Hypnosis: A Guide for Patients and Practitioners [1 ed.] 1138787175, 9781138787179

Table of contents :
Acknowledgements
Preface
Contents
List of illustrations
1 What Hypnosis Was
2 What Hypnosis Is
3 What Hypnosis Does
4 How Hypnosis Begins
5 How To Use Hypnosis
6 When To Use Hypnosis
7 Uses Of Hypnosis
8 Hypnosis And The Law
Appendix
Bibliography
Index

Citation preview

Psychology Revivals

Hypnosis

Hypnosis is now being used by doctors, dentists and therapists to help cure or relieve a wide range of illnesses, personality problems and emotional and psychological conditions. It has been used to treat phobias and many nervous symptoms; the help people give up smoking, alcohol and drugs; to overcome shyness, stammering, uncontrollable blushing, nail biting and certain allergies; to curb weight problems (both obesity and anorexia); to help overcome impotence, frigidity and other sexual difficulties; in dentistry as a substitute to local anaesthetics and to counter ‘needle-phobia’, tooth-grinding and excessive salivation; to alleviate pain and insomnia; to achieve relaxation in pregnancy and childbirth; and also in the treatment of behaviour problems and in crime detection. Originally published in 1981, in this book, the late Dr David Waxman – a medically qualified therapist who had practised hypnosis for over twenty years at the time of writing and who had lectured on the subject throughout the world – explains exactly what hypnosis is; gives a concise history of its practice; discusses the scientific theories about it and how it is used today; and describes what it can and cannot do and when and how it is best used.

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Hypnosis A guide for patients and practitioners

David Waxman

First published in 1981 by George Allen & Unwin This edition first published in 2014 by Routledge 27 Church Road, Hove BN3 2FA and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © David Waxman 1981 The right of David Waxman to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Publisher’s Note The publisher has gone to great lengths to ensure the quality of this reprint but points out that some imperfections in the original copies may be apparent. Disclaimer The publisher has made every effort to trace copyright holders and welcomes correspondence from those they have been unable to contact. ISBN: 978-1-138-78717-9 (hbk) ISBN: 978-1-315-76675-1 (ebk)

Hypnosis is now being used by doctors, dentists and therapists to help cure or relieve a wide range o f illnesses, personality problems and emotional and psychological conditions. It has been used to treat phobias and many nervous sym p­ toms; to help people give up smoking, alcohol and drugs; to overcome shyness, stammering, uncontrollable blushing, nail biting and certain allergies; to curb weight problems (both obesity and anorexia); to help overcome impotence, frigidity and other sexual difficulties; in dentistry as a substitute to local anaesthetics and to counter ‘needle-phobia’, tooth-grinding and excessive salivation; to alleviate pain and insomnia; to achieve relaxation in pregnancy and childbirth; and also in the treatment o f behaviour problems and in crime detection. In this book, D r David Waxman - a medically qualified therapist who has practised hypnosis for over twenty years and who has lectured on the subject throughout the world explains exactly what hypnosis is; gives a concise history o f its practice; discusses the scientific theories about it and how it is used today; and describes what it can and cannot do and when and how it is best used. He also provides a list o f addresses from which information about hypnosis and the names o f medically qualified practitioners can be obtained. D avid Waxman has practised hypnosis for over twenty years, first as a general practitioner and then as a psychiatrist. Author o f numerous articles on hypnotherapy and psychiatry, he has lectured on these subjects in many parts o f the w orld and was the founder and first President o f the Medical, and Dental Hypnosis section o f the Royal Society o f Medicine. He is cur­ rently Chairman o f the British Society o f Medical and Dental Hypnosis, Vice-President o f the Society o f Experimental and Clinical Hypnosis, a member o f the Council and British Representative o f the European Association for Hypnosis in Psychotherapy and Psychosomatic Medicine and a member o f the International Society o f Hypnosis. D r Waxman has also been very actively involved in clinical research on drugs used in psychiatry and in campaigning for the amendment o f the law on hypnosis in order to protect the public from improper use.

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HYPNOSIS A Guide for Patients and Practitioners

DAVID W A X M A N L R C P (Lond), M R C S (Eng)

UNWIN PAPERBACKS London

Sydney

First published in Great Britain in the M edicine Today series by George Allen & Unwin, 1981 First published in Unwin Paperbacks 1984 Reprinted 1984, 1987 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Unwin Hyman Ltd. UNWIN HYMAN LIMITED Denmark House 37-39 Queen Elizabeth Street LONDON SE1 2QB and 40 Museum Street, LONDON WC1A 1LU, UK Allen & Unwin Australia Pty Ltd 8 Napier Street, North Sydney, NSW 2060, Australia Unwin Paperbacks with Port Nicholson Press 60 Cambridge Terrace, Wellington, New Zealand © David Waxman, 1981

British Library Cataloguing in Publication Data Waxman, David Hypnosis 1. Hypnotism — Therapeutic use I. Title ISBN 0-04-616027-2

Set in 11 on 12 point Bembo and printed in Great Britain by The Guernsey Press Co. Ltd, Guernsey, Channel Islands.

To Shirley ‘First in thought . .

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Acknowledgements --------------------- ♦ --------------------The author wishes to express his gratitude to the librarians o f the R o y a l Society o f M edicine and to M rs J . Walters in the bibliography department for their tireless assistance in supply­ ing countless references. Also to the librarians o f the Central M iddlesex Hospital, and the R o y a l C ollege o f Physicians, to the photographic department o f the British Museum and to the M ary Evans Picture Library for the loan o f the prints o f M esm er and hypnosis and for the photograph o f Freud. Thanks are due to D r M . Jo yston Bechal, Consultant Psychiatrist, Shenley Hospital and to D r J . Dom inian, Consult­ ant Psychiatrist, Central M iddlesex Hospital, w ho were amongst the first to recognize the value o f hypnotherapy as an additional discipline in the hospital psychiatric establishment in Great Britain. I am also indebted to D r M . Elian, Consultant Clinical N europhysiologist and M r s J. Adam s, C h ie f Technician o f the Electroencephalographic Departm ent o f the Central M iddlesex Hospital, for the excellent recordings; to D r A nn W oolleyHart, Research Consultant to the M edical Electronics Depart­ ment o f St B arth olom ew ’s Hospital, for her co-operation in the measurement o f skin resistance; and to D r H .B . Gibson o f the Departm ent o f Psychology, Hatfield Polytechnic, for his in­ valuable comments and advice. Finally, m y thanks are due to the Earl o f Kinnoull, M r D avid Crouch, M P , M r Leo Abse, M P , and Professor W . Linford R ees for their encouragement and support o f m y amendment to the Hypnotism Bill.

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Preface --------- ♦--------The evolution o f the use o f hypnosis as an effective force for the treatment o f various types o f nervous illness and in certain specialized and clearly defined applications, has added a pow er­ ful com plem entary weapon to psychotherapy and psychiatry, as w ell as to general practice, dentistry and m any other disciplines o f medicine and surgery. The chequered history o f hypnosis through the ages and its misuse by charlatans and entertainers has added a dimension o f folklore, m ythology, m ystery and misunderstanding to a natural procedure which, it has recently been shown, could well have a logical and scientific explanation. In this volum e, although it is acknowledged that m any other theories and techniques exist, an attempt is made to set the record straight. The purpose is to present to the reader, both professional and non-professional, some idea o f what hypnosis was thought to be, what it is now believed by m any to be, what it does and what it does not do, and how the hypnotic state is achieved. It is also intended to act as a w arning to the public and to those not suitably qualified, to regard w ith some concern the still unknow n processes o f the unconscious mind and the pow erful effect w hich the uncovering o f early memories m ight pre­ cipitate i f carried out by those without medical or proper psychological training. DAVID WAXMAN

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Contents ♦ Acknowledgements Preface List of Illustrations

page vii ix XV

1 W H AT H Y PN O SIS WAS

i

The Birth o f a Theory Animal Magnetism Lucid Sleep Hynos or Nervous Sleep D e la suggestion A n Hysteria A Dissociation A Loving Relationship A Child-parent Relationship A Conditioned Response Some Contem porary Theories o f Hypnosis A Goal-directed Striving The Atavistic Theory Theories o f R o le Playing A Goal-directed Fantasy Other Speculations as to the Nature o f Hypnosis

2 W H AT H Y PN O SIS IS

30

Hypnosis and Sleep The Electroencephalogram Hypnosis and the W aking State The Brain, Sensation and Response Experimental Evidence o f Some Brain Functions So What is Hypnosis? A Definition

3 W H AT H YPN O SIS D O ES

44

The Psychodynamic Approach Regression T ransference

XI

Hypnosis Dream Interpretation Free Association T he Behavioural Method Desensitization H ypno-a version Retrospective Counter-conditioning Reinforcing Techniques Self-hypnosis Ego-assertive retraining 1. Ego-strengthening 2. Assertive retraining Sum m ary o f Treatment Methods

4 H O W H Y PN O SIS BEG IN S

62

A Lesson in J^istory It’s A ll in the mind So H o w Does Hypnosis Begin? Some Tests o f Hypnotizability T he Hull B od y-sw ay Test T he Postural Sw ay Test The Hand-clasp Test The Hand Levitation Test A R eal Person Resistance R apport and the Transference

5 H O W TO USE H Y PN O SIS

76

T he Induction o f the Hypnotic State Permissive Techniques 1. Eye fixation with progressive relaxation 2. Thumbnail technique Intermediate techniques 1. Erickson’s arm levitation method 2. Eye fixation w ith distraction Authoritarian Techniques 1. The direct gaze method 2. A confusional technique Children and Hypnosis 1. Picture visualization 2. Thumbnail technique— a modification Deepening o f the Hypnotic State Hypnosis at a Signal Stages o f Hypnosis

xii

Contents Hypnoidal State Light Trance Medium Trance Deep Trance Somnambulistic State P roo f o f Hypnosis 1. Post-hypnotic suggestion 2. Eyelid catalepsy Awakening

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WHEN TO USE H YPN O SIS

The Neuroses Anxiety Psychosomatic Illness 1. The central nervous system 2. The cardio-vascular system 3. The respiratory system 4. The gastro-intestinal system 5. The urinary system 6. The skin 7. The musculo-skeletal system Phobias Obsessional Illness Hysterical Neuroses The Fugue State Problems o f Personality The Social Disabilities 1. Stammering 2. Blushing 3. Nail biting 4. Nervous ‘tics’ The Addictions 1. Nicotinism 2. Alcoholism 3. Other drugs Gambling Eating and W eight Problems 1. Obesity 2. Anorexia Immature personalities Psychosexual Problems 1. Impotence 2. Frigidity X lll

99

Hypnosis 3. The sexual variations Reactive Depression

7 OTHER USES OF H YPN O SIS

131

Dentistry The Reduction o f General A nxiety Needle Phobia Analgesia G agging Tooth Grinding Excessive Salivation Excessive Bleeding Gynaecology (diseases o f women) Obstetrics (Pregnancy, labour and confinement) Pain R elief Sleep Difficulties Hypnosis and Crim e Detection

8 H Y PN O SIS A N D THE LA W

143

H o w the L aw Stands The Dangers o f Misuse The Dangers o f Abuse

150 152 156

Appendix: Addresses Bibliography Index

x iv

List o f illustrations ------------------ ♦-----------------P la tes

1 Hypnos, god o f sleep 2 Anton Mesmer 3 Mesmer’s Baquet 4 John Elliotson 5 Professor Charcot demonstrating hysteria 6 Sigmund Freud 7 A case o f psoriasis before and after treatment 8 Dr Oudet extracting a tooth under hypnosis F ig u re s

1 2 3 4

The normal electroencephalogram The reticular and limbic systems Desensitization Measurement o f skin resistance and temperature

xv

33 39

51 H7

W hether the artificial production o f these phenomena or the perform ance o f the processes w hich so often induce them w ill mitigate or cure disease, can likewise be determined by experience only, it is the im perative, the solemn duty o f the profession, anxiously and dispassionately to determine these points by experiment, each man for h im se lf. . . the prevention o f pain under surgical operations, the production o f repose and o f com fort in disease and the cure o f m any diseases. T he chief phenomena are indisputable and w e ourselves are witness to them; and in it wounds give no pain. In the name therefore o f the love o f truth, in the name o f the dignity o f our profession, in the name o f the good o f all mankind, I im plore you carefully to investigate this important subject. from the Harveian Oration by Jo h n Elliotson M .D . Cantab., F .R .S ., Fellow o f the College o f Physicians, London. 2 7 Ju n e 1846

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1

What Hypnosis Was ♦

From the beginnings o f the human race, man has endeavoured to impose his w ill and strength upon his fellow for good or for evil. From the dawn o f history, w ith the use o f witchcraft or o f w izardry, o f revelation through supernatural agencies, with the p ow er o f the w ord or the use o f suggestion, he has sought to influence the destiny o f others. From the accidental discovery o f a natural phenomenon, through magical passes and magnetic fluids have emerged the refined techniques o f the twentieth century which produce the state know n as hypnosis.

The Birth o f a Theory W here, when or how it originated is unknown. M any biblical wonders are today attributed to the hypnotic abilities o f the miracle w orker, the prophet or the saint. Th rough the sleep temples o f ancient E gypt and the healing shrines o f the Greek god Asclepius, it became evident that it wras possible for one man to influence the mind and the body o f another. O ne o f the most outstanding physicians o f early history was Hippocrates. K n o w n as the ‘father o f medicine’, he was born on the island o f Cos and lived from 460 to 377 b c . He travelled through Greece practising and teaching the art o f healing. He was the author o f numerous medical w orks and maintained that 1

Hypnosis our pleasures as well as our sorrow s— that is, our feelings or emotions— arise from the brain. Madness and delusions, Hippocrates concluded, dread and fear, sleeplessness and anxieties as w ell as deeds which are contrary to habit, all derive from the brain. Here was the seat o f disease and the centre w hich controlled the entire body. Som e 500 years later, another Greek physician, Galen o f Pergam um ( a d 129—199), w ho was second only to Hippocrates as one o f the greatest medical authorities o f antiquity, elaborated on this idea and discussed the influence o f the bod y and the mind upon each other. He conceived the notion o f some heavenly or ethereal fluid as a bridge between the two, so that physical ailments could derive from mental problem s and physical or organic illness could cause mental disturbance, through the flow o f this fluid. So gradually unfolded the idea o f emotional illness and the hope that i f this ethereal fluid could be harnessed, then man could indeed influence the course o f disease. The concept o f such a fluid and the idea o f a bridge between the body and the mind continued to occupy the thoughts o f scientists and philosophers. It was additionally held that this fluid accounted for the transmission o f light, heat and impulses o f the nervous system as w ell as o f magnetism. Then, in the sixteenth century, a Swiss physician named Theophrastus Bom bastus von Hohenheim, otherwise know n as Paracelsus, revolutionized most o f the theories o f medicine held at the time. Pursuing the ideas o f the ancient Greeks, he developed the notion that the heavenly bodies could affect humans and affect the course o f disease. A hundred years later, a Germ an scholar, Athanasius Kirchir, proposed that some natural pow er w hich he called animal magnetism was also involved. The great British philosopher and scientist, Sir Isaac N ew ton, also believed in animal magnetism and by virtue o f his authority established considerable authenticity for the idea. Thus, through the stars, through this indefinable ethereal fluid and through the activity o f certain magnetic forces, through the mind to the body, men could even influence each other. 2

What Hypnosis Was T he inter-relationship between body and mind was not a preoccupation limited to the thinkers and physicians and philosophers o f Europe alone, however. In Africa, Asia and the East the healing arts were practised b y the witchdoctor, the yogi, the fakir, and the magi, each extolling the supernatural powers o f healing o f his ow n particular skill, each claiming special pow ers o f m odifying human responses and influencing the action and reaction between one man and another. Throughout the M iddle Ages the use o f suggestion as a healing art was regarded as sacrilegious in Western Christian civilization. M iracle cures were the result o f religious faith and were often considered to be effected exclusively through sacred relics or statuary or shrines endowed w ith the special powers o f healing.

