscle, altered neuromuscular excitability in subjects with lesions of the peripheral
nerves (reaction to another type of electrical stimulation), changed
fatiguability, altered spasticity, and a corresponding complex mobility at a lower muscle activity have all been observed. It has
been noticed that these changes of the neuromuscular system activity
often result from a specific state of hypnosis and mostly from specific suggestions and their intensity. Recently we have been studying the effect of hypnosis upon the activity of the smooth muscles,
i.e. the bladder and the pregnant uterus before and during labor.
INTRODUCTION
As a result of the investigation of the functioning of neuromuscular systems in hypnosis, we have arrived at some interesting conclusions which we would like to present here. Our experiments were
performed on non-handicapped persons (Jeglic et al., 1975; Jeglic et
al., 1980; Roskar et al., 1980), on patients with disturbance of
function of the locomotor system (especially hemiparetic patients and
patients with peripheral nerve lesions) (Roskar et al., 1977; Pajntar
181

182

M. PAJNTAR ET AL.

et al., 1978; Roskar et al., 1978a; Roskar et al., 1978b; Stefancic


et al., 1978; Vodovnik et al., 1979; Gros et al., 1980; Pajntar et
al., 1980a; Pajntar et al., 1980b; Pajntar et al., 1980c; Vodovnik et
al., 1980; Zajec, 1980) and on patients with urinary disturbances
such as stress and urge incontinence (Roskar and Pajntar, 1982).
The functioning of individual neuromuscular systems were observed:
A. in the awake state
B. in hypnosis
a) with the suggestion of relaxation
b) with the suggestion of competition
c) with the suggestion of age regression
d) with suggestion of hyper- and hypo-excitability to electrical
stimulation
e) with suggestion of no fatigue
C. in post-hypnotic suggestion
D. in the awake state after a longer span of time.
The processes in the neuromuscular systems were determined by
means of the observation of EMG activities, by measuring rough muscle
force - mostly by specially constructed mechanical and electronic
equipment (Roskar et al., 1977; Stefancic et al., 1977), and by means
of the observation of certain movements of arms and legs (Roskar et
al., 1978b; Pajntar et al., 1980c).
We would like to present the functioning of various neuromuscular systems under hypnotic suggestion of the following cases:
A. Voluntary contraction of muscles
B. Electrically stimulated contraction of muscles
C. Muscle fatigue
A. VOLUNTARY CONTRACTION OF MUSCLES
1. Peripheral lesions
In the course of reinnervation after peripheral motor nerve
lesion it has been observed that the patient does not really know how
adequately to activate certain muscle groups, and that after activation, the acquisition of rough muscle force is rather slow. As the
restoration of motor reinnervation, especially in the distal parts of
the extremities, sometimes occurs very late, there is a danger that
the active contraction of muscles may appear too late relative to the
progressive process of fibrosis.
In patient I.M., the radial and auxiliary nerves had been cut by
a knife. Four months after the injury, these nerves were sutured.

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

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.

Photograph of the EMG signal of the extensor carpi radialis


taken from the screen of the oscilloscope at voluntary
contraction while the patient was in the wake state (left
side of photograph), and while the patient was in competition in hypnotic age regression (right side of photograph). In regard to the present photograph platinum wire
electrodes (manufactured by DISA) were used. The voltage
sensibility and temporal base of the oscilloscope are equal
for both side of photograph (100~ V/division, 10m seconds/
division)

184

Fig. 2.

Fig. 3.

M. PAJNTAR ET AL.

The first measurement records of isometric torque of


muscle force of wrist extensors (A) in the wake state,
(D) in suggestion of competition in hypnotic age
regression, and (E) in posthypnotic suggestion. The
arrow indicated the beginning of a contraction.

Measurement records of isometric torque of the muscle force


of the wrist extensors in the same patient as in Fig. 2, one
week later, (A) in the wake state, (B) same suggestion for
contraction in hypnosis, (C) suggestion of competition in
hypnosis, and (D) in suggestion of competition in hypnotic
age regression.

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

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-~.-.-..--.

Con trol uperiment

EMG
loot

do.s.fI

awah

lImV

~.LL
.~.

tzON

..

hypl\. ',gr.. ,ion

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.

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

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.

The power frequency spectra demonstrated some mechanisms induced


by hypnotherapy even better. It may be seen that the whole power
increased significantly and that the main frequency domain of the
agonistic EMG activity changed during the maximum of voluntary isometric contraction due to the hypnotic state and the pertaining
hypnotic suggestion. It should be observed that the power of the
higher frequency range from 150 Hz to 400 Hz appeared in muscular
activity mostly in hypnosis and in the post-hypnotic state.
At least two neurophysiological mechanisms in the motor control
of skeletal muscles may be the reason for the effects observed. The
first one may be that new motor units of paretic muscles are activated during the maximum of voluntary contraction, and the second one
that the frequency of recruitment of the motor units already active
in the awake state increase under the influence of hypnotic and
post-hypnotic suggestions. Both mechanisms are determined by supraspinal motor control, which may influence alpha motor neurons through
different descendent motor pathways directly or indirectly through
gamma neurons and reflex pathways, and initiate the contraction of
pertained muscle fibers. On the basis of the results obtained it
cannot be concluded which of the two mechanisms caused the increased
activity of paretic muscles in hypnosis. But we may say that new
descendent pathways in motor control of this muscle were awakened by
hypnotic suggestion in the first attempt and that the success of the
next attempt was even better.
In hemiparetics the activity of the paretic agonist muscle group
also often depends on the spasticy of the antagonist, since the
latter prevents the activity of the paretic agonist. In this field,
hypnotic suggestion may again give good results.

188

M. PAJNTAR ET AL.

Measurements of the wrist extension torque in another patient


showed that the results obtained in hypnosis, especially in hypnotic
age regression, were better than in the awake state. The effects
remained obvious in post-hypnotic activity as well. It may be seen
that at maximal voluntary contraction, the EMG activity of the antagonistic muscle was much more intense than in the agonist muscle
group. In hypnotic relaxation it is reduced and the decrease is even
greater in the suggestion of age regression. In spite of the reduced
EMG activity of the agonist muscle in the suggestion of relaxation,
the effect of dorsiflexion was more intense. The greatest effect of
dorsiflexion in hypnotic age regression is therefore ascribed in this
case to the reduced spastic activity of the antagonist and to the
more intense activity of the agonist (see Figure 6).
In hemiparetics voluntary contractions improve under the influence of hypnotic suggestions also from the functional viewpoint
(Roskar, 1978c). Dorsiflexion of a hemiparetic patient is characterized by excessive inversion, but in hypnosis it improves and acquires
a more normal eversion.
With the suggestion of relaxation and with specific suggestions
for correct gait the motor function of the entire disturbed lower
extremity during walking may be improved in hypnosis (Pajntar et al.,
1980c). The improvement in walking was tested by computer on-line
analysis of goniometric functions (measurements of changing joint
angles) of the ankle, knee and hip, and by polyelectromyography.
The left part of Figure 7 shows goniograms in the awake state
and the right part in hypnosis. It may be noticed that the goniograms in hypnosis are changed, especially knee flexion and extension,
they are significantly more similar to the goniograms obtained for
the unaffected extremity.
The left part of Figure 8 represents the EMG activity of the
affected lower extremity for the individual enumerated muscles, and
the right part shows the results in hypnotic relaxation. It may be
seen that in more functional walking the muscle activity is reduced.
The EMG activity is reduced with hypnotic suggestion of relaxation in the equivalent muscles of the unaffected leg. With lower
activity of muscles of both affected and unaffected leg in hypnosis,
better functional gait is obtained. This is shown in Figure 9.
3. Urethral Sphincter
The phenomenon and degree of urinary incontinence in women very
often depends on certain psychosomatic factors. We have studied the
usefulness of hypnotherapy in the treatment of patients suffering
from urge and combined stress-urge incontinence (Roskar and Pajntar.
1982).

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

1st experiment

test
measurement
EIliG

200jN

200)111

hypnr

".d

i2ii

..

hypn , ' ued

EIIIIG a"laOOn'"

100)N

hl'l>" f'e9l'nsoon pollllypn. I .1S

."I'lIon,SI


control of

.. th experi me nt

. ... k.

189

hypn. revr-ion

poelllypn . .1S '

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.

C('I"I 01'1 TP I~ FUNCTIONS . FILL -PRRneJ- F _ ltEel


L _l.

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 . . .

Print out of the on-line computer analysis of goniometric


functions during gait of hemiparetic patient for the ankle,
knee and hip of both extremities (left side hemisparetic and
right side normal) in (A) wake state and (B) in hypnotic
suggestion.

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS


" W " K E
~

HYP~-RELAXfD

-.ide (affected)

l>

Fig. 8.

191

0 "

0 '1 t.

t H1 (

F l

"

C T 1 0 " 5

The records of EMG activities of the important muscles and


goniometric functions in the ankle, knee and hip of the
affected-left leg in hemiparetic patient during walking in
wake state (left half of the figure) and during hypnotic
relaxation (right half of the figure).

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

RIC H T - alde (unaffected)

Fig. 9.

The records of EMG activities of the important muscles and


goniometric functions in the ankle, knee and hip of uneffected-right leg in hemiparetic patient during walking in
wake state (left he If of the figure) and during hypnotic
relaxation (right half of the figure).

Figure 11 represents an EMG record of the urethral sphincter


(the first and the third trace) and a record of the intravesical
pressure by the full bladder (the second and the fourth trace) at
voluntary retention of urine and during coughing. In the awake state
urine escapes at coughing, while in hypnotic age regression, the
activity of the sphincter, especially during coughing, intensifies in
time and urinary incontinence does not occur.

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS


AWAKE

193

1 HYP OTIC RELAXATIO

REGRESSION

Fig. 10.

Records of EMG activity of the paraurethral sphincter in


patient with sensory urge urinary incontinence during
various phases of the therapeutic procedure.

B. ELECTRICALLY STIMULATED CONTRACTIONS OF MUSCLES


1. Peripheral lesions
Electrical stimulation of paralyzed or paretic muscles can
produce functional muscle contraction, which enables the patient to
perform useful movements again. The discipline dealing with this
problem is called functional electrical stimulation (FES). There is
mur.h evidence in the literature that the response to electrical
stimulation may be modified by psychological input from the patients.
We have been examining the characteristics of electrically stimulated
paretic muscle contraction in the hypnotic and post-hypnotic state
(Pajntar et al., 1977; Jeglic et al., 1977).
The disappearance of motor responses of muscles in perip'heral
nerve lesions can usually be re-evoked by electrical stimulation (see
Figure 12). Single impulses are normally used for the maintenance of
the functional state of denervated muscles until their reinnervation
is achieved. These impulses are of 100-150 ms. duration, and have
10-20 mA power, depending, however, on the area of the electrodes.
In hypnotic suggestion of age regression to the time prior to the
accident and on the suggestion of hyper-excitability to electrical
impulses, the effect of electrical stimulation increases up to five
times. While in the awake state the electrically stimulated motor
response ceased to appear at the impulse of 100 ms. duration, in age
regression it appeared to the impulse duration of 50 ms., and on the
suggestion of hyper-excitability to electrical impulses to the impulse duration of 20 ms. It is interesting to note that the interruption in suggestion (the hypnotist's conversation with another
member of research team) resulted in an immediate reduction of the
motor response. Even more significant is the observation that in the
suggestion of hyper-excitability to electrical impulses, tetanic
stimulation proved to be successful. Tetanic stimulation is used for
stimulation of normally innervated muscles and had until then proved
incapable of evoking a contraction of affected muscles.

194

M. PAJNTAR ET AL.

Vollinlar Y contr. of
p -Ivir floor mll des

DII r mq '"llqh lIlq

A.... AKE

RE(,RL 'SIO'<

Fig. 11.

Records of EMG activity of the paraurethral sphincter


(upper trace) and intra vesical pressure signal (lower
trace) in wake state and in hypnotic age regression during
voluntary contraction of the pelvic floor muscles (left)
and during coughing (right side of the figure) in patient
with stress-yrge urinary incontinence.

195

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS


2. Hemiparetics

Different neuromuscular responses were obtained in hemiparetic


patients with electrical stimulation in hypnosis, (Roskar et al.,
1977; Pajntar et al., 1978; Roskar, 1978; Roskar, 1980).
Figure 13 demonstrates the influence of hypnotic and posthypnotic suggestion on electrically induced isometric dorsiflexion of
a hemiparetic's foot. In the middle part of the picture the records
of dorsiflexion torque signal for electrically induced contractions
in various phases of the experiment may be seen. The initial part of
the curve at each contraction was recorded during threshold stimulation and the second one during submaximal stimulation. Above are
the M. waves for the threshold EMG activity and below for the submaximal activity. We may see that the muscular response obtained
more intense on the hypnotic suggestion of relaxation than in the
awake state, and that the intensity increased even more following a
post-hypnotic suggestion of relaxation. It may be seen that the
amplitude of direct M-response was increasing and its wave shape
changing more and more under the influence of hypnotic suggestions.
Therefore it may be concluded that the number of stimulated motor
units increased in hypnosis though the electrical stimuli remained
unchanged.
The increased number of excited motor units at the same parameters of electrical stimuli may be attributed to the increased
excitability of motor nerve fibers or to the contribution of supraspinal facilitatory inflow as a result of hypnotic suggestions.

Fi1-iOi ,.,
,upms
I.,

,..... ,.......,,.

1M

t.

.Bl 01 'N.

,~n

. f~o. 511

... ...

<.J:

II II ll ..11

:.;;

n. ,,,. im,

A 'A~'" ;', .: In,

J
'J

....

,. ,

i. p Liz.
illOlnA

,,~

... l.

h!'i ij

~lIik: lU ~

i.

tlIJ.; ,:.

i;' " i ' j

.,

, :-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..;

:..:;

The records of dorsiflexion torque signal (middle part of


the figure) in various phases of the experiment for four
electrically induced contractions of dorsiflexion in ankle
joint. Upper and lower parts of the figure represent the
photos from the oscilloscopic screen for the signal of EMG
of agonist (upper beam) and dorsiflexion torque signal
(lower beam) during threshold stimulation and during submaximal stimulation respectively.

In an attempt to explain what is happening during the hypnotic


suggestion of hyper- and hypo-excitability M-response changes, we
applied a specific experimental method, utilised in neurophysiology,
using the thenar muscle in a group of normal subjects. In order to
exclude the influence of different transmissions of otherwise identical suggestions (e.g. variations in the hypnotist's voice), the
trance state was induced by means of an automatic tape recorder
(Rudel et al., 1980).
The median nerve of the forearm was bipolarly stimulated by
single voltage impulses with the frequency of 0.5 Hz, duration of 0.3
ms. and amplitude 20-40 V, which induced 50% of the supramaximal
amplitude of the M- wave. The stimulation provoked a contraction of
the thenar muscle which adduces the thumb. The measurements in the
described experiment were analyzed as regards the latency, amplitude,
wave shape, form and duration of the M-response and the possible
manifestations of other side responses (F-wave, H-wave) (see
Figure 14).

197

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

to scope trigg.r

to osc:illo.cop.

ground
Iectrod.

':' DC coupled ditto


emp .
,I

I,

::

letency of M - ,r pon. .
,

~di ...cl M -

...l :... ~tjmulu. ert.fe~t


I

Fig. 14.

response

The scheme of the measuring procedure for the evaluation of


the M-responses of the thenar muscle and adduction of the
thumb respectively. On the photograph of the M-wave
typical parameters for evaluation of the M-wave are shown.

As we can see from Figure 15, of the cumulative data gathered


from 20 M-waves for each phase of the experiment, the peak value of
the M-response significantly increased during hypnotic relaxation.
The added suggestion of hyper-excitability exerted an even greater
influence on the peak value. Such an intensified response may be
noticed also in post-hypnotic suggestion immediately after awakening,
as well as fifteen and thirty minutes later.
Figure 16 shows the EMG responses for the two other subjects.
It may be seen that the M-response of both subjects during the hypnotic suggestion of relaxation and the suggestion of hyper-excitability to electrical impulses increased. It is also noticeable, especially in the final part of the response, that the shape of the wave
changed in the way shown in the first row or in the way shown in the
second row (probably the F-response). In both patients an additional
response appeared in the suggestion of hyper-excitability - a response which we interpreted because of its latency as an H-wave.
In Figure 17 the differences between the M-wave and the supposed
F-wave in the various phases of the experiment are given. It may be
seen that the response in the awake state is small and that it significantly increases in hypnosis. Superimposed M-responses in the
v~rious phases of the experiment were plotted after computer analyses.

198

M. PAJNTAR ET AL.

15'

reltcitlb.

Fig. 15.

1aJ."
1>-"-

Cumulative tracings of the M-wave signal in different


phases of the hypnotic experiment with suggestion of
hyper-excitability.

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

i-r- ..... -'-

:..] ~

Fig. 16.

~ !

1-

i i I I I I-!

o' AWAKE ~ , .!+l

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

Cumulative tracings of the electrically induced muscle


responses (M-wave and H-wave) in different phases of the
hypnotic experiment.

The differences presented in the previous figure were evaluated


by a computer analysis, which produced the presented results for
latency, peak values, duration of the entire response and the integral of the surface area (see Figure 18).
Similar results were obtained also during the suggestion of
hypo-excitability to electrical impulses. Figure 19 gives the data
for two subjects. A lower M-response during the suggestion of hypo-

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

199
K.B.-2-c p .

Fig. 17.

Superimposed M-responses in the various phases of the


experiment plotted after computer analyses.

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

PEAK VALUE 2.4.IMVI -15S./HVI


-32./HVI
DURATION
14.IIIMSI
INTEGRAL
.9768SE+12/HV*HSI
LATENCY
3.961MSI
INTEGRAL (AVERAGE- II)
.88186E+.2IMV*HSI
LATENCY (AVERAGE- II)
3.96/HSI
HYPNOSIS RELAXED
PEAK VALUE 237S/HVI -214S/MVI
-46,/HVI
DURATION
14.14/MSI
INTEGRAL
.8171.E+14/MV*MSI
LATENCY
3.981MSI
INTEGRAL (AVERAGE- II)
7721IE+.4/MV*MSI
LATENCY (AVERAGE- II)
3.'7IMSI
HYPNOSIS HYPEREXCITABILITY
PEAK VALUE 234S/HVI -2181/MVI
-SIIIHVI
DURATION
13.781MSI
INTEGRAL
.617 26E+15/MV*MSI
LATENCY
4 2IMSI
INTEGRAL (AVERAGE- I.)
5 I 356E+15IMV*HSI
LATENCY (AVERAGE- II)
4 21MSI
POSTHYPNOTIC SUGGESTION
PEAK VALUE 227IIMVI -1835/MVI
-475/MVI
DURATION
14.64/HSI
INTEGRAl.
.15416E+.SIMV.MSI
LATENCY
4.72/MSI
INTEGRAl. (AVERAGE- 5)
.17735E+.5IMV*HSI
LATENCY (AVERAG E- 5)
4.69/1'151

Fig. 18.

Typical parameters of the M-response signal for different


phases of the experiment given by on-line computer
analyses.

2. Electrically stimulated contractions


Functional electrical stimulation is used in physiotherapy in
numerous cases of locomotor system damage. Electrical stimulation,
however, very quickly causes fatigue of the stimulated muscles. The
almost immediate manifestation of fatigue of the electrically stimulated system is due to the decreased number of excited muscle fibers
caused by changes in excitability mechanisms.
Figure 21 is a time diagram of relative values of the isometric
mc>ment at plantar flexion of the foot obtained in an experiment with
a nonhandicapped subject. We may see that in the awake state the
isometric moment was the result of fatigue reduced to half of its
value in two and a half minutes. In the hypnotic state of relaxation
it increased slightly at the beginning and even after three minutes

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

Fig. 19.

201

Cumulative tracings of the M-wave for different phases of


the experiment with hypnotic suggestion of hypo-excitability for two subjects (upper one and lower one). Note
different time bases for different cases.

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.

The records of sustained maximal voluntary contraction in


wake state and in hypnosis with suggestion of competition
and no fatigue. The first upper trace - isometric torque
of muscle force in dorsiflexion of foot, the middle and the
lower trace the EMG of agonist and antagonist respectively.

CONCLUSION

The phenomena presented here allow us to conclude that with


hypnosis, the functioning of the neuromuscular system may be significantly influenced, either by increasing or decreasing the functioning
of voluntary or electrically stimulated contractions, and that the
function of movements may be improved. Two suggestions proved to be
most efficient: 1) physical and mental relaxation, and 2) age regression. In age regression the patient recalls the ideomotor system.
which is likely to result in a reconstruction of the forgotten motor

203

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS


M

11;,

2,5
2,0

r\

1,5

5,8N~,__________ 5,2 __ ._ __

_ ).;;. ____. _ \ __/

__

/'-1's'

S?_ _ ______ _

___~,O~ _______________________ '.:: __________________ _

0,5

'AWAKE----'

Fig. 21.

Fig. 22.

,,
,,
,

relaxed

,_________________________

I(min)
1

1 P.J.
I 20.3.75

IN HYPNOSIS

---------------1 PL. FL.

Time diagrams of normalized isometric torque of foot


dorsiflexion during sustained electrical stimulation in
different phases of the experiment in normal subject.

Records of isometric torque of foot dorsiflexion during


sustained electrical stimulation in wake state (upper
record) and during hypnotic sleep (lower record) in
hemiparetic patient.

204

M. PAJNTAR ET AL.

agonistantagonl.stin h}pno

Me u ru ,

a,

- no

r-r-r-r-r

Fig. 23.

The photographs from the oscilloscopic screen: upper beam


is EMG agonist, lower beam is EMG of antagonist, during
sustained electrical stimulation of the peroneal nerve in
normal subject at the beginning in the awake state (upper
photo) and in hypnosis with suggestion of no fatique at the
beginning, after 1 minute and after 2 minutes (from left to
right).

contractions or in a strong intensification of these contractions


under additional suggestions. With regard to relaxation, on one hand
it intensifies the functioning of the voluntarily stimulated neuromuscular systems, and on the other hand it prevents an excessive
functioning of the involuntarily reflex stimulated antagonistic
systems.
We do not pretend to have given a final, comprehensive explanation of the observed phenomena. Many of our explanations are doubtless incomplete. partly because of our incomplete knowledge of neurophysiology and partly because of our generally insufficient knowledge
and poor understanding of the functioning of the human organism in
hypnosis.
REFERENCES
Gros. N Pajntar, M and Acimovic-Janezic. R 1980. Re-education
of neuromuscular system in hemiparetic patients by means of
hypnosis, in: "Hypnosis in Psychosomatic Medicine." M.
Pajntar, E:-Roskar. and M. Lavric, eds Slov.soc.clin.exp.
hypn.,Kranj. 249-253.
Jeglic. A Pajntar. M and Vodovnik. L 1975, Modification of FESinduced motor response by means of hypnosis, Proc.of 5th Int.
Symp.on External Control of Human Extremities, Belgrade.
59-68.

