TYPES OF SUGGESTION
Suggestion can be defined as the uncritical acceptance of an idea. It is the process by which sensory impressions are conveyed in a meaningful manner to evoke altered psychophysiologic responses. One cannot necessarily equate suggestion with hypnosis unless the latter is accompanied by diversion. However, the acceptance of ideas by suggestion must be differentiated from logical persuasion. Persuasion is not suggestion, and suggestion is not persuasion!
Suggestion provides sensorial data input or information to the higher centers. All sensory input routes continually receive data from verbal, nonverbal, intraverbal, or extraverbal communications. This is done not only via the five senses, but through other sources (e.g., temperature and pressure sensations, and kinesthesia). Verbal, which includes preverbal, communication refers to information transmission by sounds and words. Nonverbal communication refers to gestures and grimaces. Intraverbal communication is concerned with modulation of the voice. An orator, for example, with emphatic vocal inflections holds his audience's attention more readily than one who speaks in a monotone. Extraverbal communication deals with the implications of words or phrases which are more apt to reduce criticalness. Thus the harsh command “stand up” is likely to produce resistance to carrying out a suggested act. Contrarily, if one softly asks, “Are you not tired of sitting down?” the chances are that the person will stand up, especially if the request is accompanied by a nonverbal gesture symbolic of the desired act. Thus the whole complex of mannerism, inflection of voice, and implied meaning of the words employed plays an important role in facilitating perception, cognition, and response. Aristotle's maxim—“Nothing is in the mind that did not pass through the senses”—is literally true.
THE NATURE OF SUGGESTIBILITY IN HYPNOSIS
Nearly all subjects believe that their responses are produced by the hypnotist. In reality, it is the subject who initiates the acts in response to an appropriate expectant attitude. Where criticalness is reduced, a suggested act usually is automatically carried out without the individual's logical processes participating in the response. And when one suggestion after another is accepted in ascending order of importance—task motivated suggestions—more difficult ones are accepted, particularly if the sensory spiral of belief is compounded from the outset. This is called abstract conditioning and, in part, helps to explain the role that suggestibility plays in the production of hypnotic phenomena.
Suggestibility is further enhanced by a favorable attitude or mental set that establishes proper motivation. This depends not only on the technic utilized to produce it, but also and to a greater extent on the quality of the relationship—the rapport—established between operator and subject. Thus mere suggestibility per se does not account for hypnotizability, but rather increased suggestibility is a constant feature of hypnosis. However, the concept of increased suggestibility does not explain the complexity of the phenomena that occur during hypnotic behavior.
There is an extensive literature on the nature of suggestibility in hypnosis. Some investigations reveal that with a male operator suggestibility is slightly greater in females than in males.47,110,112 Other data indicate that the sex of the hypnotist shows no appreciable differences.48 However, since hypnotic suggestibility largely depends on motivation, it varies from person to person and even changes in the same person, depending on his needs and drives. Therefore, though it cannot be correlated significantly with sex, there are some changes with age.76 Children are more hypnotizable than adults, peaking out between ages 9 and 12. However, the relationship of hypnotic susceptibility to personality in children remains to be clarified.72 Adult responsivity levels are established about age 16, and diminish in middle and old age.11 The degree of suggestibility also is determined by the way an individual reacted to suggestions from others in the past, either by the structuring or the setting or by the prestige of the person who gave the suggestions, and by the way the suggestions were interpreted. A subject may be highly suggestible to stimuli affecting his health, yet he may be nonsuggestible to persuasive salesmanship. In the latter area, his critical faculties are aroused. Yet the same person may be very suggestible to political and religious persuasion, especially if the exhortations seem to fit in with his cultural and value systems. Of course, suggestibility always must be differentiated from gullibility, which implies the use of deception.
Often the degree of suggestibility cannot be evaluated because of the extent of neurotic involvement. It is believed that psychoneurotics are more suggestible than emotionally healthy persons,107 and that even psychotics are susceptible to suggestion.1,12,38,44,53,65,69 Another investigator notes that normal subjects are more susceptible than neurotics and psychotics.48 However, exhibitionists who submit to hypnosis for entertainment purposes are very suggestible because of their expectancies and also because they have no symptoms to lose. Of particular interest is the paradoxical reactor, who believes he is not susceptible to suggestion, but who, because of his innate stubbornness, reacts with positive suggestibility.
Hypnotizability is not related to intelligence. It often depends more on the manner in which subjects utilize their attention span,43,66 their ability to respond to vivid imagery,95 and their creativity.16 The way individuals become involved in imaginative experiences apparently has some correlation with the depth of hypnosis.50,97,104 It has been observed in a landmark study that simulating subjects and subjects told “simply” to use their imaginations to experience suggestive phenomena did not differ in their overt responses from those subjects who were actually hypnotized.80 However, the differences found between hypnotized and simulating subjects seems to be subjective. The hypnotized subject clearly sees the state as somehow different from normal waking consciousness. Hypnotized persons are more likely to describe the imaginal suggestions as real and vivid. This is contrary to the simulator's experiences, inasmuch as he has not been conditioned.
Conditioning theorists are aware that whenever a suggestion is repeated over and over again, this usually leads to a quasi-conditioned reflex, which, in turn, is dependent upon previously established associative processes. The effects of reflex conditioning have much in common with hypnotic conditioning.19 Conditioning by suggestion or hypnosis has masqueraded under a multiplicity of healing terms from time immemorial and relies heavily on “misdirection of attention.”
Misdirection of attention, as it relates to hypnosis, is merely a diversionary maneuver or “smoke screen” to obscure the fact that suggestion in one guise or another is used to influence an individual. A formal hypnotic induction procedure is a ritual which makes full use of misdirection; the operator “slips in” suggestions when the subject is least expecting them. During induction, for instance, the subject's attention is fixed upon his eyelids by the remark, “Your eyes are getting very, very heavy.” If his eyes actually become very heavy, then he is ready to believe other suggestions that he attributes to the operator's “powers.” The subject does not realize that the heaviness of his eyelids actually was induced by the constant and fatiguing position of the eyes, staring upward at the ceiling. He believes that his eye fatigue resulted from the operator's suggestions of heaviness.