Animal Magnetism In 1734, Franz Anton M esm er (plate 2) was born in the small village o f Iznang near Lake Constance. The son o f a poor forester, little did his parents know that in later years he was to formulate the theory w hich was to take him to the very height o f fame and fortune, and that his name was to add a new w ord and a new dimension w ithin the international w orld o f healing. Y ou n g M esm er first trained for the priesthood, but later changed his mind and was accepted at the U niversity o f Vienna as a student o f law. Som e time after this, however, he again changed course. He transferred to medicine and obtained his degree in 1766 at the age o f thirty-tw o, rather later in life than the average doctor. But, he had the background o f a sound and w orld ly training. He became a highly reputable physician and was ever interested in the search for newer and m ore effective methods o f treating his patients. D uring his studies he had become involved in discussions w ith a professor o f astronom y and Jesuit ecclesiastic, Father M axim ilian Hell. This man had treated the sick by attaching specially shaped magnetized plates to the affected parts o f the body, and had succeeded in relieving them o f their ills. Mesmer, w ith a broadness o f vision and a know ledge o f the

3

Hypnosis sciences as they were accepted at that time, combined the theories o f astronom y w ith N ew to n ’s recently pronounced laws o f gravity to advance an idea o f animal gravitation, w hich was the natural pow er know n as animal magnetism. As a result, in 1776, he w rote a dissertation on The Influence of the Planets on the Human Body. Subsequently, w ith the persisting ideas o f an ethereal fluid, o f animal magnetism and o f the w ork o f Father Hell, he maintained that these forces could be harnessed to restore the harmonious balance o f bodily functions and for the relief o f human suffering. M esm er had made his great discovery when he was treating a young lady named Fraulein Oesterline w ho for several years had been suffering from a ‘convulsive m alady’ together w ith ‘the most cruel toothache and earache follow ed b y delirium, rage, v o m itin g 'a n d sw ooning’ . He prescribed for her the continuous use o f ‘chalybeates’, w hich w ere presum ably some form o f iron tonic. He prevailed upon Father Hell to have made for him by his craftsmen a num ber o f magnetized pieces o f iron w hich would fit to his patient’ s stomach and legs. Miss Oesterline reported strange sensations running dow n her body and she was relieved o f her ailments. M esm er deduced from this that it was essential to maintain an equilibrium between the natural magnetic fluid, which, it was asserted, filled all living things, and the magnetic fluid w hich was thought to fill the universe. Thus in the thrilling days o f the great discoveries in gravity, mathematics, electricity, and astronomy, the exploring mind o f Franz Anton M esm er offered his name to that which he genuinely believed to be a scientific and logical explanation o f the phenomenon he was able to produce, the phenomenon o f animal magnetism. From the very beginning it was evident in w hich w ay the ideas o f M esm er w ere to evolve. He treated patients by fitting magnets to various parts o f the body and was able to effect m any wonderful and dramatic cures. As a result, his reputation increased and he prospered greatly. He married the rich w id o w o f a form er officer in the Austrian arm y, one Anna von Bosch (or Posch), and together they established a large circle o f w ealthy and famous acquaintances. T h ey owned an elegant

4

What Hypnosis Was house in Vienna in w hich they held lavish parties and gave musical soirees. The great W olfgang Amadeus M ozart w rote an opera called Bastien et Bastienne, the original perform ance o f w hich took place in M esm er’ s garden theatre. Magnetism became a cult and M esm er its high priest. As a result o f his spectacular fame his w ork was regarded by m any more orthodox physicians w ith considerable cynicism however. He reached the zenith o f his glory, but was doom ed to downfall. As was the failing o f m any w ho follow ed him, and is even to this day, M esm er often failed to recognize the real nature o f the illness he was treating. His fate as a physician and magnetize]; in Austria was sealed by the eventual outcome o f his treatment o f M arie-Therese Paradis, a pianist w ho had been ‘blind’ since the age o f four. M esm er had restored her eyesight, the loss o f w hich w ould today be recognized as an hysterical blindness. (This type o f problem is discussed in Chapter 6.) O ther physicians were envious o f the results and caused doubt as to the credibility o f M esm er’s treatment. M arie-Therese’s father, w ho was a secret­ ary to the Em peror and Empress, was afraid that his daughter’ s pension and several other advantages m ight be forfeited, and his attitude together w ith the manipulations o f M adam e Paradis caused the unfortunate girl to relapse into her previous blind state. As a result, a great furore arose. M esm er was repudiated b y the U niversity o f Vienna and left the country to settle in Paris in 1778. In France, M esm er’s most prominent supporter was D r Charles d ’Eslon, physician to the Count d’Artois w ho was later to becom e Charles X . M esm er soon became the rage o f Paris. His clinic was lavishly furnished, thickly carpeted and heavily curtained. The great man him self is reputed to have w orn a lilac cloak and to have held an iron rod in his hand. In the centre o f his consulting room stood a large vat called a baquet (plate 3), from w hich projected metal bars. W ater and iron filings filled the baquet and his patients sat round it, each grasping one o f the iron bars. M irrors, strategically placed around the room , reflected and concentrated the light and soft music which, said M esm er, intensified the magnetism, filled the air. In this

5

Hypnosis mysterious and awe-inspiring setting, D r M esm er passed around the circle o f patients, each in a high state o f expectancy, and touched each one w ith the iron rod. M an y then fell about in convulsive movements and described strange and bizarre sensations. A fter tw o or three sessions they proclaim ed them ­ selves cured o f the affliction from w hich they were reputed to be suffering. In spite o f all w hich is now regarded as theatrical and meaningless ritual, M esmer firm ly believed that he was in fact harnessing this ethereal force and that he could cause it to flo w through his body, to his fingers and through the iron rods to the bodies o f his patients, to restore in them the natural balance o f health w ith the universe. Later he maintained that he could achieve such a balance personally and w ithout the aid o f the magnetic rods. O nce again, however, M esm er’s great healing art caused much enm ity amongst his contem porary physicians and in 1784 K ing Louis X V I set up a R o y a l Com m ission to investigate animal magnetism. Am ongst its members was the statesman, scientist, writer, and n ew ly accredited Am bassador o f the U nited States o f Am erica, Benjam in Franklin; D r Joseph Guillotin, the inventor o f the notorious beheading instrument used in France; and Antoine Lavoisier, scientist and discoverer o f oxygen. The fact that both D r Guillotin and Lavoisier w ere subsequently executed by the very instrument w hich bears the name o f the inventor, was in no w ay a reflection o f their w ork on this Com m ission. Nevertheless, the great and important standing o f these people alone was sufficient p ro o f o f the impact w hich magnetism or mesmerism had on the events o f the time. T h e Com m ission concluded that the cures could be explained only by the im agination and imitation o f the subject. U n fortu­ nately no report was made o f the positive results o f M esm er’s w o rk or o f the psychological implications o f the illnesses and the results o f his treatment. U nfortunately too, the Com m ission also failed to comprehend that the cures w ere genuine enough even i f there appeared to be no physical or organic origin to the illness. M esm er stood condemned and soon afterwards, refusing to renounce his beliefs, he was forced to retire. He fled through 6

What Hypnosis Was Europe, returned to Paris for a b rief spell and then m oved to M eersburg on Lake Constance where he died on 5th M arch 18 1$ . He left behind a name, a legend and a charisma w hich still haunts the consulting room s o f legitimate psychotherapy. One o f M esm er’ s disciples was the M arquis Chastenet de Puysegur. It was Puysegur w ho discovered somnambulism, a new dimension o f magnetism, a state in w hich subjects could open their eyes and talk and obey instructions and yet remain ‘m agnetized’ . The somnambulistic subjects w ere thought to be endowed w ith particular powers o f prophesy and o f diagnosis and their em ploym ent for the latter purposes became a fashionable and profitable venture. U nder the influence o f Puysegur, the unlimited enthusiasm o f the magnetizer again earned the antagonism o f orthodox medicine. The ideas o f M esm er and his contemporaries spread to the U nited States and throughout the western w orld. The earliest record o f the use o f animal magnetism in Britain is o f J .B . de M ainauduc, a pupil o f Charles d’Eslon w ho lectured on the subject in 1788 in London and in the West o f England. He was greeted w ith a great deal o f enthusiasm but hardly w ith the same fervour w hich met the disciples o f M esm er in France. Later, in 1829, R ichard Chenevix, a Fellow o f the R o y a l Society, having learned his skills from a w idely renowned priest, the A bbe di Faria, demonstrated his technique to a num ber o f English physicians, amongst them on ejoh n Elliotson (plate 4). C henevix had said, ‘in the w hole dom ain o f human argu­ ments, no art or science rests upon experiments m ore numerous, m ore positive or m ore easily ascertained. T o me (and before m any years the opinion must be universal) the most extra­ ordinary event in the w hole history o f human science is that M E S M E R IS M even could be doubted’ . B o rn in 1786, Elliotson was the son o f a prosperous druggist in South London. He went to Edinburgh U niversity, graduated in 18 10 and continued his studies at Jesus College, Cam bridge. He was a contem porary o f the poet Keats. A fter qualifying as a physician, he toured the Continental schools and then started a practice in London in The Borou gh near the united hospitals o f

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Hypnosis G u y ’ s and St Thom as’ s. At that time the teaching o f medicine was organized through private enterprise. A n y physician w ith sufficient capital could open his ow n lecture theatre, conduct his ow n course and be sure o f a regular attendance. Elliotson was appointed assistant physician at St Thom as’ s Hospital on 17th O ctober 18 17 , and in 1823 he was appointed full physician but was not allowed to lecture. In fact, no physicians o f St Thom as’ s Were allowed to do so at that time, but another factor was that he had specialized in medical jurisprudence w hich was a new science not then taught at the United Hospitals. His lectures w ere vivid and popular w ith students but unpopular w ith Sir Astley C ooper w ho owned the lecture theatre. Later, however, he managed to get the clause in his appointment w hich barred him from lecturing, rescinded. Elliotson was nevertheless angered and complained to the Board. It is reported that the Grand Com m ittee o f St Thom as’s Hospital regretted that he had not written ‘in language m ore temperate and decorous’ . This indicates the character o f the man. He subsequently delivered his lectures in a private medical school in Southw ark and the m ore popular they became the m ore did he gain the disfavour o f the establishment within St Thom as’s. Som e time later, he was to become one o f the champions o f a new venture— the N e w U niversity College, the U n iversity in London which was to be the stronghold ofnon-denom inational education. That ‘godless institution o f G o w er Street’, as it was called, was eventually established and the foundation stone was laid in 1827. Elliotson was elected Professor o f Medicine in 18 3 1. In 1834 the N orth London Hospital was opened and Elliotson was appointed physician. In 18 37 it was to become U niversity C ollege Hospital and largely through Elliotson’s efforts, the study o f medicine had m oved to university level. Elliotson believed that students should be taught at the bedside rather than by serving a five-year apprenticeship to an older doctor. It should be remembered that he was practising at a time w hen physicians treated their patients by bleeding, w ith leeches and w ith purging. Surgeons operated without anaesthesia and Joseph Lister had not yet been heard of. P asteur w asj ust ten years old and psychological 8

What Hypnosis Was medicine was still in its infancy. A t this point Elliotson saw the demonstration o f Chenevix and later met a pupil o f Mesmer himself, the Baron Dupotet. He was inspired to explore for himself, the mysteries o f the human mind. In those years, Elliotson was making medical history. He was one o f the first to use the stethoscope and taught the proper manner in which to examine the chest. He made many discoveries and valuable observations on the use o f drugs. He gave the highly prestigious Lumleian lectures at the R o y a l C ollege o f Physicians in 1829 on ‘The A rt o f Distinguishing Various Diseases o f the Heart’ , and his notes on the ‘T h eory and P ractice o f M edicine’ were a great contribution to treatment. But he was restless and highly industrious and his modern inno­ vations in medicine, in attire and in behaviour resulted in a certain lack o f popularity amongst his colleagues. Perhaps because o f this, and his dark and handsome appearance, he was reported to be a Je w , not a very popular distinction at that time. He was influenced by the theories o f Franz Joseph Gall, a Viennese physician, w ho was the founder o f the study o f phrenology in w hich it was claimed that mental development could be measured by examination o f the skull. Gall was a great student o f the mind and maintained that emotions acted independently o f the w ill and that this often resulted in physical effects. W e m ay read in this the anticipation o f the discovery o f the unconscious mind. The later acceptance by Freud that our neuroses or nervous habits are buried in the unconscious and that therein lies the origin o f subsequent neurotic illness could be said to be the direct result o f Elliotson’s w ork. M esm er and di Faria had maintained that animal magnetism was effected through the united wills o f the doctor and the patient. The patient exhibited convulsive movem ents o f the body and passed into the mesmeric trance state, in which state he could be cured o f his ills. Som nam bulism and the highly receptive state o f the patient’s mind then follow ed. U nder its influence, Elliotson said ‘wounds give no pain’ and certain diseases could be cured. It was thought that through super­ natural forces special diagnostic powers were given to the doctor, so that he was able to understand the true meaning o f

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Hypnosis disease. Elliotson accepted these ideas w ithout dispute. O rigin ­ ally sceptical about what he had seen, he suddenly changed his view s and began givin g demonstrations himself. He realized that apart from physical treatment there was another h alf to medicine— the study o f the m ind— but he was halted at its frontiers. He recognized the seem ingly im pregnable resistances, the emotional defences and the pow ers o f im agi­ nation o f the patient but was unable to penetrate the barricades. He experimented continuously and lectured and demonstrated repeatedly to hundreds o f students and to men o f fam e and o f fortune, but still under the disapproving eye o f the hospital authorities. Elliotson’s close friend was a man named Thom as W akley w ho qualified as a m em ber o f the R o y a l C ollege o f Surgeons in 18 17 but w ho gave up medicine, became a M em ber o f Parliament and started a medical magazine called the Lancet. W akley reported Elliotson’s demonstrations o f various trance and somnambulistic states extensively, and was at first a considerable supporter o f these experiments. A fter some demonstrations by the Baron Dupotet o f mes­ merism in seven cases o f epilepsy, Elliotson felt that it was his duty to investigate the matter further. A t that time tw o sisters, Elisabeth and Jan e O key, presented themselves at the hospital and came under his care. U nfortunately, Elliotson failed to recognize their hysterical personalities. He demonstrated on them publicly and showed the effects o f mesmerism. H e used on them the somnambulistic state for the purposes o f diagnosis and by doing so created a great deal o f antagonism. He was finally tricked by W akley and denounced by him in the Lancet. The medical authorities requested him to cease these public ex­ hibitions and as a result he resigned from the hospital on 24th D ecem ber 1838. This is described by M errington in his book University College Hospital and its Medical School: a History. Elliotson was a friend o f G eorge Cruikshank, the painter and illustrator, and also o f the famous British novelist, W illiam M akepeace Thackeray. In fact, he had once saved Thackeray’s life and the novelist showed his gratitude by portraying him as D octor Goodenough in his books Pendennis and The Adventures 10