SOME NEUROMUSCULAR PHENOMENA IN HYPNOSIS

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.

Roskar, E., and Pajntar, M., 1982, Treatment of urinary incontinence


by means of hypnosis, Paper of 9th Int.Congr.on Hypnosis and
Psychosomatic Medicine, Glasgow.
Rudel, D., Pajntar, M., Roskar, E., and Vodovnik, L., 1980, Automatic
conduction of research measurements in hypnosis with tape
recorder and feedback from subject, in: "Hypnosis in Psychotherapy and Psychosomatic Medicine,"M. Pajntar, E. Roskar,
and M. Lavric, eds., Slov.soc.clin.exp.hypn.,Kranj, 139-145.
Stefancic, M., Pajntar, M., Roskar, E., Ugrinovski, S., and Drugovic,
M., 1977, Evaluation of hypnotic effects on motor activity in
patients with peripheral nerve lesions, 1st Medit.Conf.on Med.
Biol.Engn.,Sorento, Italy, Digest of papers, 1-81, 1-84.
Stefancic, M., Pajntar, M., Zajec, J., and Drugovic, M., 1978,
Hypnosis in patients with low back pain, Report, 1st European
congress of Hypnosis in Psychotherapy and Psychosomatic medicine, Malmo, Svensk Tidskrift for Hypnosis, Orebro, 5-6,
12-14.
Vodovnik, L., Rebersek, S., Roskar, E., Pajntar, M., Jeglic, A., and
Gros, N., 1980, Psychological modifications of electrically
induced motor responses in paretic muscles, in: "Hypnosis in
Psychotherapy and Psychosomatic Medicine," M~Pajntar, E.
Roskar, and M. Lavric, eds., Slov.soc.clin.exp.hypn.,Kranj,
113-118.
Vodovnik, L., Roskar, E., Pajntar, M., and Gros, N., 1979, Modelling
the voluntary hypnosis induced motor performance of hemiparetic patients, IEEE Trans.Man.Systems and Cybernetics, SMC,
9:850-855.
Zajec, J., 1980, Rehabilitation of patients with low back pain by
means of hypnosis, in: "Hypnosis in Psychotherapy and Psychosomatic medicine," M. Pajntar, E. Roskar, and M. Lavric, eds.,
Slov.soc.clin.exp.hypn.,Kranj, 254-256.

THE ESSENTIAL ASPECTS OF SELF-HYPNOSIS

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.

The Fading of the General Reality Orientation


Absorption in the experience
Receptive. expansive. free-floating attention; that is. an
ability to let the mind wander freely and to wait for what
floats into awareness.
Rather large fluctuations in trance depth. particularly in the
beginning of learning to employ self-hypnosis.

The first two (The Fading of the General Reality Orientation.


and Absorption) set the stage for hypnosis per se. hetero-hypnosis as
well as self-hypnosis. They are essential characteristics of both.
However. there are two other structural characteristics which
differentiate self-hypnosis from hetero-hypnosis: Expansive. freefloating attention. and ego receptivity to stimuli coming from
within. They are state specific for self-hypnosis; while concentrative attention. and receptivity to stimuli coming from a single
outside source (the hypnotist on whom the subject or patient steadily
focusses his attention) are state specific for hetero-hypnosis.
In addition. we found that in self-hypnosis there tends to be
more imagery than there is in hetero-hypnosis. Imagery in self209

210

E. FROMM

hypnosis is vivid, rich, quite realistic and personally meaningful.


There are no complex, bizzare conglomerations. as one might find in
hallucinogenic experiences.
Self-hypnosis requires adaptation to the altered state; in the
beginning of self-hypnosis there is a great deal of anxiety and
self-doubt. particularly in the first few days. As the subject
becomes more familiar with the state he feels more comfortable in it.
He spends less time worrying about failures in self-suggestions or
failures to reach a deep hypnotic trance state; his ability to enter
trance easily and quickly increases as does the Fading of the General
Reality Orientation. the absorption in the experience. and the trance
depth.

Not all subjects who are excellent hetero-hypnotic subjects are


equally good in producing self-hypnotic states. There are certain
personality characteristics related to the ability for self-hypnosis.
For the last eight years my former students and I have been
working on a large research project on self-hypnosis. The methodology and many of the results have been described elsewhere (Fromm.
et al., 1981). In the paper to be presented at this convention. I am
going to discuss only the essential aspects and results of this
research, as well as some new findings which stem from further analyses of the data done during the last year.
Self-hypnosis. like hetero-hypnosis (Fromm, 1977. 1978-79.
1979), is an altered state of consciousness in which imagery plays an
enormous role. As a result of our research we differentiate between
structural and content categories that characterize the phenomena of
self-hypnosis. Most of them are common to self-hypnosis and heterohypnosis, though some to varying degrees. The structural factors
that comprise the essence of self-hypnosis are:
1.
2.
3.
4.
5.

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.

Absorption, the sense of being caught up in the content of the


session or in the phenomena experienced, has been recognized as being
an important characteristic of hetero-hypnosis (J. R. Hilgard, 1970;
Tellegen and Atkinson, 1974). It is equally important in selfhypnosis. The same holds for Shor's (1962) GRO factor, the fading of
the General Reality Orientation. These two factors set the stage for
any hypnotic experience and seem to be interdependent (FrommOet al.,

ESSENTIAL ASPECTS OF SELF-HYPNOSIS

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.

ESSENTIAL ASPECTS OF SELF-HYPNOSIS

213

Depending on the subjects' particular needs and problems, the


content of the self-hypnotic trance may be different for individual
subjects. But the five structural components, absorption, attention,
trance depth, GRO and ego receptivity are exerting some form of
influence on the content dimensions, also on each other. They are
interdependant. For instance, as one becomes more aud more ego
receptive to stimuli coming from one's Preconscious and Unconscious,
more and more absorbed in the inner experience, the General Reality
Orientation fades increasingly into the background and one goes into
deeper trance states. Similarly, when attention is more focused in
trance, one's ability to go deeper is enhanced and one's awareness of
the outside world fades further into the background. But we could
also say that as the subject's ability to enter trance quickly and
efficiently develops, his/her absorption in the trance phenomena
becomes greater, which in turn in related to the fading of awareness
of the external surroundings.
Thus, absorption is effected by the way in which ego receptivity
and attention are being used; but the reverse is also true. If ego
receptivity and expansive or concentrative attention are turned
towards the inside, absorption occurs. In self-hypnosis, absorption,
ego receptivity, and attention are turned towards the inside. In
hetero-hypnosis they are fixated on what the hypnotist suggests.
We do not conceptualize the structural components as having
primary causal effects on each other or on the contents of the selfhypnotic experience, but we do conceive of them as interdependent
structures super-ordinate to the content of the experience in selfhypnosis.
The content of the phenomena reported in any self-hypnosis
experience reflects the individual's choices. The quality and the
strength of the experiences are closely interwoven with the structural aspects of self-hypnosis. These structural variables exert a
great influence on the nature of the experience. ON the basis of
their interaction and as the result of continued practice, they define, within broad parameters, the intensity, the depth of involvement, and the beauty of the experience.
REFERENCES
Fromm, Erika, 1977, An ego-psychological theory of altered states of
consciousness, Int.J.clin.exp.Hypnosis, 25:372-287.
Fromm, Erika, 1978-79, Primary and secondary process in waking and
in altered states of consciousness, J.Altered States of
Consciousness, 4:115-128.
Fromm, Erika, 1979, The Nature of hypnosis and other altered states
of consciousness: An ego-psychological theory, in: "Hypnosis:
Developments in Research and New Perspectives," E. Fromm and
E. Shor (eds.), Aldine, New York, 81-103.

214

E. FROMM

Fromm. E Brown. D. P Hurt. S. W Oberlander. J. Z Boxer, A.


M., and Pfeifer. G 1981. The phenomena and characteristics
of self-hypnosis. Int.J.clin.exp.Hypnosis 29:189-254.
Hilgard, J. R 1970. Personality and Hypnosis: A study of imaginative involvement. University of Chicago Press, Chicago,
(revised edition. 1979).
Short R. E., 1962. Three dimensions of hypnotic depth. Int.J.clin.
exp.Hypnosis. 10:23-38.
Tellegen. A and Atkinson. G 1974. Openness to absorbing and
self-atering experiences ("absorption"). a trait related to
hypnotic susceptibility. J.abnorm.Pyschol 83:268-277.

REPRESENTATIONS OF SELF-HYPNOSIS IN PERSONAL NARRATIVES

Erika Fromm, Andrew M. Boxer and Daniel P. Brown*


University of Chicago
Department of Behavioral Sciences
5848S University Avenue, Chicago, Illinois 60637, USA
Abstract
In a longitudinal study of self-hypnosis (SH), 33 subjects
practiced SH one hour per day for four weeks. The subjects recorded
their experiences following each daily SH sessions.
The present study examines intra-individual changes in selfhypnotic experiences, based on the written journal narratives, and
will compare them to the questionnarie findings published earlier
(Fromm, et al., 1981). The journals will be divided into three
groups based on the subjects' overall success in self-hypnosis, as
perceived by the subjects: 1) those who had unusual and remarkable
self-hypnosis sessions; 2) those who felt they were successful; 3)
those who defined their SH experiences as unsuccessful. Objectively,
all subjects in this study had scored highly on standard heterohypnotic susceptibility scales in prescreening. Intra-individual
change will be examined through the sequences of daily reports for
each SIS journal with special references to the specific selfsuggestions made, how they succeeded, and what the accompanying
phenomena and state of consciousness were. The most important parts
of three journals, one representative from each of the groups, will
be presented, discussed, and related to the results of the earlier
study.

*Daniel P. Brown is now at Cambridge Hospital, Cambridge,


Massachusetts.
215

216

E. FROMM ET AL.

In a longitudinal study of self-hypnosis (SH), 33 subjects


practiced SH one hour per day for four weeks, the subjects recorded
daily in a journal three aspects of the SH experiences following each
SH session: 1) the subjective impression of their self-hypnotic
experiences for each particular day; 2) the self-suggestions
attempted; and 3) a report on the depth of their trance as measured
by the North Carolina Scale (Tart, 1970) near the beginning, approximately in the middle, and towards the end of the hour.
The present study is based on the analysis of the journal
narratives. It is an extension of our research on the phenomena and
characteristics of self-hypnosis published earlier (Fromm, et al.,
1981), which dealt mainly with the results of the SH Questionnaires
we had constructed and given to the same 33 subjects at the close of
their four weeks of self-hypnosis.
The journals were divided into three groups based on the subjects' overall success in self-hypnosis, as perceived by the subjects
themselves: 1) three subjects had extraordinarily successful selfhypnosis sessions; 2) twenty-seven subjects felt their sessions were
successful; 3) and three defined their SH experiences as unsuccessfuly. Three journals have been selected, one from each group. The
most noteworthy parts of these journals will be presented and discussed.
The diaries of the three highly successfuly Ss are extremely
interesting, imaginative and colorful. Those of the two (or three)
unsuccessful Ss are boring because they are totally without fantasy.
Scoring categories had been developed from the quantitative
results of the SH Questionnaires (Fromm et al., 1981). Many of these
were also used in the analyses of the diaries. But in analyzing the
diaries we were also open to the possibility of finding new categories. Indeed, several new categories emerged: Insight, Strong
Affect, Dissociation, Amnesia, and Ego-Inactivity. This last category was scored whenever an S would note that he was just relaxing,
having no thoughts or memories or imagery; doing nothing; experiencing nothing else but relaxation.
As we had done before, we established three categories Structure, Content, and Context. The present paper is concerned only with
Structure and Content.
The Structural Category embraces the following areas:
Concentrative Attention
Expansive Attention
Ego Activity
Ego Receptivity

SELF-HYPNOSIS IN PERSONAL NARRATIVES

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."

On Day 4. S 108 became frustrated because the harder he tried to


concentrate on the suggestions that he gave to himself. the less he
succeeded in deepening the trance. He still wanted to control the
experience.

On Day 7. he finally added Imagery to Ego Activity to deepen the


trance. quickly followed by Ego Inactivity. and Ego Receptivity. He
let it happen rather than trying to force it, and thus became much
more successful in his endeavor to deepen the trance.
On Day 8 he allowed even more Ego Receptivity. which led to
Imagery; and he used less Ego Activity and control.
"In this session I decided to take a less structured approach to
any deepening suggestions. After induction I concentrated
solely on my breathing - I tried to see it as an involuntary and
effortless process and I tried to concentrate on the movement of
air through the nose and lungs. This was very relaxing. and
before long my concentration was diverted by many types of
spontaneous images."
On Day 9 he again allowed more Ego Receptivity and Expansion of
Attention; which led to a wealth of imagery. a beautiful dream. the
latent content of which exemplifies Self-Hypnosis as a Regression in
the Service of the Ego:
"I spent rather longer than usual in trying to go deeper but it
seemed that trying even in this abstract way was not very effective for producing a deep trance. As soon as I stopped concentrating on my breathing. imagery began to occur spontaneously.
There was such a quantity of imagery that I felt I didn't have
time to evaluate or explore it - I could relax and observe. It
was as if my imagination was overflowing with miscellaneous
ideas.
My dream for this period was somewhat disjointed and
discontinuous. First I am with a group of people - they seem to

SELF-HYPNOSIS IN PERSONAL NARRATIVES

219

be my friends although I don't recognize any of them. We are on


our way to a sports arena to watch some kind of professional
game. We arrive and buy our tickets and walk into the arena
through a long series of dingy corridors. When we get inside
there are only a few people present although the arena is huge.
While I am talking to my friends, I suddenly notice the playing
field has changed to grass and the "inside" of the arena is
actually "outside." Further, everyone is now dancing on the
grass - I think this is very puzzling. But I don't mention it
to anyone. My next image is that I am dancing myse1f- swinging
a girl around very fast like I used to do playing as a child."
But he continued to struggle between the tendency to want to
control all of his experiences and the rising knowledge that he
should let go. Because he could not really re1inguish control, he
was unable to learn that letting to, i.e., Ego Receptivity and Expansive Attention would lead deeper and faster into the profound stages
of trance he wanted to achieve, than would Ego Activity and Attention
Concentration.
S 108 was a very talented subject. But unlike S 081, the highly
successful S we shall discuss next, he also was a person to whom
control meant a great deal. This prevented him from being very
successful in self-hypnosis.
Contrast S 108's report with the narrative of S 081, one of our
excellent (High) Ss who was not a bit concerned about "letting go."
This S, in reality, was an 18 year old girl, but her imagination
encompassed as wide range of ages. Here is an excerpt from Day 3:
"Again I spent more time in a quiet trance with occasional
thoughts running through. I regressed to a baby, first new
born, then 8 months, and then two years old, and then 9, and
back to 18. As newborn I hardly moved. I just lay there and
looked around the room. Everything looked new and big. At 8
months I moved more and sucked my hand and made sounds. At 2 I
rocked and repeated mommy and daddy and made odd sounds. By the
time I was nine I was bargaining with the popsic1e man to give
me a popsic1e and some dry ice. I then went back up to 18. I
was a cat for a few minutes and did a lot of purring. The most
interesting part tonight was being a baby. Not being able to
talk, or sit up just gurgle."
Effortlessly, she went into all kinds of interesting experiences
and imagery, but kept enough control (again effortlessly) to get
herself out of uncomfortable hypnotic situations and into more enjoyable ones as in the following example, Day 6:
"First of all today I suggested I was a prisoner in my
room. I was going to be in it alone for a year. I went around,

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.

Most of the experiences of S 081 were delightful and interesting


to her. They also give the reader the strong impression that the S
always experienced Deep Absorption and the GRO. But she rarely
mentioned Absorption and the GRO in herediary.
This 18 year old girl, in her typical adolescent identity struggle (Erikson, 1980), uses the SH experience to put herself into many
niches and life roles in order to find one that would fit her.
Here are some more examples showing S 081's rich imagery.
Day 16 she reflected:

On

"Today I went into trance for 10 minutes and decided to become


an old woman. I had some crocheting next to me that I was
doing, and so I started it. I was talking to a grandchild telling a story. I was very old. I moved creakily and slowly.
Every chain I made crocheting was an effort. I was telling a
story about my brother and a woman. I told it carefully, and
each word was said so slowly that I'd forget what the entire
sentence was. I got tired telling the story and crocheting, so
I told my grandchild to let me rest. I went back into a restful
trance. I really like becoming different characters. I go into
a trance and either decide what character I want to be ahead of
time, or just let whatever happens happen. I count to 5 or so,

SELF-HYPNOSIS IN PERSONAL NARRATIVES

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:

"+ left hand light-floating

- whole body floating


- dream
+ memory of kindergarten shopping trip
+ mental chess game
+ taste of corned beef sandwich

Ability to concentrate definitely heightened chess game


sufficient although not astounding. Still unable to experience
dream. Felt distracted by minor noises in room (some noisy
plumbing, mostly)."
Day 14:
"At the end of the 2nd week, these sessions seem to be getting
less, rather than more interesting; and I am having more and
more trouble using up an hour."
Day 23:
"I fell asleep after about 30 minutes of trance during which I
gave myself no specific suggestions. I still can't quite tell
the difference between trance and this light, normal sleep."
Poor self-hypnotic subjects like S 045 lack the ability for
Imagery, Ego Receptivity, Expansive Attention, and creative experiences in self-hypnosis. It may be possible to teach them selfhypnosis for the control of pain by teaching them to divert their
Concentrative Attention to pleasant thoughts or memories. But we

222

E. FROMM ET AL.

doubt that they can use self-hypnosis creatively for working on


emotinal problems. even for diminishing anxiety. We believe that the
Successful and Very Successful SH subjects can work on their problems
by means of their ability to listen and look at that which comes up
from within (Ego Receptivity), by their being capable of Expansive
Attention. and by their having facile imaginations and little need to
defend against Strong Affect.
Summary
The richness of imagery and the much greater variety of structural and content categories used in self-hypnotic experience differentiate the diaries of the Successful and Highly Successful subjects from those of the poorer ones. Thus, it would seem wise for us
to give subjects at least an imagery test before deciding to teach
them self-hypnosis for anything else but relaxation and perhaps pain
control.
Meanwhile, a great deal more research will be done by us on the
fascinating SH diaries we have collected.
Acknowledgement
This research was supported in part by a grant awarded to the
senior author through the University of Chicago, by the Biomedical
Research Support Grant PHS5 S07 RR-07029-13
REFERENCES
Erikson, Erik, 1980, Identity and the Life Cycle, W. W. Norton &
Company, New York. (a reissue; originally published in Psychological Issues I, 1959).
Fromm, E., Brown. D. P., Hurt, S. W., Oberlander. J. Z Boxer, A.
M and Pfeifer. G., 1981. The phenomena and characteristics
of self-hypnosis, Int.J.clin.exp.Hypnosis, 29:189-254.
Tart, Charles, C., 1970, Self-report Scales of hypnotic Depth,
Int.J.clin.exp.Hypnosis. 18:105-125.

AN INVESTIGATION INTO AUDIOTAPED SELF-HYPNOSIS


TRAINING IN PREGNANCY AND LABOR
G. P. Davidson,* N. D. Garbett** and S. G. Tozer*
*Department of Psychological Medicine, Wellington
Clinical School of Medicine of the University of Otago
Wellington Hospital, Wellington, New Zealand
** New Zealand Force Hospital, Singapore
Abstract
Fifty primigravidae were approached by their obstetricians, and
invited to participate in a study using self-hypnosis training in
pregnancy and labor, as a relaxation and pain-relief technique.
Their agreement was followed by random selection into experimental
and control groups. The group was offered audio taped self-hypnosis
training for the six weeks prior to their expected dates of delivery.
The control group proceeded in the usual manner. Both groups were
interviewed post partum, by a worker whose voice was unknown to the
subjects.
Hypotheses tested related to the expected differences in duration of labor, chemoanalgesia, and in the mother's subjective experience of childbirth. These results, with intercorrelations among
other variables, are discussed. Recommendations are made, that
audio-taped self-hypnosis training represents a viable cost-effective
adjunct in obstetric practice.
INTRODUCTION
There can now be little doubt that hypnosis is effective in
easing distress in childbirth. For at least five decades there has
appeared a steady stream of publications attesting to its usefulness
in relieving pain. The eminent American obstetrician De Lee (1955)
and De Lee and Greenhill (1939) recommended it as an anesthetic agent
and as an adjunct to chemoanesthesia 'to mitigate the pain of parturition'. As early as 192~, Schultze-Rhonof achieved a success rate of
223

224

G. P. DAVIDSON ET AL.

89.5% in 76 cases, although he noted the two disadvantages of the


time necessary to condition the patient, and the need for the presence of someone at the delivery who is trained in the technique.
Another obstetrician, Kroger, with De Lee (1943) commented that
hypnosis not only effects pain relief but also 'has unrealized possibilities for making childbirth not merely the equivalent of a
surgical operation, but rather a satisfying psychological experience'. Kroger and Freed (1951) later asserted that 'the hypnoidal
state is a safe amnesic, analgesic, and anesthetic agent. There are
no untoward effects on the mother or baby'.
Such views were tested by the obstetrician Abramson and the
psychologist Heron (1950), who gave an average of four hypnotic
training periods to 100 primiparas and multiparas, and compared their
experiences to those of 100 controls. They concluded that 'it may
give very significant relief from the discomfort of labor even in
cases which do not show the spectacular results sometimes obtained'.
Abramson and Heron found their hypnotic group had labors on average
two hours shorter in the first stage than did their control group,
and that the former group required significantly less chemoana1gesia.
However, they too noted the difficulty of 'the time and effort required on the part of the physician to give the prenatal training
another difficulty is that the hospital staff is not trained to deal
with patients in the hypnotic state'.
The obstacle of cost-effectiveness in prenatal preparation is
dealt with by Michael (1952) by mass or group hypnosis. From his
results in a comparative study of 30 subjects hypnotically prepared
against 30 controls, he makes three points: (1) hypnosis can benefit
the parturient woman by assuring relaxation and abolishing the pain
of labor, (2) the duration of labor is shortened, and (3) the training of labor ward staff in the handling of the hypnotic patient is
most important and can be easily accomplished.
Other studies are similarly encouraging: August (1960) attempted hypnoanesthesia in 351 out of 442 expectant mothers, and
found it 'successful' as the sole analgesic agent in 328 (93.5%).
Mody (1960) reported on 20 patients with an average success of 75%.
In his study 'there appeared to be no relationship between the extent
of relief of pain and the number of sittings or the depth of hypnosis'. Mosconi and Starcich (1961) secured excellent results in 79%
of 100 obstetric patients using hypnosis. A substantial study by
Gross and Posner (1963) compared the results of 200 cases delivered
by the same obstetrician before he became interested in hypnosis,
with 200 subsequent with whom he routinely used hypnosis. The hypnotic group required less analgesia, had shorter labor times, and
experienced greater 'morale' benefits. However, they like others
noted the question of cost-effectiveness in time spent preparing the
patient.