EVERYDAY ASPECTS OF SUGGESTION AND HYPNOSIS
Suggestion by misdirection of attention accounts for the success of many types of “therapy.” Whenever a patient with a psychogenic complaint develops a favorable mental set that a particular type of therapy will help, he is aided not so much by the therapeutic modality as by his inner conviction or faith that he will be helped. The effects are greater if he has been referred to the doctor by a person who has obtained results from similar “treatments.” Here misdirection in the form of a placebo effect brings about the favorable mental set so essential for enhancing the subject's expectation of success.
One of the most important ingredients for hypnotic suggestibility is the expectation of help from one who is in a prestigious position. If convinced of the truth of this person's words, the subject behaves differently because he thinks and believes differently. From time immemorial, all healing by suggestion or hypnosis has been based on this mechanism. If the idea is accepted that increased suggestibility is produced by a favorable mind-set or attitude, catalyzed by the imagination, then hypnotic responses fall into the realm of conviction phenomena. As such, they are subjective mechanisms which are inherently present, to a degree, in all individuals. They result from the subject's imagination compounding the sensory spiral of belief until conviction occurs. Hence, “It is indeed a wise hypnotist who knows who is hypnotizing whom!”67
An extreme degree of suggestibility is illustrated by medical students who, owing to their imagination, develop the signs and symptoms of many of the diseases they study. The role of the imagination in the production of symptoms is generally admitted, and therefore it seems reasonable to infer that what is caused by the imaginative processes may be reversed by counterconditioning the imaginative processes.
Suggestibility also can affect the hypnotist. There is increasing evidence that the therapist has to be considered an integral part of the therapeutic setting.14 It is important to study the hypnotist's response to the patient he is hypnotizing. The influence of the patient on the hypnotist also requires more evaluation.14,19,42 Pertinent here is the patient who makes the therapist feel omnipotent because he thinks he cured the patient with his methods.
Altered states of consciousness, reverie, meditation, and sleep or wakefulness, which are fluctuating states of attention or awareness, are poorly understood at present. Is a mother who can sleep through a thunderstorm and yet hear the cry of her baby really asleep? In meditation or reverie, or a daydream, one often may not hear even though ostensibly “awake.” Everyone has had the experience of “listening” attentively to another person and yet not hearing a word. For all practical purposes, we were “asleep” at the time. Data indicate that discussions that take place while a patient is anesthetized can be recovered postoperatively through hypnotic recall.19 Sensory impressions noted subliminally can be reproduced; a song heard over and over again eventually can be hummed without our being aware of how it was “learned.” Repetitive stimulation of any of the sensory input organs can induce a state of increased receptivity to suggestion. Therefore, if a stimulus is sufficiently maintained, the desired response eventually will be produced.
It is obvious that suggestions leading to hypnosis in its broadest sense occur as a part of everyday existence. This begins during our formative years—when a child hurts his hand, his mother's kiss usually relieves the pain. And, as an adult, he responds more readily to attentive suggestions whenever he is placed in a situation that contains some or all of the elements that were present during his conditioning as a child.49,100
The capacity to be hypnotized is probably “programmed” into the central nervous system as the result of a million or more years of genetic endowment. One portion of the brain, the neocortex, deals with reality. During hypnosis there is a special kind of awareness, characterized by the ability of the phylogenetically older brain—the subcortex—to respond to ideas, images, and feelings which may or may not be related to reality. In a dream, for example, one can float out of the window and land on the roof. Here, distortion of reality occurs because of complete lack of discrimination or cortical inhibition. It is likely, therefore, that when cortical functioning is selectively inhibited, as it is apparently during hypnosis, the altered perceptions can be organized into a wide variety of thought patterns wholly unrelated to reality.
There is a wide field in which to maneuver when one uses hypnotic suggestions to “tap” the brain's capacities. According to neurophysiologists, the human brain has about 10 to 15 billion neurons in which to process and store information.108 Each neuron, in turn, has the capacity to store a tremendous number of “bits” of information or memories. Furthermore, a single neuron has one or more synapses or “switches.” The sum total of these limitless possibilities, associations, or potential interactions for memories, feelings, ideas, and attitudes simply staggers the imagination!
It is estimated that by the age of 50 the brain contains some 70 trillion “bits” of information or memories as part of what is referred to as the imagination or experiential background. This gives us some idea of the magnitude of the field that is capable of responding to the proper inputs. No wonder the brain has been referred to as an “enchanted loom”!
PHYSIOLOGICAL CHANGES DURING HYPNOSIS
The extensive literature bearing upon the physiological changes supposedly associated with hypnosis has been reviewed by several investigators.21,24 It has been proposed that such physiological changes might be due to “neutral hypnosis” (i.e., the hypnotic state before any type of suggestion is given for specific changes).24 An increase in oral temperature was noted in neutral hypnosis with corresponding rise in temperature in other portions of the body.87 The rise was attributed to the associated anxiety,106 but other investigators observed that changes did not differ appreciably from those associated with relaxation.85 Corroborative studies on electrodermal responses,32 and on blood chemistries55 showed no differences in hypnotized subjects as against the nonhypnotized. Identical physiological changes in simulators as in hypnotized subjects have been noted.26 Crasilneck and Hall reviewed the pros and cons of this fascinating area.25 They quote other investigators who observed an increase in venous flow during hypnosis.107 Still other researchers noted reduced blood flow in the eye and increased tissue vulnerability.18,102 The interested reader would do well to consult Leon Chertok's fascinating treatise on the psychophysiological mechanisms of hypnosis.21
THE HYPNOIDAL “STATE”
The hypnoidal “state” refers to a precursor of hypnosis, usually induced by nonformalistic technics. Through fixation of attention, for example, the monotonous stimulus of a white line on a highway induces a tiring effect upon the driver. This eventually leads to some degree of dissociation that can produce a hypnoidal effect, and this, in turn, can merge with true sleep. Depending upon the degree of dissociation, it resembles hypnosis. The hypnoidal “state” is characterized by some detachment as well as by physical and mental relaxation. The attention span fluctuates more toward abstractional states. Since critical thinking is reduced, enhanced suggestibility results.
