In this chapter there will be a brief description of how communication, the chief tool of the hypnotherapist, relates to semantics, perception, and learning, as well as of the contemporary developments that the behavioral and physical sciences have made in the comparative study of the messages of control and communication in man and machine—cybernetics. These disciplines regard man as a highly evolved and complex automaton or “servomechanism,” regulated by the transmission of feedback data—that is, a process by which error-correcting information is fed back to maintain homeostasis. Cybernetics suggests new hypotheses for understanding neurophysiologic functioning and, perhaps, such behavioral responses as hypnosis.
ROLE OF HYPNOSEMANTICS IN THERAPY
It has been stressed that words are important tools in the arsenal of the hypnotherapist. Responses during hypnosis are due to the manner in which words are interpreted by the subject. Most hypnotized persons respond with a literalness to the meaning of words. For instance, if a nonhypnotized person is told, “Raise your right hand,” he usually lifts the entire arm. The hypnotized individual invariably raises his hand because he responds exactly as suggested.
The anxiety-ridden patient, however, is likely to attach a different connotation to certain words, particularly during the induction. Therefore, such phrases as “going down, down,” “falling deeper and deeper,” “you are in a sleeplike state” should be avoided, as they may be equated to sexual or death fantasies. Illustrative is the phrase, “Imagine that your body is like a ‘dead weight.’” Those who regard hypnosis as a deathlike or a “suspended animation” phenomenon will generally respond unfavorably, but proper orientation will negate this misconception.
Others, with a low threshold to anxiety, will overreact even to harmless words. The degree depends on previous associations. At the first sign of an untoward reaction to a word or a phrase, corrective measures must be instituted. Words that might shock the patient should be eliminated from the vocabulary of the hypnotherapist, especially in obstetrics. Instead of asking a hypnotized patient in labor, “How are your pains?” the word “contractions” should be substituted for “pains.” In surgery, lack of “word-watchfulness” often can interfere with recovery. The calamitous effect of words in the production of hypochondriasis is well documented.
It is also easier to make a disturbed person sicker by words, or even grunts or gestures, than to make him well. It is not without reason that it has been said, “A word can make or break a man,” and it is this which accounts for most of the dangers attributed to hypnosis. Much difficulty can be obviated by the careful measurement of words. The science of measuring words is called semantics—the systematic study of the meaning of words. General semantics is the study and the improvement of human evaluative processes to language with special emphasis on their relationship to signs and symbols, including language.
The semantic significance of words for psychophysiology is that they constitute real, conditioned stimuli. Thus patients can be habituated to key words which will invariably evoke behavioral responses, as in hypnosis. Pavlov bound up speech, hypnosis, and the conditioned reflex in a statement which the years have done nothing to alter.22 He said:
Speech, on account of the whole preceding life of the adult, is connected up with all the internal and external stimuli which can reach the cortex, signalling all of them and replacing all of them, and, therefore, it can call forth all those reactions of the organism which are ordinarily determined by the actual stimuli themselves. We can, therefore, regard “suggestion” as the most simple form of a conditioned reflex in man.
In other words, the mere mention of a word associated with a certain physiologic or psychological reaction elicits that reaction even though the original stimulus has been forgotten. Thus a word does not become meaningful until a conditioned reflex between it and some conditioned or unconditioned stimulus takes place in the cortex. In the child, for instance, the word “hurt” acquires a definite meaning only after it has been associated with real pain. After that, the appropriate conditioned reaction to the word “hurt” can be evoked to reproduce the exact conditioned response (pain reaction). Once a conditioned reflex is established, the person automatically reacts without thinking to the nongenuine stimulus that has become a part of the reflex. In the example just given this would be the word “hurt.”
It even has been observed that a verbal stimulus alone provokes a stronger reaction in hypnotically conditioned subjects than an actual pinprick.24 Pavlov's conditioning, in the classic manner, is somewhat analogous to the effects obtained by repetitive posthypnotic suggestions. The only difference is that, in the latter, full use is made of the inborn feedback mechanisms—the ideomotor and ideosensory responses. These do not require learning.