AUDIOTAPED SELF-HYPNOSIS IN PREGNANCY AND LABOR

225

A less enthusiastic report came from a study of 200 cases by


Winkelstein (1958). who found that while hypnosis was 'satisfactory
in the maintenance of anesthesia during labor and delivery'. there
was no effect on the shortening of labor and 'hypnosis cannot be
recommended as a routine procedure for all parturient women (because)
the special prelabor training and constant attendance upon the
patient during labor involved more time than the average obstetrician
can afford or is able to devote'. (It may be noted that the absence
of a control group as such allowed only within group comparisons of
'successful' with 'unsuccessful' patients, i.e. those in whom hypnosis could not be induced at the time of labor. Also the measure
used was not duration of labor, but rather time from admission to
hospital, to birth).
These and other studies confirm a general interest in hypnosis
from three points of view. Firstly, there is interest in its potential for reducing the duration of labor, and especially of the first
stage of labor. Secondly, there is interest in its apparent effect
of reducing the amount of pain and thus chemoanalgesia required.
Thirdly, there is interest in its ability to facilitate a better
psychological experience for the parturient woman.
No study known to the present authors deals more clearly with
these three facets than that of Davidson (1962). Comparing the
labors of 70 patients trained in hypnosis with those of 70 patients
given physiotherapy training for labor, and 70 control patients, she
found a significant reduction in the duration of the first stage of
labor for the hypnosis group, along with a significant reduction in
reported pain and chemoanalgesia required. Further, patients using
hypnosis reported that their labors were more pleasant than did
patients in other groups, and also that they were more positive about
having subsequent children than the other groups were. By using
group training sessions in hypnosis, Davidson was able to conclude
that the time spent antenatal1y (1~ hours for six patients) made the
procedure with its associated benefits well worthwhile. It should be
noted however, that the patients themselves were allowed to choose
which group they joined, so non-randomness is a possible source of
bias in this study.
By contrast, a study by Rock et al. (1969) was reported of a
non-volunteer group of 22 subjects who had no training in preparation
for labor and who were in active labor when hypnosis was first attempted. In the adverse conditions of a noisy hospital ward, it is
interesting that hypnosis was judged effective in pain relief, as
compared with controls. In reviewing this and other studies, Hilgard
and Hilgard (1975) commend the study for its efforts to measure the
hypnotic responsiveness of each subject, and point out that though
statistically not significant, the results are in the expected direction, that the more responsive patients rated their labor more positively.

226

G. P. DAVIDSON ET AL.

One further study deserves mention, since it specifically uses


self-hypnosis, and reports in detail on 30 obstetric patients who
were seen once a week for 8 weeks (Kline and Guze, 1955). At subsequent delivery, 57% required no drugs and 17% had less than average
drug dosage. The researchers recommend the technique as a costeffective method of relieving pain and enhancing patient participation in childbirth.
The senior author in the present study had previously researched
the usefulness of audiotaped self-hypnosis training in anxiety reduction in a general medical practice sample. The question occurred:
If audiotaped self-hypnosis is successful in a generalized setting,
might it not be also useful obstetrically, in a way that avoids the
previously reported disadvantages of an excessive time requirement
and the need for trained staff? Further, might it not avoid the
difficulties of dependence, by keeping not only the hypnosis but also
the training itself in the patient's hands? The present study was
designed with these questions in mind, as well as to test the following hypotheses:
1.
2.
3.
4.

That the duration of labor will be shorter for those subjects


who were offered the audiotaped self-hypnosis training, compared
with controls.
That the pain experienced by those subjects who were offered the
audiotaped self-hypnosis training, will be less than the controls.
That those subjects offered audio taped self-hypnosis training
will report a more pleasant experience of labor, compared with
controls.
That those subjects offered audio taped self-hypnosis training
will report a more positive attitude towards having more children in the future, than will controls.

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.

AUDIOTAPED SELF-HYPNOSIS IN PREGNANCY AND LABOR

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')?

The interviewer also discussed and noted general comments from


subjects about the technique, and with their permission, gained
certain data from their hospital files.
The self-hypnosis training cassette was a C-60 format, the first
(30 minute) side being a general introduction to relaxation and
hypnosis, concluding with a brief induction, which subjects listened
to once only. The second side was to be listened to every two days
or so, and contained a hypnotic induction with specific suggestions
for pain relief and positive attitude, to be associated with relaxation. Subjects were told by the tape that they could choose how
they were to employ the hypnotic technique, i.e. in the first stage
of labor only, or as a daily pre-labor relaxation technique, or to
help sleep, or whatever.
Such a methodology was employed because:
1.
2.

3.

4.

The Hawthorne effect was abolished or minimized, since the


training was audio taped (i.e. no high status obstetrician was
directly hypnotizing subjects).
Random assignment into groups was seen to be an improvement over
those studies in which self-selection by patients either into
groups or to an obstetrician known to use hypnosis, could be a
source of bias.
The cost-effectiveness criticism is met, since absolutely no
extra professional time is required, nor is the presence of a
hypnotically-trained clinician required throughout or at any
time during the delivery.
The authors wished to subject the method to a field test, in
which conditions were as adverse or normal as possible (i.e. no
'positive set' was created by training of hospital staff, and
doctors were not asked to participate in any way in the procedure other than in handing over the training cassette at the
outset).

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.

Duration of first stage of labor, with attitude to labor: r


0.528 (p <0.01).
Pain experienced in first stage of labor, with attitude to
labor: r = - 0.657 (p <0.001).

No variables intercorrelated significantly in the control group.


Further, of the 25 subjects who used the cassette, 19 said later
that they would be keen to use the technique to prepare for any
subsequent iabors. Over 50% of the group volunteered that the trainTable 1.

First Stage of Labor

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

AUDIOTAPED SELF-HYPNOSIS IN PREGNANCY AND LABOR


Table 2.

Table 3.

Second Stage of Labor


Variance

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

Pain - 1st Stage of Labor (LASA, 10 cms, no pain severe pain)


Group
Experimenta I
Control

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

2nd Stage of Labor (LASA, 10 cms, no pain - severe pain)


Group

'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)

Other variables which did not distinguish between the groups


Memory of labor (all, part, or none of labor)
breast feeding (established or not established)
presence of the father during 1st stage of labor and birth
dilatation of cervix on admission
requirement for episiotomy and perineal repair
Analgesic and/or anesthetic requirements
use of oxytocic agents
mother's emotional state (calm and relaxed or fearful)
Apgar score (quantitive measure of the baby's well-being at 1
and at 5 minutes after delivery).

230

G. P. DAVIDSON ET AL.

Table 5.

Attitude to Labor (LASA, 10 cms, very unpleasant very pleasant)


Average
rating

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

Attitude to Having More Children (LASA, 10 cms, definitely


against it - very keen)
Average
rating

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

AUDIOTAPED SELF-HYPNOSIS IN PREGNANCY AND LABOR

231

first stage of labor (Abramson and Heron, 1950; Callann, 1961;


Davidson, 1962) we did not find that the audiotaped training in
self-hypnosis resulted in such a reduction (refer Tables 1 and 2).
Larger sample numbers may have produced a more favorable result on
this variable, since the arithmetic mean in the present study was
deceptively vulnerable to the influence of three high scores.
Further, since no attempt was made to select patients likely to be
responsive to hypnosis (in fact, quite the contrary, a rigid randomization was imposed), it could be expected that the present technique
would be more likely to reduce the duration of labor if patients were
selected for hypnotizability. This is recommended by Hilgard and
Hilgard (1975), for research purposes, but they conclude that practically, 'the less hypnotizable probably reap the benefits that all
can achieve from relaxation and fear reduction, while the more hypnotizable receive the further benefits of hypnotic analgesia'.
With regard to pain, the picture is clearer: Patients using the
audiotaped self-hypnosis training reported significantly lower levels
of pain than did controls (p <0.01). This confirms the second hypothesis of the present study, but it should be noted that it applies
to the first stage of labor only, and not the second stage. Nevertheless, that the technique is demonstrated significantly to reduce
pain during this critical phase should encourage its acceptance, as
is recommended by previous researchers who have found similar analgesic effects with 'direct' hypnosis or self-hypnosis training (e.g.
Davidson, 1978, August, 1960; Kline and Guze, 1955; Kroger and De
Lee, 1943; Michael, 1952).
Almost all authors report a marked diminution in the need for
chemical analgesia in hypnotically trained patients. 'This fact is
one of the main indications for the method, giving greater safety to
mother and child as chemical anoxia is eliminated' (Davidson, 1962).
In the present study, though the hypnotically trained patients reported less pain than controls, the groups did not differ significantly in the amounts of analgesia administered prior to delivery.
This may indicate that routine obstetric practice is to give Valium
or Pethidine pre-delivery, without close titration against reported
pain, as no attempt was made to inform labor ward staff regarding the
experimental status of each patient. It may be significant that 17
out 25 hypnotically trained patients were given no chemoanalgesia at
delivery, compared with 7 out of 25 control patients.
Davidson (1962) found that 70% of her autohypnosis group described the labor as pleasant, whereas only 23% of her physiotherapy
patients and 33% of her controls looked back on labor as pleasant.
The results of the present study cannot be directly compared because
of the assessment technique, but are in the same direction, with the
ratings by the hypnotically trained patients being significantly more
positive than those of the controls (p <0.05). It should be noted
that this 'attitude to labor' variable correlated negatively with the

232

G. P. DAVIDSON ET AL.

duration of the first stage of labor (r = - 0.53, P <0.01) and also


negatively with the pain experienced during the first stage (r = 0.66, p <0.001). The significance ascribed to the need for lessening
the duration and pain of labor, and consequently enhancing its
psychological quality, will depend on the significance one may give
to whatever beneficial effects this factor may have for the welfare
of the mother, her child, and perhaps for the father too.
The final variable results confirm this, that the hypnotically
prepared women had a more positive attitude towards having more
children, than did controls (p <0.01). This confirms the fourth
hypothesis of this study, and concurs with the findings of Davidson
(1962), that the patient trained in auto-hypnosis is more likely to
be enthusiastic about having further children than is the patient not
given such training. Again, the significance of these findings is
determined.by the significance one ascribes to such a positive
psychological attitude in the mother.
SUMMARY

Fifty primigravidae were randomly allocated into experimental


and control groups. The former differed by being each offered an
audio taped self-hypnosis training cassette, with no other intervention. The results did not indicate any significant difference in
duration of labor, but did support the hypotheses that the hypnotically prepared women report less pain and have more positive attitudes to their labor and having further children. Discussing various
approaches to the use of hypnoses in obstetrics, August (1965) concludes that 'whatever combination of chemical and psychological
therapy, either, both, or none, must be decided in each specific
situation by the physician for the patient. The primary and only
purpose of therapy must be ever in mind, a normal healthy mother and
a normal healthy baby'. It is respectfully suggested that audio taped
self-hypnosis training is an effective, low cost, and non-invasive
adjunct in practical support of that purpose.
REFERENCES
Abramson. D., and Heron, W. T., 1950, An objective evaluation of
hypnosis in obstetrics, Am.J.Obstec.Gynecol., 59:1069-1074.
August, R. V., 1960, Obstetric hypnoanesthesia, Am.J.Obstec.Gynecol.,
79: 1131-1138.
August, R. V., 1965, Hypnosis in obstetrics. Varying approaches,
Am.J.clin.Hypnosis, 8:47-51.
Callann, T. D., 1961, Can hypnosis be used routinely in obstetrics?
Rocky Mount.med.J., 58:28-30.
Davidson, G. P., 1978, Self-hypnosis training in anxiety reduction,
Aust. Fam. Physician, 7:905-909.

AUDIOTAPED SELF-HYPNOSIS IN PREGNANCY AND LABOR

233

Davidson, J. A., 1962, An assessment of the value of hypnosis in


pregnancy and labor, Br.med.J., 5310:951-953.
De Lee, S. T., 1955, Hypnotism in pregnancy and labor, JAMA,
159: 750-754.
-De Lee, S. T., and Greenhill, J. P., 1939, Yearbook of Obstetrics and
Gynecology, Chicago, Yearbook, 164.
Gross, H. N., and Posner, N. A., 1963, An evaluation of hypnosis for
obstetric delivery, Am.J.Obstet.Gynec., 87:912-920.
Hilgard, E. R., and Hilgard, J. R., 1975, Hypnosis in Relief of Pain,
Los Altos, California, Kaufman.
Kline, M. V., and Guze, H., 1955, Self-hypnosis in childbirth: A
clinical evaluation of a patient and conditioning program,
J.clin.exp.Hypnosis, 3:142-147.
Kroger, W. S., and De Lee, S. T., 1943, The use of the hypnoidal
state as an amnesic, analgesic and anesthetic agent in obstetrics, Am.J.Obstet.Gynec., 43:655-661.
Kroger, W. S., and Freed, S. C., 1951, Psychosomatic Gynaecology,
Philadelphia, Saunders.
Michael, A. M., 1952, Hypnosis in childbirth, Br.med.J., 1:734-737.
Mody, N. V., 1960, Report on twenty cases delivered under hypnotism,
J.Obstet.Gynec.,India, 10:3-8.
Mosconi, G., and Starcich, B., 1961, Preparation for childbirth with
hypnosis, Rev.Latin Amer.Hypn.Clin., 2:29-36.
Rock, N. L., Shipley, T. E., and Campule, C., 1969, Hypnosis with untrained non-volunteer patients in labor, Int.J.clin.exp.
Hypnosis, 17:25-36.
Schultze-Rhonof, F., 1922, Zentralbl.f.Gynsk, 46:247.
Winkelstein, L. B., 1958, Routine hypnosis for obstetrical delivery,
Am.J.Obstet.Gynec., 76:152-160.

CHANGE IN SUBJECTIVE EXPERIENCES DURING


THERAPEUTIC SELF-HYPNOSIS
R. Van Dyck, Ph. Spinhoven and J. Commandeur
University of Leiden
Postbus 1251
2340 BG Oegstgeest, Holland
Abstract
Although imagery is a central element in many hypnotherapeutic
and behavior modification procedures, relatively little is known
about the process by which these imagery scenes operate.
This study is intended to identify some of the process variables
that are relevant to the therapeutic outcome of hypnotic imagery. As
the investigated procedure relies upon imagery alone, we are also
interested in the occurrence of non-suggested changes on the cognitive level as related to the outcome of therapy.
The subjects were 5 phobic patients of low hypnotizability who
were first trained in self-hypnosis and then were hypnotically reorientated towards an imaginary future scene at which their symptoms
are to be alleviated. The patients were provided with a tape-recording of these sessions for further daily training at home.
Patients were asked to monitor several aspects of their practice
sessions at home at at two points during the therapy period they were
interviewed about their thoughts and experiences during the hypnotic
imagery with the aid of a videotape of their hypnotherapy sessions.
A comparison of successful vs unsuccessful participants was
carried out. Related to a successful outcome were the occurrence of
self-initiated goal-directed fantasies as well as an unsuggested
shift towards more rational cognitions about the phobia.

2~

236

R. VAN DYCK ET AL.

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

SUBJECTIVE EXPERIENCES DURING SELF-HYPNOSIS

237

Anderson, 1967), involvement (Hilgard, 1970), distraction (Van Nuys,


1973), goal-directed fantasies (Spanos, 1971) and believability
(Sarbin and Coe, 1972). As this therapeutic procedure relies upon
imagery alone, we were also interested in the occurrence of nonsuggested changes on the cognitive level as related to the outcome of
therapy.
METHOD
An intensive design study was undertaken with five outpatients
who were referred for phobic complaints to the Leiden Psychiatric
University Clinic. No effort was made to select patients with a
positive attitude towards hypnotherapy. After their consent was
obtained for participation in the research project, their opinions
about hypnosis were noted and their hypnotizability was assessed with
the Stanford Hypnotical Clinical Scale. As measures of anxiety we
used the Fear Survey Schedule III (Wolpe and Lang, 1964; Arrindell,
1980). In order to assess the rigidity of their phobic cognitions,
the patients were asked to generate more rational alternative opinions to their present irrational ideas as noted from a cognitivefunctional analysis of their phobia. The degree of rationality, was
rated independently by two judges, using criteria from Rational
Emotive Therapy (Maultsby, 1975).
During the training period which lasted two weeks, and the
treatment period which as investigated for four weeks, the patients
were asked to monitor several aspects of their practice sessions:
vividness of the imagery, degree of relaxation, task orientation and
involvement in the imagery. In addition they were asked to describe
any disturbing or helpful thoughts or events that occurred during the
practice session. The content of this information was rated by the
two independent judges on the following aspects: occurrence of
distracting thoughts; evidence of continuing awareness of phobia,
self-initiated goal-directed fantasies and indications of believability of the imagery.
At two points during the therapy period (week 3 and week 5) the
patients were interviewed about their thoughts and experiences during
the hypnotic imagery, in order to obtain additional information about
the items of their daily monitoring. In order to facilitate recall,
the patients were shown a videotape of their therapy session; the
tape was stopped at regular intervals at which they were asked to
report their experiences.
A trend line analysis was made of both the data scored by the
patient himself and the data scored by the two independent judges.
After seven weeks the pre-treatment measures were repeated and a
post-experimental inquiry was conducted. This was repeated 6 months
later at the follow-up.

238

R. VAN DYCK ET AL.

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.

At the pre-treatment stage the patients that would turn out to


be the successful ones shared a neutral or positive opinion
about hypnosis. All three obtained a hypnotizability score of 1
(out of a maximum of 5). Low as this score may be, both the
unsuccessful patients scored even lower, that is 0 and they
expressed scepticism about the usefulness of hypnosis before
therapy.
While none of the patients was able to generate rational alternatives before therapy, those that were successful did at outcome
generate at least one rational alternative to three of their
irrational phobic ideas, while the unsuccessful patients failed
to show this cognitive shift (inter judge reliability in scoring:r=.83).
The several trendlines that express the development of the
process-variables cannot be summarized in a simple pattern. In
order to obtain a clearer picture we will compare the results of
the most successful patient (number 1) with the least successful
patient (number 4).

Self report variables


3.1

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

SUBJECTIVE EXPERIENCES DURING SELF-HYPNOSIS


Table 1.

239

Difference - scores of the 5 patients on the Relevant


Subscales of the FSS-III
pretest

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

agoraI*lObia and factor 3 = fear of lxxlily in juzy ,


death and illness.

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.

Judge rated variables


We now turn to the variables that were scored by the two judges
(r = .80) on the basis of the patients' notes and their responses at
the interview sessions:
3.5

3.6

3.7
3.8

Awareness of phobia (Figure 5) was at an unchanging high level


for the unsuccessful patient (4) and clearly dropped for our
successful patient (1). However the other 2 successful patients
showed an increasing awareness of their phobic thoughts as
therapy went on.
Self-initiated goal-directed fantasies (Figure 6) were almost
absent in the unsuccessful patient and occurred increasingly
with our successful patient. A moderate to high level of selfinitiated goal-directed fantasies seemed to be typical for the
three successful patients in contrast to both the unsuccessful
patients.
Occurrence of distracting thoughts (Figure 7) did not differentiate between patient (1) and (4) nor for any of the others.
Believability of the imagery (Figure 8) was continuously absent
in patient (4) and clearly on the increase in patient (1). This
distinction, however was not quite as clear for the other three.

240

R. VAN DYCK ET AL.


training-

max.

therapy-period
(-:patient(l) )
( .... --:patient (4

--------- ... - ------_ ..

min.

23456

Fig. 1.

weeks

Results of the trend line analysis (vividness of imagery).


therapy-period

.,,

-- ___ ... __ ~_---------------- ..

,,,

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-

SUBJECTIVE EXPERIENCES DURING SELF-HYPNOSIS


max. 5

241

therapy-period

4
3~

____________________

2 _______________________ _
min.l

4
weeks

Fig. 4.

ll'aX.5

Involvement in the imagery.