Our lives are full of hypnoidal contacts and relationships that are referred to by psychologists as “waking hypnosis.” Repetitive radio and television commercials, advertising propaganda, and good orators or actors heighten the attention span in a meaningful manner and enhance our suggestibility. When watching an interesting motion picture, our attention is focused on the screen, and we soon enter into a hypnoidal “state.” Varying degrees of emotion are registered as we identify with the action in the film. Reality is made out of unreality. Whenever the necessity for reality thinking is obviated, a type of waking hypnosis occurs. After walking out of the theater, we usually blink our eyes for a moment to orient ourselves. Without realizing it, we were in a hypnoidal “state” and on the way to being effectively “hypnotized.”
Waking hypnosis here occurs as the result of utilizing ordinary experiences.
The frequency of naturally occurring quasi-hypnotic experiences has been described,96 but no correlation was found between a high incidence of such experiments and increased hypnotizability. The experience of so-called trance has also been analyzed in meticulous detail, indicating that it can occur spontaneously. Obviously, it is the result of a wide variety of stimuli, whereas hypnosis requires the interaction of another person who presumably induces the trance. However, as already mentioned, hypnosis is not simulation.83
Mass suggestion, mass hypnosis, subliminal projection, brainwashing, propaganda, and evangelistic appeals leading to altered behavior are also produced by nonformalistic hypnotic technics. Thus a knowledge of the everyday aspects of scientifically applied suggestion—hypnosis—has profound implications for an understanding of all mental functioning.
Animal hypnosis is discussed in this section because of its relevance to understanding human hypnosis. Though different, animal “hypnosis,” or immobility reflex (I.R.), displays some of the phenomena noted in humans.41,58,59,60 A chicken placed in a horizontal position develops a tonic immobility characterized by an extensor rigidity of the limbs—catalepsy—when a line is drawn from the eye that is closer to the ground. The immobility may be due, in part, to restriction of activity. Other illustrations of seemingly hypnotic phenomena are seen throughout the animal kingdom. The female spider, which is much larger than the male and ordinarily kills him, is rendered immobile by stroking her belly just before copulation. A snake is “hypnotized” or charmed by the to-and-fro movements of the flutist; and the bird that sings the most sweetly attracts the most potential mates.
The older literature posits a similarity between animal hypnosis and a hypnoidal stage, the latter being a primitive type of resting stage noted in animals. The more primitive the animal, the more apparently hypnoidal is its sleep state.98 From a phylogenetic standpoint, sleep and hypnosis may have evolved from primitive hypnoidal mechanisms. However, it should be stressed once again that the capacity of a human to enter into hypnosis is due primarily to the social or interpersonal relationships induced by the symbolic or experiential meaning of words and other stimuli. In animals, on the other hand, hypnosis is produced chiefly by physical manipulations, such as restraint which leads to fear, torpor, and regressive behavior. Thus animal hypnosis is not the same as human hypnosis.20,21 Klemm has reviewed the rather extensive literature on animal hypnosis and has had a wide experience in this area.60 He states, “I am by no means certain that the two states are comparable, but animal hypnosis does seem to be characterized by heightened attention (or by less distraction), and as a result they learn conditioned reflexes more effectively than controls.” Other investigators believe that animal hypnosis can be used as an experimental model for a better understanding of human hypnosis, at least in terms of its biological aspects.52
Autohypnosis, or self-hypnosis, usually is produced by previous posthypnotic suggestions made by the operator. Every autosuggestion was originally a heterosuggestion. Varying degrees of autosuggestion and autohypnosis account in no small measure for the success of the metaphysical “sciences” and religious spiritual-healing movements.
Suggestions have a much greater chance of being followed when they appear to originate from the self rather than being instituted by another person.77 If the patient feels that he can facilitate recovery by such therapy, he develops more motivation. The resultant self-pride in this achievement strengthens the confidence essential for recovery. Autohypnosis also makes available a tremendous reservoir of unrecognized potential strength—the “forgotten assets.” Diligent practice, however, generally is necessary to obtain a satisfactory depth; lesser degrees are attained more readily.
It has been suggested that autohypnosis is the primary phenomenon, and that heterohypnosis is in effect guided self-hypnosis.89 These findings contradict a stereotype of hypnosis based on heterohypnosis of a passive subject by an active hypnotist.
Rapport has been defined as a harmonious relationship between two persons. In hypnosis, it results from restricted attention to some or all stimuli residing in the field of awareness.34 Thus rapport, as it relates to the hypersuggestibility produced by the hypnotic situation, is a special kind of relationship in which the operator's suggestions are followed more readily. This is due to the greater belief and confidence established in him.
When greater attention is paid to the words of the operator, a subject usually responds with almost a pinpoint literalness or specificity to suggestions, especially if they are in accord with his wishes and needs. Thus, wherever a “pipeline of communication” is established between a sender and a receiver, a suggestion or “message” will be understood if there is no interference, “noise,” or static on the circuits (garbling or unintelligibility of the signal).
Some subjects in good rapport even will respond to an operator's posthypnotic suggestions as a printed or written order, such as “Go into a state of deep relaxation.” Even blind persons and deaf mutes can be hypnotized through other sensory modalities if there is good rapport. Others respond to the voice of the operator over the telephone, provided they have been appropriately “cued” for this posthypnotic suggestion before hand. Even an associate without prior knowledge of hypnotic technics, upon a prearranged signal, can readily produce deep hypnosis in a willing subject.
It has been contended that the rapport in hypnosis is due to emotional dependency on the operator. However, there is no more dependency in the hypnotic situation than in any other psychotherapeutic relationship. When autohypnosis is incorporated into therapy, whatever dependency exists is minimized or eliminated. The success of all psychotherapy is based on a good interpersonal relationship, which is essentially a shared experience. Because of the intense and close interpersonal relationship produced by the hypnotic state, both operator and patient enter into good rapport, since it provides each with an emotional satisfaction that otherwise could not be obtained.71 More research should be directed toward one of the most essential psychological phenomena of hypnosis—the shared qualities of rapport.
One can conclude from the above that patient rapport denotes the ability and willingness of the patient and the operator to enter into an intensified emotional relationship with each other. As a result, the subject is motivated to accept the beliefs that are so necessary for the establishment of conviction. These are the special requisites for hypnotic induction, utilization of the hypnotic state for production of behavioral responses, and subsequent behavioral changes.