During autohypnosis, the mere thought of a word or a phrase elicits the same responses that it ordinarily would following posthypnotic suggestions. In hypnotic sensory-imagery conditioning, the words act in the “mind's ear” as “inner speech,” because subcortical structures cannot differentiate between a vividly imagined experience and a real one. The reason is that the only information available to the cortex for validation about a given situation is what one believes to be true about it!
Illustrative is the work of Hudgins, who conditioned the pupillary reflex to voluntary control.14 When the verbal command “Contract” was given to a group of hypnotized subjects, together with a light (unconditioned stimulus) and a bell (conditioned stimulus), the pupils contracted without the light or the bell. In other subjects, pupillary contraction occurred at the mere thought of the word! This response remained as long as 2 months without reinforcement. The importance of this work indicates that conditioned responses achieved through posthypnotic suggestions have great durability and tenacity. Similar conditioning, achieved at nonhypnotic levels, is more rapidly extinguished.
Conditioning by certain words can also “ring bells” to produce other psychophysiologic changes; the suggestion of “ice” or “snow” causes shivering and often a temperature drop in susceptible subjects. Everyone apparently “possesses verbally conditioned bells waiting to be rung.”28 However, it must be emphasized that physiologic responses are not obtained by the meaning of the word per se, but rather by the image that is conjured up.
The importance of semantics for hypnosis is that words establish associational reflexes which automatically activate ideomotor and ideosensory responses. The more the subject is involved in one ideomotor and ideosensory response after another, the more he will respond, and, as a result, the more dissociation from reality occurs: every suggestion is now accepted as a belief. Thus the subject now accepts the hypnotist's words as reality, and unreality is readily transformed into reality.
ROLE OF COMMUNICATION IN PSYCHOTHERAPY
To achieve a better understanding of the roles of thinking and learning, one must know how communication of information occurs. A comparison between the electrical transmission of messages and the exchange of information between humans will be described in more detail in the next chapter. The former, developed by telecommunication engineers, may help us to understand the psychology of the cognitive processes, especially hypnosis. Communication in the ordinary sense, however, is particularly important in psychotherapy and will now be discussed.
Communication has been defined as any process that leads to an exchange of information.27 It is not a technic but, rather, an attitude directed toward the sharing of information for a purpose.3,5,12,27,30Whenever there is an overlapping of experiences, as in the doctor-patient relationship, both understand, accept, and adjust to each other's communications more readily. Therefore, effective communication in psychotherapy makes full use of the patient's capacities to respond experientially to meaningful suggestions of the operator. Also, greater response occurs if the operator recognizes the patient's needs and motivations.
Yet few physicians exploit the communication processes to their maximal potential. Still fewer recognize that the hypnotic relationship affords a vehicle for effective communication of ideas and understandings which can unlock the hidden recovery forces present in the patient. Skilled hypnotherapists, who utilize the nuances of permissive yet directive communication, are aware that clarity and warmth in the semantics and the sounds of words distinctly benefit their patients. So essential is good physician-patient communication that an updated course in therapeutic semantics should be mandatory for students in medicine and psychology.
The semantic approach has corrected spurious identifications, mis-evaluations, and recently acquired harmful conditioned reflexes through strong persuasion based on Korzybskian principles.15 Ruesch and Bateson point out that “communication is the link that connects psychiatry with all other sciences.”25 They note that “jamming of the networks” or overloading of the neural pathways leads to disruption (anxiety). Continual exposure to semantic confusion, along with other factors, may produce schizophrenia in predisposed persons.2
The objectives of psychotherapeutic communication can be accomplished at the interactional level by “either reducing the number of confusing messages or by prevention of jamming.”26 There are two major problems in any type of psychotherapeutic communication. First, the depth of one's feelings must be meaningfully conveyed so that they can be understood and accepted by the patient. Second, the doctor must listen attentively. The important notion of the feedback of information is relevant to both patient and therapist as it automatically answers the questions, “How am I doing?” and “To what extent will I permit myself to share with another?” The insecure, anxiety-ridden patient usually cannot share or express himself effectively because of his own inadequacy. Other disturbed persons, such as the affect-blocked individual, fear self-revelation and subsequent loss of respect. To obviate these, the therapist, on the basis of the information available, must put the patient at ease and build up the patient's self-confidence and self-esteem.