- - - - -----. - - - - - - - - - - - -

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

R. VAN DYCK ET AL.

max.s

- -- -

min. I

-- --- ------- -----2

Fig. 6.

weeks

Goal-directed fantasies.

max.s
4

3
2~

__-::-::-:
___:-:-::-:__ _

~~~

1:..=.:-----

min. I

Fig. 7.

weeks

Occurrence of distracting thoughts.

only in a limited way. Hypnosis as such may have played only a


modest part in the clinical improvement that some of our patients
show.
A "skills training paradigm" does not seem to fit well with the
patterns that we found in the trend-analysis of imagery. relaxation
or most other variables that can be understood as skills. It must
however be kept in mind. that the period under observation was
limited to six weeks. This maybe too short a period for any noticable improvement in skills.
In the follow-up interviews. we learned that the effect of
repetition was appreciated differently by the successful and the
unsuccessful patients. To the former. it contributed to a growing
conviction about the possibility of good results. To the latter the
element of repetition was clearly boring and aversive. It contributed mostly to their already present scepticism.
A positive finding was the concurrence of self-initiated goaldirected fantasies and clinical improvement. Most likely, it is no
accident that the three patients who profited from the procedure of
future-oriented imagery were good at goal-directed fantasies: the

SUBJECTIVE EXPERIENCES DURING SELF-HYPNOSIS

243

max. 5

min.l--------------------2

Fig. 8.

4 weeks

Believability of the imagery.

therapeutic procedure is actually a complex goal-directed fantasy.


All three also passed item 1 of the SHCS. This item is an ideomotor
instruction in which the subject has to imagine that both his hands
will be pulled together by magnets, once more a goal-directed fantasy. Apart from the skills aspect that seems to be involved here,
the other important factor may have been that these patients initiated new goal-directed fantasies by themselves. That is, they imagined scenes and detailed in addition to what was offered on the tape.
This is a clear sign of deeper engagement in the therapy process than
passively awaiting suggested effects.
A further common feature of the improved patients was the cognitive shift in their phobic cognitions at the end of the observed
treatment period. This consisted in more rational thinking about
their phobia; they began to "doubt" slightly the dangerous nature of
tnose situations or subjects that they used to be very afraid of. As
the therapy procedure was limited to offering imaginary scenes and
did not contain any direct cognitive instructions, this must be
considered an indirect result of the procedure. It is likely that
this cognitive shift on its turn contributed positively to the credibility of the procedure and the effect of therapy.
If we combine the findings of a moderately positive attitude of
expectancy before therapy, a positive score on item 1 of the SHCS,
the occurrence of self-initiated goal-directed fantasies and a cognitive shift during therapy, we can conceive the positive outcome to be
the product of a complex circular interaction. This would include
the presence of a skill or trait (to act on goal-directed fantasies),
a procedure which relied on this skill and moderately positive expectations which stimulated the mobilization of the skill. In time this
produced cognitive changes which increased the belief in results,
eventually validated by changes on the level of actual experience.
A possible clinical application of this view would be to recommend a selection of patients in order to obtain a good fit between
the procedure and the patients' skills. Strong positive expectations

244

R. VAN DYC!{ ET AL.

should not be considered to be essential, but some interest would be


required. Changes on the cognitive level may be stimulated more
directly in order to promote a favorable interaction and the occurrence of self-initiated goal-directed fantasies may be investigated
by interviews or diary reports during therapy in order to find out in
time whether or not any therapeutic change is on its way.
REFERENCES
Arrindell, W. A., 1980, Dimensional structure and psychopathology
correlates of the Fear Survey Schedule (FSS-IIII) in a phobic
population: a factorial definition of agoraphobia, Behav.Res.
Ther., 18:229-242.
Diamond, M. J., 1974, Modification of Hypnotizability: a Review,
Psychol.Bull., 81:180-198.
Dyck, R. Van, 1980, An individualized procedure for learning therapeutic self-hypnosis. Paper presented at the 2nd European
Congress of Hypnosis and Psychosomatic Medicine, Dub rovnik ,
12-18 May.
Erickson, M. H., 1954, Pseudo-orientation in time as a hypnotherapeutic procedure, in: "Advanced Techniques of Hypnosis and
Therapy: Selected Papers of Milton H. Erickson, M.D.," J.
Haley, ed., Grune and Stratton, New York, 369-389.
Fromm, E., Brown, D. P., Hurt, S. W., Oberknder, J. Z., Boxer, A. M.,
and Pfeifer, G., 1981, The phenomena and characteristics of
self-hypnosis, Int.J.clin.exp.Hypnosis, 29:189-246.
Hilgard, E. R., 1965, Hypnotic susceptibility, Harcourt Brace and
World, New York.
Hilgard, J. R., 1970, Personality and hypnosis: a study of imagin
ative involvement, University of Chicago Press, Chicago.
Lazarus, A. A., 1973, 'Hypnosis' as a facilitator in behavior
therapy, Int.J.clin.exp.Hypnosis, 21:25-31.
Maultsby, M., 1975, Help yourself to happiness through rational selfcounselling, Marlborough House Inc., Boston.
Sachs, L. B., and Anderson, W. L., 1967, Modification of hypnotic
susceptibility, Int.J.clin.exp.Hypnosis, 15:172-180.
Sarbin, T. R., and Coe, W., 1972, Hypnosis: a social psychological
analysis of influence communication, Holt, Rinehart and
Winston, New York.
Sheehan, P. W., 1979, Hypnosis and the process of imagination, in:
"Hypnosis: Developments in Research and New Perspectives:" E.
Fromm and R. E. Shor, eds., Aldine Publishing Company, New
York, 381-411.
Shor, R. E., 1959, Hypnosis and the concept of the generalized
reality-orientation, Amer.J.Psychother., 13:582-602.
Singer, J. L., 1974, Imagery and daydream methods in psychotherapy
and behavior modification, Academic Press, New York.
Spanos, N. P., 1971, Goal-directed fantasy and the performance of
hypnotic test suggestions, Psychiatry., 34:86-96.

SUBJECTIVE EXPERIENCES DURING SELF-HYPNOSIS

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.

WHY IS HYPNOSIS EFFECTIVE IN PAIN CONTROL?

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.

Pain and disability play major roles in bringing patient and


physician together. They are also basic clues in the diagnostic
workshop leading to appropriate treatment. Before and after completion of the diagnostic workshop, analgesics or narcotics are
249

250

P. SACERDOTE

prescribed or administered for pain control, as long as pain relief


does not interfere with diagnosis or treatment.
From a teleological view-point pain represents an alarm system
aimed at protecting the individual from major injuries. On the other
hand, we know that the level of pain perceived by the person for any
specific injury or pathology is not a fixed quantity, rather it
varies with time and cirumstances. The changes in the intensity and
quality of the pain are in part the result of conscious and unconscious controls exerted by the subject himself or his nervous system.
Basic for an understanding of the effectiveness of hypnosis in pain
control is the fact that under normal circumstances, pain is regulated by mechanisms which are below or outside the conscious level of
awareness. In fact, we must keep in mind that the entire body, and
the nervous system in particular, operate to a large degree independently of our conscious attention. A few examples will be sufficient
to clarify these statements.
The intrinsic muscles of the eyes regulate the diameter of the
pupils in response to the wave-length and the intensity of the light;
they also alter the shape and focal length of the crystalline lens
according to the distance between objects and the retina. The extrinsic muscles move both eyes simultaneously so that the occiptal
cortex can perceive a coherent image from both retinas. The movements can be convergent, or parallel, or divergent, according to the
distance between the fundi and objects.
The muscular layer in the blood-vessel walls regulates the
volume and speed of the circulation according to local thermal,
chemical, or bio-electric stimuli, or to signals originating in
various regulatory centers in the central or peripheral nervous
systems. These changes in the flow are coordinated with cardiac
functions and are related, in part, to the requirements or organs
and tissues for adequate levels of oxygen and carbon dioxide.
The tonus, contraction, or relaxation of the muscles controlling
the bones between the membrana-tympani and the cochlea react to the
intensity and frequency of sounds and to messages from central auditory centers in the eNS. Through this modulation the internal ear is
protected from excessive intensity and frequency, while low-volume
sounds are amplified.
With regard to pain control, noxious stimuli, before they reach
the thalamus and the cortex (there to be perceived as pain) are
transduced, inhibited, or increased at various synaptic levels along
the spinal cord and the brain. The opening or closing of the synaptic gate is in response to messages received from higher centers,
altered to the more slowly travelling pain messages. (Melzack and
Wall 1965). The inhibition of conduction at various synapses may
depend on localized production of naturally occurring opioids. This

WHY IS HYPNOSIS EFFECTIVE IN PAIN CONTROL?

251

is a simplified view of a sample from the many regulatory mechanisms


which are in constant activity or vigilance independently of the
individual's conscious or subconscious volitional systems.
More remarkable examples of organized biochemical activity
outside of conscious awareness, are the conveyance of coded messages
through the DNA and RNA systems for the reproduction of complicated
molecules, cells, organs, tissues, and entire individuals.
Teleologically, we can conceptualize all these very complex
functions as aimed at the coninuation of life in the individual and
in the species. We can say that these complex functional systems
together constitute the physiological unconscious. On the other
hand, it appears obvious that there exist ordinary and extraordinary
means of communication between our conscious and subconscious volitional systems and this multifaceted unconscious. These means of
communication must function somewhat as computer programmers capable
of translating our thoughts, intentions and feelings into a biological language that molecules, nuclei, and organelles within the
cells, the tissues, and the organs can understand and activate.
These computer-programmers are active at all times. But it appears,
from clinical evidence and from experimental data, that at certain
levels of hypnosis, the programming is facilitated. Some subjects
and patients, learn during hypnosis, to translate from conscious and
subconscious language to physiological and anatomical language and
continue to retain and utilize such facilitation outside of formal
states of hypnosis. This is a theoretical outline that can serve to
clarify and explain the therapeutic efficacy of hypnotic approaches
in biological terms.
The achievement of satisfactory states of hypnosis, and of
positive results, however, is complicated by the existence of expected and unexpected conscious and subconscious emotional realities
which can enhance or inhibit the pure physiological processes of
hypnotization and the translation from intention to activation.
The other main factor that interferes with the reaching of
sufficiently deep trances is the degree of hypnotic talent which is
variable from subject to subject. Both experimenters and clinicians
are largely in accord on the issue of statistical distribution of
talent; 15 to 20 per cent of a random population demonstrate a very
high level of talent, 70 to 75 per cent have intermediate talent, and
the remaining have negligible or zero talent. The issue of whether
the degree of talent can increase with appropriate training and
practice is still the subject of debate among the experts.
Talent for hypnosis probably largely coincides with some innate
ability to translate ideas and feelings instantaneously into physiological realities and creative multi-sensory images. For instance,
some highly talented individuals practically smell the fragrance of a

252

P. SACERDOTE

rose when it is mentioned to them. begin to salivate at the thought


of an attractive dish. instantly smile in response to a pleasant
expression or to a hand-shake. They may also have the ability and
tendency to become fully involved with a task. so as to cease to
notice or respond to other activities around them. In some ways
these hypnotically talented individuals have already a more direct
communication between volitional intention. and feelings and the
actual activation of specific physiological and psychological processes. It is therefore comparatively easy to train such subjects
into achieving control over their physiological activities and response. including the control of pain.
As mentioned before. conscious and subconscious emotional problems can either enhance or inhibit the activation of deep states of
hypnosis and the translation from feelings and intentions to active
beneficial physiological responses, including. naturally. the inhibition of pain-perception.
Some students of the phenomena of pain and hypnosis like to
distinguish physical pain from suffering and from other emotional
components: distress. anguish. depression. (Hilgard and Hilgard.
1975).
There are also questions as to whether pain should be considered
a real sensory modality. similar to the specific senses of sight.
hearing. smell. taste. touch. It is also a fact that the ethnic or
social group to which the person belongs plays a part in the ways in
which the pain is perceived and the manner of the response.
The fact that clinical pain contains the elements of distress.
anguish. suffering and depression does not mean that only the pain of
psychological (functional. or psychosomatic) origin can be controlled
or alleviated through hypnosis. For instance the intense and protracted pain of extensive burns (Crasilneck et al 1955; Margolis
and DeClement. 1980) and of advanced cancer (Sacerdote. 1962. 1964.
1965. 1966a. 1966b. 1968a. 1968b. 1970. 1977a. 19776b. 1980) as well
as nagging back-ache (Sacerdote 1978) tic doloureux (Sacerdote 1972).
and phantom pain (Sacerdote 1982). respond to hypnosis when other
modalities prove inadequate. Psychological factors that favor paincontrol or interfere with it. are rational and conscious. or largely
subconscious. Among factors that facilitate the control of pain
there is the obvious conscious motivation the suffering patient has
to escape from the anguish and agony of severe persistent or recurring pain, also the subconscious need to escape from the controls and
limitations imposed by the medical and nursing staff and by the
hospital administration; actually a need to be in control rather than
the passive object of doctor's often impersonal care.
Paradoxically. the need for being in control may interfere with
the induction and deepening of the hypnosis. as many patients tend to

WHY IS HYPNOSIS EFFECTIVE IN PAIN CONTROL?

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

In cases where the trauma originally responsible for the pain


has been handled by workmen's compensation boards. or by insurance
companies and lawyers. there can be a strong motivation to preserve
the disability and pain until the issue of satisfactory compensation
has been resolved. Such motivations. when fully conscious, belong to
the category of malingering. When mostly subconscious the are closer
to hysterical conversion. Either way. such motivations are often
sufficient to neutralize the efforts of the hypnotherapist. as they
had already frustrated the efforts of various other specialists who
had used different modalities. such as surgeri. medication. biofeedback. acupuncture. electric stimulation. and other psychotheraputic interventions.
The physician or psychologist who is using hypnosis for effective pain-control needs to be well aware of all the above mentioned
possible positive or negative interactions and interferences. He
must also keep in mind that. independently from his ability. training. and experience. elements of transference and countertransference
play an important part in the outcome of the attempted hypnotic
approach. If for any reasons. conscious or unconscious. the patient
dislikes the personality of the therapist or distrusts him. failure
becomes inevitable. Reciprocally. the doctor may dislike or distrust
the patient. or become angered or frustrated by the apparent stubbornness with which the patient consistently fails to respond. either by
remaining at a very superficial level of hypnosis. or by failing to
produce any of the expected effects. We have to deal with the expressed and unexpressed expectations of therapist and patient. also
with the failure of the therapist to make the patient understand how
hypnotic responses should develop. (Sacerdote 1974). The entire
issue of resistance to hypnosis and resistance to hypnotherapy needs
to be treated separately.
We come now to examine. as schematically as possible. the various modalities for inducing the patient. first to reach an effective
hypnotic level. then to choose a sequence of creative and interesting
ideas that he or she can use for translating his or her. as well as
the therapist's intentions into real positive results.

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-

WHY IS HYPNOSIS EFFECTIVE IN PAIN CONTROL?

255

ences which I have described is present in sufficient strength.


Somewhat less talented patients will respond with various degrees of
success. Even if maximum results are obtained at the time of the
first visit we cannot be sure that the improvement will be maintained, either because the element of novelty or surprise is wearing
off, or because the factors which had worked to maintain intense pain
are again becoming too active, thus disturbing the new balance that
had been achieved. In some cases we may have to change to alternative approaches; for example:

Indirect Suggestions of Relief


This may be achieved simply by suggestions of progressive relaxation with consequent decrease of sensitivity. Or we can use the
technique suggesting of so-called glove-anaesthesia in one hand with
subsequent transfer to the painful areas.
Substitution of Symptoms
We suggest the possibility that the patient may become aware of
sensations of pressure, or pulling, or itching in place of the pain
experience.
Displacement of Symptoms
The painful sensations in the diseased part of the body can be
transferred, for instance, to the hand or just one finger. Or, it
may be explicitly or implicitly suggested that the doctor's hand,
placed on the painful part of the body, may absorb or remove the
pain, or that the pain may become a tingling sensation, or a
vibration, or may even be the vibration of a musical chord.

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

Time and Space Distortion


Time distortion often occurs spontaneously during hypnosis, or
it may be achieved by direct or indirect suggestions, so that the
patient preceives the periods of intense pain as much shorter than
they are in reality (Erickson 1958). Major distortions of time and
space can lead to perceiving time and space as progressively expanding; this can usually result in the development of mystical states
during which the patient develops unbelievable calmness and serenity,
oblivious to pain, illness, and possible death (Sacerdote 1977a).
It is very useful, before and during hypnosis, to prepare the
patient for the reality of achieving authentic pain relief. Depending on his intellectual and educational level, we explain in terms
understandable to him, how and why, in hypnosis, most bodily functions, including pain, can be brought under more effective control.
The more sincerely we believe in our own explanations, the more
easily we convey our expectations to the patient. For well informed
patients, we may use anatomical and physiological terms, for others
we may suggest the simile of electric wiring, switches and knobs to
control volume and sound. When it comes to imagery it is probably
best to utilize the patient's own experiences rather than our own
knowledge.
In spite of the theoretical explanations, some patients may
simply accept the effect of hypnosis as some kind of miraculous
intervention, such as the laying-on of hands to relieve pain and cure
disease. Other subjects are not ready to accept hypnosis unless a
crystal ball, or a rotating spiral is presented in front of their
eyes.
It is desirable and very essential to have the effects of one or
more sessions of hypnotherapy continue in the future, either by
post-hypnotic suggestion or by learning to use self-hypnosis, so as
to reproduce the results even when the therapist is not present. For
some subjects post-hypnotic suggestions may be unnecessary. They
have learned to control pain in hypnosis, and the learning is transferred to the conscious level. Generally self-hypnosis is effective
if it reaches a level where there occurs dissociation between an
observing and directing ego and the body-self that is guided into
achieving comfort and tranquillity with freedom from pain.
Or the patient can learn to accept the reality of painless pain.
That means that he has perceptions of the existence and location of
the pain, but without the accompanying suffering and anguish. This
permits him to avoid the fear that, by not perceiving the pain, he
may fail to recognize and point to the doctors the appearance of new
developments in the disease.

WHY IS HYPNOSIS EFFECTIVE IN PAIN CONTROL?

257

In concluding this brief presentation, I want to point out that


when we talk in terms of mind, or of thinking, understanding, speaking, visualizing, hallucinating, perceiving, feeling, etc. we are
talking about specialized manifestations of the activity of groups of
interrelated neurons in the central and peripheral nervous systems.
There is a continuum of communications and interactions between what
we conceive as mind, feelings, emotions, and all the other body
realities.
I also need to stress the point that even our relatively advanced understanding of the nervous system and the body is still very
far from being complete, precise, and accurate. For instance, we
have not yet been able to find precise correlations between changes
in the electroencephalograms and certain states of hypnosis, nor have
we documented the correlations between the state of hypnosis, the
patient's changing perceptions and the disappearance of pain. Still,
the formulations that I have presented can be at least as useful to
the physician as the directions for turning buttons and dials on a
T.V. set are to the average layman, even though most people have only
the vaguest ideas about electric phenomena, electronic circuits, and
transmission of signals from distant stations to their television
sets, the limited instructions and knowledge are sufficient for
obtaining the desired results.
REFERENCES
Crasilneck, H. B., Stirman, J. A., Wilson, B. J., McCranie, E. J.,
and Frogelman, M. J., 1955, Use of hypnosis in the management
of patients with burns, J.Am.med.Ass., 158:(2)103-106.
Erickson, M. H., '1958, Hypnosis in painful terminal illness, Am.J.
clin.Hypnosis, 1:117-121.
Hilgard, E. R., and Hilgard, J. R., 1975, Hypnosis in the Relief of
Pain, Los Altos, Calif., Kaufmann, 86-102.
Margolis, C. G., and DeClement, F. A., 1980, Hypnosis in the treatment of burns, Burns, 6:253-254.
Melzack, R., and Wall.~D., 1965, Pain mechanisms: a new theory,
Science, 150:971-969.
Sacerdote, P., 1962, The place of hypnosis in the relief of severe
protracted pain, Am.J.clin.Hypnosis, 4:150-157.
Sacerdote, P., Terminal cancer's pain: relief through hypnotherapy,
in: "Psychosomatic Aspects of Neoplastic Disease," D. M.
Kissen and L. L. Le Shan (eds.), Lippincott, New York,
121-130.
Sacerdote, P., 1965, Additional contributions to the hypnotherapy of
the advanced cancer patient, Am.J.clin.Hypnosis, 8:308-319.
Sacerdote, P., 1966a, Hypnosis in cancer patients, Am.J.clin.Hypnosis, 9:100-108.
Sacerdote, P., 1966b, The uses of hypnosis in cancer patients.
Proceedings: Conference on Psychophysiological aspects of
cancer. Annal N. Y. Acad. Sciences, 125:1011-1019.

258

P. SACERDOTE

Sacerdote. P 1968a. Psychophysiology of hypnosis as it relates to


pain and pain problems. Am.J.clin.Hypnosis. 10:236-243.
Sacerdote. P 1968b. Involvement and communication with the terminally ill patient. Am.J.clin.Hypnosis. 10:244-248.
Saderdote. P 1970. Theory and practice of pain control in malignancy and other protracted or recurring painful illness.
Int.J.clin.exp.Hypnosis. 18:160-180.
Sacerdote. P 1972. Eclectic approaches to hypnotherapy. Am.J.Psychother. 26:511-520.
Sacerdote. P 1974. Convergence of Expectations: An essential component for successful hypnotherapy. Int.J.clin.exp.Hypnosis.
22:95-115.
Sacerdote. P 1977a. Applications of hypnotically elicited mystical
states to the treatment of physical and emotional pain. Int.J.
clin.exp.Hypnosis. 25:309-324.
Sacerdote. P 1977b. Hypnotherapy in managing terminally ill
patients. Cat.T.62. Cat.64. BMA Audio Cassette Publ New
York.
Sacerdote. P 1978. Induced dreams: About the theory and therapeutic
applications of dreams hypnotically induced. Gaus. New York.
Sacerdote. P 1980. Hypnosis and terminal illness. in: "Handbook of
Hypnosis and Psychosomatic Medicine." G. D. Burrows and L.
Dennerstein (eds.). Elsevier/North Holland Biomedical.
Amsterdam. 421-442.
Sacerdote. P 1982. Erickson's. Contribution to Pain Control in
Cancer. in: "Ericksonian Approaches to Hypnosis and Psychotherapy."'Zeig. (ed.). Brunner/Mazel, Inc New York.

HYPNOSIS AND PLASMATIC BETA-ENDORPHINS

G. Guerra.* G. Guantieri.** and F. Tagliaro***


*Hospital Service Command. RMNE. Verona. Italy
**"H. Bernheim". Center for Studies on Clinical Hypnosis
and Psychotherapy. Verona. Italy
***Institute for Medical Semeiotics. University of Padova
in Verona. Italy
Abstract
The importance of B-endorphins and other polypetides has been
demonstrated recently in the central modulation of pain and in analgesia. Diagnostic and clinical implications have been prospected in
the pain field. and in relation with B-endorphins affinity with
endogenous opiate receptor. in opiates addiction.
Owing to the difficulty of B-endorphin determination in biological fluids. the studies have supplied interesting but contradictory results. We have less information about the behavior of
these neuropeptides during hypnosis under neutral. analgesic and
painful suggestions and this is the field of our research. The
authors are studying normal and heroin addicted subjects. Plasmatic
B-endorphin determination is performed by a radio-immunologic method
after a chromatographic step (gel filtration or HPLC). Preliminary
data would suggest interesting modifications of B-endorphins in
peripheral blood during strong suggestions of pain in the hypnotic
state.
INTRODUCTION
In different laboratories between 1971 and 1973. some researchers successfully demonstrated the existence of a receptor present at
the level of the central nervous system and capable of binding opium
derivatives (Simon et al 1973; Pert and Snyder. 1973; Goldstein.
1974; Terenius. 1973; Simon et al 1947). This discovery led to the
259

260

G. GUERRA ET AL.

conclusion that if a stereospecific receptor for alkaloids of opium


existed, it should logically have the ability to bind andogenous
molecules similar to opium and its derivatives.
Molecules of this kind were in fact soon identified in a class
of polypeptides having an action analogous to morphine and termed
"endogenous opiates". By means of sophisticated radio receptor
binding (Johansson et al., 1978) and histoimmunofluorescence (Coons,