Catalepsy, an interesting phenomenon of hypnosis, is characterized by a peculiar involuntary tonicity of the muscles. The limbs remain in almost any position in which they are placed; the waxy molding of the fingers and the extremities is known as flexibilitas cerea. During eyeball catalepsy, the eyes do not move when the head is turned slowly—they remain “frozen” or “fixed” when the head moves. At nonhypnotic levels, there generally is a quick darting of the eyes, which is associated with a time lag or an economy of motion.
Catalepsy usually denotes that a light or a medium stage of hypnosis has been achieved, and its presence enables the operator to determine the depth at which he is working. Very few psychophysiologic investigations have been made of this common hypnotic phenomenon.
Ideosensory activity refers to the capacity of the brain to develop sensory images, which may be kinesthetic, olfactory, visual, auditory, tactile, or gustatory. A common example of ideosensory activity is looking at a fire and “seeing” the “face” of one's beloved. During negative ideosensory activity, there is a denial of actual sensory experiences, such as not seeing or hearing something that actually is present (e.g., looking for one's pencil and finding it in front of one). A typical example is the complete absorption in an interesting book that produces a selective type of “deafness” to irrelevant stimuli. Imagining the “smell” of a certain odor that does not actually exist is an example of a positive ideosensory activity.
Ideosensory activities are used as misdirection to obtain a somatic response. The subject must be involved in as many ideosensory experiences as possible, as this facilitates hypnotic conditioning. The subject must think of these in terms of his own memories, ideas, and sensations, that is, those that he has already experienced. When, for example, the author wishes to induce hypnoanesthesia, he has found the following suggestion to be helpful, “Your hand is getting just as numb as if it were frozen, or as if you had been sitting or sleeping on it.” Nearly everyone has experienced this sensation. Naturally, to elicit ideosensory activities, the posthypnotic suggestions must revive responses previously experienced by an individual—his experiential background. The mention of a specific food to a hungry individual, for instance, is likely to produce salivation only if he has experienced the taste of that particular food.
The section on technics will illustrate how ideosensory activities are employed to effect somatic responses. Comprehension of the nature of ideosensory processes is necessary to understand the modus operandi of hypnosis.
Ideomotor activity is one of the phenomena used to facilitate suggestibility. It refers to the involuntary capacity of muscles to respond instantaneously to thoughts, feelings, and ideas. These built-in responses are necessary for survival. An example of ideomotor activity is seen when a mother puts a spoonful of food up to a baby's mouth and her own mouth opens. Leaning in the direction of the ball carrier on a favorite football team and the backseat driver's stepping on the brake of a careening car are other ideomotor activities spontaneously produced without the awareness of the individual.
All induction technics depend on the subject's being unaware that he has made such physical responses to suggestion. He does not realize that they are the result of his own thoughts. In the section on induction technics, it will be shown how ideomotor activities are utilized to invoke the subject's belief and thus lead to the expectation of hypnosis.
Chevreul's pendulum test (described in Chapter 5), the operation of the Ouija board, oil- and waterwitching, clairvoyance, and even extrasensory perception to a degree, depend upon the involuntary or ideomotor muscular responses associated with the ideosensory processes of the individual. Subcortical mechanisms are responsible for the primary or inherited responses, manifested as involuntary reflexes. These are not learned, and include blinking, pupillary dilatation or contraction, endocrine responses, peristalsis, breathing, and cardiac functioning. Even though breathing and blinking can be controlled volitionally, most of the vital functions are under autonomic control.
It is possible, however, to “build in” other reflexes upon those that are involuntary and to make these increasingly subject to volitional control. Biofeedback has demonstrated that the autonomic nervous system is not as autonomic as we have been led to believe. The greater control of autonomic functioning accounts for the feats of Yoga and the transcendence of normal voluntary capacity achieved by posthypnotic suggestions.
It has been pointed out that highly motivated subjects can perform to the same degree at nonhypnotic levels.7 One investigator contends that it is possible to obtain an increase in the range of behavior,81and according to another writer, subjects will oblige the hypnotist if the experimental setting is conducive to the expected response.114
At nonhypnotic levels, the autonomic nervous system attempts to act in response to all new situations, and it is corrected by awareness of reality. In the case of the back-seat driver, the discriminatory portion of the cortex appraises reality and returns the conviction that he is not in danger. Without such awareness, he would produce responses as if he were the driver, as happens in dreams, hallucinations, and psychoses.
Reality results whenever incoming information in the form of sensory perceptions can be validated with previously stored data; this results in automatic behavior and response. During hypnosis, however, the operator's suggestions are accepted as reality because of selective cortical inhibition; the incoming information does not have access to the stored data; therefore it cannot be validated. Thus the increased suggestibility, leading to production of hypnotic phenomena, is brought about by the interplay of two forces—automatic activity (ideomotor and ideosensory) and selective cortical inhibition. Stated simply, when ideas that lead to “ideoid” (idea-like) actions are interpreted as reality, the resultant convictions lead to hypnosis!
POSTHYPNOTIC SUGGESTIONS AND CONDITIONING
Acts carried out after the termination of hypnosis in response to specific suggestion are called posthypnotic phenomena.111 A suggestion given during hypnosis serves as the stimulus, and the act becomes the response. A posthypnotic suggestion and a conditioned reflex serve a similar purpose except that the former is not established by repetitive trial and learning in the classic sense. Rather, a posthypnotic act is a complex task because it is related to some degree with the hypnotic induction. It is often carried out as the result of a single session of “learning.” Moreover, it is not as rapidly extinguished as a conditioned reflex.
The posthypnotic act, even though carried out long after it is suggested, is probably a spontaneously self-induced replica of the original hypnotic situation. A posthypnotic suggestion may last for minutes to years.33,34,37,45,56 It is agreed, however, that it may remain effective for several months.57,84 During this period, decrement occurs in the quality of the posthypnotic performance. Periodic reinforcement, however, tends to increase its effectiveness; repeated elicitation does not weaken it.