Whenever communication bogs down to superficialities, rapport is decreased. As an unintentional defensive mechanism, many patients stray from the subject. Thus, to obviate resistance, the discussion should be relevant to the patient's problems. It is in the handling of the disturbed patient that the physician's ability to communicate reaches its greatest potential. Since the hypnotic situation induces greater receptivity, more information is available for the understanding necessary for personality integration.
ROLE OF COMMUNICATION AS A CONTROL MECHANISM IN PSYCHOTHERAPY
Haley contends that the therapist and the patient try to control different areas of the psychotherapeutic relationship.7 The therapist does this by setting the rules for therapy, thus being “one up” while, at the same time, denying his superior position; the patient attempts to defeat the therapist by his symptomatic behavior. However, the therapist always wins because he can impose a “double bind.” This refers to a situation in which an individual is confronted by two contradictory messages which prevent him from successfully protesting or leaving the field.8 In the struggle to circumscribe each other's behavior, the person imposing the symptomatic double bind must win. An example of a double bind is the wife who asks her husband to wash the dishes because she claims that she is dizzy. She, of course, denies controlling the behavior of her husband but blames it on her symptom.
In a typical double-bind maneuver during therapy, a patient's insistence that he cannot help himself is accepted rather than opposed. He is directed in such a way that he must stop behaving in the way he does or stop denying that he is behaving in that way. There is a similarity between symptomatic behavior of the patient and the tactics of the therapist. When the patient behaves in a symptomatic way and uses the double bind, he is met by an opposing double bind. The patient can quit, comment on a contradiction posed to him, or cease suffering double-bind maneuvers himself.9 Whatever he does, he loses. If he leaves, he remains sick; if he comments, he is trying to control the therapist; and if he abandons his own double-bind maneuvers, he gives up his symptomatic behavior. From this point of view the patient is forced by the therapist to behave differently, whether he likes it or not, particularly when the therapist is most permissive.
Resistant maneuvers are dissipated by accepting them and redefining them as cooperation by double binds. Suggestions can be concealed or given in the form of a double bind so that the patient will not be aware of their implications.10 For example, if a patient has a pain, he can be told, under hypnosis, “Any pain that can be increased can be decreased,” and then asked, “You do wish to have less discomfort, do you not?” If the pain is increased, the patient is accepting the premise that the pain can be decreased. Phobic reactions can be relieved in a similar fashion. As Haley aptly put it, “Hypnosis might be defined as the art of getting someone to do what you tell him while indicating that he isn't doing it.”10
Psychodynamicists contend that they do not employ a directive approach. Yet, according to Haley, communication on a nondirective basis is an impossibility, because the therapist, by continually redefining the therapeutic situation, maintains control of the relationship.11 The “non-directive” therapist makes the patient communicate in an indirect way—much as the patient once used symptoms to control others (secondary gains). This also permits the therapist to deny that he is in control of the relationship. In addition, the patient always hands control over to the therapist when he hangs onto his every remark, and especially when he asks him to interpret his dreams, thoughts, and free associations. Also, he must change his maneuvering voluntarily, on the slightest indication of the therapist. On the other hand, he cannot use the therapist's maneuvers because he is always in a “one-down” position.