What Hypnosis Was of Philip. Elliotson opened the M esm eric Hospital in London’ s Fitzroy Square where one o f his disciples was Charles Dickens, to w hom he taught the art o f mesmerism. U nfortunately, Dickens used this to treat a certain lady suffering from delusions and hallucinations, w ith almost disastrous results and causing a profound threat to his ow n marriage. Elliotson later started a new journal called The Zoist which was m ainly concerned w ith mesmerism and in w hich numerous cases o f treatment w ere reported. For example, he quoted the case o f a young w om an w ho had an amputation o f the thigh under mesmerism and felt no pain. T he operator noted that, whilst the patient’ s pulse rate remained around fairly normal, his ow n increased to double its rate! There follow ed details o f seventy-six operations completed without pain. It must be understood that, apart from the use o f brandy, at this time mesmerism was the only form o f anaesthesia available before ether was introduced by M orton in 1846 and chloroform by Sim pson in 1847. O nce the surgeon R o b ert Liston had used ether for a m ajor surgical operation on 21st Decem ber 1846 mesmerism as an anaesthetic was abandoned. A fter that time, the w orld became familiar w ith the perform ance o f painless surgical operations by means o f ether or chloroform , so that operations under mesmerism passed unnoticed. Y et there remains a record o f no less than 400 operations perform ed by this method. In Issue N o. 23, the last issue o f The Zoist published in 1848, there appeared an article by D r Elliotson entitled the ‘Cure o f a true cancer o f the female breast w ith mesmerism ’. In this article the rem oval o f a diseased mass, not w ith a knife but w ith mesmerism alone, is reported in detail. T he patient was an unmarried m iddle-aged lady. In 18 4 1 she was discovered to have a breast tum our w hich had become widespread. It was Elliotson’s intention first o f all to prepare the patient for surgery. She was seen by many famous surgeons o f the day, including B ro d y, Liston and Cooper, and all confirmed the cancerous nature o f the grow th, some advising immediate surgery, while others declared it inoperable. Elliotson decided to take the matter into his ow n hands. The

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Hypnosis patient, R osin a Barber, was mesmerized, frequently as often as three times daily. She was a deep hypnotic subject and was kept in what was described as a ‘happy trance’ for hours at a time. She made slow and steady progress. She put on w eight, her well-being im proved, her strength increased. The skin healed and there was eventual resolution o f the mass. It is interesting to note that on an occasion when D r Elliotson was aw ay in Europe the patient relapsed, but she made rapid im provem ent again on his return. ‘Five years and upwards, was she mesmerized’ w rote Elliotson, and in September 1848 the report stated, ‘the cancerous mass is now com pletely dissipated, not the slightest lump is to be found nor is there the slightest tenderness o f the bosom or the arm pit’ . This finding was also verified by m any eminent surgeons o f the day, some o f w hom had originally examined the patient. Perhaps this story o f Jo h n Elliotson and R osin a B arber should not be view ed w ith too much scepticism. There is a good deal o f research in progress today on the consequences o f stress and o f the suppression o f anger, and any possible effect these m ay have on the production o f illness and even o f cancer. It m ay therefore not be too far-fetched an idea to consider that the reduction o f anxiety and tension w hich Elliotson was able to produce w ith his mesmeric treatment was sufficient to cause the gro w th to subside. Thus the greatness o f the man surpassed his difficult person­ ality and unpopular ideas and, when the controversy w hich the O key sisters created had subsided, he was invited to give the annual oration at the R o y a l C ollege o f Physicians in London, in m em ory o f W illiam H arvey. H arvey was also an extrem ely controversial figure. He was famed for his discovery o f the circulation o f the blood and had him self been reviled and denigrated for his convictions. In a deed executed on 21st Ju n e 1656, H arvey exhorted his fellow physicians ‘to study and search out the secrets o f nature by w ay o f experiment and for the honour o f the profession’. Elliotson was able to draw a parallel between his ow n discoveries and the discoveries o f W illiam H arvey and indeed between the fate o f H arvey and his own decline and fall. ‘The 12

What Hypnosis Was medical profession’ said Elliotson ‘was not contented w ith denial o f the truth— they stigmatized H arvey at the time as a fool and so the w orld thought he must be a fool and did not consult him as before and he fell in his practice extrem ely.’ O f the effects o f mesmerism he said, however, ‘never was it more necessary than at the present moment to bear all these things in mind. A body o f facts is presented to us not only w onderful in physiology and pathology but in the very highest importance in the prevention o f suffering and in the cure o f disease . . .’ . A t about the time that Jo h n Elliotson was publishing the reports o f his experiments w ith mesmerism, numerous other reports o f operations w ere published in The Zoist. A certain D octor Engeldue wrote, ‘M r W ard a surgeon o f W ellow in 1842 rem oved a poor m an’s leg under the mesmeric superinten­ dence o f m y friend M r Topham and this case was to be the most important w hich had been presented to the medical profession’. Jam es Esdaile, a Scottish surgeon w orkin g in Calcutta, perform ed several hundred operations quite painlessly. M an y o f these are reported in copies o f The Zoist w hich are still available. His instructions to the ‘anaesthetist’ w ere usually "to be mesmerized for an hour and a h alf daily for five days’ . He founded the Calcutta M esm eric Hospital and received the blessing o f the Earl o f Dalhousie, the G overnor-G eneral o f India. U nfortunately, however, the British medical authorities o f the time rejected his reports.

Lucid Sleep In the year 18 13 , a Portuguese born in Goa, the A bbe Jo se Custodio di Faria, w ho had taught R ichard Chenevix, was givin g public demonstrations o f animal magnetism in Paris. He com pletely ignored M esm er’s elaborate ritual o f magnets and sim ply asked his patients to concentrate on feelings o f relaxation and sleep. Thus he regarded the necessity o f suggestion as the important factor in producing the desired state. A lthough his subjects had to possess certain necessary predispositions, he considered the relationship between the patient and him self o f greatest importance. His term for animal magnetism was ‘lucid 13

Hypnosis sleep’ and it w ill be seen that these ideas w ere a genuine and significant advance towards later theories o f the nature o f the hypnotic state.

Hypnos or Nervous Sleep Jam es Braid was born in Fifeshire in Scotland in the year 1795. He was educated at the U niversity o f Edinburgh and after qualifying as a surgeon he settled in Manchester. In 18 4 1 he attended demonstrations o f mesmerism given by a Frenchman, Charles de La Fontaine and learning the art from him became intensely interested in the w o rk o f Elliotson. He too entirely rejected the concept o f animal magnetism and o f ethereal fluids, and developed his ow n theories o f a condition o f increased susceptibility and suggestibility. He maintained that the mes­ meric state was in fact a form o f sleep and in 1843 published a book entitled Neurypnology or The Rationale o f Nervous Sleep Considered in Relation with Animal Magnetism. A t first he considered it to be a physical condition o f the nervous system, but later changed his mind and decided that it was hypnos— a form o f sleep. Thus the term hypnotism was coined. A lthough now adays a m ore scientific explanation o f the state as in fact both a psychological and a physical condition is generally accepted, the w ords hypnosis and hypnotism have becom e part o f the English language. Braid entirely discounted the exotic effects claimed by the mesmerists and magnetizers. From evidence it had received, the French R o y a l Com m ission had concluded that patients under the influence o f the mesmeric state could be made to perform certain deeds against their w ill. T o d ay w e kn ow that this is a m yth and a recent article by C am pbell Perry o f M ontreal, in the International fournal o f Clinical and Experimental Hypnosis, clarified the problem o f possible hypnotic coercion and compliance. It was Braid, how ever, w ho really first attempted to set the record straight and to disprove some o f the m ore sensational claims o f the mesmeric state. He demonstrated in both public and private experiments that, whilst they w ere in hypnosis, the judgem ent o f his subjects was such as to make them even m ore

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What Hypnosis Was fastidious as regards propriety o f conduct than when they were fully awake. Braid, in accordance w ith the discovery o f the A bbe di Faria, also maintained that hypnosis could be induced sim ply by fixing the patient’ s attention on some object— a technique that is basic to most o f the induction methods used today. Certainly there was no need for the lilac cloak or the baquet or the iron rods, nor for any o f the paraphernalia required by the early follow ers o f Mesmer. Hypnosis, or animal magnetism or mesmerism, call it what you w ill, was once and for all time established as a condition in w hich both the physical and the mental state are altered, a state in w hich the mind and the body are finally bridged, a state the evidence for which could no longer be disputed. Jam es Braid died in i860. The great inventor o f psycho­ analysis, Sigm und Freud, said o f him that he, perhaps m ore than anyone else up to that time, could be regarded as the first really scientific student o f hypnotism.

De la suggestion In the year i860 a medical practitioner named D r Am broiseAugust Liebeault founded a clinic at N ancy in France. Here he began to test the ideas o f Jam es Braid, using the method o f fixed attention. A t the same time he gave the patient pow erful and repeated suggestions o f relaxation and o f sleep. He had considerable success w ith his methods but unfortunately was discredited by Professor H ippolyte-M arie Bernheim , a famous neurologist w orkin g in the university o f the same town. Subsequently, however, the latter was com pletely converted to Liebeault’ s view s, not only o f the part that the im agination played in illness but also o f the value o f suggestion under hypnosis. W ith scientific precision he proceeded to investigate the use o f hypnotism and in 1886 he published the results o f his labours. His w ork was entitled D e la suggestion or Suggestive Therapeutics. He agreed w ith Braid that hypnosis was a form o f sleep but maintained that it was brought about by a specific condition o f enhanced suggestibility, by a method o f especially

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Hypnosis concentrated verbal suggestions. There is no doubt that the strength o f Bernheim ’s reasoning and the great and important status o f the man himself, helped to establish hypnotherapy as one o f the most valuable forms o f treatment for nervous illness know n at the time. Professor August Forel (18 4 8 -19 3 1) was a Swiss psychiatrist o f great repute. His w ritings occupy a prominent place in the w o rld ’ s literature on hypnosis and he maintained that the ideas o f Braid and Liebeault w ere amongst the great discoveries o f the time. As a physician, he had extensive experience o f the use o f hypnosis and castigated the ‘scoffers and unbelievers’ w ho made rash judgem ents about its nature and effects. He supported the idea o f the N ancy school that hypnosis was produced by suggestion. Most important o f all, he maintained that the hypnotic state could be achieved in the m ajority o f people w ith very little trouble and was not peculiar to persons o f a particularly abnormal nervous sensibility. Later, however, Freud concluded that one could no m ore satisfactorily define suggestion than one could explain hypnosis!

An Hysteria D uring the latter part o f the nineteenth century the figure o f Jean M artin Charcot (plate 5) bestrode the medical stage in Paris like a giant. B orn in 1825, he was tall in stature, alo o f and im m ensely popular. It was considered to be a great privilege to w o rk under his guidance and physicians o f eminence travelled from far and w ide to attend his demonstrations. As a professor in diseases o f the nervous system at the Salpetriere Hospital, there came under his care a large number o f patients suffering from epilepsy and hysteria and in the year 1878 he began to investigate them w ith the use o f hypnosis. A t this time, both he and the pupils w ho hypnotized for him still believed in the use o f magnets and the ideas o f magnetism. O ne o f the features o f an hysterical illness is the imitation o f other diseases and C harcot’s young hysterical patients w ere able to m im ic the unfortunate seizures o f the epileptics w ith w hom they w ere housed. A t first he failed to recognize this but later 16

What Hypnosis Was discovered that these symptom s could be rem oved or even produced through the use o f hypnosis. He w ron gly concluded that only patients suffering from hysteria could be hypnotized and that the hypnotic state itself was a form o f hysteria. Nevertheless, he had made the dramatic discovery, through the use o f hypnosis, o f the true nature o f hysterical illness. U p to that time it was com m only believed that hysteria occurred only in w om en and that it was due to a misplacement o f the w om b. In fact, the Greeks had a w ord for it and that was the w ord for w o m b — hustera. Because o f the large num ber o f patients available to him and his persistent enthusiasm and relentless investigations, Charcot showed that the condition could occur in either sex. M oreover, because o f his experiments w ith hypnosis he revealed the true nature o f hysterical sym ptom s— that they w ere without doubt the result o f a nervous condition and in no w ay related either to epilepsy or to the ‘wandering w o m b ’ . U nfortunately, Charcot persisted in his beliefs in magnetism and the physical origin o f the hypnotic state. He supported the view that the condition was brought about by stroking with magnets or other external methods w hich then resulted in an altered state o f the nervous system. M oreover, it could only be effected in certain persons o f a particular disposition and especially in hysterics. In this he was com pletely at odds w ith the Liebeault-Bernheim school and as the latter ideas became more firm ly established, so C harcot’s w ork was attacked as being unscientific. W ith his death in 1893 it can be said that the last remaining ideas o f animal magnetism had been finally laid to rest and were interred w ith his bones for all time. His fame remained unsullied, however, and no physician o f this century w ould deny the enormous contribution o f Professor Charcot to our know ledge o f diseases o f the nervous system and to modern psychiatry.

A Dissociation A dissociation means a separation or a splitting. In this case, the idea advanced by Pierre Janet (1859 -19 47) was that in the true 17

Hypnosis nature o f the hypnotic state, there occurred a dissociation or splitting o f the conscious from the unconscious parts o f the mind. Janet was one o f the most famous pupils and collaborators o f Charcot. He w as an author and philosopher and qualified as a doctor o f medicine in 1893. In 1902 he became Professor at the C ollege de France and made enormous contributions to the principal subjects studied at the Salpetriere, nam ely hysteria and hypnosis. O ne o f his most famous books, Psychological Healing, is even today considered a very valuable reference and is an impressive contribution to the subject o f psychiatry. Janet developed his ow n individual explanations o f the nature o f hysteria and o f the hypnotic state and believed that the dissociative process was a progressive one occurring during the induction o f hypnosis. As the conscious mind was suppressed, he thought, so the unconscious gradually surfaced until in deep hypnosis it took over completely. That is, the subconscious became the conscious. He felt that this was the same process that took place in hysteria and was also responsible for other nervous disorders. Thus he concluded that most neurotic symptom s had a hidden meaning. He anticipated the theories o f Freud, advanced shortly afterwards, that because the true meaning o f our nervous problem s was often too painful to be faced, it was therefore pushed back into the unconscious mind w here it became responsible for all sorts o f problems. Although today w e appreciate that a state o f dissociation m ay occur in hypnosis, it does not always do so and cannot be accepted as an explanation o f the hypnotic state as a whole. N o r can it explain the basic suggestibility o f hypnosis and various other phenomena w hich can be produced.