Posthypnotic suggestions usually are followed irrespective of the depth of the hypnosis. Completion depends more upon the nature and the difficulty of the suggested task than upon the depth of the hypnosis.110 Internal or external factors, of one type or another, can prevent fulfillment. When this happens, profound anxiety may be produced. Therefore, a posthypnotic suggestion should not be of a bizarre nature, but in keeping with the subject's needs and goals.
Some subjects develop a complete amnesia for the posthypnotic act and yet readily follow the original suggestion. Others can be aware of the original suggestion as they carry it out. Still others remember the suggestion only after the completion of the act. Response to posthypnotic suggestions might be compared with the compulsive behavior noted in all of us at times. We know what we are doing, but do not know why! If the setting in which the posthypnotic suggestion occurs is altered, or if the expectant attitudes change between the time of the suggestion and the time when it is about to be carried out, then deeply hypnotized persons can cancel even the original suggestion.36
Unless the subject is a volunteer for a stage hypnotist, ridiculous suggestions usually are rejected. Most of these volunteers are exhibitionists and seldom mind carrying out suggestions that are compatible with their usual or desired behavior. Whether or not a suggestion is carried out also depends upon the wishes and the intentions of the subject.13,70 The type and the quality of the operator's communication also affect the response. When working with a subject in hypnosis, an extraverbal approach such as, “You wouldn't mind opening the window after you come out of this relaxed state, would you?” minimizes resistance. If the posthypnotic suggestion is not followed, a remark such as, “It's stuffy inside. I wonder how we can get some fresh air in the room?” is usually effective. A cue of this type often reinforces a posthypnotic suggestion given during hypnosis.
When a posthypnotic suggestion that is not fully in accord with the subject's desires is carried out, he usually rationalizes the unusual behavior. Purposeless posthypnotic suggestions are as readily forgotten as other instructions given at nonhypnotic levels.93 The greater tenacity of posthypnotic suggestions stems from the graded effects of previously invoked beliefs such as lid heaviness and limb catalepsy, which, when compounded by ideosensory responses, lead to automatic conviction. Since the subject felt the operator's initial suggestions, he naturally believes and follows other and more complex posthypnotic suggestions. The subject, just as during the induction, is wholly unaware that his own ideomotor and ideosensory responses initiated the posthypnotic response.
The complex mechanisms involved in the fulfillment of a posthypnotic suggestion are the result of a series of conditioned sensory impressions and muscular activities. The subject develops a belief in the reality of a subjective experience and response following a posthypnotic suggestion. He accepts its reality as readily as any belief associated with dreaming, thinking, and perceptual reorganization. One investigator thinks that there is no essential difference between behavior in the “hypnotic” and “posthypnotic” periods; in other words, that all phenomena elicited by means of posthypnotic suggestions are seen during hypnosis.4 However, the reverse is not always true, and there is a difference between a posthypnotic and waking suggestion in carrying out a task performance.
Amnesia may or may not occur spontaneously during hypnosis. It is not a reliable criterion of the hypnotic state.105 It may be conceptualized as a mechanism that interferes with the retrieval of information; the subject appears unable to bring the forgotten material into awareness.78 More often it is produced through posthypnotic suggestions. When it has occurred, there is a selective loss of memory following dehypnotization. The subject is “unaware” of what has occurred during hypnotically produced amnesia; however, the recollections are only held in abeyance. Most good subjects, when rehypnotized, can remember nearly everything that happened during the hypnotic session; others gradually forget some or all of their experiences. Still others, even though deeply hypnotized, have an inordinate need to maintain control and will not develop amnesia. Intensive studies have been made to determine whether the consequences of amnesia derive directly from the specific content of posthypnotic suggestions.15,82,101,105
The phenomenon of amnesia occurs as an everyday experience. The name of an old friend, for example, can be forgotten temporarily when an introduction is being made. Either spontaneous or suggested amnesia can be used for evaluating the depth of hypnosis; the former generally is indicative of deep hypnosis (i.e., somnambulism). Here loss of memory for whole segments of an individual's life is produced; the dissociation is analogous to the fugue states noted in amnesia victims. Suggested hypnotic amnesia is somewhat comparable with the everyday experience of repressing painful experiences. The duration of the amnesia is not predictable. The reader interested in all aspects of posthypnotic amnesia is directed to an excellent symposium on the subject, published in 1966.103
Amnesia can often be obtained by means of the following instructions: “You may find it very convenient to forget everything that I suggested. Imagine that your mind is like a blackboard that has just had everything erased.” Another method is to say, “After you open your eyes, you will have no recollection of what I said to you while you were in a relaxed state. However, all the suggestions I gave you will be effectively carried out as specified.”
Dissociation is somewhat similar to hypnotic amnesia. It refers to the inherent ability of a hypnotized subject to “detach” himself from his immediate environment. This phenomenon occurs at nonhypnotic levels, as in reverie states. An individual may be completely dissociated and yet retain his capacity to function adequately. This dissociated state is similar to dreaming, when one “sees” himself performing many activities. Nearly all situations produced in dreams can be attained in the dissociated state by appropriate posthypnotic suggestions.
A well-conditioned subject can “step out” of himself and see himself sitting on the other side of the room. Dissociation frequently is used to induce hypnoanesthesia. The following remark to a deeply hypnotized patient in a dentist's chair automatically will raise the pain threshold: “You would not mind going out to the ball park, would you? It is such a nice day for a baseball game, isn't it?”
A portion of the body, such as a limb, can be “anesthetized” through dissociation; the person does not feel the “separated” part. This can be produced as follows: “You can feel and see both arms in your lap, can't you?” This suggestion may be given while the subject has his arm extended in rigid catalepsy. Obviously, if a positive visual and tactile hallucination is produced by the suggestion to “see” both arms resting comfortably in his lap, then the extended cataleptic limb becomes the dissociated arm, and it automatically becomes impervious to pain without any mention of anesthesia! It has been clearly demonstrated that during amnesia tasks of some complexity could be carried out simultaneously, even though some of them are out of awareness.64
Depersonalization can be induced readily in a good subject through posthypnotic suggestions. He can be told to forget his own identity and assume that he is another person. This is accomplished most easily by asking him, “Who is your favorite person?” The operator then suggests that he is that person. Depersonalization can be used for psychotherapeutic purposes that are similar to those mentioned under dissociation.