HELPFUL HINTS ON HOW TO COMMUNICATE EFFECTIVELY IN PSYCHOTHERAPY
1. In handling resistance, ask questions such as, “You can see my point of view, can you not?” Or ask a question that either leaves a choice or is good for the therapist's position. Still another approach is, “Do you mean that this is so?” This makes the patient feel accepted, and he will usually elaborate on the query in another way.
2. Remember that words have more than one meaning; therefore, rephrase the patient's statements in order to get his meanings.
3. Realize that words represent only a few selected details of what the patient really perceived. Therefore, when listening to the description of an object, an event or another reality situation, or when describing something to the patient, remember that important particulars usually are omitted.
4. Never make dogmatic judgments on insufficient facts. However, a decision often must be risked from an incomplete collection of facts. Take such risks only when absolutely necessary.
5. Never think in terms of black and white only; shades of gray may exist. Always examine the middle ground between two opposing ideas, since there is more than one way of doing a thing. The possibility of alternatives must always be kept in mind.
6. Think before speaking. An inadvertent remark often is a common cause of a communication breakdown.
7. Being too friendly when conveying therapeutic explanations inevitably will cause a loss of prestige.
8. Never give a patient carte blanche with a phrase like “You know what I mean?” The patient usually does not understand!
9. Be brief, and discuss one specific topic at a time. This avoids “scattering” or distraction.
10. Watch for the psychological moment or the proper timing for therapeutic interpretations. Then get across what you want to get across and what you mean to get across.
11. Discuss the patient's explanations, so that you can be sure that they convey his point of view.
12. Remember that actions speak louder than words; note the implications of nonverbal communications in both yourself and the patient.
13. Listen to what the patient is trying to say. Inattention is disturbing. Never intimate before hand that you know everything that is going to be said.
14. Avoid dogmatism. Be flexible and reasonable when voicing your differences. A handy formula to prevent being considered opinionated is to use the phrase “it seems to me,” rather than stating flatly, “it is a fact.”
15. Never directly challenge what is patently a falsehood. Rather, if the issue is important, ask subtle questions to ascertain the truth.
ROLE OF PERCEPTION IN HYPNOSIS
The problem of perceptual discrimination is pertinent for learning theory, and particularly important for understanding the nature of hypnosis. Recently, several investigators have increased our understanding of the ways in which we learn to perceive.6,16,27 However, no one ever perceives “all” of any situation, but only enough to deal with it. What is perceived is based on the “functional probabilities” or the “best bets,” based on the individual's past experiences. Hence, two or more individuals' perceptions will be similar only if their past experiences and motivations are alike. Thus differences in views, kinds and rapidity of environmental change, and cumulative effects of experience mold perception. Bridgman observes that, since no one can get away from himself, there are limitations on our understanding of perception and reality.4 Hence some of the major paradoxes of modern science have arisen. Actually, there is no absolute free will and no absolute determinism. Absolutes are human concepts and have no basis in fact.
Some learning probably occurs through the process of redintegration, which may be defined as the “triggering” of imaginative identifying impressions representing specific situations of prior experiences. Thus the brain has the freedom to manipulate and to be guided by reality as it perceives reality. In hypnosis there is an increased capacity for redintegrative processes. This is the basis for hypnotic sensory-imagery conditioning. Neurophysiologic observations indicate that an original experience can be recalled, whether or not it was a fact, a dream, or a fantasy.23
Until recently, little was known about the psychological interrelationships within which hypnotic phenomena could be considered. We are indebted to Kline for his penetrating insights into these fruitful areas for research.17 He believes that there is no such thing as a hypnotic state per se, but rather that it manifests itself as a fluctuating phase of awareness closer to hyperacuity than to sleep. To be sure, however, there are hypnotic phenomena and hypnotic relationships, and these do not require a formalistic induction procedure for their establishment.