A Loving Relationship It was left to D r jo s e f Breuer (18 4 2-19 2 5), a Viennese physician, to find the vital clue and to extend the use o f hypnosis into a m ore valuable and therapeutic field. Breuer was a talented pioneer in the use o f hypnosis for the treatment o f hysteria. He elaborated the view that it was due to earlier traumatic 18

What Hypnosis Was experiences. D uring the years 18 8 1 and 1882 he was treating a young girl named Bertha Pappenheim. She was know n in his case-book as Anna O. and was diagnosed as suffering from an hysteria. In her case this was characterized by various paralyses, disturbances o f vision, speech disorders, and mental changes. He hypnotized her and allowed her to speak about her problems. He invited her to recall details o f their origin and while she was unburdening herself to him she gave vent to feelings o f severe agitation and restlessness w ith considerable outpouring o f emotion. These w ere the original feelings w hich she had experienced when her problem had started. In this w ay Miss O. was able to retrace her buried memories to the events that she had considered to be the cause o f her troubles. In the terms o f Janet, her subconscious had com e to the surface. The result was that w ith the recovery o f these memories and w ith the fact that she had simultaneously given vent to her feelings, the symptoms now disappeared. Thus Breuer developed the technique o f regression, o f taking his patients back, in time, in place and in m em ory, to the origin o f their problem s— or to what they considered to be the origin. He allowed them to talk, to express those feelings which had occurred at the time and to re-enact the emotional responses. In fact, to liberate the ‘strangulated affects’ or suppressed emotions o f certain painful memories, as Janet was additionally thought to have discovered. In this w ay they were relieved o f their symptoms. Breuer was a friend o f another Viennese physician, the great Sigm und Freud (plate 6). Freud was born in M oravia in 1856 o f a middle-class Jew ish fam ily. He chose a scientific career and enrolled as a medical student in the U niversity o f Vienna at the age o f seventeen. His earlier w o rk was in research and he certainly put these interests first. He was the author o f several learned papers and finally qualified as a physician in 18 8 1. A fter establishing a firm reputation for himself, he was awarded a much coveted travel scholarship to study w ith Charcot at the Salpetriere— an experience w hich was to revolutionize his ideas and bring about a profound change in his life. It was at the Salpetriere that his interests turned to psy­ chology. He formed a good relationship w ith Charcot by

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Hypnosis translating some o f his w orks into Germ an, and acquired a sound know ledge o f hypnosis. In 1887 he began to experim ent w ith it him self but, dissatisfied w ith the theories held in Paris, visited Bernheim at N an cy on the advice ofP rofessor Forel. He studied Bernheim ’s ideas o f suggestion and his techniques and on returning to Paris incorporated these methods w ith those used by Breuer. T h ey form ed a close relationship, w orkin g and researching together for m any years. Freud was fascinated b y the case o f Anna O. and persuaded Breuer to continue w ith the method so that they could study the effects. T h ey called the release o f em otion w hich this hypnoanalytic technique had produced, a catharsis. This is a w ord derived from the Greek, meaning a cleansing or purging, and it was used because they maintained that patients had purged themselves o f their problems. This was the reason for their recovery. In a join t w o rk published in 1895 called Studies on Hysteria, Breuer and Freud affirmed that by the use o f this method hysterical patients could be relieved o f their symptom s. But Freud, exploring the problem later in greater depth, recalled that whilst in hypnosis, Anna O. had been able to retrace the origin o f her sym ptom s to the time o f the severe illness o f her father w hom she had been nursing and to w hom she was particularly devoted. C ould it have been that she had seen in Jo s e f Breuer this fatherly figure and w ith that im age had experienced w hatever love or erotic sensations this had evoked? T he possibility o f some sexual emotions was established in Freud’ s mind and he called this the transference situation, w hich was to become one o f the cornerstones o f his future theories. W ith this and Jan et’ s idea o f the dissociation o f the conscious from the unconscious mind, the entire concept o f psychoanalysis was born. Thus, as a direct result o f the use o f hypnosis, by the end o f the last century psychiatry had taken a great leap forw ard into the future. It was from these early experiments and his collaboration w ith Breuer that Freud developed his ideas o f sexual sym bo­ lism. He formulated what was to becom e almost a science in its ow n right, the idea o f dream interpretation, and subsequently discarded the use o f hypnosis entirely to pursue the method 20

What Hypnosis Was know n as free association. Nevertheless, he maintained that i f psychotherapy was ever to become w idely available to the public, the use o f hypnosis as a short-cut procedure w ould be essential. Throughout their w ork, Breuer continued to support C har­ cot in his theory that hypnosis was a form o f hysteria, but his farseeing observation eventually led Freud to believe that this was not the w hole truth o f the matter. Freud compared the hypnotic state w ith that o f being in love. Hypnosis, he said, is a very particular form o f loving relationship. So popular was the use o f hypnosis at this time, that when, in 1900 the Russian composer, Sergei Rachm aninov, became depressed and unable to concentrate on his music, he sought help through the use o f hypnosis. His condition had occurred as a result o f learning o f some adverse criticism o f one o f his works. D aily, he attended at the consulting rooms o f a successful physician in M oscow , D r N ikolai Dahl. He was treated by hypnosis and given suggestions for relaxation and for relief o f his mental ‘block’ . A t the appropriate time these suggestions w ere follow ed by positive feelings o f w ell-being and confi­ dence. His coping abilities and pow ers o f concentration in­ creased and soon after he composed one o f his greatest masterpieces, w hich he dedicated to the doctor. This was the Piano Concerto N o. 2 in C M inor. The rejection o f hypnosis by Freud was nevertheless a serious setback to its use, particularly to research on the subject and to further understanding o f its meaning. Apart from its occasional em ploym ent for the treatment o f ‘shell shock’ during the tw o W orld Wars, hypnosis was abandoned for the m ore fashionable and less evocative technique o f psychoanalysis, whilst orthodox psychiatry, assisted by the enormous contributions in research by the pharmaceutical industry, developed extensive physical and chemical methods o f treatment. In retrospect, however, what was disappointing was that the man w ho opened the road to exploration o f the mind by the use o f hypnosis, w ho veritably laid the foundation stone and built the edifice o f the new science o f psychoanalysis, and w ho invented a new language by w hich it could be described, 21

Hypnosis rejected the enormous potential w hich set him on his course. Freud was eventually forced to leave Austria in 1938 by H itler’ s invading armies and m any o f his case notes and publications were destroyed. He died in London a year later at the age o f eighty-three.

A Child-parent Relationship Sandor Ferenczi, born in H ungary in 1873, was a w orker o f renow n and distinction in the developm ent o f the practice o f psychoanalysis and contributed considerably to the view s expressed by Freud. He agreed w ith him, too, that the state o f hypnosis was similar to being in love. But he maintained that this was m ore in the nature o f the relationship o f child to parent. The patient trusted the hypnotist, he did w hat he was bid and his attitude was one o f blind faith based on both love and fear, said Ferenczi. The therapist must have the prestige and authority o f the all-pow erful father so far as the patient was concerned. In Ferenczi’ s view , therefore, the patient must trust the hypnotist as a child has im plicit trust in his father. Additionally, in the Freudian sense, the patient must have a deeply em otional liking for the doctor w hom he can trust. The weakness o f this theory, how ever, is that just as the child does not autom atically obey his father, the patient in hypnosis w ill not necessarily obey blindly any suggestion that is made to him. B y the time o f his death in 1933 Ferenczi had been acclaimed one o f the greatest w orkers in the field o f psychoanalysis. But as w ith all the theories so far expounded, he had failed to explain the true nature o f the hypnotic state.

A Conditioned Response The significance o f suggestion and the psychoanalytic theories o f Freud w hich emerged all-pow erful into the twentieth century, were met w ith considerable resistance b y a dominating figure whose ideas revolutionized psychological thinking throughout the w orld. 22

What Hypnosis Was Ivan Petrovic P avlo v (1849—1936) was a great Russian physiologist. Th rough his brilliant animal experiments he showed how habits, reactions and responses in humans are form ed from our earliest days, to establish our behaviour in our every w alk o f life, unless or until new habits are learned. The son o f a clergym an o f peasant stock, young Ivan attended theolog­ ical college and then continued his studies in science at the U niversity o f St Petersburg w here he was to become one o f the w o rld ’ s most brilliant researchers. He developed an interest in the physiology o f digestion, and from 1902 until his death he worked on the functions o f the brain. For his achievements, he was awarded a N obel prize in 1907 and in 19 13 became the D irector o f the Institute o f St Petersburg. In his investigations, P avlo v cut the salivary ducts (the tubes w hich convey the saliva to the mouth) in the cheeks o f dogs. He was then able to attach a tube to the cut end o f the duct in each dog and divert the saliva to a receptacle. In this w ay he could measure the drops o f saliva w hich flowed each time the animal was given food. O n each occasion the givin g o f the food was preceded b y the ringing o f a bell. In time, the same num ber o f drops o f saliva w ere produced by the sound o f the bell alone, without the accom panying food. He called this a conditioned reflex and he found that this w ould eventually die out or become extinguished i f the bell was continuously sounded w ithout the presentation o f food to the animal. The reaction could be strengthened or reinforced b y giving food again. It was also found that this type o f conditioning could be extended to numerous other habit reactions. So far as hypnosis was concerned, P avlov thought that this too was a kind o f conditioned response in w hich the suggestions given by the therapist could produce certain changes in the physical and psychological w orkings o f the mind. He felt that the cortical or higher centres o f the brain— that is, those centres w hich w ere m ore recent in evolution, the civilizing and critical centres— w ere inhibited or dampened dow n b y the words o f the hypnotist, allow ing the m ore prim itive, less inhibited parts o f the brain to become dominant. These prim itive centres are m ore susceptible to suggestion, and i f the same w ords are

23

Hypnosis repeated on each occasion, then a conditioned response to these w ords w ould be established. This particular response could be the state w e kn ow as hypnosis. Nevertheless, he still maintained that this was a particular form o f sleep. In his researches, P avlo v had also demonstrated how even a very m inor stimulus could result in a particular and similar response on each occasion. This w ould account for the reason that a patient could go into hypnosis at a signal, a w ord or, say, a tap on the shoulder, having previously been conditioned so to do. There is no doubt that in hypnosis, conditioning does take place: conditioning to close the eyes at a certain signal, conditioning to achieve complete physical relaxation, con­ ditioning to allow mental calm, and conditioning to respond to certain other signals in a specific manner— but, overall, a conditioning which has only been achieved by the absolute and trusting and w illing compliance o f the subject.

Some Contemporary Theories o f Hypnosis A Goal-directed Striving In 1 941 R o b ert W hite o f Harvard U niversity, in an article in the Journal of Abnormal Psychology, stated that ‘hypnotic behaviour is meaningful, goal-directed striving, its most general goal being to behave like a hypnotized person as this is continuously defined by the operator and understood by the subject’. He stressed the importance o f m otivation— that is, that the subject must want to be hypnotized. He concluded that a w ellintentioned patient w ith a good relationship w ith the therapist w ill allow him self to play the role expected o f him and one w hich has been repeatedly explained to him b y the latter. Thus he hears and understands perfectly and tries to behave in the different w ays suggested to him. This striving is well illustrated by W hite in his paper, in the exam ple which he gives o f the state know n as catalepsy. This is a condition in w hich the body and the limbs remain rigidly in w hatever position they have been placed. For example, the operator m ay instruct the subject to extend his arm and w ill then go on to suggest that the limb has become so rigid that it is 24

What Hypnosis Was impossible to m ove it and m oreover that should he attempt to do so he w ill fail. W hite’s contention was that the hypnotized person fully understands the operator’ s intention and in a subservient manner responds by stiffening his arm, then trying and failing to bend it. In other words, he is striving to behave like a hypnotized person, as has been defined by the hypnotist. I f the subject is surprised by this result, it is because he fails to recognize that it is not because the operator has forced his w ill on him, nor that his ow n w ill is not sufficiently pow erful to overcom e the suggestion. Had it been truly the will o f the subject to resist, he would have succeeded. In fact, the subject had secretly hoped that his ow n w ill w ould not prevail. Nevertheless, W hite points out that in anaesthesia, for example, the patient is striving to behave as i f part o f the body is devoid o f normal feeling. This does seem a little difficult to accept. Dentists using hypnosis can produce loss o f pain sensation during the rem oval o f a tooth. N orm ally this operation is looked upon as an extrem ely painful procedure. M oreover, the w ill to succeed must have been a considerable accomplishment in the days o f Esdaile and Braid w ho, w ith the influence o f animal magnetism or hypnos, w ere able to produce sufficient anaesthesia for the amputation o f a lim b and similar m ajor surgery, or for procedures norm ally quite impossible to tolerate! So W hite introduced another factor, ‘an altered state o f the person’, to support his hypothesis. He maintained that i f the subject was given a post-hypnotic suggestion— that is, if, whilst in hypnosis, he was told that on awaking from that state he w ould perform a certain act— then on being instructed to open his eyes and be w ide awake, he w ill do so, but w ill in fact still remain in the hypnotic state until he has carried out that act. This is because to behave like a hypnotized person means to act as i f he were w ide awake and then carry out the post-hypnotic behaviour. The same applies to the effect o f post-hypnotic amnesia or loss o f m em ory. The subject is told that he w ill forget a certain event and so he strives to behave as if the events o f the trance w ere forgotten. I f the behaviour o f the patient is directed towards a certain goal, what actually happens within the brain and central 25

Hypnosis nervous system, and what, does W hite maintain, is the nature o f the hypnotic state? ‘M uch evidence’ he says ‘has been ac­ cumulated showing that the hypnotized person can execute suggestions which in a normal w aking state w ould lie w ell outside the realm o f his volitional control.’ Thus hypnosis must consist o f something additional to mere role-playing. In other words, it must consist additionally o f a particular altered state o f the nervous system itself. M an y experiments up to that tim e had attempted to show that the hypnotic state was not in any w ay a form o f sleep but that in fact it was a particular waking state. H o w then can such suggestions under hypnosis be carried out? This is a question for which, to this day, there has not been given an entirely satisfactory explanation. It is a question to which, hopefully, the recent upsurge o f medical interest and the increase in research into hypnosis w ill soon provide the true answer. Inevitably that explanation must account for the processes o f the imagination, the sleep-like appearance, the suggestibility, the dissociative symptoms, the love and the trust and the conditioning w hich the earlier w orkers have suggested. But additionally it must also explain the altered state o f the human mind, a state w hich is neither w aking nor sleeping, but is a real and measurable yet altered awareness. It is a state in w hich the hypnotized subject is capable o f producing all those phenomena which those magnificent giants o f the M esm eric tradition w ith their vision and dedication bequeathed to the hypnotherapists o f today for the benefit o f mankind and for the relief o f suffering.

The Atavistic Theory A new hypothesis o f the nature o f the hypnotic state was formulated in 1957 by an Australian psychiatrist named Ainslie Meares. His idea, based on the P avlovian theory o f the inhibition, the gradual switching off, o f the m ore advanced centres o f the brain, allowed for increased activity o f the low er, older and m ore prim itive areas and a greatly increased state o f suggestibility. Meares considered that logical thought was only a recently acquired function o f the mind. In prim itive man, simple ideas were accepted by the prim itive mechanism o f 26

What Hypnosis Was suggestion and this concept, concluded Meares, could be used to explain the nature o f hypnosis. In his Atavistic T h eory he maintained that the mental function o f the patient regressed to a prim itive level where the pow er o f suggestion operated and ideas w ere accepted without criticism. Added to this, in the hypnotic state there w ere certain other reactions and psycholo­ gical defences, responses and ‘com m unity o f feeling w ith the hypnotist w hich is hypnotic rapport’ stated Meares. In an article in the Medical Journal of Australia, he offered an explanation o f the w ork o f Breuer and Freud. He said that when a patient is regressed to an earlier event in his life, ‘the mechanism which keeps the uncom fortable thing repressed ceases to function properly and he is able to bring out the repressed matter’ . Lewis W olberg, in his book Medical Hypnosis, supported his view s when he said that in hypnosis, critical faculties are tem porarily suspended.