HYPERMNESIA OR MEMORY RECALL
Hypermnesia refers to the retrieval of information or an increase in memory recall greater than that achieved at volitional or nonhypnotic levels. This phenomenon, too, is seen in some degree as a part of everyday life. How often, when walking along a certain street, one thinks: “Whatever happened to my old buddy, Jim? I can remember when we used to play on this very block.” All memories, no matter how trivial, are stored in the brain and leave an indelible impression. Most of these can be recovered when the proper pathways of association are stimulated.
Under hypnosis, a good subject apparently can recall memories long since forgotten. One investigator believes that the magnitude of recall or retrieval of information obtained under hypnosis is increased only slightly,79 whereas another thinks it is much greater than at nonhypnotic levels.93 One researcher reports increment in memory skills and an increased ability to forget or repress,35 but this was not corroborated by others.109 The information recalled may be inaccurate, however, and one must realize that hypnotic subjects can fabricate material readily. Hypermnesia must be differentiated from revivification, which is essentially an actual reliving of an incident at the time at which it occurred. Memory recall is obtained by posthypnotic suggestions such as, “Perhaps you might like to tell me all about your graduation from grammar school, and what did you say was the name of your school?” The emphasis here is on the past tense, whereas in revivification the question would be asked in the present tense.
The author has used hypermnesia for recall of pertinent information that has helped to solve crimes and legal problems. In one instance involving a large sum of money, a subject remembered where he had been on a specific date 8 years prior to the hypnotization. In this instance, recall of the facts was verified.
Hypnotic recall has been used to pierce an amnesia for the cause of an air crash. The investigator induced a dissociation of the personality in which the “observing ego” watches what the “experiencing ego” is doing to cause the accident.86 As a result of his fascinating work, the Civil Aeronautics Board (C.A.B.) decided that hypnosis would be the method of choice to bring to light hidden details of an air crash.
Working with the Federal Bureau of Investigation, the author has been involved in the use of hypnosis in getting witnesses to crimes to recall them in greater detail, thus providing useful investigative leads (see Chap. 23).
REVIVIFICATION AND AGE REGRESSION
Revivification must be differentiated from age regression. In revivification, the hypnotized person actually relives earlier events of his life; all memories following the age to which the subject is regressed are eliminated. On the other hand, in age regression, the subject plays a role; there is a simulated pattern of acting out of past events in the framework of the present.88 This type of age regression is called pseudorevivification.
The phenomenon of revivification is produced by posthypnotic suggestions directed toward progressively suggesting disorientation as to the year, the month, and the day; then, by appropriate suggestions, an earlier age level is reached. Some investigators believe that long-forgotten memories are not reactivated but rather are simulated, and that nonregressive elements are present.79 However, it has been demonstrated frequently that in revivification the subjects exhibit many of the personality traits of earlier periods in their lives. Intellectual functioning, for example, which is indicated by the manner of speaking and the choice of words, is childlike; the handwriting changes, and there are other objective manifestations that corroborate the validity of the revivification.
It is possible, however that much of the descriptive material revealed during revivification is due to role-playing or “screen memories.” This “misremembering” can occur in response to a prior suggestion that a specific act took place; later the act is reinstated as if it were an original memory. It appears that recall is not improved for unimportant mnemonic material but is improved greatly under hypnosis when strong emotional elements are associated with the memories.29 The meanings and the motivations associated with spontaneous revivification during hypnotherapy have been described.22
The best way to obtain revivification is for the operator to identify himself with a surrogate figure that the subject once knew. If, for example, the operator plays the role of a friendly person, he can remark: “You are now in the fourth grade. I happened to be talking to your teacher, and she told me how well you are doing in school.” Some subjects will respond with genuine affection and warmth.
Though this has been challenged, psychophysiologic revivification is authentic if the Babinski reflex is elicited.40 A spontaneous Babinski reflex may also appear whenever the subject's perceptions and sensations are compatible with the regressed chronologic age.62 However, neither of these investigations used naïve subjects—a crucial point. Revivification is not valid if the subject's vocabulary is incompatible with his present chronologic age level. Other observations at nonhypnotic levels indicate that revivification in the form of complex somatic changes can occur during drug-facilitated abreactions.75 However, here too, the reliability of the results is open to serious question.
There are various degrees of revivification and regression that can occur simultaneously, depending on the depth of hypnosis. This accounts for the diversity of opinions as to their distinguishing features. Nevertheless, the effects of either revivification or regression can produce what seem like meaningful emotional experiences that are compatible with earlier age levels.92 It seems that most spontaneous age regressions contain some facet of revivification as well as regression.62 This has been referred to as retrogression61 or dynamic regression.91
An interesting example of simulation once occurred while a female patient was being regressed to a very early age level. She imitated a neonatal position, became mute, and appeared to be sucking the breast. Fortunately, this patient had been given two sets of cues for dehypnotization: (1) she could terminate it herself, or (2) she could respond to the shoulder signal (a touch on the left shoulder). Both sets of signals should be given to all patients who are being regressed to ensure that the situation can be controlled if communication at the verbal level is lost. This should be done even if simulation or role-playing is suspected. It is possible that hypnotic age regression may function to produce those experiences which are retrievable. For those that are not, the individual may provide the best substitute possible by enacting the appropriate role.99
To obtain revivification, the subject is told that, upon a given signal, “You are soon going to be 10 years of age, and you can see yourself clearly at that age and everything that is happening.” (A few minutes are allowed to elapse to allow sufficient time for the reorientation to take place.) The signal is now given. The subject is asked, “What is the date today? How old are you today? What are you doing? Who are some of the people around you?” Additional conversation in the past tense will help to establish the regression more firmly.
How the handwriting changes in a good hypnotic subject who has achieved revivification is illustrated by the examples given on page 18.
It is believed that both hypnotic age regression and “age progression” are forms of psychological activity that involve disorientation for the subject and a reorganization of his perceptual equilibrium and control mechanisms, with particular reference to time-space perception.61 The term “age progression” refers to the artificially induced disorientation of a hypnotized subject who hallucinates living in the future but who still retains his present chronologic age. It does not refer to reversing a regression (making a person return to his present chronologic age), as when a regressed subject is told during hypnosis, “You are now growing older: 10; 12 years of age; and now you are 14 years old.”