1958) techniques, it was possible to establish their tissue distribution. It was thus apparent that the encephalins (metencephalin and
leu-encephalin) were present in numerous cerebral areas (basal ganglia, cortex, hypothalamus, limbic areas), at the synaptic level, and
also in the medulla (second and third lamina, substantia gelatinosa
in the zone of Roland). Apart from the eNS, the encephalins have
been found in Auerbach's myoenteric plexus, in the sympathetic ganglia and in the suprarenal medulla (Johansson et al., 1978). Regarding their function, there are valid reasons to believe that they are
neurotransmitters or inhibiting neuromodulators (Snyder, 1977). The
endorphins (alpha, beta, gamma and delta), on the other hand, do not
seem to have an even distribution any more than do the encephalins.
According to Cox et al. (1975), they are present only at hypophysary
(middle and posterior lobes) and hypothalamic levels. According to
Bloom et al. (1978), beta-Endorphin is also present at septal, mesencephalic and pontine levels. In biological tests, beta-Endorphin
turns out to have fairly slow onset and offset times, in contrast to
the encephalins, which show very short on- and off-set times. Thus
endorphin activity is of the "neurohormonal" type, as demonstrated by
Erdos et al. (1978), as against the encephalins' neurotransmitting
activity. Probably beta-endorphin plays a decisive role in control
of the endocrine function since, like morphine, it has the property
of varying the release of the hypophysiary hormones (Bonnet et al.,
1978). Moreover, since they show properties similar to those of
exogenous opiates, many writers have hypothesized an interaction with
the neurons concerned in the pain and anxiety mechanisms. Interest
in the opiates has not however been confined to the field of algology, vast though it is. Indeed, from the assumption that morphine, an exogenous homologue of the endorphins, was able to modify
the human psychological "pattern", some writers have tried to determine whether there was any correlation between psychic illness and
quantitative or qualitative alterations of the endogenous opiates
(Lazzari et al., 1980). Other important lines of research concern
the role of the endorphins in control of temperature. control of the
endocrine function (Lazzari et al., 1980), in drug dependency
(Plescia et al 1981), in control of food intake, and in control of
arterial pressure. The discovery of the endorphins and the evidence
of their relationship with the afferent nociceptive mechanisms has
led many researchers to consider their function both in illnesses
where pain is the dominant symptom and in experimental conditions of
analgesia, anesthesia and induced pain. Many writers have demonstrated the analgesic property of the endorphins in animals: this

HYPNOSIS AND PLASMATIC BETA-ENDORPHINS

261

has also been done with patients objecting to narcotics. Naloxone


has in fact been shown in various experiments to reduce the pain
level in both animals and man (Levine et al., 1978; Boduar et al.,
1978; Preje et al., 1978). Recent studies have further shown that
central stimulation of the periaqueductal gray matter produces an
analgesia opposed by Naloxone. In the course of these experiments an
encephalin-like substance, thought to be responsible for the analgesia, has been found in the cerebro-spinal fluid (Kumajawa et al.,
1975). Intraventricular administration of encephalin to experimental
animals produced the same effect as electrostimulation of the
periaqueductal gray matter, clearly indicating the role of these
substances in the phenomenon (Akil et al., 1978). Many techniques,
such traditional acupuncture, electro-acupuncture and transcutaneous
electro-stimulation of the brain, produce a state of analgesia with a
rise of endorphin levels in the cerebro-spinal fluid, such effects
being countered by Naloxone (Scarcelli, 1981; Lazzari et al., 1981).
Pomeranz (1978). in studies conducted on animals, has shown that
hypophysectomy nullifies the analgesic effects produced by electroacupuncture, and the same result may be obtained by administration of
Naloxone. The hypothesis that the endorphins are responsible for
this type of analgesia is further supported by the fact that the
effects have fairly long onset and offset times. According to Bloom
et ale (1978), however, hypophysectomy does not lead to any variation
of the hypothalamic endorphin content, thus creating a controversy.
Salar and Job (1978) have recently demonstrated that transcutaneous
electrostimulation can activate the endorphinergic system, with a
consequent increase in endorphin levels in the cerebro-spinal fluid,
even in patients not suffering from pain.
In human pathology the role of the endorphins in chronic pain
and analgesia has been brought to light by numerous researchers. It
has been seen that treatment with Naloxone restored the nociceptive
reflexes in some cases of congenital insensitivity to pain. Terenius
(1978) has recently noted that endogenous opiate levels in the cerebro-spinal fluid are considerably lower than normal in patients
suffering from chronic organic pain, while they are normal or even
higher than normal in patients affected by chronic "psychogenic" pain
(or by other pain with no detectable organic cause). Sicuteri (1978)
has recently demonstrated that patients suffering from severe recurrent headaches had endogenous cerebro-spinal opiate levels notably
lower during the critical periods than in the intercritical periods.
The hypothesis this work supports is therefore that the cause of
headaches might be in a "genetic malfunction" of the endogenous
pain-detecting mechanisms.
In the therapeutic field, the effect of analgesia by electrostimulation of the peraqueductal gray matter and the medial thalamic
nuclei has been studied, using stereotactic surgical techniques, in
man (Akil et al., 1978). The possible action of endogenous opiates
has been studied in an attempt to explain the physiological mechanism

262

G. GUERRA ET AL.

of hypnotic analgesia. Tests carried out by Goldstein and Hilgard


(1975) have demonstrated that, contrary to expectations. hypnotic
analgesia is not brought about by the endogenous opiates; in fact
administration of Naloxone following hypnotic induction did not
cancel the analgesic state. This is the background to our study,
which is intended to confirm, using different subjects and methods of
hypnosis, both the Goldstein/Hilgard findings on the role of the
endogenous opiates, in particular the endorphins, in hypnotic analgesia, and the variations of these substances under experimental
conditions of pain provoked during hypnotic induction. As a reference measure we have used the beta-endorphin plasma level.
MATERIALS AND METHODS

We studied 9 healthy and highly motivated volunteers, having a


positive relationship with the operator (seven males and two females
between the ages of 24 and 52). Hypnotic induction was carried out
by a non-authoritarian technique; analgesia was obtained in the right
arm and hand in the first session with one subject, who had 20 years'
experience in the production of numerous hypnotic phenomena, in the
others at the 5th or 6th session, after they had progressively gone
through first inhibition of voluntary movements, then perception of
heat, coolness and cold, in one session after another, via intensely
experienced visualizations suggested according to the subject's
requirements. Analgesia was obtained after another 3 or 4 sessions,
monitored in each case by repeated insertion of a normal sampling
needle. Onset of analgesia and intensity of the hypnotic state were
established both by objective criteria (facial expression, muscle
tone, eyeball movement, response to pain stimulation. appearance on
reawakening etc.), and from the subject's own experiences (posthypnotic amnesia, personal evaluation of experiences under trance and
comparison of these with pain stimulation in the waking state, etc.).
Blood samples were taken at the last session, ten minutes before
induction in the waking state and again once hypnotic analgesia had
been ascertained. In two subjects a sample was also taken during
extremely painful experiences induced under hypnosis (scalding of the
right hand and arm and crushing of the right hand). To the blood
samples were added EDTA and 500 KIU/ml of Trasylol. The blood was
kept on ice and subsequently separated in a refrigerate centrifuge;
the plasma was then collected in separate test tubes and kept at
-20 o e until it was analysed.
The first phase of the beta-endorphin dosage was the stripping
of beta-lipotropin from the sample for analysis. This was necessary
because the antiserum used in the final radioimmunological process
showed a complete cross reactivity between the beta-endorphin and
beta-lipotropine molecules. To free the plasma from the interfering
molecule it was incubated overnight at +4 o e with a suspension of
specific anti-beta-lipotropin antibodies bound to a solid matrix (IMN

HYPNOSIS AND PLASMATIC BETA-ENDORPHINS

263

Corporation, Minnesota, USA), which were then eliminated by centrifugation.


The beta-endorphin was extracted from the plasma after acidification of the latter, by means of hydrophobic interaction chromatography on pre-packed ODS columns (SEP-PACK). The material was then
eluted from these with a water/methanol mixture (1/1). The eluate
was dried in a nitrogen flow, transferred to a borate tampon at pH
8.6, and finally subjected to radioimmunological treatment using
commercially available (IMNC) reactants. The total percentage recovery of standard beta-endophin by this method has always been found
to be from 90-105%.
RESULTS AND DISCUSSION
Table 1 and Figure 1 show the plasma values of beta-endorphin as
found in our subjects, before induction and during hypnosis in the
analgesia phase. As the table and figure indicate, no significant
variations of beta-endorphin plasma levels can be detected. This
biochemical result accords with the observations of Goldstein and
Hilgard (1975). In fact, in their experimental model, Naloxone (the
specific opponent of the opiate receptors) is unable to counteract
the hypnotically induced analgesia. Furthermore, various other
experimental conditions in laboratory animals indicate the existence
of states of analgesia not reversible by Naloxone treatment, involving cerebral circuits other than the endorphinergic paths (Grau et
al., 1981). For example, it has been shown that in rats, (Willer et
al., 1980) analgesia from stress is divisible into two phases of
which one depends on noradrenergic mechanisms and does not appear to
be modified by treatment with Naloxone, while the other involves the
endorphinergic paths and is counteracted by Naloxone. The experimental situation is "critical", and various factors, e.g., duration
and intensity of the stress stimulus, may influence results. Moreover, results found in animals cannot always be extrapolated directly
to the human situation, as Carli et al. (1978) indicate.
In our study we also wanted to measure the plasmatic concentrations of ACTH and cortisol. Neither ACTH nor cortisol vary significantly in the patients we studied. Furthermore, in two patients
- of whom only one had for many years been specially trained for
hypnosis - it was possible to measure the concentration in the plasma
of beta-endorphin during hypnosis with suggestion of pain. The data
obtained indicate the existence under such conditions of interesting
variations in levels of peptides, although more extensive data is
needed before conclusions can be drawn, since the responses of the
trained and the untrained subjects appear to differ.
All in all, the results obtained would seem to point to the
existence of hypnotic analgesia unrelated to endorphin variations,

264

G. GUERRA ET AL.

Table 1.

Levels of Plasmatic Beta-endorphin in


9 Subjects before and during Hypnotic
Analgesia

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

HYPNOSIS AND PLASMATIC BETA-ENDORPHINS

265

would also measure the variations in pain-threshold and in levels of


endorphin (as well as of other peptides related to the phenomenon of
pain-detection) after hypnosis in association with interacting pharmacological treatments (Naloxone).
REFERENCES
Akil, H., Watson, J., Berger, T. A., and Barchas, J. D., 1978, Endomorphine, Beta-LPH and ACTH: biochemical, pharmacological and
anatomical studies, Adv.Biochem.Psychopharm., 18:125.
Bloom, F. E., Rossier, J., Battemberg, F., and Ling, N., 1978, Betaendorphin cellular localization and behavioral effects, Adv.
Biochem.Psychopharm., Vol.18, 19:84. Raven Press, New York.
Boduar, R. S., Kelly. D. D Spiaggia, A., Ehrenberg, C., and
Glusman, M., 1978, Stress produced analgesia and morphine
produced analgesia: last of cross-tolerance, Pharmacol.
Biochem.Behav., 8(6):661-666.
Bonnet, K. A., Miller, J. M., and Simon, S., 1978, Opiates and endogenous opioid peptides, 335-343, North Holland Publishing Co.,
Amsterdam.
Carli, G., Farabollini, F and Pontani, G., 1978, Pain and animal
hypnosis. Further studies on the effects of morphine and
Naloxone, Proc.2nd Int.Cong.on Pain, Montreal.
Coons. A. H., 1958, General Cytochemical Methods, 109-111. Academy
Press, New York.
Cox, B. M., Ophiem, K. E., Teschemacher, M., and Goldstein, A., 1975,
A peptide-like substance from pituitary that acts like a
morphine; purification and properties, Life Science,
16:1772-1782.
Erdos. E. G., Johnsson. A. R and Boyden. N. T., 1978. Inactivation
of encephalins: effect of purified peptidyl dipeptidase and
cultured human endothelial cells, Adv.Biochem.Psychopharm.,
Vol.18, 45-49, Raven Press, New York.
Goldstein, -A., 1974, Opiate receptors. Life Science. 14:615.
Goldstein A., and Hilgard, E., 1975, Failure of the opiate antagonist
Naloxone to modify hypnotic analgesia, Proc.Natl.Acad.Sci.,
USA. 72:2041.
Grau, J~., Hyson, R. L Maier. S. F., Madden. J. IV, and Barchas,
J. D., 1981, Long-term stress induced analgesia and activation
of the opiate system, Science, 213:1409-1411.
Johansson, D., Hokfelt, T., Elde, R. P Schultzberg, M., and
Terenious, L., 1978, Immunohistochemical distribution of
encephalin neurons, Adv.Biochem.Psychopharm., Vol.18, Raven
Press, New York.
Kumajawa, T., Perl, E. R., Burgess, P. R., and Whitehorn, D., 1975,
Int.J.Comp.Neurol., 162:1-12.
Lazzari, C., Di Monda, E., Fazzari, G., Almici, G. M., Pelliccioli,
G., Callea, L., and Giupponi D., 1980, Oppiati endogeni:
storia, aggiornamenti e prospettive, Rassegna di Studi
Psichiatrici Senese, 69:250.

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.

HYPNOSIS IN THE ALLEVIATION OF THE SMOKING HABIT

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

major studies on the hypnotic treatment of


decade have been made by Edmonston (1981).
subject was reviewed in a special issue of the
of Clinical and Experimental Hypnosis in 1970.

Individual authors have reported a wide range of results. from


Cohen (1969). who has not been able permanently to stop people from
smoking to Von Dedenroth (1946). who claimed a success rate of 94% in
1.000 patients followed up for over 6 years.
More conservative results have been reported by Spiegel (1970)
and Stanton (1978) both using a single treatment method. Spiegel
reported a 20% success rate with 615 hard core smokers over a 6 month
period. whilst Stanton reported a 45% success rate after a 6 month
period also.
269

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

HYPNOSIS IN THE ALLEVIATION OF SMOKING

271

complete abstension or otherwise. The Stanford Clinical Scale for


Adults (Morgan and Hi1gard, 1979) was applied to all patients to test
for hypnotic responsiveness. The methods used are now described.
METHOD
This embraces the initial interview, hypnotic induction and
deepening, ego-enhancing suggestions, post-hypnotic suggestions
concerning smoking, covert sensitization and suggestions for se1freinforcement. Self-hypnosis is included in subsequent sessions.
At an initial interview, details of the patient's smoking habits
are elicited, as well as any relevant medical history, and a discussion about hypnosis encouraged. Besides the usual questions of
why, when and how much he smokes, details of previous attempts to
quit are elicited, and especially the current reasons for wanting to
quit. The last are categorized into 3 grades of motive of decreasing
severity, as fo11ows:1.

2.

3.

Fear of a specific illness, e.g. lung cancer.


Worry over symptoms of ill health, e.g. irritating cough,
shortness of breath, etc.
Others, e.g. financial, wishing to show a better example by
abstaining, being a slovenly habit, etc.

He is told that will power alone is not enough to control the


habit - it could not stop him desiring cigarettes. He is told that
he would more readily quit smoking by the use of imagination and that
he could obtain what he wanted through the increase of self awareness
which hypnosis allows. Through the paradox of hypnotic control, he
would be more than ordinarily receptive to suggestion and would see
more clearly why he should quit, and could confidently anticipate
this.
Hypnotic Induction is brought about by a utilization technique,
and deepening brought about by counting forward. An image is always
given immediately after the induction to reinforce and deepen hypnosis further and direct hypnotic suggestions are given immediately
after this since at this point hypnotic depth is greatest. If clear
imagery is not obtained, further deepening may be obtained by the
imagination of a relaxing situation without visualization, e.g. lying
on his bed in his own bedroom. Covert conditioning procedures are
introduced after post-hypnotic suggestion and before suggestions for
reinforcement.
EGO-ENHANCING AND SPECIFIC POST-HYPNOTIC SUGGESTIONS
These follow on induction and deepening. Suggestions are given
that the patient will become more relaxed, calmer, more confident and

272

M. A. BASKER

have more control over his thoughts, emotions and attitudes. He is


told that "the urge to smoke will vanish as a result of the strong
feelings of confidence you feel now, and cigarettes will mean nothing
to you. The smell and taste of tobacco will have no appeal for you.
There will be no time, no place when you will feel an urge to smoke.
You will be more and more pleased over quitting and the more time
passes, the more you will realize you never wish to smoke again."
COVERT CONDITIONING
One or more images are used to reinforce the avoidance response.
These can be individualized with the patient role-playing an interview with a doctor involving the results of medical tests, as used by
Janis and Mann (1965). The patient imagines he is hearing the unpleasant results of smoking on his own body from a doctor, and is
given a final post hypnotic suggestion that "at any time hence you
feel the urge to take a cigarette, you will think of this scene and
the terrible feeling it evoked in you."
A more useful image could be having the patient imagine himself lying on a beach under a blue sky, seeing a red sail, smelling
the sea air, tasting the salt on his lips, hearing a swish of waves
on the shore, and feeling the hot sand under his body. He reaches
for a cigarette, lights it, concentrates on its taste and smell. A
cloud of stale yellow smoke appears and envelops him. He throws his
cigarette and lighter into the water. He hears the 'plop' as they
enter the water. The beautiful image appears in all 5 sensory
modalities.
Yet another technique is to ask the person to picture himself
smoking heavily all day. His eyes are bloodshot, his breath stinks,
his mouth is dry, parched, hot. His throat is constricted. His
clothes and hands smell of tobacco smoke. He wheezes, his chest is
painful, he has palpitations. He gets up, walks to the window,
flings it wide open. He takes a deep breath of fresh, cool air.
He feels marvellous. In this image a relief stimulus is introduced.
As the patient makes and avoidance response to escape the unpleasant
effects of smoking he is reinforced by feelings of well being.
SUGGESTIONS FOR REINFORCEMENT
It was thought helpful after changing a habit to develop in the
patient a greater capacity for self-reinforcement so that he may
become less dependant on external sources of reward where this is not
provided by covert sensitization. He can be reminded of times in the
past when he had feelings of satisfaction over some noteworthy
achievement, and then carry it forward into the current situation so
that he feels more relaxed and comfortable in not smoking.

HYPNOSIS IN THE ALLEVIATION OF SMOKING

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.

Stanford Hypnotic Clinical Scale


(SHCS:Adult). Particular data
(N = 60).

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

The difference in results is significant Cn.f.


Yates test).

It will be seen that 64% of high susceptible patients abstained


after 6 months, 45% of medium and 25% of low. All those with a raw
score of 5 abstained after 6 months, and none of the patients with a
raw score of three.
The effect of motivation in the cessation of smoking through
hypnosis is shown in Table 3. Motivation is shown as being either
the fear of a specific illness, or the worry over symptoms of ill
health or other reason.

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.

HYPNOSIS IN THE ALLEVIATION OF SMOKING

275

The effectiveness of covert conditioning was determined by the


vividness and clarity of the creative imagination or fantasy rather
than whether the patient was in a light of deep trance state.
Improvement of results would only be anticipated by raising the
motivation and expectations rather than hoping for a late response.
REFERENCES
Cautela, J. R., 1975, The use of covert conditioning in hypnotherapy,
Int.J.clin.exp.Hypnosis, 23:15-27.
Cohen, S. B., 1969, Hypnosis and smoking, J.Am.med.Assoc.,
203:335-337.
Edmonston, W. E., 1981, "Hypnosis and Relaxation," John Wiley, New
York.
Janis, I. L., and Mann, L., 1965, Effectiveness of emotional roleplaying in modifying smoking habits and attitudes, J.exp.
res.Pers., 1:84.
Kroger, W. S., and Fezler, W. D., 1976, "Hypnosis and Behavior
Modification: Imagery Conditioning," J.B. Lippinc~tt,
Philadelphia.
Nuland, W., and Field, P. B., 1970, Smoking and hypnosis: A
stematic clinical approach, Int.J.clin.exp.Hypnosis, 18:290306.
Spiegel, H. A., 1970, Single treatment method to stop smoking using
ancillary self-hypnosis, Int.J.clin.exp.Hypnosis, 18:235-250.
Stanton, H. E., 1978, A one-session hypnotic approach to modifying
smoking behavior, Int.J.clin.exp.Hypnosis, 26:22-29.
Von Dedenroth, T. E. A., 1964, The use of hypnosis with "tobaccomaniacs", Am.J.clin.Hypnosis, 6:326-331.

THE TREATMENT OF ALCOHOL AND DRUG


ADDICTION: AN OVERVIEW
David Waxman
Central Middlesex Hospital
Acton Lane, London NWIO 7NS
England
Abstract
The greatly increased evidence of drug taking in general, the
misery which is caused by this abuse and the death toll which
results, requires the continued attention of every serious minded
physician. It is essential that each patient be considered as an
individual and that his own personal needs be fully explored. The
therapist must retain an eclectic view of all forms of treatment
available and apply or adapt them as required.
In this paper physical and psychological dependency is considered and the wide are of the common drugs of abuse is reviewed.
A detailed summary of the recent literature on the treatment of
alcoholism using hypnosis is discussed.
It is emphasized that the problem of alcoholism as well as that
of all types of drug dependency, addiction and misuse should be
examined over the entire range of the patient's life situation,
including cultural background, early environment, peer groups, social
habits, marital and family relationships as well as of his own personality, threshold uf anxiety and coping abilities.
A full psychiatric and psychosocial assessment must be made of
each patient. It is desirable that a trained social worker investigates the social background and environment and institutes whatever
immediate assistance and follow up support that can be given in this
area and that the family can be counselled and guided through the
difficult weeks, months or even years ahead.

277

278

D. WAXMAN

The use of psychopharmological drugs and other techniques is


considered and the therapist is warned that he must be prepared to
shoulder responsibility not only for the immediate treatment of the
patient but for the long term surveillance and support of someone
with a basis personality difficulty.
Thou hast the keys of Paradise, oh just, subtle, and mighty
opium! (De Quincey 1821).

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.

TREATMENT OF ALCOHOL AND DRUG ADDICTION

279

However. whilst the ingestion of alcohol is considered a social


attribute. even a necessity in the majority of modern cultures.
nicotine addiction is now frequently frowned upon. whilst indulgence
in cannabis is considered only slightly more evil. Nevertheless
dependency on opiates and other drugs of addiction is everywhere
looked upon as a distinct social abuse.
DEFINITIONS
There has been in the past some confusion of nomenclature but
since "addiction" proved difficult to distinguish from "habituation"
the single condition of drug dependence is often used although this
distinction is disputed by many and Oswald and Lewis (1971) have made
the point that addiction is a perfectly good word.
The World Health Organization defined a drug as "a substance
which when taken into the living organism may modify one or more of
its functions." The drugs to which I will refer are those which
affect the mental state and are classified as "mind altering." that
is. produce a change in subjective experience involving feelings.
behavior and perception.
Drug dependence has been defined as "a state. sometimes psychic
and sometimes also physical resulting from the interaction between a
living organism and a drug. characterized by behavioral and other
responses that always include a compulsion to take a drug on a continuous or periodic basis in order to experience its psychic effects
and sometimes to avoid the discomfort of its absence." Tolerance may
or may not be present and a person may be dependent on more than one
drug.
There is also drug abuse. which may be defined as "the persistent or sporadic excessive use of a drug inconsistent with or unrelated to acceptable medical practice."
The main features of drug dependency therefore are:
1.

Psychological dependency which means that the person feels the


emotional need for the drug which lessens tension. improves the
mood and keeps away unpleasant symptoms.

Physical dependency which implies that certain physiological


changes take place as a result of the drug so that when the
effect wears off, the withdrawal symptoms are experienced.
The latter may comprise trembling, dizziness. nausea and sleeplessness. relief from which is obtained by taking the drug
again. The dose may gradually be increased in order to obviate
these symptoms and eventually a state of chronic intoxication
may occur.

280

3.

D. WAXMAN

Tolerance. This is the condition in which the individual's


metabolism is able to deal with increasing doses of the drug.
This develops rapidly with the opiates and amphetamines and may
be lost equally rapidly. Thus with the opiates for example,
after a period of abstension, if the user will then revert to
his former dose, the result may well be fatal.

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.

TREATMENT OF ALCOHOL AND DRUG ADDICTION

281

Nevertheless a family history of alcoholism, mental illness,


personality difficulties and antisocial behavior, often emerges. A
leading article in the British Medical Journal (1977) pointed out
that the same sort of evidence that suggests genetic features in
intelligence and schizophrenia also applies to alcoholism.

HISTORY AND DIAGNOSES


Before attempting treatment, as in any other problem, a full
sociopsychiatric history must be obtained. An attempt should be made
to establish the etiology of the problem so that where necessary and
if possible the patient is encouraged to remove from the environment