Theories o f Role Playing In studies extending over m ore than tw enty years, during which time he has published a form idable number o f articles on the subject, D r T. X . Barber o f Massachusetts developed some further ideas o f the hypnotic phenomenon. He has emphasized that hypnotic perform ance depends upon the attitudes, m otiv­ ations and expectations o f the subject towards the hypnotic state, and that his willingness to co-operate in carrying out what is expected o f him is the important factor. The subject tries hard to play the role o f the hypnotized person and this role, say Barber and his co-workers, involves ‘thinking and im agining with the suggestions’. These ideas are perhaps an extension o f the goal-directed striving o f R o b ert White. J. R . Hilgard, a prominent Californian psychiatrist, has summed up this view point by stating that a good hypnotic subject must possess a number o f characteristics in com m on w ith the dramatic actor!

A Goal-directed Fantasy Nicholas Spanos o f the M edfield State Hospital in Massachus­ etts, a collaborator and co-author o f Barber’s, developed the 27

Hypnosis role-playing idea into what he called goal-directed fantasy. In this theory, the ‘thinking and im agining w ith suggestions’ is directed into im agining a situation which, i f it actually occurred, w ould produce the results w hich the suggestions im ply. Thus, for example, i f a suggestion is made that the subject is raising his arm, and i f he simultaneously visualized a pulley or a balloon pulling at his arm, then he w ould be engaging in a ‘goal-directed fantasy’ . It has been suggested that good hypnotic subjects fail to evaluate or criticize the ex­ periences suggested by the hypnotist, whereas the poor hyp­ notic subject is continually contradicting or resisting the reality o f the suggestion given. It must be pointed out, however, that most o f these view s are o f hypnotic behaviour rather than theories o f hypnosis as a state in itself.

Other Speculations as to the Nature o f Hypnosis Som e other w orkers have suggested that hypnosis results from an inhibiting or blocking o f the cells o f the brain, or that certain changes take place in the nerve functions, or that there is a reduction in the blood supply to the brain. O ne thing is apparent to every medical clinician w ith experience in hyp­ notherapy, however. There is no doubt whatsoever that hypnosis is an altered state o f human activity. There is no doubt either that in that condition he is in a highly increased state o f awareness. The degree o f suggestibility varies w ith the depth o f hypnosis o f w hich the individual is capable. Y et in spite o f this there is no loss o f control but an increased vigilance and awareness by the subject o f his ability to control and exploit his own capabilities. A ll those theories described above are the results o f a considerable amount o f clinical experience and observation, o f experimental investigation and inquiry extending over m any years. Each attempts to give a psychological explanation o f the hypnotic state. Equally fascinating and evocative, how ever, is the attempt to explain the true scientific nature o f hypnosis. W hat actually happens in the nervous system and to the physiology, the actual

28

What Hypnosis Was w orkin g o f the human body, in order to produce this state o f mind? W hat is w aking, what is sleep, what is hypnosis? Is there truly something special about the hypnotic state? W hat is the bridge between body and mind?

29

2

What Hypnosis Is ♦

’Tis ’Tis ’Tis ’Tis ’Tis ’Tis

above reason, cried the doctors on one side; below reason, cried the others. faith, cried one; a fiddlestick, said the others. possible, cried one; impossible, said the others. Laurence Sterne (17 13 —1768)

U ntil fifty years ago, this bridge between the body and the mind seemed impassable. From the mystical environm ent o f the baquet, an abundance o f explanations and definitions emerged into the clearer light o f the twentieth century. Philosophical, esoteric and hypothetical conceptions each offered a psycholo­ gical description o f the hypnotic state. Few w ould agree, however, that any o f the view s hitherto advanced expressed the precise nature o f the phenomenon. M agnetism, a form o f sleep, suggestion, an hysteria, a dissociation, a loving or child-parent relationship, a conditioned response, goal-directed striving or fantasy, atavistic regression, or role-playing. Each idea had its proponents and its champions. Y et none provided the vital link w hich w ould establish the neurological pathways to the brain, thus finally closing the gap between the body and the mind.

30

What Hypnosis Is

Hypnosis and Sleep U p to 1952 the hypnotic state was still considered to be a form o f sleep. The Hypnotism Act, by w hich the British Parliament sought to restrict the use o f hypnosis for the purposes o f entertainment, assigned the follow in g meaning to it. ‘H yp ­ notism ,’ it states, ‘includes hypnotism, mesmerism and any similar act or process w hich produces or is intended to produce in any person any form o f induced sleep or trance . . .’ Learned articles still referred to hypnosis as sleep and therapists w ere using the instruction ‘go to sleep’.

The Electroencephalogram The clues w hich eventually directed research to the indisputable evidence o f a physical explanation o f the hypnotic state resulted from C aton ’s discovery in 1875 that electrical impulses eman­ ated from the brain. In 1929 Hans B erger invented a machine called the electroencephalograph which, by the application o f electrodes to the scalp, was able to record these impulses. It was shown that rhythm ic electrical pulsations w ere produced b y the brain and so at last there was available a method o f interpreting changes in the brain, both in health and in disease, for research and diagnosis. The impulses w ere recorded as w aves or cycles on a graph. T h ey varied in the w aking state and in sleep and w ere eventually shown to record changes in hypnosis too. Thus opened a vast new area for research. Hypnosis had travelled far since the days o f animal magnetism and was at last to cross the bridge. In 1937, Loom is, H arvey and Hobart investigated the electroencephalographic (EEG) changes occurring in sleep. T h ey recorded five stages— drowsiness, a relaxed rhythm , sleep, and tw o other stages o f deeper sleep. In the first stage o f drowsiness regular high amplitude w aves o f eight to tw elve cycles every second are seen. This is know n as the alpha rhythm and occurs in all o f us when w e are relaxed w ith our eyes closed, in quiet and peaceful surroundings. In this stage the eyes make gentle rolling movements. A minute or so

3i

Hypnosis later, the second stage is reached. The alpha w aves disappear and are replaced by slow, low er-voltage waves. Som e minutes later, the third stage is reached. These w aves are slow and the eye m ovem ent disappears. In stage four the w aves are slower still and the voltage increases, and in the fifth stage there is a highvoltage low -frequency rhythm o f about one cycle per second. In 1953, tw o Americans, Eugene Aserinsky and Nathaniel Kleitm an, observed sleeping infants and noted a rapid m ove­ ment o f the eyeballs beneath the closed lids occurring at intervals during sleep. T h ey noted the same phenom enon in adults and made E EG recordings during these stages. T h ey demonstrated some very special activity o f the brain w ith very fast beta w aves o f up to tw enty cycles per second. This phase o f sleep was called R ap id Eye M ovem ent (R E M ) sleep and in norm al adults was found to occur at intervals o f about ninety minutes during a night’ s sleep and to last from ten to fifty minutes. W e now kn ow that many im portant changes take place in the body during this stage. Aserinsky and Kleitm an, curious to kn ow what was going on, awakened their subjects at this point w ho reported that they had been dreaming. T h ey w ere m oreover able to give vivid descriptions o f the content o f these dreams. These eye movements w ere similar to those o f a person w ho is awake and looking around. It has therefore been suggested that in the R E M phase, it is as i f the sleeper is view in g a play and the stage is his w orld o f dreams. A t the termination o f each period o f R E M sleep or dream sleep, or ‘paradoxical sleep’ as it is also called, stage one sleep is again resumed and the cycle is repeated (Fig. 1). As the very retention o f the name implies, the persistence o f the idea that hypnosis was a form o f sleep led m any w orkers to investigate the problem further w ith the use o f the E EG machine. In fact, in earlier experiments it seemed difficult to identify any real differences. O ne o f the first investigators was J.B . Dynes in 1947. A lthough he found that he could produce most o f the usual phenomena, his electroencephalographic studies failed to reveal any changes in the hypnotized subject. T h ey showed that he was m erely relaxed and so Dynes decided that hypnosis was not a variation o f sleep.

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What Hypnosis Is Beta rhythm

Greater than 12 cps

Alpha rhythm

8-1 2 cps

Theta rhythm

4 -7 cps

Delta rhythm

F ig u re i

A.

A

A

/ A , /\/A

A

A

Less than 4 cps

T h e n orm al electroencep halogram

In 1949, W ayne Barker and Susan B u rg win, pursuing these investigations, found that w hen subjects w ere put into hypnosis and closed their eyes, they im m ediately produced the E E G recordings similar to those found in the first stage o f sleep. These w ere the lo w voltage, fast alpha w aves w hich diminished for a few seconds when the hypnotist alerted the subject b y givin g him a suggestion, w hich was then carried out. Continued suggestions designed to reduce wakefulness produced a dim i­ nution o f the amplitude and percentage o f alpha activity. Patterns typical o f deeper stages o f normal sleep w ere also observed. Barker and B u rg w in made a distinction in hypnosis

33

Hypnosis between a stage o f hypnotic suggestibility and one o f hypnotic sleep and also concluded that a form o f sleep, indistinguishable in the E E G from true sleep, m ay be produced in hypnosis. In 1959, Chertok and Kram arz, from the Centre de M edicine Psychosom atique in V illejuif, France, concluded, Electroencephalographic investigations in the present state o f this technique cannot furnish irrefutable p ro o f regarding the question o f similarity or dissimilarity between the hypnotic state and sleep. It should be made clear, however, that up to this time, E E G measurement was m ostly based on a single recording made from the back o f the head and usually compared w ith the reading taken in an equally relaxed subject just before he was hypnotized. Later techniques w ere far m ore sophisticated, as a result o f w hich researchers were able to be considerably m ore accurate in their readings. But in 19 57 and i960 Professor B a rry W yke, a neurological scientist w orkin g at the R o y a l College o f Surgeons in London, gave papers to the British Society o f M edical and Dental Hypnosis (then know n as the Dental and M edical Society for the Study o f Hypnosis) in w hich he agreed that the E E G o f a person in the early stage o f hypnosis, w hen he has his eyes closed and is physically relaxed, resembles that o f the norm al sleepy subject. As suggestions are given that the hypnotic state is deepening and various hypnotic phenomena are demonstrable, the alpha rhythm shows little change in frequency but dim in­ ishes m arkedly in voltage so that it m ay seem almost to disappear. W hen specific suggestions are given that the subject should sleep, however, the voltage increases, the frequency diminishes and the E E G recordings are identical w ith those seen in norm al deep sleep. W yke pointed out, therefore, that the brain w aves o f the hypnotized person are similar to those w hich w ould be produced i f that person were awake but relaxed. The brain w aves only change ‘when sleep is deliberately and specifically induced by the hypnotist\

34

What Hypnosis Is A ccordingly, it could be concluded that the deeply hyp­ notized person, i.e. one w ho w ill carry out all the suggestions made by the hypnotist and w ho w ill produce all the pheno­ mena know n o f the somnambulistic state, is not asleep but in a very special state o f relaxation. N o r is the subject awake in the accepted sense. Hypnosis and sleep are distinct states and whilst the subject is in the hypnotic state he m ay also be hypnotized into falling asleep. Additionally, w ith exposure to a m onotonously repeated stimulus such as a flashing light or the sound o f a ticking clock, the initial response to the signal becomes less and less marked as the subject becomes used to that stimulus, or ‘habituated’ to it, and he m ay even fall asleep without being told to do so. This sort o f reaction has been said to have occurred occasionally to drivers on a m otorw ay passing dow n a long avenue o f trees or posts.

Hypnosis and the Waking State Valuable w ork from another point o f view was reported by London, Hart and Leibovitz in 1968. T h ey criticized the lack o f differences found in earlier studies between waking and the hypnotic state. M ost experimenters had used only highly susceptible subjects w ho routinely produced similar E E G alpha recordings, but they maintained that there w ere really measur­ able differences in hypnosis. Those w ho could not easily be hypnotized differed in their responses from the highly sus­ ceptible. T h ey differed in their nervous system functions and in the recordings o f their alpha rhythm. Since very susceptible people showed high alpha durations, other studies had been unable to differentiate between w aking and hypnosis. T h ey concluded that hypnotic susceptibility has measurable physiolog­ ical levels. A m ore recent study was reported to the Am erican Psychiat­ ric Association by Professor Ulett and his co-w orkers in 1972. T h ey embarked on a series o f investigations in w hich they attempted to measure certain electrical changes w hich might take place in the brain during the hypnotic state and thus to

35

Hypnosis establish a firm explanation o f hypnosis in terms o f the w orkin g o f the nervous system o f the body. B y now they were able to analyse their findings b y electronic means and there was no doubt that additional variations could be defined. Their results showed strong evidence that hypnosis existed as a physical reality w hich could be conclusively demonstrated by the use o f modern scientific instruments. Additionally, by testing w ith certain drugs, they w ere able to show that this was a reality w hich could be demonstrated not only in the physiology but also in the chemistry o f the nervous system. The E E G showed an increase o f alpha activity and a significant decrease in slow waves. A com pletely new finding was that superimposed on the slow w aves was that other activity o f very high frequency already mentioned, the beta w ave, which increased during the testing period. Som e further studies by R ozh n o v, Aladjalova and K am en­ etsky w ere carried out m ore recently in the U S S R and the findings w ere presented at the 7th International Congress o f Hypnosis and Psychosom atic M edicine held in Philadelphia in 1976. T h ey confirm ed that hypnosis was a special state w hich differed from either sleeping or waking. U sing an especially sensitive technique o f recording electrical changes by what is know n as infraslow oscillations, they noted variations w hich had not previously been discovered. Instead o f the gradual process o f transition from a sleepy state to hypnosis, they recorded a sudden shift. Further data obtained suggested that as hypnosis deepens to the somnambulistic level there are also more changes in the electrical activity o f the brain. Changes also occur during hallucinatory experiences. For exam ple, i f it is suggested that the subject can smell the scent o f a rose there is a definite alteration o f electrical activity in the brain. In the w aking state no such change is noted when subjects are actually presented w ith a strong-smelling substance. These Russian w orkers confirm ed that there is a definite alteration in both the psychological and the physical state in hypnosis; a special state w hich differs from both sleep and wakefulness. These facts in no w ay disproved or im plied the abandonment

36

What Hypnosis Is o f all the earlier ideas o f an altered psychological state, but at last there was affirmative evidence o f the unique and scientifically proven existence o f an altered state o f the brain as w ell as o f the mind, a state w hich w e call hypnosis.