Therefore, it is obvious that hypnosis cannot be explained in terms of such constructs as “consciousness,” “unconsciousness,” or “deep sleep.” Kline thinks that consciousness, too, is an illusion, which, though very real, cannot be separated from physical happenings, as it merely reflects the meanings conceptualized within one's own sensory order, namely, with existence or reality. He contends that reality is determined by a number of impressions, principally arousal, which are converted into behavior and become meaningful through the associations, the experiences, and the involuntary reactions that characterize the nature of responsiveness.17
Since illusions constitute an important part of reality, they produce exceedingly complex reactions. This is demonstrated during a great dramatic moment in the theater when the entire audience is, in reality, “hypnotized.” Here a meaningful illusion is created, and each person's change in reality perception occurs as the result of his own experiential reactions to himself and his environment. New meanings and associations are brought forth which cause a subject to behave differently because he thinks and believes differently.
PSYCHOPHYSIOLOGY OF PERCEPTION
The psychophysiologic mechanisms by which past and present impressions blend into perceptual realities are not too well understood. Suffice it to say that under the affective influence of a comparison of an imagined future with an experienced past, the brain attempts continuously to predict the goals that will help maintain equilibrium. As Kline notes:
All of this infers a dependency upon those stimulus-response modalities which go into the organization and creation of self-equilibrium. Equilibrium starting on a molecular basis rises to equilibrium on a molar (whole entity as contrasted with molecular), self-concept, body image basis.18
The temporal lobes are in the center of perceptual activities. These areas with their deeper limbic structures mediate the integration of instinctual, affective and autonomic processes. To this, the activities of the sensory and premotor cortex add the processes of perception, their apperceptive integration, and the fantasy formation which is built around the central core of the instinctual drives. Ostrow also suggests that temporal lobe afferents may mediate the controls which pleasurable affects exercise on psychic functions.21 However, much more data must be obtained before these concepts can be validated.
The neural mechanisms capable of recognizing visual and auditory forms have been described by Pitts and McCulloch.19 They postulate a system of impulses which sweep up and down over interlacing fibers in the cortex and thereby provide a scanning arrangement for the recognition of patterns of incoming sensory stimuli. The methods by which hypnosis utilizes these scanning mechanisms for maintaining increased perceptual awareness or selective attention are discussed in Chapter 32.
ROLE OF LEARNING IN HYPNOSIS
The interaction between perception and learning is called a microgenetic process.1 The cognitive theories of learning assign an important place to perception. Motivation based on needs and drives of the individual, as well as exploration, reinforcement and trial-and-error learning play an important role for all goal-seeking organisms.13
Attempts to explain learning theory have developed into behavioral theories of varying degrees of complexity and sophistication, beginning with Pavlov's conditioned reflex theory and extending to Watson31 and others who immediately followed him and who incorporated his principles into psychological theory. They failed to realize that they were dealing with simple and elemental units of behavior. In their desire to introduce scientific rigor into psychology, they created their image of man and involved few variables of behavior beyond the stimulus-response sequence. Other behavioral learning theories avoided hypothesizing what might occur within the organism.
Although important proponents of learning theory still maintain this parsimonious view, the mainstream of learning theory recognizes that there are intervening variables before and between the time a stimulus impinges and a response occurs.20 It is becoming self-evident that the reflex arc is not representative of the elemental unit of behavior. Rather, the fundamental building block of the nervous system is the feedback loop which follows the laws of electrical activity and cybernetic principles. The relationship of these important concepts to physiologic psychology and hypnosis will be discussed in Chapter 32.
The relationship of learning theory, hypnosis, and behavior therapy is discussed in the next chapter. Here a graduated approach is used in order to make contact with the unadaptive learned behavior so that the patient can unlearn it and replace it with adaptive behavior. Hypnosis can help to simulate real-life situations and make therapy easier by relaxing the patient, providing scene visualization and imagery to help in reducing the associated anxiety and tension.