Research concerned with “age progression” into future periods has been reported.54 It is difficult to accept the data on age progression without checking the subject's ability to simulate advancing years at nonhypnotic levels. Moreover, the possibility of role-playing has not been ruled out. It is hard, too, to understand how an individual can relate material for which he has no inputs.
The fact that an individual can be regressed to a previous age by no means indicates that the opposite, namely, age progression, can be achieved. However, a form of “age progression” (i.e., pseudo-orientation in time) can be of great clinical value in understanding how a hypnotized subject might react in the future to stressful situations that are suggested at his present chronologic age.23
Good examples of pseudo-orientation in time from the author's clinical practice are cases of apprehensive and tense individuals who came for consultation for the advisability of having vasectomies.68 In deep hypnosis, one subject was told that the actual surgery had been performed 5 years ago; an amnesia for the posthypnotic suggestion was given. He was then asked, “How have you been feeling since you were sterilized?” He replied, “Oh, Doctor! I haven't had a good night's sleep since my operation. It's made me very tense and nervous.” After dehypnotization and removal of the hallucinatory experience, he was advised to postpone surgery until meaningful material could be worked through. By such measures he eventually was able to accept the consequences of the proposed surgery and ultimately achieved better personality integration.
HYPNOTIC ANALGESIA AND ANESTHESIA
Analgesia, or the first stage of anesthesia, is characterized by a lack of startle reaction, facial flinch, and grimaces. Although insensitivity to pain can be simulated readily, hypnotized persons seem to withstand more discomfort and pain than would otherwise be possible. Hypnoanalgesia usually is more effective than “biting the bullet” or voluntary control of pain. Soothing verbalizations suggesting insensitivity often can result in analgesia and occasionally in anesthesia. Hysterical anesthesia is obviously the “other side of the coin” of hypnoanesthesia.
Anesthesia refers to a complete lack of awareness of pain. The question arises as to whether hypnoanesthesia is due to amnesia, or whether the sensory threshold is increased due to role-playing. The latter was negated by recent studies which showed that increased stability of arousal was present and that evoked responses occurred during hypnosis in subjects who could control organic pain hypnotically.2Electromyographic studies indicate that in hypnosis the pain is present in the tissues, but there is no awareness of it. This has been validated in a brilliant presentation using automatic writing; the dissociated hand indicated on a scale that pain was being experienced while the subject consciously denied it.51 Theories of pain transmission have been revised on the basis of comparison between relief of pain by lobotomy, opiates, placebos, and hypnosis.3
Since the physiologic reactions to painful stimuli, such as increased heart rate, respiration, and galvanic skin reflexes, are diminished, hypnoanesthesia apparently is genuine.31,94 Moreover, perceptual adaptation to prism displacement, which requires the presence of normal sensations and proprioceptive feedback, did not occur in hypnotic anesthesia.39 It has been shown further that there is a positive relationship between the depth of hypnosis and the degree of induced anesthesia.113
Hyperesthesia refers to increased sensitivity to touch. It is noted commonly in hysterics. That there is a wide variability in pain perception indicates that subjective interpretation of pain is not a reliable indicator of hyperesthesia or, for that matter, of anesthesia. Hyperesthesia may be due to a lowered threshold to discomfort.3
Hyperesthesia is produced hypnotically by means of the following suggestions: “Imagine that you are in your own bathroom. Would you mind describing the location and the color of your bathtub?” (“It is next to the toilet, and it is a white one.”) “Now you will turn the hot water faucet on. Which one is it?” (“It is the left one.”) “Notice the steaming hot water filling up the tub.” (The patient nods.) “Now will you place your toes in the water to see how hot it is?” A good patient will grimace with discomfort. If he states, “I didn't feel the heat,” one can use a posthypnotic suggestion such as, “You will feel a sensation of warmth when you are able to imagine your foot in the tub of hot water. Perhaps it will be at the next session.”
Cutaneous hyperesthesia usually is induced readily in emotionally disturbed individuals. Those who have organic pain syndromes are more sensitive to hypnotically suggested discomfort. Thus it can be hypothesized that pain is not necessarily a fixed response to a hurtful stimulus, but rather that its perception is modified by our past experiences and expectations, and more subtly by our cultural attitudes. Hence pain is synthesized out of present thoughts, fears, and motivations. In support of these views, it has been noted that placebos are more effective in persons whose stress and anxiety are greatly intensified.10 Their effectiveness is due largely to reducing the anxiety component associated with pain.
Negative and positive hallucinations involving any one of the senses can be produced, as in dreams, by appropriate suggestions. In deep somnambulism, the eyes may be opened without affecting the depth of the hypnosis. A good subject can be made to “see” a person, to “hear” a voice, or to be “deaf” to spoken words, as discussed on page 12.
During deep hypnosis, there is a hyperacuity of all the senses, at least for the suggestions of the operator. As a result, there apparently is an increase in vision, hearing, touch, and smell, which is greater than can be demonstrated at nonhypnotic levels.30 Color-blindness, tubular vision, scotomata, and even “total blindness” have been induced. “Deafness,” in varying degrees, involving one or both ears, has been described.63,73 Similarly, taste and smell have been altered.
Many of the hallucinations are difficult to distinguish from those produced by everyday experiences and distortions. It is contended that the hallucinations are due to elicitation of organic reaction patterns or, in some instances, to simulation5 or role-playing.28 Since various brain formations, such as the temperature center, may be influenced by posthypnotic suggestions involving hallucinatory experiences of coldness, the first explanation may be correct.
Posthypnotic hallucinations are produced with the following suggestions: “Perhaps you might enjoy opening your eyes and still remain in a deep, relaxed state. You will see everything that is suggested to you. At first everything will be blurry, and then the various things I suggest will get much clearer.” It is a good idea to begin first with simple hallucinations of objects which fit into the immediate environment, such as an imaginary ashtray or desk.
One can first suggest, while the subject still has his eyes closed, that he “see” the ashtray on the operator's desk (it is vividly described), and he is to indicate when he sees it. It is then suggested: “After you open your eyes, you will see the ashtray on my desk just as I described it. Also, you will be able to walk around and look at it, pick it up, examine it, and describe it.”