which sustains his addiction. Knowledge of the background will help
to establish the diagnosis. Correct questioning should ascertain the
level of anxiety and particular importance must be directed towards a
possible diagnosis of depression. Merry et al. (1976) point out the
high incidence of depressive symptomatology amongst patients with
alcoholism and in their families and that suicide is common in this
group.
With all this , additionally the problem of psychotic behavior
should be carefully investigated. Psychotic symptoms may be the
result of alcohol or other drugs. It may, however, be possible to
establish that these were present before the dependency occurred and
treatment will therefore be directed accordingly. Additionally, it
must be remembered that the effects of one drug may modify, aggravate
or confuse those of another and multiple drug abuse is unfortunately
all too common.
Physical examination is essential. The degree of nutrition
should be assessed, evidence of needle marks, skin infections and
thromboses in the area of puncture wounds may give compelling evidence and additional examination may reveal an enlarged liver.
TREATMENT
Since personality difficulties, affective disorders and other
psychiatric disorders so often result in alcohol and drug addiction
and since the original function of the addiction was to produce a
defence between the individual and his personal difficulties, both of
these factors have to be taken into account in any treatment. Not
only must the drug be removed, but the patient must be helped to live
without it.
1.

Removal from Drug Culture Environment. The first essential is


to remove the patient from his environment into a special unit
and to attempt to replace the addictive substance with some less
harmful chemical.

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.

Treatment of physical condition. The physical condition of the


patient requires strict attention. It has been shown by Shaw
and Thomson (1977) that 60% of alcoholics are likely to be
vitamin deficient whatever their social class. High potency
vitamin injections should be used as the alcoholic patient may
be unable satisfactorily to absorb oral doses.

4.

Treatment of Associated Psychological Condition. In view of the


frequent occurrence of a reactive depression as a result or
alcohol withdrawal even if it was not previously present, then
antidepressant medication should be considered. Long term
lithium therapy may be given because of this oft co-existing
chronic depression. Other psychological problems would indicate
additionally the prescription of the appropriate medication.

5.

Support of Appropriate Social Services. The social services


should be mobilized for all the support that can be offered, in
assessing and counselling families of addicts and in an attempt
to improve housing and general social conditions where necessary. The social worker, the health visitor, the probation
officer and the very valuable assistance of Alcoholics Anonymous
should all be considered. An up to date summary of the services
available in Great Britain is given by Bissell at al. (1982) and
of the functions of Alcoholics Anonymous by Lloyd (1982).

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.

TREATMENT OF ALCOHOL AND DRUG ADDICTION


7.

283

Hypnotherapy. Finally we come to the use of hypnosis in the


treatment of alcoholism. This is no innovation. In a review
written in the last century a German author named Moll (1889)
listed some six European authorities as having experience of the
hypnotic treatment of alcoholism.

A review of more recent work has revealed a very considerable


number of papers published over the past 30 years on the use of
hypnosis for the treatment of alcohol and drug addiction and some of
these are briefly referred to below.
Wolberg (1948) amongst other techniques described suggestive
therapy as a method of choice in the deeply hypnotizable alcoholic.
Griffith Edwards (1966) in a controlled trial on "Hypnosis in
the Treatment of Alcohol Addiction" compared two groups in a total of
twenty matched pairs, one using disulfiram with all the available
support mentioned above and the other in which daily hypnotherapy was
given additionally, suggesting relaxation, a wish to remain sober, a
sense of accomplishment and well being, a determination to continue
the use of disulfiram and a continued interest in A.A. Overall it
was found that hypnosis was of no value as an adjunct to conventional
treatment of alcoholism.
McCord (1967) described a twenty-five year old male treated by
one session of hypnotherapy with suggestions of deep relaxation and a
gradual loss of desire for alcohol. Unfortunately, the history
indicated that the patient had a personality disorder and relapsed
again when anxiety was at its maximum. The response to post-hypnotic
suggestion as used in this case is unreliable and the case emphasises
the need for a more general approach.
Langen (1967) defined two kinds of drinkers, the excessively
habitual and the addictive and obtained best results using hypnosis
in the case of habitual drinkers.
Kraft (1968) described a case of drinamyl addiction in a youth
with many social difficulties. He was treated by hypnosis which was
directed towards helping him to communicate with others without
anxiety.
Smith-Moorhouse (1969) in an excellent paper described the
treatment of patients with minor degrees of personality disturbance
and neurotics leaving the more severly disturbed to the local
psychiatric unit. He emphasizes the need to employ additionally
pharmacological, psychological and social aids.
He gave post-hypnotic suggestion for the improvement and maintenance of good health, by supporting the use of chemical aversion,
by dealing with the problem of increased tension, teaching his
patients "self-relaxation" and by his own technique of hypnoanalysis.

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

TREATMENT OF ALCOHOL AND DRUG ADDICTION

285

the problem of the inadequate personality who so commonly is unable


to face the world without the reinforcement which the dependency
demands. With this in mind, ongoing therapeutic support is an
absolute necessity.
Voegtlin and Lamere (1942) criticized the vagueness and unreliability of the descriptions of treatment using hypnosis and the
numerous reports since that date have done little to refute this
belief. Too many papers approach the problem with a euphoria that
reflects the conviction of the therapist rather than the needs of the
patient.
Numbers of victims quoted by many authorities are merely the tip
of the iceberg. Will any single precipitating cause ever be found
for drug dependency? It is extremely unlikely. Thus with the large
number of aetiological factors involved it is essential that every
available resource be utilized in any attempt to eradicate it.
Every therapist must be eclectic in his approach and hypnosis should
be regarded only as a complementary weapon to facilitate treatment.
How much of the problem is genetic in origin, how much environmental and how much due to the personality or the psychological make
up of the person?
A very considerable number of clinical trials remain to be
carried out supported by statistically credible experimental evidence.
The techniques of hypnosis, themselves mutidisciplinary, will
not alone solve this problem. This is a question for the doctor, the
experimental psychologist, for industry and for government. All must
play a part in attempting to eradicate a very insidious epidemic.
Perhaps it is fitting to conclude with the following extract.
"What are you doing down there?" he said to the tippler, whom he
found settled down in silence before a collection of empty bottles
and also a collection of full bottles. "I am drinking," replied the
tippler, with a lugubrious air. "Why are you drinking?" demanded the
little prince. "So that I may forget," replied the tippler. "Forget
what?" inquired the little prince, who was already sorry for him.
"Forget that I am ashamed," the tippler confessed, hanging his head.
"Ashamed of what?" insisted the little prince, who wanted to help
him. "Ashamed of drinking!" The tippler brought his speech to an
end and shut himself up in an impregnable silence and the little
prince went away, puzzled (Saint-Exupery 1945).

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.

TREATMENT OF ALCOHOL AND DRUG ADDICTION

287

Miller, M. M., 1976, Hypnoaversion treatment in alcoholism,


nicotinism and weight control, J.Natn.med.Ass., 68:129-130.
Oswald, I., and Lewis, S. A., 1971, Addiction or dependence,
Br.med.J., 2:229.
Paterson, A. S., 1974, Hypnosis as an adjunct to the treatment of
alcoholics and drug addicts, Int.J.Offender ther.comp.Crim.,
18:40-45.
Saint-Exupery, A. de, 1945, "The Little Prince," Heinemann, London,
40-41.
Smith-Moorhouse, P. M., 1969, Hypnosis in the treatment of
alcoholism, Br.J.Addict., 64:47-55.
Shaw, G. K., and Thomson, A. D., 1977, "Alcoholism: New Knowledge and
New Responses," G. Edwards and M. Grant, eds., Croom Helm,
London, 328-334.
Voegtlin, W. L., and Lemere, I., 1942, The treatment of alcohol
addition: A review of the literature, Q. J.Stud.Alcohol.,
2:717-803.
Wolberg, L. R., 1948, "Medical Hypnosis," Grune and Stratton, New
York, 323-341.

HYPNOSIS AND SEXUAL DISORDERS

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 -

358 (202 male. 156 female)


134 (37.4%)

A detailed history was taken in every case and where applicable


a physical examination was carried out to exclude any organic cause.
Hypnosis was induced and followed by the technique of ego-strengthening in every case. Most of the patients were taught autohypnosis.
In the method of video hypnodesensitization, the relaxation was used
in conjunction with video taped hierarchies depicting most aspects of
normal heterosexual relations while the patient was under trance and
was asked to keep his eyes open. Similarly the technique of hypnoconditioning with slides was used for various sexual dysfunctions.
Hypnotic recall was quite helpful in some cases where the patient was
asked to visualize a past successful and happy heterosexual relationship to reinforce the suggestions of a desired pleasurable heterosexual response.
METHODS USED
1.
2.
3.
4.

Ego-strengthening
Video hypno-desensitization
Hypno-conditioning with slides
Hypnotic recall

The diagnostic categories of these patients are shown in Table


1. Most of the male referrals were prompted by female partners or
wives.

HYPNOSIS AND SEXUAL DISORDERS

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

Female (N=88)Loss of interest

36

Non-orgasm

23

Vaginismus

10

Dyspareunia

10

Increased 1ibido

eyes open is provided with suggestions, to practice at home the


behaviors seen on the slides. Thus, their sexual activities keep
pace with their progress through the hierarchy.
The coordinated use of hypnosis and behavior therapy is a practical approach to the treatment of sexual disorders and in particular
'those cases where anxiety is a significant component. Hypnosis
itself is used as a simple method of relaxation training that, in
addition, facilitates the therapeutic process by heightening visual
imagery, by the reinforcing of a conditioning process, by post hypnotic suggestion and by allowing for revivification and recall of
past experiences (Misra 1979, 1980). The average number of sessions
of hypnosis used to produce the desired physiological response was 8
to 10 sessions of half an hour's duration. The methods described
have proven of great value with the treatment of various sexual
disorders using hypnosis. The main advantage of this therapy is that
it does not require a cotherapist.
The following three case histories illustrate the problem dealt
with in the clinic by hypnosis:1.
Mrs. M. aged 28 years was referred from the Family Planning
Clinic for non-orgasm of two year's duration. She was unable to
reach orgasm inspite of enough time spent in foreplay (excitation)
with her husband. She was gradually developing lack of interest in
her sexual behavior. She recovered her normal sexual function with
satisfactory orgasm in 6 sessions of hypnosis.

HYPNOSIS AND SEXUAL DISORDERS

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.

HYPNOTHERAPY IN MALE IMPOTENCE

K. Fuchs, I. Zaidise, B. A. Peretz and E. Paldi


Dept. of Obst. & Gynecol. "B"
Rambam Medical Center, Faculty of Medicine - Technion
Haifa, Israel
Abstract
Impotence is defined as the male inability to achieve erection
strong enough to perform intercourse. It has mainly a psychological
origin. It is the consequence of such problems as unsolved childhood
conflicts, previous disappointing sexual experience, destructive
inter-action between the couple, punishment of guilt feeling, state
of anxiety, etc. The current therapy of psychogenic impotence may be
based on one or more methods such as psychoanalysis, behavior modification, sensate focus method, biofeedback and hypnosis. Most of the
methods are time-consuming and some require the participation of the
sexual partner, which is not always available.
Hypnotherapy of impotence is well-known and has gained popularity as treatment is of relatively short duration and can be
carried out with the patient alone and without his partner. The
common hypnotherapy methods combine relaxation with direct suggestions of positive and satisfying sexual behavior. The cases presented are those of 9 men aged 25-58, treated in.the years 1975-80,
suffering from secondary impotence. The duration of impotence was
1-6 years and there was no related organic problem. The immediate
cause of the impotence was myocardial infarction - 2 cases, family
crisis - 2 cases, loss of child with guilt feeling - 1 case, failure
in university studies - 1 case, no obvious reason - 2 cases. The
method of treatment was hypnotherapy lasting 1-3 sessions with
indirect suggestions according to Milton Erikson (1979) verbalization. All the patients regained their potency, one of them required
an additional session 6 months later. The therapy of impotence
represents a crisis intervention. Impotence should be regarded as an
emergency case and thus be cured in a short time to prevent separ297

298

K. FUCHS ET AL.

ation of the couple and fixation of the symptom.


therapy is the method of choice.

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.

People are more comfortable in discussing sexual dysfunction.


The wOman acts a more aggressive sexual role which is extremely
threatening to the male.

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

HYPNOTHERAPY IN MALE IMPOTENCE

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

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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):

Subsequent to this report we have treated 5 more patients with good


results.

HYPNOTHERAPY IN MALE IMPOTENCE

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.

After this single therapeutic session, the patient reported that


successful intercourse had taken place 3 days later. He was treated
with an additional ~ession to reinforce the results. All nine
patients regained their potency after 1-3 sessions. One of them
required an additional treatment six months later because of anxiety
and financial difficulties.
The follow-up was over a year and except for the above-mentioned
case there were no relapses.

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)

HYPNOTHERAPY IN MALE IMPOTENCE

303

Although this approach seems to be logical, it is gradually


being abandoned. During treatment many other relevant conflicts are
brought into light and these should be solved. As a consequence the
treatment is long lasting, (sometimes years), expensive and not
always effective, (O'Connor and Stern, 1972). Comparative evaluation
of the effectiveness of the various methods of treatment of secondary
impotence finds that psychoanalysis and deep psychotherapy produce a
cure rate of 57% (O'Connor and Stern, (1972).
b)
Rapid symptomatic treatment trying to overcome the present
problem without dealing with the deep and underlying factors. These
methods do not intend to change the entire psychosexual structure of
the individual, but only to restore the adequate sexual function as
it was before the development of impotence.
The brief conjoint behavioral approach is very popular at the
present time. An example of this approach is the "sensate focus"
technique described by Masters and Johnson (1970). The technique is
based on modification of sexual behavior turning the bedroom atmosphere into a relaxed supportive and undemanding one. The physiological symptom of impotence, namely the inability to achieve
erection, is not treated at all because it is regarded merely as a
by-product of the psychological disturbance. Moreover, no one can
achieve an erection intentionally so it cannot be taught. Helen S.
Kaplan (1974) uses a similar behavior modification technique but
integrates it with short-term psychotherapy, and sometimes also with
hormonal treatment intended to increase the male libido. Despite the
limited goal of this technique, its success rate is quite satisfying,
achieving about 80%.
However, these techniques have some disadvantages. The major
one is the need of a co-operative sexual partner who takes an active
and prominent role in the treatment. Many patients do not have such
a partner. Surrogate partners are used in some clinics to overcome
this shortcoming but create grave moral problems. The duration of
the treatment lasts at least two weeks and is quite expensive.
Hypnosis as an effective therapeutic tool in secondary impotence
has been known for a long time (Alexander, 1974; Fabri, 1975;
Deabler, 1975; Jacks, 1975; Crasilneck, 1979). However, its use is
limited mainly because most sex therapists are not familiar with the
technique. Hypnotherapy has the following advantages over other
methods of treatment: (a) Deep relaxation of the body and mind is
quickly achieved both during sessions and at home (by teaching the
patient autohypnosis); (b) adequate suggestions are given to
strengthen self-confidence and potency feelings in the patient; (c)
inhibitions and resistances are easily overcome; (d) whenever necessary, psychotherapy can be used during the hypnotic trance; (e) only
the patient himself is treated and the participation of the partner
is not required; (f) duration of treatment is short and can be

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K. FUCHS ET AL.

accomplished in separate sessions while the patient can stay in his


natural environment.
Our method is different from the usual hypnotherapy technique in
using indirect suggestions as described by Milton Erickson (1979).
Those suggestions are preferable as they aim directly towards the
patient's subconsciousness. These suggestions are accepted much
quicker and more readily and incite less anxiety and resistances.
Having used the usual hypnotic methods for more than 30 years in
our clinic, on changing to the new technique we were surprised by its
effectiveness. We recommend every sex therapist who is acquainted
with hypnosis to try this technique.
REFERENCES
Alexander, L., 1974, Treatment of impotence and anorgasmia by
psychotherapy aided by hypnosis, Am.J.clin.Hypnosis, 17:33-43.
Beigel, H. G., 1980, The hypnotherapeutic approach to male impotence,
in: "Application of HypnOSis in Sex Therapy," H.G. Beigel and
W.R. Johnson, eds., Chapter 29, 259-266, Charles C. Thomas,
Springfield, Ill.
Crasilneck, H. B., and Hall, J. A., 1975, "Clinical Hypnosis," Grune
and Stratton, NY, San Francisco, London, 279-287.
Crasilneck, H. B., 1979, The use of hypnosis in the treatment of
psychogenic impotence, in: "Hypnosis 1979," G.D. Burrows, D.R.
Collision and L. DennerStein, eds., Elsevier/North Holland
Biomedical Press, 1-7.
Deabler, H., 1975, Hypnotherapy of impotence, Am.Soc.Clin.Hypnosis,
8th Annual Meeting, Seatle Wa.
Erickson, M. H., and Rossi, E. L., 1079, "Hypnotherapy an Exploratory
Casebook," Irvington Pub!. Inc., New York, 257-262.
Fabri, R., 1975, Hypnosis and the treatment of sexual disorders,
Am.Soc.Clin.Hypnosis, 18th Annual Meeting, Seat Ie Wa.
Freud, S., 1979, On sexuality, Vol. 7, The Pelican Freud Library,
Harmondsworth.
Jacks, F., 1975. Hypnosis and the treatment of sexual dysfunction,
Am. Soc. Clin.Hypnosis, 18th Annual Meeting, Seat Ie Wa.
Kaplan, S. H., 1974, "The New Sex Therapy," Brunner-Mazel and
Quadrangle, The New York Times Book Co., New York, 255-288.
Kinsey. A. C., Pomeroy, W. B., and Martin, C. E., 1948, "Sexual
Behavior in the Human Male," W.B. Saunders Co., Philadelphia
and London, 59-109, 218-262.
Kroger, W. S., and Fezler, W. D., 1976, Impotence and premature
ejaculation. Chapter 11, 139-149, in: "Hypnosis in Behavior
Modification, Imagery Conditioning:" Lippincot Co.,
Philadelphia.
Masters, W. H., and Johnson, V., 1970, "The Human Sexual Inadequacy,"
Little Brown, Boston, 157-213.

HYPNOTHERAPY IN MALE IMPOTENCE

305

Nuland, W., 1978, "The Use of Hypnosis in the Treatment of Impotence,


Hypnosis at its Bicentenial," F. Frankel and S. Z. Zamansky,
Plenum, New York and London, 221-227.
O'Connor, J. F., and Stern, L. 0., 1972, Results of treatment in
functional sexual disorders, NY State J., 1927-1934.
Rothman, D., and Kaplan, S. H., 1972, "Psychosomatic Infertility in
the Male and Female in Modern Perspectives in PsychoObstetrics," Howells, ed., Brunner-Mazel, New York, 31-52.
Stekel, W., 1965, "Impotence in the Male," Vol. I, Vol. II, Grove
Press Inc., New York.
Ward, W.O., 1980, "The Hypnotherapeutic Treatment of Impotence, in
Application of Hypnosis in Sex Therapy," H.G. Beigel and W. R.
Johnson, eds., Charles Thomas, Springfield, Ill., 272-281.
Further Reading:
"Sexuality and Disability," Vol. 4, No.2, summer 1981, (Human
Sciences Press).

HYPNOSIS, COERCIVE PERSUASION, AND THE LAW:


A HISTORICAL PERSPECTIVE
Jean-Roch Laurence and Campbell Perry
Concordia University
Psychology Department, H-531
1455 de Maisonneuve Blvd. West
Montreal, Canada
Abstract
The current controversy surrounding the use of hypnosis for
legal investigative purposes is paralleled by a similar debate during
the last decades of the 19th century. Although the debate took place
mainly in France, legislation was enacted in most European countries
restricting the practice of hypnosis to professionally trained
persons. In most countries, the legal restrictions were much more
severe than are found in North America currently. The present paper
reviews the main viewpoints, and presents several legal cases involving the use of hypnosis on two of the issues that preoccupied 19th
century colleagues. These concern (a) the issue of hypnotic coercion
and (b) the use of hypnosis to "refresh" the memories of crime
victims. The relevance of 19th century thinking to the current North
American situation is emphasized.
INTRODUCTION
In 1883, in his History of Criminal Law, Stephen summarized the
constant quest by investigative forces for new, quasimagical means of
gathering information, as follows:"It is far pleasanter to sit comfortably in the shade rubbing
red pepper into a poor devil's eye than to go about the sun,
hunting up evidence."
In this passage, the author referred among other things to
hypnosis that was flourishing at that period in Europe.
309

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J-R. LAURENCE AND C. PERRY

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.

HYPNOSIS, COERCIVE PERSUASION AND THE LAW

311

On the first of these issues, the question of hypnotic coercion,


19th century investigators largely came to a dead-end. This was
partly because they had to deal with a set of views about hypnosis,
which were inherited from the period of Mesmer, concerning the possible abuses of hypnosis. In a secret report to the King of France,
the Franklin (1784) Commission stated that it was possible to seduce
a woman using hypnosis, something that was admitted by many of the
animal magnetists. Indeed, D'Eslon, on whose magnetic practice the
Benjamin Franklin Commission had performed nearly all of its observations, had stated that only professionals such as he himself should
be permitted to practice magnetism, because of such risks.
It is clear that the Commissioners equated magnetism with sexual
seduction. For instance, it characterized what we would now call the
hypnotic relationship in the following terms:
"A long period of closeness, essential physical contacts, transmission of individual warmth, fusion of the gazes; these are the
well-known roads that Nature has always favored for the communication of intimate emotions and sensations." (Morand, 1889).
This theme was picked up in a diversity of sources during the
subsequent 100 years and most of the times in an inappropriate
way. For instance an unsigned article in the Lancet (1828/29)
after commenting on the first surgical operation performed with
magnetism as the sole anesthetic, concluded as follows:
"By far the most interesting of the cases which have yet
occurred in the practice of the animal magnetizers, are those in
which the patients have been females, and pregnancy one of the
results. This curious effect, at one time, made magnetizing a
highly popular operation."
By the late 19th century, this concern with seduction had
broadened into a more general concern about the coercive power
of hypnosis. The investigators however who attempted to answer
these questions became bogged down on two other major issues of
this period.
Firstly there was the belief that repeated hypnotic induction
was deleterious to the nervous system, and could lead to permanent
organic damage. Most authors of this period agreed with this assumption. Indeed, very often in legal cases the crucial issue was one of
how often the person had been hypnotized.

An American example was the Spurgeon Young case of 1897 in New


York State. This is perhaps the best illustration of this point.
Spurgeon Young was a black youth who died at the age of 17 and had
been for the 6 months before his death a chronic "sensitive" subject.
He had been repeatedly hypnotized for protracted periods by lay

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J-R. LAURENCE AND C. PERRY

hypnotists. The Court in this case asked a panel of medical jurists


to determine the degree to which repeated hypnotic induction by
unskilled individuals could have caused "physical injuries" which
incited the disease of which he died.
The Honorable T.J. Hudson, regarded as an authority of this
period (and author of "The Law of Psychic Phenomena") summarized the
expert opinion. In reply to this written question, he wrote:
"In my opinion, there could be but one inevitable result, namely
a shattered nervous organism, leading eventually, if life is
prolonged, to imbecility or insanity" (Wheless, 1897).
To make matters worse, experiments appeared to support these
types of conclusion. These, however, were done with animals, since
it was not ethical to abuse human subjects. For example, Mi1neEdwards presented the following data to L'Academie des Sciences in
1882. The subjects were six hens who were repeatedly hypnotized for
more than three weeks. After three weeks, one hen became hemiplegic
and died within hours. Within three months all hens had died.
Lafontaine, (1843 and 1860), the magnetist who first interested Braid
in hypnosis, likewise reported that he had killed a frog in 13
minutes using an eye fixation technique. He had also used the same
technique successfully with garter snakes, lizards and toads.
It was only towards the end of the 19th century in France that
this issue of repeated hypnotic induction came to be reformulated in
a more plausible manner. Certain investigators (Binet and Fere,
1888) began to see the issue in more social-psychological terms;
namely that repeated induction could build up undue influence, or
heightened rapport between the hypnotist and the hypnotized person.
This could be falsely attributed to hypnosis, rather than to interpersonal effects which can be obtained without hypnosis.
A second major 19th century belief about hypnosis which obscured
forensic thinking was the view that spontaneous post hypnotic amnesia
was the main criterion of deep hypnosis. As a result, experiments