REFERENCES
1. Arieti, S.: The microgeny of thought and perception. Arch. Gen. Psychol., 6:454, 1962.
2. Bateson, G., et al.: Toward a theory of schizophrenia. Behav. Sci., 1:251, 1956.
3. Bois, J.S.: Explorations in Awareness. New York, Harper, 1957.
4. Bridgman, P.W.: The Way Things Are. Cambridge, Mass., Harvard University Press, 1959.
5. Dollard, J., and Miller, N.E.: Personality and Psychotherapy. New York, McGraw-Hill, 1950.
6. Gardner, R.W.: Cognitive control principles and perceptual behavior. Menn. Clin. Bull., 23:241, 1959.
7. Haley, J.: Control in psychoanalytical psychotherapy. In Progress in Psychotherapy. vol. IV. New York, Grune & Stratton, 1959, pp. 48-65.
8. Ibid., p. 50.
9. Ibid., p. 64.
10. Ibid., p. 55.
11. Ibid., p. 61.
12. Hayakawa, S.I.: Language in Thought and Action. New York, Harcourt, Brace, 1940.
13. Hilgard, E.R.: Theories of Learning. New York, Appleton-Century-Crofts, 1956.
14. Hudgins, C.V.: Conditioning and the voluntary control of the pupillary light reflex. J. Gen. Psychol., 8:3, 1933.
15. Kelley, E.C.: Education for What Is Real. New York, Harper, 1947.
16. Kilpatrick, F.P.: Perception theory and general semantics. ETC.: Rev. Gen. Semantics, 12:257, 1955.
17. Kline, M.V.: Clinical and experimental hypnosis in contemporary behavioral sciences. In Introductory Lectures in Medical Hypnosis. New York, Institute of Research, 1958.
18. ____________: Freud and Hypnosis. New York, Julian Press, 1961.
19. McCulloch, W.S., and Pitts, W.: A logical calculus of the ideas imminent in nervous activity. Bull. Math. Biophysics, 5:115, 1953.
20. Miller, G.A., Galanter, E., and Pribram, K.H.: Plans and the Structure of Behavior. New York, Holt, 1960.
21. Ostow, M.: Psychic contents of brain processes. Psychosom. Med., 17:396, 1955.
22. Pavlov, E.P.: Twenty Years of Objective Study of the Higher Nervous Activity Behavior of Animals. Moscow, Medzig Publishing House, 1951, p. 376.
23. Penfield, W.: Memory mechanisms. Arch. Neurol. Psychiat., 67:178, 1952.
24. Platonov, K.: The World as a Physiological and Therapeutic Factor. Moscow, Foreign Languages Publishing House, 1959.
25. Ruesch, J., and Bateson, G.: Communication: The Social Matrix of Psychiatry. New York, Norton, 1951.
26. Ibid., p. 19.
27. Ruesch, J., and Prestwood, A.R.: Communication and bodily disease. In Life Stress and Bodily Disease. Assoc. Res. Nerv. Ment. Dis. Proc., 29:211, 1950.
28. Salter, A.: What Is Hypnosis? Studies in Conditioning. New York, Farrar, Straus, 1955.
29. Santos, J.R., and Murphy, G.: An odyssey in perceptual learning. Menn. Clin. Bull., 24:6, 1960.
30. Sondel, B.: The Humanity of Words. Cleveland, World Press, 1958.
31. Watson, J.B.: Psychology from the Standpoint of a Behaviorist. Philadelphia, Lippincott, 1919.
ADDITIONAL READINGS
Chase, S.: The Tyranny of Words. New York, Harcourt, 1938.
Korzybski, A.: Science and Sanity. New York, Dutton, 1933.
Lee, I.: Language Habits in Human Affairs: An Introduction to General Semantics. New York, Harper, 1941.
Meyers, R.: The nervous system and general semantics, E.T.C.: Rev Gen. Semantics, 5:14, 1948.
Miller, G.A.: Language and Communication. New York, McGraw-Hill, 1951.
Rapoport, A.: Science and the Goals of Men. New York, Harper, 1950.