Somnambulism is one of the deepest stages of hypnosis. It also is observed in sleepwalkers who have no recollection of their nocturnal experiences. Nearly everyone has had a roommate who talked in his sleep. A conversation can be carried on for some time without any recollection on the part of the sleeper. He can even respond to post hypnotic suggestions. It is surprising how many such individuals will perform various acts later without ever realizing how they were suggested. Most of these individuals are “natural” somnambulists who exhibit many hypnotic phenomena without going through formalistic hypnotic induction. These persons can develop spontaneous analgesia and anesthesia, dissociation, and depersonalization. Some are classified erroneously as multiple personalities.
Somnambulism generally is associated with amnesia; acts are performed without subsequent recollection. The subject appears to be in a dreamlike state; however, somnambulism is not sleep. Recognition of the objective signs of the somnambulistic stage are described below. The somnambulist still retains generalized memory but cannot remember the events that occurred during hypnosis. Hypnotically inserted suggestions automatically become convictions in the somnambule. Because of the extensive cortical inhibition, the subject has no knowledge of how the convictions were established. As a result, the hypnotically induced convictions prevent incoming sensory information from being tested against reality! This inability of the subject to appraise the operator's suggestions, together with the amnesia, furnishes an explanation for somnambulism.
The first thing to do when developing somnambulism is to get the subject to open his eyes without affecting the depth of hypnosis. The method for effecting this was described above. An amnesia must then be produced, if it has not occurred spontaneously. Finally, the subject must be cued to respond to a specific posthypnotic suggestion.
The nature of the cue can vary, depending upon whether hetero or autohypnosis is utilized. In the former, a touch on the right shoulder can be the signal to reinduce somnambulism at the next session. Frequently, without saying a single word, the author makes use of a cue such as merely lifting the subject's arm. If it becomes cataleptic (the armdrop test), deep hypnosis has been induced. The subject can use a count-down method from 100 to zero; as the numbers decrease, the hypnosis will get deeper and deeper until somnambulism is reached. Somnambulism often can be transformed into sleep, and vice versa.
Automatic writing, too, occurs at nonhypnotic levels. “Doodling” while conversing on the telephone is a common manifestation of this phenomenon. The material produced by a good subject's automatic writing has considerable meaningfulness to the hypnotized patient. The hypnotherapist can make good use of its symbolic meaning, especially when working with those who cannot express themselves.
Specifically, the subject is told that the dissociated hand holding the pencil will write even while he is engaged in conversation. It will do so without any attempt on his part to control its movements. He is also instructed that he will have no knowledge of what is being written, that after being dehypnotized, he will understand that the significance of the material appears nonsensical or cryptic, and that it can be interpreted by the subject in a subsequent session.
The actual verbalization for establishing dissociated handwriting is as follows: “Your hand will get numb and cold; it is losing all feeling, all sensation, and all movement. You do not feel your hand as I rub it—it is getting very numb, and the hand no longer feels attached to your wrist. Now, as you raise your arm, it will feel as if the hand is no longer attached to your wrist. Now, as you raise your arm, it will feel as if the hand is no longer attached to your arm. You no longer have any control over your hand. However, your hand can remember everything about you. If you cannot remember something in particular about yourself, your hand will be able to remember it and write out the answer. If it is too painful for you to face or talk about it, your hand will write it. If you do not tell the truth, your hand will write the correct answer without your controlling it. Nor will you know what the hand is writing. However, after the relaxed state is terminated, you will easily recognize what you have written.”
Time distortion is one of the most interesting and clinically valuable phenomena of hypnosis. It refers to the remarkable capacity of the human brain to appreciate time, condense time, or expand time.
Everyone has a “clock” in his brain that is capable of judging time with extraordinary accuracy. All of us have had the experience of arising at a much earlier hour than usual to do something we enjoy, and often we can wake up within several minutes of the designated hour. This indicates, of course, that many of us can estimate time at nonhypnotic levels with great precision.
Time can drag while one is waiting for a cab on a cold, rainy day, even though it is due in 2 minutes. In this instance, 2 minutes can seem like 20 minutes (time expansion). Contrarily, when one is pleasantly engaged in conversation with an old friend while waiting for a cab, 20 minutes can pass as if they were only 2 minutes (time condensation or contraction). It is maintained that a drowning man recapitulates whole segments of his life in a few split seconds. Thus the brain obviously has the capacity to condense a considerable amount of memorial data even at nonhypnotic levels.
In a good subject, time distortion can be induced readily through posthypnotic suggestions. Briefly, 1 minute of subjective or experiential time can be equated with 10 minutes of clock time (time lengthening). On the other hand, 10 minutes of clock time can be condensed to 1 minute of subjective or experiential time (time contraction). The phenomenon of time distortion utilized in hypnotherapy has been described by Cooper and Erickson.23
Posthypnotic suggestions to induce time distortion are given as follows: “Every minute of actual time will seem like 10 minutes to you. Time will go by very, very slowly; it will seem like an eternity. Every 5 minutes that you remain in this deep and relaxed state seem almost as long as an hour. If you wish, in less than 10 minutes, you can see almost an entire motion picture again, and really see it better than when you actually saw it.”
The degree to which these phenomena can be elicited, however, often depends on the depth of hypnosis attained. Less than 20 percent of subjects readily manifest many of the phenomena, and the remainder share the experiences to varying degrees. One must keep in mind that the results are not as dramatic as some uninformed sources lead one to expect. This view has been supported by others.7,32With reference to the validity of age regression, it has been posited that the idea that there is an “ablation” of all subsequent memories is too extreme to be supported by acceptable studies.48Nevertheless, the sensory alterations, when they appear in good subjects, have high validity.
The important phenomena associated with hypnosis have been discussed briefly. Since they also occur at so-called nonhypnotic levels, hypnotic phenomena follow the natural laws of thought and behavior. Current and past literature is replete with many ingenious methodologies for obtaining hypnotic phenomena. Their fundamental characteristics have been discussed. These phenomena are elicited in various combinations, depending upon the therapeutic or experimental situation, the personality, and the motivations of the subject, and also, of course, upon the skill, the empathy, and the personality of the operator.
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