The Brain, Sensation and Response The central nervous system o f the body consists o f the brain and the spinal cord. W hen they are looked at w ith the naked eye, certain parts are grey in appearance and others are white. The grey matter is m ainly made up o f nerve cells, whilst the white matter consists o f the long nerve fibres w hich conduct nervous impressions from the cells. The outer grey matter o f the brain is know n as the cortex. Em erging from the brain is the spinal cord, and the nerves o f the body w ith all their ramifications and connections. Aided by complicated chemical processes, the nervous system controls and regulates all other systems o f the body and helps them, in normal health, to act and react to each other in harmony. This nervous system is constructed o f billions o f these nerve cells and fibres and their interconnections, w hich are especially able to receive messages and to transmit instructions in reply. These ‘receiving’ nerves are eventually connected together in branches from every part o f the body, to form the m ajor nerves w hich pass via the spinal cord into the brain. Som e o f the cranial nerves conveying special senses such as sight or smell or hearing, are directly attached to the brain. Various areas o f the brain have developed w ith the progress o f mankind through the ages and the cortex is the highest and most advanced o f these structures. It is thirty years since H. W . M agoun revealed some exciting findings relating to the means by w hich our sensations are conveyed to the brain. Since this time, a considerable volum e o f data has emerged showing how the brain becomes aware o f inform ation fed into it from the w orld around, from sensations w ithin the body, and indeed from w ithin its ow n systems and facilities. M agoun discovered a com plex structure in the brain by w hich all incom ing inform ation is integrated, filtered and

37

Hypnosis assigned to effect a specific response. This area is located in the oldest part o f the brain and is called the Ascending R eticular A ctivating System, or R A system, or Brain Stem R eticular Formation. The name ‘reticular is given to it because it is made up o f a reticulum or network o f nerve fibres w hich ascends from a cavity in the low er end o f a part o f the brain called the fourth ventricle. It then passes to an area in the front o f the brain or fore-brain, know n as the thalamus, a large cell station w hich has the hypothalamus in its floor (Fig. 2). W ithin this network, the nerve fibres communicate w ith each other so that each sensation monitors the other and can be modified i f necessary. This R A system feeds into the limbic system, w hich is an area o f very prim itive development and which in turn connects to the cortex. Som e connections from the nerves in the spinal cord as w ell as from the cranial nerves pass their sensations through the R A system and into the limbic system. T he limbic system thus receives messages from the nerves o f the body through the R A system and is able to m onitor the emotions w hich these sensations signal. T h ey are checked, examined and modified, and the final message is passed to the cerebral cortex for translation into activity. The fore-brain also receives some messages direct from the spinal cord as w ell as from the R A system. The cortex is then able to evaluate all these signals and, i f a response is decided, m ay then produce a direct action, or send a message back through the R A system, and so there is m onitor­ ing and even m odification o f this message throughout the course o f sensation, appreciation and action. It is through the limbic system that the brain is prim arily concerned w ith human emotions and w ith the integration and co-ordination o f a response to those emotions. It has been shown that the electrical activity o f the brain depends upon the stimuli which reach it from this R A system. The awareness o f the individual o f his environm ent is mediated and modulated through the R A system and this results in the appropriate variations in the E EG recordings. W hen this system is functioning, the E E G readings show activity, as in the normal routine o f daily life. In the darkness, how ever, w ith eyes closed

38

What Hypnosis Is

KEY Thalamus Hypothalamus |

) Lim bic system and its components — Ascending reticular tract

mmmm Message travelling to cortex via limbic system ............. Message travelling to limbic system

mmmmi Message travelling directly to cortex

Figure 2

The reticular and limbic systems

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Hypnosis and in quiet surroundings, w ith general w arm th and com fort to eliminate the intrusion o f all disconcerting sensations, this activity is dampened dow n and the brain w ill drift into sleep. The R A system virtually closes down. I f w e are to remain awake there must be a constant flow o f reminders through the R A system to the brain, stimulations w hich give us something to think about, something to do. It is possible to cut o ff all sensations for a considerable time. This is know n as sensory deprivation and has been used by certain states and organizations against political prisoners. I f attention is directed to one particular stimulus and held fixed by concentration, then other stimuli are blocked. We m ay concentrate on a television program m e, for example, and be quite oblivious to what is going on around us. The thrill and excitement m ay claim our complete attention so that w e fail to hear the sound o f the telephone or noises from w ithout— w e have quite disregarded them. Perhaps I am listening to some beautiful music whilst reading a book and som ebody treads on m y toes— the sensation o f pain supersedes all else. The music is no longer heard, the sound is blocked and I lose m y place in the book. The overriding sensation w hich dominates all else is the pain in the toes. Conversely, i f one stimulus is blocked, others m ay prevail— for example, blind people m ay develop an acute sense o f hearing, touch and other sensations. R A activity m ay also be altered by disease or by drugs such as tranquillizers, which decrease general awareness, and by anxiety, w hich increases awareness. It has been suggested that during the introduction or induction o f the hypnotic state the voice o f the therapist passing, as it does, along its specific nerve pathw ay in the R A system becomes isolated so that the attention o f the subject is entirely concentrated on his words. A ll other incom ing sensations are discouraged. B y the fixed attention and the trust and good positive m otivation which previous w orkers have all empha­ sized as an important requirement, the mind o f the subject is thus locked to the words o f the therapist to the exclusion o f all other impulses entering the nervous system. 40

What Hypnosis Is W hen the message reaches the limbic system it is conveyed to the appropriate part o f the brain. A nxiety, excitement, anger, all emotional responses are dampened dow n and the subject enters the psychological and physical state which is know n as hypnosis. The limbic area was discovered by Broca in 1897 and the mysteries o f its real function are still being unravelled. Recent advances in research have identified m any important structures within it. Those w hich deal w ith anxiety are know n as the am ygdala and the hypothalamus. The form er is the source o f em otion and the latter communicates w ith the cerebral cortex and produces the arousal w hich leads to those symptoms and emotions which every human being has experienced.

Experimental Evidence o f Some Brain Functions In 19 37 Jam es Papez, in the United States, w rote a paper in w hich he proposed a mechanical and anatomical basis o f emotions. He suggested that the limbic area and its connections constitute an harmonious mechanism which m ay reinforce emotions felt as w ell as the expression o f those emotions. He described a classical circuit o f events from w hich has developed a very considerable amount o f current theory about the w orkings o f the brain. Messages are passed from an area know n as the hippocampus in the limbic system to the hypothalamus, to the thalamus, and then to the cerebral cortex and back to the limbic area. A further series o f experiments w hich have becom e a classic were carried out by a psychologist, Heinrich K luver, and a physician, Paul Bucy, in Chicago tw o years later, in order to test the ideas o f Papez. U sing Rhesus monkeys, K lu ver and B u cy rem oved the lobes o f the brain containing the thalamus and hippocampus in the limbic system. H aving done this they discovered profound em otional changes and alterations in behaviour o f these animals. M ost significant was the absence o f the em otional reaction usually associated w ith fear and anger. T h ey showed, in fact, that the circuit proposed by Papez had been definitely inter­ rupted, thus adding experimental evidence in support o f his 4i

Hypnosis theory. As a direct extension o f this w ork patients suffering from severe aggressive outbursts have been treated b y similar but m odified operations on this area. There was an equally impressive discovery in recent years. O n 5 th April 1976 there died in M ontreal at the age o f eightyfive a man o f enormous stature amongst the scientific leaders o f the century. W ilder Penfield, born in the United States, was a brain surgeon and specialist in the physiology o f the nervous system w ho made very considerable contributions and discoveries. It had been found that i f the Papez circuit was stimulated by an electric current this could produce changes o f m ood often accompanied by aggression. Penfield conducted numerous experiments in which he touched a part o f the patient’ s brain called the temporal lobe cortex w ith a probe w hich could transmit a w eak electric current. His patients w ere fully conscious at the time, as the brain is insensitive to pain and all that was required was some local anaesthetic in the skin. He found that they could recall events from the past w hich they had long since thought forgotten. N ot only the events but also the em otional experience the patient had undergone at the time could be recalled. Event plus em otion are inextricably locked in our minds, in that temporal lobe o f the brain, Penfield discovered, so the m em ory o f the one w ill trigger the recall o f the other. M oreover, the subject is aware o f the same interpretations, true or false, which w ere experienced in the first place, and the past could be experienced as v iv id ly as the present. It was said o f these experiments that the recall is total and equal to that w hich can be achieved w ith patients under hypnosis. This discovery therefore has very considerable implications in the treatment o f patients, which w ill be described later. It is important to realize that although experiences in the past are pushed out o f conscious m em ory they m ay still continue to influence our behaviour in the present.

So What is Hypnosis? At this point let us return to Freud. He had discovered that the causes o f our neurotic behaviour, our neuroses, w ere buried in 42

What Hypnosis Is the unconscious mind. As a result o f his w o rk w ith Joseph Breuer, he had pre-empted the later discoveries o f Papez, K lu ver and B u cy, and W ilder Penfield. Let us now propose an answer to the question, what is hypnosis? W hen, because o f his fixed attention on a particular stimulus, the patient is relaxed into the hypnotic state, the voice o f the therapist travels in isolation along the ascending reticular tract. It is carried by the nerve fibres w hich convey sound and all other sounds or thoughts or messages w hich w ould otherwise intrude have been excluded. The voice is received in the limbic area o f the brain and suggestions can be given by the therapist, neutralizing all feelings o f emotion, anger, anxiety, fear and so on. Additionally, memories o f early events m ay be uncovered, together w ith the emotional experience those events had originally produced. Patients m ay recall and relive these experiences under hypnosis in the manner discovered by Breuer and Freud. The unconscious repressed memories w ill com e to the surface, leaving the patient free o f his neurosis. The voice o f the therapist is ‘locked’ to the mind o f the patient, to a very special part o f the mind, the unconscious itself. A tw o -w ay, closed circuit o f com m unication has been established. V ia the voice o f the therapist, the ascending reticular tract and the limbic system, the body and the mind o f the patient have been bridged.

A Definition A m ore concise definition o f the hypnotic state can now be given. This is an altered state of awareness effected by total concentration on the voice of the therapist. It will result in measurable physical, neurophysiological and psychological changes in which may be produced distortion of emotion, sensation, image and time.

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3 What Hypnosis Does ♦

W e have traced the facts about hypnosis from the mysteries o f magnetism through the psychological theories o f a condition o f the mind to a valid scientific explanation o f an hypnotic state. It emerged into the twentieth century w ith the discoveries o f Freud, as an instrument o f real psychotherapeutic potential, and in m ore recent years has been further developed as a valuable com plem entary procedure for the treatment o f a large range o f nervous problems.

The Psychodynamic Approach Before the exploratory techniques o f Jo s e f Breuer, hypnosis had m ainly been used as a method o f inducing anaesthesia for operations (as by Esdaile and Braid), for diagnosis (as by Elliotson and later b y Janet), and for sym ptom rem oval by direct suggestion (as by Charcot). Apart from this and its extensive use by spiritualists, charlatans and entertainers, it was not until the end o f the nineteenth century that other possibi­ lities for the application o f hypnosis w ere revealed.

Regression As described in the first chapter, it was during his use o f hypnosis for the treatment o f Anna O. that Breuer was able to take her 44

What Hypnosis Does back in time, place and m em ory to the origin o f her symptom s by the process called regression. In this w ay Anna was enabled to recall, or bring back to conscious m em ory, earlier events in her life w hich she thought she had forgotten. She was encouraged to talk about her problems and was allowed to give vent to the feelings which she had suffered in her mind at the time o f those early experiences. This is called ventilation and is the equivalent o f talking out a problem but at a much deeper level o f m em ory and feeling. Later on, when Freud joined Breuer in these exploratory investigations they called the emotions expressed during therapy a catharsis. Anna O. had rather cynically referred to this form o f treatment as ‘chim ney sw eeping’ or ‘the talking cure’. N ow adays, a similar process is know n as an abreaction— a release o f pent-up emotions. Freud analysed the reasons for the patient’ s symptom s by the process o f interpretation, w hich he developed. H e also considered it a vital part o f treatment to explain to his patients the reason for their symptoms, to give them deep understanding or insight. Thus through the w ork o f Breuer and Freud w e have arrived at one particular form o f treatment and this is know n as the dynam ic or psychodynam ic approach. The mind was recog­ nized as consisting o f conscious and unconscious processes either operating harm oniously or obstructing each other, and these had to be sifted, examined and put in proper perspective. Som e years later Freud realized that these recollections o f which patients spoke m ay have been entirely fanciful, or fantasy. Nevertheless, whether fact or fantasy, the important aspect was that the patient believed them to be true. As such the symptoms w ere still attributable to them and it was still essential for them to be taken into account. This entire process, when the use o f hypnosis is involved, m ay be called hypno-analysis.

Transference Freud made some momentous discoveries at that time. O ne o f the most im portant o f these he called the transference. He maintained that the patient often saw in the doctor some figure from his or her early life and displaced on to him certain feelings w hich m ay have derived from that time. The physician m ay be

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Hypnosis seen as his mother, his father, a relative, his friend— perhaps as his love. This aspect has considerable bearing on the treatment o f any patient w ith the use o f hypnosis, as w ith any other form o f psychotherapy, and its possible consequence should be a grave w arning to amateur therapists. The relationship can be a very pow erful one, especially in the close and intimate setting o f the hypnotherapeutic situation. The transference could be positive, in w hich the feelings o f the patient are akin to love. It could be negative and aggressive, in w hich the feelings are o f intense dislike. The feelings o f the therapist also have to be taken into account as they can affect his unconscious m otivation as w ell as the feelings and responses o f the patient, and thus have an effect upon treatment. This is know n as counter transference. In the early days' o f psychoanalysis, the occurrence o f the trans­ ference was considered to be a nuisance, since it could interfere w ith treatment. B y 19 12 , how ever, Freud realized that it was in fact an essential part o f the therapeutic process— provided it was properly recognized and utilized for the benefit o f the patient.

Dream Interpretation Another area which presented itself for investigation by Freud’s ever-searching mind was that o f dream interpretation. Freud called our dreams ‘the royal road to the unconscious’ . He realized that our emotions can influence our dreams and there­ fore maintained that i f dreams can be interpreted correctly, they can lead us straight to the emotions buried deeply in the uncon­ scious. As his research continued, he came to recognize sym bolic meanings to objects and activities in dreams, and so was able to use them for diagnostic purposes. Essentially, Freud claimed that dreams fulfil our deepest wishes and m any m ay have a sexual meaning. He proposed an entire new language o f sym bols— for exam ple, a house re­ presents the human body. Trees, poles, weapons, m otor cars and aeroplanes are masculine symbols and rooms, doors and caves represent female parts. T he prophets o f the Bible interpreted m any m eaningful symbols in dreams. Perhaps the most fam iliar exam ple is Jo seph ’ s interpretation o f Pharaoh’ s dreams o f seven lean kine and seven fat kine and seven lean and seven fat ears o f corn. 46

What Hypnosis Does The obvious interpretation o f the dream must be ignored, according to Freud. A lthough w e really kn ow the meaning o f our dreams, w e fail to recognize that fact. W e don’t kn ow that w e kn ow so w e think w e don’t know . The things that w e experience in our dreams, the things w e do and that others do, and the things w e see, are but symbols o f the true meaning o f the dream.