were designed to test the hypothesis that the hypnotist could induce
hypnotized individuals to commit crimes, for which subsequently they
were spontaneously amnesic. These experiments were more sophisticated than the animal ones we have previously described, and some of
them at least were very informative. For these experiments, paper
daggers and blank pistols were used to incite murder, and patients
and/or subjects were asked to steal, write false recognitions of
debts, put poison in drinks and even accuse themselves of hallucinated crimes. The results were fairly uniform and most of the time,
subjects did what they were asked.
However, following the procedures of Braid, the amnesia could be
breached quite often by rehypnotizing the subject and asking him or

HYPNOSIS, COERCIVE PERSUASION AND THE LAW

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,

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J-R. LAURENCE AND C. PERRY

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.

HYPNOSIS, COERCIVE PERSUASION AND THE LAW

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.

HYPNOSIS IN CRIMINAL INVESTIGATION:


ETHICAL AND PRACTICAL IMPLICATIONS
M. Kleinhauz* and B. Beran**
*Community Mental Health Center of Yafo, and
Behavioral Science Department of the School
of Dental Medicine, Tel Aviv University
**Community Health Center of Yafo
36, Yefet Street, P.O. Box 8676
Tel Aviv, Israel
Abstract
Hypnotic techniques are used in criminal investigations to
enhance or recover recollected evidence from witnesses who experience
total or partial amnesia for the events witnessed. This use by
clinicians working with and for criminal investigators opens a number
of practical, clinical, ethical and legal questions. On the basis of
twenty years' clinical experience with forensic investigations, three
main problematic areas are addressed. These include the practical
question of reliability of recalled evidence, the clinical question
of safeguarding the psychological well-being of the hypnotized subject, and the general conflicts stemming from the ambiguous responsibilities regarding the ethical and civil rights of the subject vis-avis the needs of the investigation.
INTRODUCTION
The use of hypnotic techniques for the enhancement of the memory
of witnesses to criminal acts has been greatly increasing in recent
years. On the basis of about twenty years' consultation in forensic
hypnosis to the Israeli police, it is our belief that the nature of
the process of hypnotically-induced hypermnesia and the inter-action
between clinical hypnotist and police investigator, both with
slightly different role expectations, create a number of ethical and
practical problems which deserve careful consideration. In this
paper we will focus on three main areas in which the extensive clini317

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M. KLEINHAUZ AND B. BERAN

cal experience of the senior author can provide illumination. First,


the degree of reliability of recalled material is explored in order
to highlight the responsibility of the clinician to alert the cr1m1nal investigator and the legal officers of the Court to the many ways
in which processes intrinsic in the nature of hypnosis may limit or
distort the induced "recollection" of the facts of a witnessed event.
In the second section, we focus on the hypnotist as clinician, and
his role relationship to the subject being hypnotized. Hypnotically
induced bypass of amnesia may have psychopathological implications
for which clinical treatment should be provided. As a clinician,
moreover, the primary goal must be to protect and promote the basic
rights of the subject to mental well-being, regardless of the contract to meet the requests of the police. Finally, in the third
section, we explore several ethical dilemmas and problems of civil
rights and law which may place the clinical hypnotist in an ambiguous
position due to his role in a criminal investigation.
HYPERMNESIA AND THE NATURE OF THE MATERIAL RECALLED
From the point of view of the clinician, amnesia may be defined
as the inability to remember a past experience which would be
expected to be recalled under normal circumstances. In a forensic
context, hypnotic techniques can be used in an attempt to uncover
information which has ostensibly been blocked by some disruption or
repression of memory in an apparently healthy individual because of
psychological causes (Kaplan et al., 1974). Retrospectively, if
hypermnesia or recall occurs under hypnosis, it can be hypothesized
that the dynamic forces underlay the amnesia. Although specific
research would be needed to confirm this involvement, the clinician
is justified in using it as a working assumption.
Criminal investigations often rely on the reports of witnesses
as a basis for collecting information about a crime. However, sometimes potential witnesses report that they are unable to remember
what they saw or experienced. In these cases investigators are
turning more and more often to the use of hypnosis to stimulate
recall that has been blocked, and inevitably the question of the
nature and validity of the material recalled is crucial. At times
conflict may exist between those who conceive of memory as a storehouse of sequentially recorded facts which can be uncovered by hypnosis, and the clinical view of memory as an active process in which
there is constant and continual restructuring of material (Bartlett,
1932). It is the clinician's responsibility constantly to warn the
investigator and the legal officers of the Court of the potential
non-factual elements in the material which may stem from psychodynamic reconstructions.
Thus, the clinical hypnotist should be aware that the total or
partial amnesia found in witnesses to a crime may have been caused by

HYPNOSIS IN CRIMINAL INVESTIGATION

319

psychological dynamics aroused by the event. There is a significant


body of information from field investigators in forensic hypnosis
which supports the view that material recalled under hypnosis often
contains inaccuracies due to these dynamics and thus should not be
taken at face value (Kleinhauz et al., 1977; Orne, 1979; Hilgard and
Loftus, 1979; Worthington, 1979).
Besides information which derives from unconscious psychological
dynamics, such as distortion, confabulation, fantasizing and/or a
combination of separate, unrelated information, false information may
be consciously introduced by the hypnotized subject for reasons of
his own (for instance, to direct the investigation away from him).
Furthermore, in established hypnotic rapport, it is known that a
subject may attempt to supply responses which comply with the expectations of the hypnotist, as he understands them from verbal, nonverbal or paraverbal clues provided by the clinician, even when in
fact he lacks the requested memory.
It is, therefore, essential that recovered material be tested
against other objective and independent evidence in order to test its
truth. Lack of such confirmation will cast doubt even on material
which may be true, although unusable, or false. It should be noted
that we can distinguish the source of lack of validity only retrospectively, if at all.
In the field we have seen many cases of partial or total nonfactual recall. For instance, in an investigation of a murder, one
witness stated to the police that he had seen a person leaving the
place where the body was found. Hypnotically induced recall (using
time regression) enabled the witness to provide a detailed account of
events. Timing in this case was crucial, and the event was described
as happening on a Monday. However, later independent information and
a subsequent confession confirmed that the events had actually
occurred on a Tuesday.
In another case, a man reported to the police that he had killed
a girl and buried her body by the sea. On first check the police
were unable to locate the body and requested that the suspect undergo
hypnosis in order to pinpoint the site. Preliminary psychiatric
evaluation revealed insufficient evidence of gross psychopathology,
and hypnosis was induced. Under hypnosis the subject produced a
lucid, detailed account of the murder and a clear description of the
place where the body was buried. However, a night-long on-sight
investigation assisted by dogs and a bulldozer failed to uncover any
sign of murder or traces of a body. Lack of confirming evidence
added doubts regarding the mental stability of the man. He was
referred for intensive and comprehensive psychiatric evaluation and
ultimately diagnosed as delusional and psychotic. Thus, in this case
the material supposedly recalled had been fantasized entirely.

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M. KLEINHAUZ AND B. BERAN

A hypnotist directed to seek specific information may ask a


question in such a way that it stimulates a response based on the
desire of the subject to meet the request, rather than true recall.
For example, a post office van containing a large shipment of money
was robbed by three armed men, who used a car to stop the van before
robbing it. In order to enhance the memory of the driver of the van,
hypnosis was used to elicit a description of the car that had blocked
his path. He was asked to visualize the license plate and to "read
off the number." Apparently this was a "leading question," since the
number which was readily provided, proved later to be the license
number of car unconnected with the crime. The clinical hypnotist was
not involved in the investigation of the owner of the car with the
license number given by the hypnotized subject. Nevertheless, the
clinician was left with a subtle and uncomfortable feeling because of
his role in causing someone to undergo an unwarranted and perhaps
unpleasant investigation. Thus, warning the police investigators
that information "recalled" may be inaccurate and guarding against
manipulation of the subject, may be insufficient in totally solving
the ethical dilemma surrounding any clues passed on after hypnosis.
Another example of contamination of data recalled under hypnosis
occurred during investigation of a kidnapping. A youngster who had
witnessed the kidnapping of a second child described the car of the
kidnapper in detail under hypnosis, stating that the gas-rationing
decal on the car's window had the number 3 on it. Following independent investigation the kidnapper was located and apprehended. His
car was as described by the hypnotized subject, except that there was
no number 3 on the decal. Apparently the youngster's otherwise
accurate recall was contaminated at this point.

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

HYPNOSIS IN CRIMINAL INVESTIGATION

321

future. Psychodynamic conflict may result from expressing that which


can be used as testimony.
Some crimes, such as assault or rape,are intense traumatic
experiences for the victims. In one case of a young girl raped at
knifepoint, the trauma caused almost total defensive amnesia about
the incident. Under hypnosis, using techniques which permitted her
to recall the event as an emotionally uninvolved observer, she was
able to relate significant details, and to describe the man involved
and the place where the rape had occurred. She assisted in making an
Identikit picture of the suspect and supplied enough information to
enable the police to locate the scene of the attack. Evidence that a
rape had occurred was found on the spot, and on the basis of the
Identikit picture a suspect was apprehended. External objective
evidence was also accumulated linking the suspect to other rapes as
well. From the point of view of the investigation, therefore, hypnotic recall was accurate and useful. However, the subject strongly
abreacted under hypnosis despite the attempted emotional detachment,
and consequent to the hypnotic session, strong depressive anxiety
outbursts occurred, and limited therapeutic intervention was necessary.
Another case illustrates the manner in which an experience can
take on symbolic meaning if linked to a prior conflict. A man was
held up by an armed assailant while parking his car. He acquiesced
totally to the demands of the robber by handing over his money and
then allowing the robber to escape with no attempt to impede his
departure. Subsequently he experienced amnesia for the details of
the event. Under hypnosis, hypermnesia was induced and the subject
was able to cooperate in constructing an Identikit picture of his
assailant and a detailed timetable for the event. Both were accurate, as confirmed independently. However, the act of reconstruction
of the event was accompanied by manifest anxiety. The subject stated
that his behavior had been "cowardly", and inappropriate for "his
father's son". After the session the hypnotist discovered that the
subject's father was a well-known war hero. Apparently, both the
amnesia for the event and the anxiety and guilt during recall were
connected to the prior dynamics of his relationship with his father
and the symbolic meaning of failure to resist the assailant. At the
conclusion of the hypnotic intervention the anxiety and guilt persisted, since the subject could no longer resolve them with amnesia.
Follow-up clinical intervention was suggested.
As noted, the actual process of recalling significant evidential
material may place the potential witness into a conflict situation,
which amnesia had been preventing. Following the discovery of the
body of a murdered girl, a witness came forward to report that he had
seen two men force the girl into a car in the vicinity of her home.
However, he was unable to remember what the men or the car had looked
like. Under hypnosis he was able to recall the scene and describe

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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

HYPNOSIS IN CRIMINAL INVESTIGATION

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.

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M. KLEINHAUZ AND B. BERAN

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.

HYPNOSIS IN CRIMINAL INVESTIGATION

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.

AN EXAMINATION OF THE EFFECTS OF FORENSIC HYPNOSIS

Howard William Timm


Center for the Study of Crime, Delinquency,
and Corrections
Southern Illinois University at Carbondale
Illinois, 62901, USA
Abstract
This study examined the efficacy of using memory assistance
procedures to increase eyewitness recall as well as the impact of
incorporating formal hypnotic induction suggestions into those techniques. The subjects consisted of 56 volunteers that were each
victims of a squirt gun shooting incident. The number of "I don't
know" responses made by those subJects when they were questioned
about that incident significantly decreased after the memory assistance procedures were employed. Contrary to the results of prior
forensic hypnosis studies, both the hypnotized and non-hypnotized
subjects had higher levels of certainty associated with "their correct
responses than with their incorrect answers. Overall, the results
indicated that the addition of formal hypnotic induction techniques
to standard guided memory assistance procedures offers neither substantial advantages nor disadvantages with respect to the amount of
information secured from witnesses.
INTRODUCTION
The primary functions of forensic hypnosis are to help develop
new leads in criminal cases by assisting eyewitnesses to recall
additional information and/or to decrease their inhibitions about
providing them. Several field studies (Schafer and Rubio 1978;
Kroger and Douce 1979; Reiser and Nielson 1980) indicate that subjects receiving forensic hypnosis techniques are more likely to offer
~dditional information.
However. it is important to note that these
field studies represent more a reflection of the benefits perceived
327

328

H. W. TIMM

by those administering the procedure than a more objective evaluation


requiring documented corroboration of the new leads.
In addition to numerous laboratory studies which examined the
effects of hypnosis on subject recall in less applied contexts, four
studies examined the efficacy of forensic hypnosis in situations that
more closely resembled field conditions. One of those studies was
conducted by Putnam (1979) who reported that the technique resulted
in no significant increases in accuracy and that hypnotized subjects
were affected more frequently by misleading questions than were those
in the waking state. In a similar study, Zelig and Beidleman (1981)
replicated Putman's findings and indicated that the subjects' level
of confidence in their responses was positively correlated with their
level of hypnotic susceptibility. Griffin (1980), however, reported
that memory was significantly enhanced using hypnosis and that hypnotized witnesses did not confabulate any more than non-hypnotized
witnesses (leading/misleading questions were reported to have been
avoided during his testing procedure). Based on the results of
another study, Timm (1981) concluded that much of the improvement in
eyewitness recall attributed to forensic hypnosis techniques may be
due to the memory assistance part of the procedure, as opposed to the
incorporation of the hypnotic induction. He also noted that subjects
who received memory assistance procedures (with or without the formal
hypnotic induction) were perceptibly less likely to respond "I don't
know" to direct questions about the crime than those who were simply
asked about the incident.
In a related laboratory study which did not involve the use of
hypnosis, Malpass and Devine (1981) also reported that eyewitness
recognition appeared to be improved by employing guided memory procedures. In addition, Smith (1979) found waking state recall could
be enhanced by instructing subjects to reconstruct mentally the
environment in which they originally learned their information.
However, apparent improvements in recall associated with memory
assistance procedures might also stem in part from certain demand
characteristics (Orne, 1959, 1962) resulting in either an increase
in the witness' motivation to offer information or a decrease in
their inhibitions to make questionable or accusatory statements.
Despite indications that both forensic hypnosis and other
related waking state procedures may serve to increase eyewitness
recall, there are also several equally compelling indications that
the techniques suffer from certain pitfalls and limitations. Hilgard
and Loftus (1979) indicate that while subjects receiving forensic
hypnosis procedures often produce a wealth of recollections, all too
often many of those recollections are fabricated. Even more
damaging, Orne (1979) suggests that during and after hypnotic interventions actual memories cannot be distinguished from confabulations
either by the subject or the hypnotists without full and independent
corroboration. Loftus (1979), however, notes that even in the waking

EFFECTS OF FORENSIC HYPNOSIS

329

state past event experiences can dramatically affect one's memory to


the extent that nonexistent details become incorporated into that
person's memory and are accepted by that individual as true reflections of what actually occurred.
The purpose of the present study is to examine whether the
number of "I don't know" responses, accuracy, and certainty levels
are associated with whether or not formal hypnotic induction techniques are administered, the subject's level of hypnotic susceptibility, or their being subjected to repeated testing. It was also
considered important to examine whether or not witness certainty
levels are positively associated with accuracy when leading/misleading questions are not intentionally incorporated into the testing
procedure. In addition, the study attempts to avoid some of the
methodological problems associated with earlier forensic hypnosis
experiments (e.g., lack of subject surprise and actual involvement in
the incidents examined, experimenters' knowledge of correct responses
at the time of testing or ability to eventually figure them out from
repeatedly testing subjects, use of inappropriate time lags, etc.).
METHOD
Selection of Subjects
The subjects consisted of volunteers enrolled in selected criminal justice classes at a large midwestern university during the
1981-82 academic year.
The courses from which subjects were drawn
were all undergraduate classes whose instructors agreed to permit
their students to participate in the experiment for extra credit.
To maintain consistency, the extra credit was standardized for all
classes, based on a fixed percentage (3%) of the total points possible in each class.
During the Fall (1981) semester 56 subjects initially both
volunteered for the experiment and completed its first phase, which
included taking the Harvard Group Scale of Hypnotic Susceptibility:
Form A (HGSHS:A). Of those original subjects, six withdrew from the
study before they completed the remaining tasks due to either graduation or withdrawal from the university at the end of that semester.
Those six people were replaced with six students drawn from a new
pool of subjects that volunteered for the study and completed the
HGSHS:A during the following semester. To help avoid significantly
changing the composition of the subject pool, the replacements were
solicited in the same manner as the earlier subjects and each dropout was replaced by a subject drawn at random from the subset of new
volunteers having the same HGSHS:A score as the original. Those
replacements were also assigned to the same treatment condition and
same experimenter to which the subject they replaced was formerly
at;t;.igllt=U.

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

final composition of subjects consisted of 36 males and 20


whose ages ranged from 19 to 30 (~=21.4. SD=4.81). The mean
the HGSHS:A for subjects assigned to Group I was 9.07 with a
deviation of 1.386. while the mean score on that test for
in Group II was 4.50 with a standard deviation if 2.117.

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.

EFFECTS OF FORENSIC HYPNOSIS

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

During the first phase of the experiment the victims were


instructed to report as soon as possible after they were shot to
another research assistant who served as the "police investigator."
The person selected to serve in that capacity appeared well suited
for that position having had 17 years of prior police and investigative experience.
The police investigator spent approximately 30 minutes with each
victim carefully noting the details of the incident, the description
of the offender, and the subjects' self-reported levels of certainty
regarding each bit of information discussed. To facilitate record
keeping and to help insure that the subjects would be asked about the
same areas the experimenters covered with them later, the assistant
was given a form to record the information supplied by the subjects.
Although that form addressed numerous categories of information (e.g.
offender's hair color, offender's weight, etc.), it did not contain
any specific alternatives within those categories.
After completing their initial report with the "police investigator," the subjects were scheduled to meet with the experimenter to
whom they were assigned. The experimenters served as mental health
professionals having the task of using certain memory assistance
procedures to obtain as much information from the victims as possible
regarding the mock crimes. The experimenters were not informed by
the "police investigator" of any information supplied by the victims
during the initial reporting sessions, nor were they permitted to see
their reports until all of the testing was completed.
The subjects reported individually to one of the testing rooms,
where they were met by their assigned experimenter. Subjects
assigned to receive the complete forensic hypnosis procedure were
given a brief explanation about both hypnosis and the forensic hypnosis technique that would be administered. After this explanation
and all of the subjects' questions stemming from it were answered,
the subjects were asked in free narrative fashion about the incident.
Subjects were simply asked, "Please tell me what you remember about
the incident." After the subjects stopped mentioning details, they
were prompted with the phrase, "Anything else?". When they finally
responded, "No" to that prompt, the experimenter proceeded to employ
a directed narrative questioning technique consisting of the following four statements: "Can you recall any additional details about
(a) when the incident occurred, (b) where the incident occurred,
(c) the offender's physical characteristics, and (d) what the
offender was wearing." Once again the experimenter would use the
"Anything else?" prompt and would not proceed to the next question
until the subjects finally said, "No."
After completing all four directed narrative questions, the
experimenters asked the subjects a series of 21 specific questions
related to the offenders' physical characteristics and clothing (e.g.

EFFECTS OF FORENSIC HYPNOSIS

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'

EFFECTS OF FORENSIC HYPNOSIS

335

responses of either black or dark brown hair as correct if their


offenders listed their hair as being black. Responses to questions
about jacket color, jacket style, shirt color, shirt style, shoe
color, and shoe style were also categorized in the same a priori
fashion. The only question to which all subjects provided correct
responses pertained to their offender's sex and race, and even on
those two questions during the simulated police interview one subject
initially reported not knowing the offender's race and another subject incorrectly identified their offender's sex.
The mean number of days it took subjects to report their mock
shooting to the assistant serving as the "police investigator" was
3.00 (SD=5.72) for subjects in the high susceptibility/forensic
hypnosis group and 2.29 (SD=2.99) for subjects in the low susceptibility/memory assistance category. The average length of time from
when the incident occurred to when they saw their experimenter was
15.07 (SD=13.36) days for subjects in the first group and 19.29
(SD=15.07) days for those in the second group. ~-tests comparing
those two sets of means indicated that the forensic hypnosis/high
susceptibility group did not significantly differ statistically from
the memory assistance/low hypnotic susceptibility group. However,
the comparatively high standard deviation values associated with each
of those means seems to reflect a bimodal distribution in which
subjects either followed through quickly or took a considerable
amount of time to complete those tasks.
Comparisons examining the number of correct, incorrect, and
don't know responses during each of the three question procedures are
presented in Table 1 for both treatment groups separately. The data
indicate that the mean number of "I don't know" responses differed
significantly over the three sessions for both groups and that the
number of incorrect responses differed for those in the low susceptibility/memory assistance group. Tukey post-hoc comparisons suggest
that the number of "I don't know" responses made by subjects in the
low susceptibility/memory assistance group was hierarchically ordered
at significant levels with subjects making the least number of "I
don't know" responses during the memory assistance procedure,
followed by both the initial experimenter and simulated police interviews, respectively. A similar pattern was noted for subjects in the
high susceptibility/forensic hypnosis group; however, the differences
between the number of "I don't know" responses did not reach statistical significant levels for the simulated police and initial
experimenter comparison or the initial experimenter and forensic
hypnosis comparison. The number of incorrect responses made by the
low susceptibility/memory assistance subjects appears to have
increased as their "I don't know" responses decreased, but once again
the differences between the simulated police and initial experimenter
interviews were not statistically significant, nor were they significant between the initial experimenter and memory assistance questioning Sessions.