Free Association As has been described, in order to exam ine the unconscious part o f the mind, Breuer and Freud originally used suggestion under hypnosis. Later, Freud adopted the straightforward idea o f sim ply asking his patients to say what came into their minds— but w ithout the use o f hypnosis. I f the thoughts dried up, the patient could be showing resistance. This term implied that there was some opposition to the process o f perm itting the unconscious to become conscious, and he called this repression. There had to be a very real reason for this and i f this could be overcom e, i f it could be determined what had prevented the meaning from becom ing conscious, then he w ould better understand the mind o f the subject. B y this method some dramatic and surprising results were obtained. Freud continued his researches into these new areas o f analysis upon w hich he had embarked. He allowed patients to discuss their thoughts freely, w ith occasional prom pting, interventions and interpretations from him to overcom e any resistance. He developed this new technique and called it free association. He found that, for him, this could be equally effective in achieving results and he gradually abandoned the use o f hypnosis to pursue this new course. In those earlier days, as Freud began to attach a sexual significance to a good deal o f these analytic revelations, Breuer found it impossible to agree and so they drifted apart. Nevertheless, the enormous contribution which these tw o men made, both individually and in their combined activities and researches, have persisted and continue to be used in the analytic techniques o f modern psychiatry. M oreover, although Freud developed his methods o f dream interpretation and o f free association without the use o f 47

Hypnosis hypnosis, both o f these procedures m ay be utilized, and to considerable advantage, in some hypnoanalytic methods prac­ tised today. As indicated in the previous chapter, hypnosis provides a direct line o f communication w ith the unconscious. Therapy is greatly speeded up and numerous other advantages have emerged w hich w ill be discussed later.

The Behavioural Method B y the turn o f the century other important theories w ere beginning to develop and the great figure o f P av lo v had emerged to dominate the scene. B y the end o f the first decade, his ideas had been enthusiastically adopted throughout the w orld and the conditioned reflex was w idely accepted as the only reasonable explanation o f habit form ation and learning. The animal experiments which led to this discovery are described in chapter i. W hen this w ork was completed, P avlov continued to study the behaviour o f animals, to research on the higher nervous centres in the brain, and to consider, too, the problem o f human behaviour. His w ork was to be o f the greatest importance to certain exciting new ideas w hich were beginning to unfold. O ne o f the first to exploit this w ork w as Jo h n B. W atson (18 78 -19 58 ), a renowned Am erican and a very controversial figure. He was educated at the U niversity o f Chicago and in 1908 was appointed Professor o f P sychology at the Johns Hopkins U niversity. His experiments have becom e classics and his influence on psychology is said to have been second only to that o f Freud. He is know n as the founder o f the school o f behaviourism . In this discipline it is considered that such ideas as consciousness or em otion are misleading and that unconscious desires as ex­ pounded by Freud and the psychoanalysts put the w rong emphasis on our behaviour. The words ‘mental state’ and ‘m ind’ w ere to be dispensed w ith for the purposes o f his experimental w ork, and psychology was to becom e the science o f behaviour. W atson’ s article, entitled ‘Psych ology as the Behaviorist V iew s it’, published in 19 13 , supported and ex48

What Hypnosis Does tended the P avlovian idea that all human activity is the result o f conditioned reflexes. Later, as the idea was broadened, the conditioned reflex became know n as the conditioned response, emphasizing that all learning was acquired by association. In other words, the recognition o f a specific signal w ould always result in a particular form o f response. From these early ideas was to develop the new science o f learning theory. It has long been considered that our behaviour is learned from the very first hours o f our life and w e can be altered by new habits formed as w e gro w older. In simple terms, learning theory means that w e learn the w ay w e behave and from this the form o f treatment know n as behaviour therapy developed. This implies that i f for any reason the old learned habits have to be discarded, they can first be unlearned after w hich new and m ore appropriate habits can be relearned. Watson and his w ife R osalie R ayn er, w ho was also a psychologist, directed their researches to the study o f children and experimented w ith learning, habit form ation and the production and rem oval o f fears. O ne o f their famous experi­ ments was to show how emotions can be altered by new learning. In 19 2 1 they demonstrated this on an eleven-monthold child w ho has become renowned as ‘Little A lbert’ . This child had no fear o f small furry animals and they gave him a white rat w ith w hich to play. H ow ever, as he reached for it they made a loud noise behind his head and the child recoiled. This action was repeated several times until eventually the child cried w ith fear w henever he was shown the rat, even without the noise being sounded. A fter several repetitions, this n ew ly acquired response generalized or spread to similar animals such as dogs and rabbits, and then to other soft furry objects such as cotton w ool and a fur coat. The child was thus conditioned to a new fear.

Desensitization Since the introduction o f new fears is rarely the object o f therapy— although this has a place in the treatment o f certain problems (see hypno-aversion, pages 5 4 -55 )— other experi­ ments w ere conducted w ith a view to relieving fears. Som e ofthis

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Hypnosis w ork was carried out at the U niversity o f California where M ary C o ver Jones, a-distinguished child psychologist, was able to condition children to lose their fears. In one classic experiment, she treated a child w ho feared rabbits by giving him his favourite food whilst bringing the rabbit nearer and nearer. In this w ay the child unlearned his fear and learned to associate the rabbit w ith something pleasant. Although this does not appear to be very subtle or original, too rapid an approach might w ell have produced m ore fear or indeed have induced a fear o f eating. It is o f course w ell know n that eating relieves anxiety. Is not food used as the most obvious w ay o f pacifying a crying child? The drink in the middle o f the night or the sweet to the child w ho has injured him self is the first-aid treatment which most mothers im m ediately apply. A great deal o f gratification is obtained from food and this is extended into adult life where m any people recognize the problem o f com pulsive eating. It is obviously impractical, as w ell as som ewhat expensive, to attempt to treat fears and other painful responses by feeding each patient w ith some especially selected delicacy. Other methods w ere therefore devised. O f these, the most popular was to associate the unpleasant or feared m em ory or object w ith a pleasant and calm feeling. It is pretty obvious that one cannot be tense and anxious and yet remain calm and relaxed at the same time. So i f the patient can be sufficiently relaxed and can be shown that he can remain so, whilst the unpleasant m em ory is recalled or whilst the feared object is faced or whilst he embarks on whatever frightening venture could trigger the symptoms, then he proves to him self that those unpleasant feelings no longer exist. He can henceforth enter into those previously frightening situations and remain com pletely calm and relaxed. He has unlearned the original fear. He no longer responds in the manner w hich was unacceptable to him and he has relearned a new and more acceptable response (Fig. 3). This process is called desensitization. Let us suppose that the com puter o f the unconscious mind was originally program m ed to react to a certain stimulus. The stimulus was any object or situation, or anything that resembled

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What Hypnosis Does S T IM U L U S

R ELEA R N ED R E SP O N SE

LE A R N ED R E SP O N SE

U N LEA R N ED

Figure 3

Desensitization

it, or even any m em ory which recalled such an object or situation. Suppose that the (learned) response was that rather intolerable nervous sym ptom which w e experience as acute fear. The current o f the computer was then tem porarily disconnected, the tape o f m em ory was wiped clean (unlearned) and the computer re-program m ed. N o w — push the button and the answer is the one you require, one that can be tolerated, one o f complete calmness. I f this is acceptable, then a new habit or response is formed (re-learned), one which is free o f nervous symptoms. The secret is therefore to demonstrate to the patient conclus­ ively that he can maintain his feelings o f complete calm and relaxation and tolerate, beyond all doubt in his mind, the original unacceptable stimulus. He must be able to remain com pletely sym ptom -free in this situation. A very great poten­ tial o f relaxation must be established so that he can successfully demonstrate this new learning. A method for developing this was devised by Edm und Jacobson, a Chicago physiologist and

5i

Hypnosis psychologist. He had found that fatigue could result from contraction o f muscles caused by mental tension alone and that all sorts o f nervous ailments could follow . Localized tension in any part o f the body, for example, could produce muscular pains, ‘fibrositis’ or ‘tension headaches’ . Mental and physical tension could react through the body, resulting in a w ide variety o f responses and affecting any system. Thus, i f w e could be taught to recognize this tension and then to relax the relevant groups o f muscles, w e would be a lot healthier. In 1938 he w rote a book called Progressive Relaxation which soon became essential reading for every therapist. Jacobson taught his patients to reduce tension by producing a very high degree o f relaxation in groups o f muscles throughout the body. His training methods were very intensive and prolonged and he often required from 50 to 200 sessions to produce the amount o f relaxation required for treatment. O bviously this was tim econsuming and, although highly effective, w ould be very slow to produce results. It can be w ell imagined that few patients today w ould embark upon so concentrated and prolonged a procedure. M odern psychologists using Jacobson ’ s technique have reduced the number o f sessions to five or ten but, again, very real devotion and application are required. Th e great advantage about the use o f hypnosis is that quite enough relaxation for treatment to start, can be achieved in one session within a few minutes. M oreover, when the subject is fam iliar w ith this technique he can be trained to go into the hypnotic state and one o f complete mental and physical relaxation at a signal. Another outstanding w orker whose researches made a considerable impact on the advance o f behavioural methods o f treatment was Joseph W olpe. W hen at the Centre for Advanced Studies in the Behavioural Sciences at Stanford in California, he presented a new idea o f psychotherapy w hich was considered to be in opposition to the psychoanalysts’ theories o f repression and for w hich he claimed considerable success. His method was to show the patient that he could overcom e an undesirable habit or a neurosis by form ing a new and m ore acceptable response given a similar stimulus or situation. In his 52

What Hypnosis Does book Psychotherapy by Reciprocal Inhibition, he demonstrates how anxiety is overcom e i f the patient is shown that he remains quite calm when presented with that stimulus or situation w hich norm ally would produce the anxiety response. In his studies he used either hypnosis or Jacobson’ s technique to produce and maintain the feelings o f calmness whilst the patient was asked to im agine the otherwise stressful situations. These items were ranked from that w hich caused the least to that w hich caused the greatest disturbance and w ere suggested to the patient in that order, or hierarchy. W olpe’s w o rk was a significant advance in behaviour therapy techniques. It offered not only a serious alternative to the repression theory o f the psychoanalytic school, but the great advantage o f econom y in time. I f w e once m ore consider what hypnosis is; i f w e accept that the voice o f the therapist travelling via this ‘hot line’ to the unconscious, the reticular activating system, reaches the mind o f the patient so that all other incom ing messages and sensations, whether from the w orld without or from within the patient’ s thoughts, are blocked; i f w e consider this closed circuit o f com m unication in w hich the unconscious mind o f the patient is locked to the w ord o f the therapist, and in which state additionally he is entirely relaxed, then perhaps w e can begin to see the vast potential o f hypnosis for the treatment o f nervous illness (the neuroses). T h rough the medium o f hypnotherapy the origins o f the problems can be brought to the surface, examined, explained— and the undesirable effect can be rendered harmless. T he patient can be regressed, he can recall, he can ventilate his feelings and his fantasies and yet remain calm. He can be permitted the benefit o f catharsis, after which he m ay be calmed again, and he can look back on early and painful experiences without unpleasant emotion. The entire range o f Freudian procedures can be utilized by the competent therapist, w ith an absence o f traumatic effect, a m inim um expenditure o f time and m axi­ m um advantage to the patient. B y now , utilizing behavioural techniques, the patient can visualize scenes and situations suggested by the therapist, such as

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Hypnosis had previously produced his neurotic symptoms, and yet retain the feelings o f complete calm. He m ay be asked to nod his head or to raise a fm ger to confirm when he is accurately visualizing this scene or the sensation the therapist is describing, whilst he remains com pletely calm and relaxed. This is know n as an ‘ideom otor signal’ and is very useful during treatment. I f necessary, this new response can be repeated over and again in hypnosis until the patient has demonstrated to himself, beyond all doubt, that he can go out into the w orld and meet those previously unacceptable threats w ithout the resultant un­ desirable responses w hich had marked his nervous illness. Thus utilizing the technique o f W olpe, w e add an enormous new dimension to the use o f hypnosis, that o f relearning or desensitization.

Hypno-aversion A n aversion is a dislike, and hypno-aversion is the creation o f a particular dislike under hypnosis. This is in no w ay artificial. It is very real and i f the patient is adequately treated and maintained it should also be permanent. It has been shown how a response to a particular stimulus or situation can be unlearned and a new response can be re-learned in its place. B y no means does every learned response produce anxiety. T he initial response could in certain circumstances be one w hich the patient enjoys but w hich he nevertheless know s is harmful, or perhaps anti-social, and is a habit o f w hich he wants to rid himself. There is no reason w h y such a prim ary response m ay not be unlearned. I f an unpleasant or unacceptable response is re-learned in its place, he w ill no longer w ish to expose him self to that particular stimulus. He w ill avoid it at all costs because he know s that he w ill certainly dislike the effects. In other words, a degree o f anxiety has deliberately been produced, j ust as resulted from W atson and R a y n e r’ s experim ent w ith poor little Albert. Aversion therapy is a w ell-kn ow n means o f treating alco­ holism, for example. D uring a certain type o f psychiatric treatment o f this problem , the subject m ay be given a fairly potent drug which w ill cause vom iting i f he drinks alcohol. He learns to associate the taking o f alcohol w ith the vom iting. In

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What Hypnosis Does another technique, he is given an electric shock whilst drinking. Here again, he learns to associate alcohol w ith the painful shock. It is not too great an exaggeration to say that hypno-aversion is a good deal kinder. The taking o f alcohol is m erely associated, under hypnosis, w ith some previous m em ory o f vom iting and the patient relearns the new response. This technique is discussed in a later chapter.

Retrospective Counter-conditioning M ost treatment suggested so far has dealt w ith the future response o f the patient. I often use a technique which I have called ‘retrospective counter-conditioning’ The patient recalls, whilst in hypnosis, how he actually responded at the time that the problem arose. He is shown that he could have reacted in a perfectly acceptable manner and is then conditioned to this response, w hich is the w ay things should have been originally. D uring previous sessions, an instance or incident m ay have been revealed w hich resulted in the emotional problem. Even i f the patient thinks this to be the case— which, as Freud main­ tained, is just as im portant— then this instance or incident is taken as the triggering stimulus. U nder hypnosis he is taken back in place and time to that exact situation. He remains com pletely calm and composed and in that state is asked to visualize the situation as it was, but now to retain the feelings o f calmness whilst he hears the distressing w ords spoken or sees the anxiety-producing object or enters into the experience which produced the original feelings and symptoms. In this w ay the subject learns that he can think about the original situation or even experience something similar and yet remain com pletely calm and relaxed. This is a most useful adjunct to other forms o f behavioural treatment using hypnosis and sometimes nothing m ore extensive is required. It must be emphasized that in all form s o f behavioural treatment, the subject must as soon as possible deliberately expose him self to what was originally the painful stimulus. This is practical retraining. He must prove to him self that his fear or his particular neurosis no longer exists.