336

H. W. TIMM

Table 1.

Mean Number of Correct. Incorrect and Don't Know Responses


During Different Interviews.

Type of

Tvpe of Interview
Si ... lated Pol ice!X)

Res~onse

Initial

Ex~erimenter!Y)

Hiqh H.)'pnotic Susceptibil


Correct

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

Low H.)'~notic Susce~tibi1 i t~ Subjects ClGrou~ II


Correct

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.

Numbers in parentheses indicate the

for the preceeding

~.

aSubjects 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

A series of t-tests were conducted which compared the means for


the two treatment-conditions (forensic hypnosis/high susceptibility
and memory assistance/low susceptibility) with respect to the nature
of the subjects' responses (correct. incorrect. and don't know)
during each questioning session. The results indicated that although
the low susceptibility subjects generally were slightly more accurate. none of those comparisons statistically reached levels that
were significantly different when nondirectional hypotheses were
considered. Therefore. overall there was not a large difference
between the high and low hypnotic susceptibility subjects with
respect to the quality of their responses.
In addition to collecting data on the accuracy of the subjects'
responses. information was also recorded on how certain they were
about each answer they provided. Table 2 depicts the subjects' level
of certainty for each of the three question sessions controlling for
both whether or not their answer was correct and for their group
classification. Responses of "I don't know" were excluded. since all
of those replies were scored as a certainty level of six. thereby
precluding any differences between sessions for that response. The
only significant difference noted was on the correct answers for high
susceptibility subjects. However. the Tukey post-hoc comparison
suggested that within that category the level of certainty attained
for the simulated police and initial experimenter sessions did not
significantly differ. nor did they between the forensic hypnosis and
the simulated police questioning sessions.

337

EFFECTS OF FORENSIC HYPNOSIS


Table 2.

Comparison of Subject Mean Certainty Ratings Reported


During Their Simulated Police, Initial Experimenter and
Memory Assistance Interviews.
Oneway
Anava

Type of Interview

Type of

Ini tial Experimenter (V)

Forensic Hypnosisa(l)

FRates

Tukey Post-Hoc
Prob.

Compari sons

Response

Simulated Pol ice(X)

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

Group I C/Hi gh Hypnoti c Suscepti bi 1 ity Subjects


I

x-v

Group II c flow Hypnotic Susceptibil ity Subjects

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

The certainty scores were also analyzed to determine the effects


of the subject's level of hypnotic susceptibility on that variable.
A series of t-tests addressing that issue were conducted for each of
the three questioning series, comparing scores based on correct and
incorrect responses as well as for those based on a combined value
which included subject ratings on correct, incorrect, and their "I
don't know" responses. The only comparison statistically significant
when a two-tailed hypothesis test was employed indicated that subjects in the high-hypnotic susceptibility/complete forensic hypnosis
group were more certain they were correct, when they were actually
wrong, than subjects in the low susceptibility/memory assistance
group. However, the nesting problem previously discussed makes it
difficult to determine how much of that effect was due to the formal
incorporation of the hypnotic induction, as opposed to being due to
the differences in hypnotic susceptibility. Since the difference in
values for incorrect responses during the initial experimenter interview also reached statistically different proportions (if one assumed
a one-tailed test was appropriate), it appears that at least part of
that effect was due to the subjects' level of hypnotic susceptibility.
To determine if collapsing the subjects' hypnotic susceptibility
scores into just two groups obfuscated the relationship between
certainty and hypnotic susceptibility, another series of tests was
conducted incorporating the subjects' actual raw scores on the
HGSHS:A. That analysis correlated the subjects' level of hypnotic
susceptibility with their mean certainty scores within each of the

338

H. W. TIMM

susceptibility/treatment groups.
presented in Table 3.

The results of that procedure are

Overall the frequencies suggest a slight trend toward subjects


with higher levels of hypnotic susceptibility reporting that they
were more certain about the accuracy of their responses, particularly
when they were actually wrong. Out of the 36 comparisons made, the
following were statistically significant: For subjects in the high
hypnotic susceptibility category, (1) the correct responses during
the simulated police interview, (2) the combined responses during
that interview, and (3) the combined responses during the memory
assistance interviews; for subjects in the low hypnotic group (4) the
correct responses during the memory assistance procedure; and for all
subjects combined, (5) the incorrect responses in the initial experimenter and, (6) incorrect responses during the memory assistance
interviews. Of those 6 significant correlations only the value for
the correct responses during the memory assistance procedure was
positive. All other correlations were negative, which reflected the
relationship depicting the higher their susceptibility, the higher
their certainty was far more prevalent.

Table 3.

Correlation Coefficients Between Mean


Certainty Scores and Subjects' Levels of
Hypnotic Susceptibility.

Type of
Response

Level of Subjects' Hvpnotic Susceptibi 1 ity


High (n=28)
Low (n=28)
Combined (N=56)

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

Initial Experimenter Interview

-.0672

-.1203

-.2417*

Memory Assistance Interview

-.1331

-.2491

-.3224**

Combined Correct, Incorrect, & Donlt Know


.0210

Simulated Police Interview

-.4088*

.1626

Initial Experimenter Interview

-.1070

.0611

.0518

Memory Assistance Interview

-.3955*

-.0086

-.0564

Note.

*.
**!

<.05
<.01

Negative correlations indicate that the higher the subjects' level


of hypnotiC susceptibility, the higher their level of certainty.

EFFECTS OF FORENSIC HYPNOSIS


Table 4.

339

A Comparison of Mean Certainty Scores for Correct and


Incorrect Responses.
Type of Response

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

Simulated Pol ice Interview

Initial Experimenter Interview

Memory Assistance Interview

Note.

Numbers in parentheses indicated the SO for the preceeding M.


the subjects certa i nty.
~

The higher the mean value, the lower

aGroup I consi sted of high hypnotic susceptibil ity subjects, n=28.


bGroup II consisted of low hypnotic susceptibility subjects, n=28.
CSubjects received the complete forensic hypnosis procedure.
dsubjects received the forensic hypnosis procedure without a formal hypnotic induction.

The last set of certainty score comparisons to be discussed


examined the relationship between how certain subjects felt about
their individual responses and the accuracy of those answers. Once
again subjects "I don't know" responses were excluded from the calculations, because they were automatically assigned the value of 6 (the
possible values, in descending order of certainty, ranged from one to
six). The results of a series of t-tests comparing the subjects'
mean certainty values for both their correct and incorrect answers
are presented in Table 4. During all three questioning sessions both
the high and low hypnotic susceptibility subjects were consistently
more certain about their correct responses than they were about their
wrong answers at highly statistically significant levels.
DISCUSSION
Throughout the results section numerous statistical tests were
reported which examined a wide range of hypotheses associated with
this study. As with all research, it is important for the reader to
consider the possible disparity between meaningful and statistically
significant differences. Given the small number of subjects tested
in this study, certain potentially meaningful differences might not
have reached statistically significant levels. Therefore, it is
critical for the reader to consider both the magnitude of the differences as well as their respective probabilities when interpreting
those results.

340

H. W. TIMM

Several interesting relationships were noted in this study. As


previously mentioned, the subjects appeared to decrease their number
of "I don't know" responses each time one of the new questioning
procedures was initiated. Since many of the statements provided in
lieu of that response were incorrect, it appears that a substantial
portion of that effect might have been due to certain demand characteristics compelling the subjects to guess, as opposed to having been
primarily due to the enhancement of their recall. Unfortunately it
is extremely difficult to determine what percentage of the correct
changes should be attributed to guessing and what portion to improved
recall. The reason for that dilemma stems from not being able to
determine from the data the functional probabilities associated with
each of the alternatives to the different questions. On certain
questions, such as identifying the offender's weight, an extremely
wide range of possibilities existed. However, even on questions with
dichotomous alternatives, such as the offender's sex, the subjects'
guesses were probably more a reflection of their prior conceptions
about the offender's probable characteristics than of each alternative having an equal probability of being mentioned. Thus, how
closely subjects' prior conceptions matched the offender's actual
characteristics would also have to be taken into consideration in
determining the functional probabilities.
Although the differences were not significant in the manner in
which the observations were grouped, there also appears to have been
a trend for subjects with lower hypnotic susceptibility levels to be
overall slightly better witnesses. Their possible superior performance might be due to their being less affected by external cues and
suggestions; however, this conclusion is rather speculative
especially given the lack of statistical significance.
Another consistent trend that did not reach significant proportions in the manner in which it was tested, was the increase in
the subjects' certainty about their responses to questions asked by
the experimenters before and after the memory assistance procedures
were administered. It seems likely that if this relationship was not
simply due to chance, it might be relecting certain demand characteristics, resulting in the subjects being somewhat more conservative
during their pre-test measure, than after they received their respective memory assistance treatment. This possible relationship could
stem in part from the subjects attempting to reward the experimenters
for their efforts to help them to remember. However, it is also
likely that each time the subjects repeated their stories it became
harder for them to differentiate between whether they were recalling
their originally encoded memories or bits of information acquired
later. This seems particularly feasible since those subsequent bits
of information could serve as part of the foundation for their later
memory reconstructions. Thus their increase in certainty might
simply reflect the subjects being relatively more certain that they
heard or thought of a particular response before, as opposed to being

EFFECTS OF FORENSIC HYPNOSIS


actually able to detect it as one of their
of information.

341
originally encoded bits

One of the least anticipated findings discovered in this study


was the highly significant difference noted between the certainty
ratings the subjects provided for their correct and incorrect
responses. Those findings were contrary to the ones attained in
similar hypnotic recall studies conducted by Putnam (1979) and Zelig
and Beidleman (1981). The extent of the relationship between hypnotic susceptibility and certainty response reported by Zelig and
Beidleman (1981) also seems to be smaller in this study and more
centered around the subjects' incorrect answers. The apparent
reasons for these discrepancies appear to relate to differences in
the questioning procedures. In the present study an attempt was made
to utilize a procedure that would reduce the possibility of leading
questions, whereas the reverse was true in the other two pieces of
research. Thus, if highly susceptible people are indeed more likely
to be affected by external cues and suggestions, one would expect
their responses to be alerted to a greater extent when leading
questions are incorporated into the questioning procedure.
As with most laboratory studies, attempts to generalize the
aforementioned findings to field situations should be done with
caution. Several factors associated with both the subjects tested
and the mock crime situation utilized in this experiment may tend to
limit the external validity of this study.
Although the subjects had no idea when they would be shot and
several weeks had transpired before the first subjects were squirted,
the subjects knew in advance that sometime during the academic year
someone would approach them, shoot them with a squirt gun, and that
they would later have to try to identify that individual. They also
knew when they were attempting to identify their offender that no one
would actually be punished for the offense and that the police would
not be mislead by any incorrect information supplied by them. The
subjects were also all relatively young college students majoring in
criminal justice, which might have positively affected their ability
to identify others, especially the offenders who were also college
students. In addition, while the subjects were probably startled to
some extent by the commission of the mock offense, it was clearly a
far less traumatic ex?erience than being the victim of a serious
crime.
Despite going to considerable lengths to utilize a forensic
hypnosis procedure consistent with those commonly used in the field,
it should be noted that numerous other variations and alternative
procedures are currently used. In addition, limitations on the
availability of video tape equipment prohibited the questioning
sessions from being recorded, which should be done in all forensic
hypnosis applications. Not only did this require the experimenters

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.

EFFECTS OF FORENSIC HYPNOSIS

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.

HYPNOSIS AND THE LAW:

THE ROLE OF

INDUCTION IN WITNESS RECALL


Dr. Graham F. Wagstaff
Department of Psychology
The University of Liverpool, PO Box 147
Liverpool L69 3BX, England
Abstract
This paper will present a critical evaluation of recent reports
which suggest that hypnosis may be used to facilitate recall of
witnesses for forensic purposes. Emphasis will be given to the fact
that such anecdotal reports appear, at least superficially, to contradict a large body of experimental evidence which indicates that
hypnotic procedures do not facilitate recall to a level greater than
that achievable in a motivated waking state. However, experimental
work in this area has previously not involved recall of material
relevant to police work, and there have been no systematically controlled trials to determine the role of hypnotic induction per se in
the interrogation of witnesses. This paper will present the results
of studies which examine the relative importance of factors such as
hypnotic induction, relaxation and situational factors in facilitating recall in contexts more relevant to police work. It is hoped
that the identification of such factors in the hypnotic situation may
also help to provide techniques for use outside the hypnotic situation for witnesses who are hypnotically insusceptible.
INTRODUCTION
Much interest has been shown recently in claims that hypnosis
may be a useful tool for facilitating the memory of witnesses and
complainants in police investigations (Kleinhauz et al., 1977;
Reiser, 1980; Haward, 1980; Haward and Ashworth, 1980; Hibbard and
Worring, 1981). However, whilst these reports seem to present a
compelling case, they are based largely on anecdotal evidence.
Indeed, it is significant that they would seem to contradict a large
345

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G. F. WAGSTAFF

body of experimental evidence apparently showing that hypnotized


subjects are not able to remember better than subjects in a motivated
waking state. A judicious reading of relevant experimental literature indicates that, contrary to the interpretation of some
(Kleinhauz et al., 1977; Haward and Ashworth, 1980; Hibbard and
Worring, 1981), it is highly questionable whether there are strong a
priori reasons for assuming hypnosis has a special value in facilitating memory, at least in situations where other incidental factors
such as stress or embarrassment are not involved.
Evidence that has been cited as relevant to this issue by advocates of forensic hypnosis has come from two main areas; experiments
on memory for previously learnt material, and hypnotic age regression. Whilst a number of early studies purported to indicate
that hypnotized subjects could recall more learnt material than
waking subjects (Hammer, 1954; Illovsky, 1963; Rosenthal, 1944;
Sears, 1954, 1955; Salzburg, 1960; Stalnaker and Riddle, 1932), these
studies have been criticized for failing to apply at least one of a
number of appropriate control procedures (Barber, 1965; Wagstaff,
1980).
Using more appropriate control groups, Parker and Barber (1964)
found that hypnotized subjects did no better than unhypnotized subjects on measures including memory for meaningful nouns. This result
accords with others which indicate that hypnotized subjects do not
remember more material than unhypnotized subjects (Fowler, 1961;
Schulman and London, 1963). Indeed, in one study by Wagstaff and
Ovenden (1979), in which subjects were required to learn and recall a
word list with special time distorting instructions, the three hypnosis groups (low, medium and high susceptibility) all scored significantly lower on recall than the waking control groups. Other
more recent studies seem inconclusive (for a review see De Piano and
Salzberg, 1981).
The experimental literature on age regression appears to be
equally inconclusive. In spite of the claims of some earlier studies
(True, 1949; Reiff and Scheerer, 1959) there is now strong support
for the view that hypnotically regressed subjects cannot recall past
events in any more detail than suitably motivated waking subjects
(Barber, 1962, 1969; O'Connell et al., 1970; Barber et al., 1974;
Wagstaff, 1981; Yates, 1961). This view is in agreement with conclusions from other studies which indicate that, when appropriate
controls are applied, hypnotic performance is not superior to waking
performance on a variety of motor and cognitive tasks. Thus, for
instance, Orne (1971) writes, "Studies with simulating subjects, as
well as other recent research have demonstrated that hypnosis does
not magically increase capacities beyond those available in a motivated waking condition."

INDUCTION IN WITNESS RECALL

347

THE PROBLEMS OF DESIGN RELEVANCE


Although there would appear to be a contradiction between the
experimental literature on hypnosis and memory, and claims made for
forensic hypnosis, there are a number of features of the standard
hypnotic learning and recall paradigms which may make their relevance
to the witness interrogation procedure somewhat debatable. Some of
the main differences can be summarized as follows:
1.
Experimental studies have typically included standard laboratory
stimulus material, such as word lists. The applicability of this
material may be dubious in view of Rosenthal's (1944) observation
that hypnosis is less effective with recall of meaningless material,
or of meaningful material which is not part of an organized context.
2.
In laboratory studies both learning and recall have occurred
within the hypnosis situation, whereas in the typical eye witness
situation the learning tends to be incidental, and occurs outside of
the recall context.
3.
Hypnosis procedures in forensic investigation employ a range of
suggestions and instructions in addition to hypnotic induction per se
which have not been present in most laboratory studies. In particular, forensic hypnotists may use time-regression and revivication
procedures to facilitate the witness' memory of incidental events,
details and emotional experiences (Hibbard and Worring, 1981).
Consequently any controlled experimentation relevant to actual
forensic investigation must take these three factors into consideration. Recent attempts to investigate recall and recognition under
hypnosis, controlling these factors, have again been contradictory
and inconclusive in their findings (Putnam, 1979; De Piano and
Salzberg, 1981; Zelig and Beidleman, 1981; Griffin, 1980; Timm,
1981). Nevertheless, as forensic hypnotists employ a range of techniques in addition to hypnotic induction per se, and if the police do
not generally use these additional procedures, it becomes pertinent
to evaluate the relative effectiveness of these procedures with and
without the induction of hypnosis. The rest of this paper will deal
with the results of some preliminary attempts to investigate this
issue experimentally.
At the experiments cited in this paper represent only the beginnings of systematic research into this area at Liverpool, they are
limited in their use of stimulus material of a non-traumatic nature.
This decision was made partly on ethical grounds, and partly because
claims have been made that hypnosis can be used with advantage on
subjects who are not in a state of traumatic shock or intense anxiety
(see e.g. Hibbard and Worring, 1981; Haward and Ashworth, 1980).
Certainly in many instances when a crime has been committed details
are required of witnesses who may not even have been aware that a

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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~

One obvious feature of many hypnosis procedures is eye closure.


The failure to control this very obvious variable could easily confound studies of hypnosis which employ waking control groups. as
members of the control group may have their eyes open. On a priori
grounds it seems reasonable to hypothesize that eye closure could aid
memory. in as much as it may allow greater concentration. In order
to test this hypothesis the following experiment was conducted.
Forty undergraduate volunteers were randomly assigned to two
independent conditions. eyes open and eyes closed. and tested individually. Each was given a standard card on which were displayed
pictures of 20 objects (e.g. car razor. clock and cigarette lighter)
for 30 seconds. One minute later they were requested to recall the
objects. either with eyes closed or open. Apart from the eye closure
instruction. the instructions and temporal conditions were identical
for each subject. A t-test indicated that the eyes-closed group
recalled significantly more items than the eyes-open group (p<0.05
one-tailed). The means were 9.55 and 8.55 for the eyes-closed.
eyes-open groups respectively.
These results seem to suggest that eye-closure has a small, yet
significant effect. on recall of meaningful visual stimuli. As such.
although not all recall under hypnosis occurs with the eyes-closed.
the eye-closure variable should be taken into account when appropriate.
HYPNOTIC INDUCTION AND RELAXATION
The next experiment attempted to assess the role of hypnotic
induction per se in facilitating memory for material relevant to
forensic investigation. However, it also included an evaluation of
the role of relaxation. as the majority of hypnotic induction techniques used by forensic hypnotists employ suggestions for relaxation. I
The subjects were 43 unpaid. experimentally naive. volunteers.
The stimuli were ten,colored slides depicting a range of detail
relevant to the kinds of items witnesses might be asked to recall
such as people, buildings. clocks, cars and number plates. Questions
were presented in the form of a 25 item standardized questionnaire

INDUCTION IN WITNESS RECALL

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

HYPNOSIS AND GUIDED MEMORY


According to the results of the previous experiment it seems
unlikely that hypnotic induction per se, or the incidental variable
of relaxation, can alone account for the improvements in memory
claimed for forensic hypnosis, at least in situations where the
stimulus material is not of a traumatic nature. Consequently it
becomes important to assess the importance of the revivication procedures often employed in forensic hypnosis. If one scrutinizes the
revivication procedures described by investigators such as Hibbard
and Worring (1981) it is evident that they bear a close resemblance
to the guided memory procedure of Malpass and Devine (1981). The
guided memory procedure was developed quite independently of the
field of hypnosis in an attempt to assess the role of cognitive
factors in state-dependent learning and retrieval. The work grew out
of findings such as those of Smith et al. (1978), and Smith (1979),
which demonstrated that retrieval is better when subjects are
returned to the environmental context in which the stimulus material
was presented, and that recall can also be facilitated if subjects
are returned to another environment but given instructions to use
their memory of the study environment. Malpass and Devine (1981)
adapted the paradigm in order to assess whether cues to use memory
would aid face recognition by eye witnesses. In order to do this
they gave subjects incidental information and asked about the context
in which the target person had been seen and their feelings at the
time. For instance, subjects were told: "Sit back in your chair, be
comfortable and try to visualize the room, the things in it and the
events that happened Do you remember where you were sitting?
Did you come to the demonstration with another student? Do you
remember how you felt or what you were thinking? Can you remember
your reaction? Try to picture the vandal in the front of the
room What color was his shirt?" etc. (Malpass and Devine, 1981).
Subjects receiving this treatment gave 60% correct identifications of the target person from a photographic line up compared to
40% by an untreated control condition.
In forensic hypnosis the hypnotist will also endeavor to familiarize him/herself with the incidental, as well as the obviously
relevant, features of the crime and may ask similar questions and
give similar instructions in the revivication procedure. For
instance, the revivication procedures described by Hibbard and
Worring (1981) include statements such as:
"You are at (give specific location). Where are you?
Now look around you and tell me what you see.
What are you wearing? What are you doing?
What is happening? Where are you sitting?" etc.

INDUCTION IN WITNESS RECALL

351

In view of the similarity between hypnotic revivication and


guided memory an experiment was devised to test the relative efficacy
of a guided memory/revivication procedure with and without hypnotic
induction. 2 Forth-seven naive subject volunteers were shown a 7
minute videotape of an episode involving crime and violence. They
were told they were participating in a study of 'violence and the
media'. The subjects were randomly assigned to three groups, hypnosis, guided memory and control.
Following the presentation of the video the hypnosis group was
given the hypnotic induction procedure for the BSS followed by the
LSS. They were then given a time regression suggestion based on the
procedure devised for forensic purposes by Hibbard and Worring
(1981). This is turn was followed by a 12 minute guided memory/
revivication procedure based on that