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Hypnosis

Reinforcing Techniques Self-hypnosis This very special skill, also called auto-hypnosis, is a method by w hich patients m ay produce for themselves the state o f hypnosis as brought about by the doctor in the consulting room . This is a sort o f built-in ‘do it yourself’ technique o f self-help w hich w ill result in considerable additional benefit. First o f all, any person w ho wishes to obtain the m axim um advantage from treatment by hypnosis must com m it him self to the task and to a realization that this form o f treatment is a tw o w ay process. It cannot all be left to the doctor, and this cannot be said often enough. The active participation o f the patient is required and such an involvem ent w ill mean devoting a little time for him self every day, not just when he visits the doctor. W ith this in mind therefore, self-hypnosis can be a very im portant part o f therapy, although it is by no means alw ays effective or even a requirement. It is learned in the follow in g w ay. The subject is relaxed into hypnosis and asked, whilst in the hypnotic state, to visualize him self about to carry out the exercise o f self-hypnosis. He is asked to im agine him self lying on his bed or on a couch, or resting in an armchair or w herever he prefers. The entire technique o f induction is then repeated by the therapist as i f the subject is saying it to himself. It is recorded in his mind and he w ill effectively recall the entire process on opening his eyes. It should be repeated as often as possible until he becomes efficient at it, and the m ore often he repeats it whilst on his ow n the better he gets at it. He is asked to carry out the exercise for a twenty-m inute session once or tw ice daily. A well-m otivated patient w ill do so and this w ill enorm ously enhance the effects o f treatment. The advantages are as follow s: 1. Continuous practice w ill help to reduce the general level o f anxiety. 2. Each session as carried out by the doctor m ay be repeated by the patient in his ow n time, and thus the effect is reinforced. 3. Events which could produce anxiety m ay be anticipated and

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What Hypnosis Does visualized by the patient whilst he remains in the state o f calm. This could be called auto-desensitization. 4. The independence and m aturity o f the patient is encouraged and the transference simultaneously reduced. 5. It can also be used in therapy, as a relaxation exercise in preg­ nancy, in labour, in insomnia, for the prevention or reduction o f asthma and m igraine attacks, in specific fears such as flying phobias, in derm atology (skin diseases) to reduce irritation, in pain relief, for the production o f anaesthesia, and in dentistry. Additionally, patients m ay be taught a ‘quickie’ in order to produce a relaxed state in a few seconds by a special code word, taught whilst under hypnosis. The eyes remain open, they are fully aware o f their surroundings, they continue doing just what they w ere doing— even driving a m otor car— but without panic feelings or tension. The benefits o f this are obvious. Instruction in self-hypnosis, however, is not essential in all cases. Som e patients, especially young adolescents and those w ith problems o f personality, m ay require to lean heavily and for a considerable period, on the support o f the doctor.

Ego-assertive Retraining The ego m ay be said to be the part o f the personality w hich is experienced as being oneself. It functions at unconscious level and is a highly complicated developm ent in psychological terms. On it depends what w e think o f ourselves, how w e deal w ith ourselves and how w e deal w ith others. It varies very considerably between one person and the next and treatment m ay in volve some very positive attention to this area. General suggestions m ay be given to a patient w hich w ill help him to im prove his im age o f himself. It is a very individual thing and in each case has to be tailored especially to meet the age, sex and general needs o f the subject. This method is discussed exten­ sively by the late D rJo h n Hartland in his book Medical and Dental Hypnosis. He called it ego-strengthening. Positive feelings can also be suggested to the patient whilst he imagines situations or confrontations w hich com m only cause him anxiety. O ne such method was described by D r S. 57

Hypnosis R achm an in 1968 in a publication entitled Phobias, Their Nature and Control. He showed how feelings o f self-assertion could be encouraged in patients by allow ing them to express their emotions spontaneously and repeatedly so that eventually these feelings o f self-assertion became a conditioned response. I have devised a combination o f ego-strengthening and assertive therapy, which m ay be called ego-assertive retraining, for application to those patients whose self-image is poor and whose ability to assert themselves m ay be lacking. 1. Ego-strengthening. In his book, D r Hartland divides the patient’s therapeutic needs into those w hich arise as a con­ sequence o f the psychological condition itself, such as anxiety and fear, and those that arise from defects in the personality o f the patient, such as lack o f confidence and maladjustment. He found that the use o f his method resulted in handsome dividends in every case. In a typical ego-strengthening routine D r Hartland w ould impress upon his patients, whilst they w ere under hypnosis, a brighter outlook for the future. ‘E very d ay’ he w ould say, ‘you w ill become physically stronger and fitter . . . m ore alert . . . more w ide awake . . . m ore energetic’, and so on, givin g his patients strong positive feelings o f w ell-being. He w ould match these b y saying ‘you w ill becom e less easily tired . . . much less easily fatigued’ . R epetition w ould continue to give the patient hope and encouragement. In m y technique, ego-strengthening should be divided into the subjective— that is, how the patient feels in him self (more o f the Hartland m ethod)— and the objective— that is, how the patient looks, or thinks he looks. The ego-strengthening phase, therefore, must be specifically designed for each patient. For example, in objective ego-strengthening, a young lady w ith a poor im age o f herself m ay be told to take a good look at herself in a m irror, and see the real image o f herself, not the im age that she has always thought herself to portray. ‘Take a good look at yourself. Y o u are young and fit and healthy looking. Y o u are pretty and have excellent features and a good com plexion. Y o u are tall and slim and have a good figure. Y o u are well-dressed, very presentable and likeable in every w a y ’ and so on. For the

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What Hypnosis Does male— ‘Y o u are fit and tough and strong and virile’ and so on. Untruths are, o f course, avoided at all costs and so all those pleasing characteristics w hich every single person possesses, but w hich the patient perhaps does not see, should be emphasized w ithout undue exaggeration. In this w ay, the patient’s selfim age w ill gradually im prove. 2. Assertive retraining. Assertion as taught by R achm an can be an effective means o f reducing anxiety, particularly in social situations. The patient is encouraged to assert him self and to express his real emotions, and repeatedly to assert him self in the presence o f the doctor. In this w ay, his anxiety in this particular situation is dampened down. The Am erican authors Joseph W olpe, w ho is a professor o f psychiatry, and Arnold A. Lazarus, a professor o f psychology (a form idable combination), describe in their book on Behaviour Therapy Techniques m ore specific assertive training procedures. T h ey first point out to the patient how unattractive people find someone w ho cannot say ‘boo’ to a goose and always seems to take the easy w ay out. Salt is rubbed into the wound by focusing on the enorm ity o f the injustices which the patient endures as a result. Then the patient is asked to recount some specific incident in w hich he was unable to assert himself. Play-acting, which they call behaviour rehearsal, follows. Here the patient re-enacts the incident w ith the therapist in the role o f the other person. The roles are then exchanged and the therapist demonstrates to the patient the appropriate assertive response. Im proved feelings o f self-assertion are easier to acquire w ith the use o f hypnosis because the patient cannot feel threatened when he is in a relaxed state. Additionally, the self-assertion w hich is taught does not im ply an aggressive response. The symptom s o f the anxious patient must not be converted to feelings o f anger. Emotions w hich can be developed by the egoassertive technique should also include those o f showing friendship, affection and love. The patient is first asked to construct a list o f the type o f people w ith w hom he cannot assert himself, w ho cause him to feel anxious and in whose presence are produced some o f the symptom s o f w hich he complains. Such people need not necessarily be authority figures such as the

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Hypnosis school teacher or the boss. T h ey m ay be his friends at school or at w ork, to w hom he cannot speak in a relaxed w ay or crack a jo k e — or perhaps his girlfriend to w hom he cannot express the w ords o f affection he is longing to say. N o w , w hen relaxed in hypnosis, the patient can effectively visualize being in the presence o f the ‘threatening’ figure and feel equal to saying what he wished, without feelings o f tension and w ithout anxiety, remaining calm and confident in him self A combination then o f ego-strengthening and assertive retraining w ill help the patient to venture into social situations w hich previously have been surrounded by a w all o f fear.

Summary o f Treatment Methods The techniques for the treatment o f the neuroses and allied conditions, w hich m ay be carried out when the patient is relaxed in hypnosis, have been described. These m ay be summarized as follow s: A . The Freudian (dynamic or psychodynamic) methods 1. Hypno-analysis: Regression R ecall Ventilation Catharsis Interpretation Insight 2. Use o f the transference 3. Dream interpretation 4. Free association B. The behavioural methods 1. Desensitization 2. H ypno-aversion 3. Retrospective counter-conditioning C. Reinforcing methods 1. Self-hypnosis 2. Ego-assertive retraining 60

What Hypnosis Does Each case must be judged on its ow n merits and any com bination o f these stages m ay be utilized i f required. The basis o f each is the extrem e relaxation w hich hypnosis produces. A state o f physical relaxation w hich is combined w ith feelings o f mental calm. A state w hich can be maintained throughout the therapeutic session, w hatever additional suggestions m ay be made. W hether dynam ic exploration is then embarked upon, or behavioural techniques, or both, depends entirely upon the experience o f the therapist and his decision as to what is best for the patient. Psychodynam ic exploration is not necessarily going to be helpful and m ay be quite inappropriate— for example, in older persons. Desensitization alone m ay bring m ore positive and acceptable results. O r both forms o f treatment m ay be combined. W hen the repressed memories have been uncovered, the damage which has resulted b y virtue o f the response which was originally learned w ill not necessarily heal. A desensitization technique can then be em ployed. Sim ilarly, self-help through self-hypnosis and personality im provem ent through egoassertive retraining m ay be em ployed as additional thera­ peutic aids for the benefit o f the patient. In this w ay a large range ofillnesses and a considerable age range o f patients m ay be treated w ith perfect safety. Emphasis must again be placed on the fact that the patient must possess good positive m otivation for recovery and that treatment be carried out by a properly qualified therapist w ith a sound know ledge o f psychiatry.

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4 How Hypnosis Begins ♦

‘It w ould be a mistake to think that it is very easy to practise hypnosis for therapeutic purposes. O n the contrary, the technique o f hypnotizing isjust as difficult a medical procedure as any other. A physician w ho wishes to hypnotize should have learnt it from a master o f the art and even then w ill re­ quire such practice o f his ow n in order to achieve successes in m ore than a few isolated cases. Afterw ards, as an experienced hypnotist, he w ill approach the matter w ith all the seriousness and decisiveness which spring from a consciousness o f undertaking something useful and, indeed, in some circum ­ stances necessary. The recollection o f so m any cures brought about by hypnosis w ill lend his behaviour towards his patients a certainty which w ill not fail to evoke in them too an expectation o f yet another therapeutic success. A n yone w ho sets about hypnotizing half sceptically, w ho m ay perhaps seem comical to him self in this situation and w ho reveals by his expression, his voice and his bearing that he expects nothing from the experiment, w ill have no reason to be surprised at his failures and should rather leave this method o f treatment to other physicians w ho are able to practise it without feeling damaged in their medical dignity, since they have convinced themselves, by experience and reading, o f the reality and im portance o f hypnotic influence’. 62

How Hypnosis Begins Thus w rote Sigm und Freud in 1891 and his w ords are no less true today than they w ere nearly a hundred years ago. He emphasizes the need for know ledge, experience and confidence. The serious nature o f the treatment is not overlooked nor is the trust w hich the patient must show in the physician. The purpose o f this chapter is not to teach the uninform ed or the inquisitive the secrets o f hypnosis but rather to rem ove some o f the mysteries and doubt inherent in the processes o f the induction o f the hypnotic state, and to act as a w arning to the curious or to those w ho w ould use a valuable medical therapeutic process for the purpose o f entertainment or illegitimate gain. Indeed, the very nature o f the serious disturbance which m ay underlie some apparently simple superficial symptom s should be enough to protect against any im proper use. So, bearing in mind this still valid historical warning, the w ould-be patient should select his therapist w ith the greatest care and only be guided by his general practitioner. It is the latter w ho in the long run is the best ju d g e o f the problem and the possible psychological origin o f the symptoms, and it is he w ho must bear the ultimate responsibility for the health o f the patient. This is where the trusting should start. It is the general practitioner w ho w ill be able to guide the patient to the most suitable therapist. There is always the patient w ho is in search o f the miraculous cure, one that w ill make him better. There is the patient w ho has tried everything and w ill even try hypnosis. There is also the patient w ho doesn’t want to get better. Perhaps this sounds rather strange but it must be recognized that there are those for w hom symptom s serve a purpose, w ho use them unw ittingly to manipulate spouse or fam ily or friends, those whose symptom s shelter them from underlying fears or whose symptoms constitute a facade beneath w hich they can find protection from the environm ent and from the w orld. There m ay be those who, through personal motives, misuse their symptoms. It is the function o f the good and experienced therapist to show the patient the meaning o f his problems and that he w ill live a happier and m ore rew arding life w ithout them. But there is also the patient w ho attends for treatment w ith

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Hypnosis the hope and the confidence and the trust that the experience and wisdom o f the therapist w ill help him find relief from his suffering. He understands that a few m agic passes and a post­ hypnotic suggestion w ill not effect any permanent cure. He realizes that the lilac cloak and the magnetic rods belong to the past and the supernatural pow ers o f any self-acclaimed Svengali are but fantasy or fiction. The aura o f m ystique w hich to some extent still surrounds the hypnotist and his w orks as a result o f the continued exploitation o f the art has left some element o f doubt in the mind o f even the most inform ed. It is im portant for every potential patient— and indeed for the general public— to understand that the hypnotic state is now considered to have a scientific explanation and that hypnotherapy is the logical form o f treatment which has developed as a result. B y and large w e are a drug orientated society and few w ould question the effects o f the tablets prescribed by the doctor. Psychotherapy in general and hypnotherapy in particular must be accepted as the form o f treatment w hich really gets to the root o f the trouble.

A Lesson in History A fter a thorough and searching exploration o f the symptom s and the history o f the patient, after exhaustive questioning and research into the origin o f the problem , the experienced physician m ay decide to treat by hypnotherapy. It should be made clear to the patient that although the use o f drugs m ay be essential where certain psychiatric problems exist, there m ay be circumstances in which drugs m ay help him only to tolerate the situation but do not necessarily offer a cure. The therapist should be someone w ho has the know ledge and the legal right to prescribe drugs when and w here necessary. Alternatively, he should be an experienced psychologist w ho has the facility to refer the patient for drug treatment, i f necessary. The object o f the exercise is to get the patient better, not to demonstrate the art o f hypnosis. Indeed, there is always the possibility that there is a physical origin to the problem. It is essential therefore that the patient is physically examined and appropriately in­ vestigated i f there is any element o f doubt. O n ly someone properly qualified could recognize this fact. 64

How Hypnosis Begins Param ount importance therefore is attached to the initial routine history taking and diagnosis w hich is as vital as in any other field o f medicine. The makers o f history tell their ow n story. E very patient must be encouraged to tell theirs, thus helping to make a full contribution to treatment. A doctor must learn to understand the language o f the patient, to interpret its real meaning. He must be prepared to listen and w ill find that most patients are relieved to be allowed to talk about their symptoms. The silence o f listening indicates sym pathy and concern. This fact in itself is therapeutic and rapport and understanding are established w hich w ill set the character o f subsequent treatment. N ot every problem necessarily has a deep-rooted cause. The origin m ay appear to be fairly obvious. The claustrophobic patient w ho was trapped in a lift at a time when he was bombarded w ith business or financial anxieties. The asthmatic child, terrified o f school or o f some situation in the home environment. The symptom w hich is used to avoid entering into situations which cannot be faced or the adolescent who, uncertain o f his status in society, responds w ith some manifes­ tation o f anxiety w hich results in his nervous symptom s and anti-social behaviour. In spite o f the obvious, however, not every answer must be taken at its face value. W hat is the basic personality o f the subject and what sort o f person really lies behind the symptoms? W hy does one person develop sym p­ toms, whereas another in apparently similar circumstances does not? This, amongst m any other questions must be in the mind o f the therapist. A decision must be made whether to explore the deeper recesses o f the unconscious, or to treat at a m ore superficial level and relieve the troublesome symptoms. Hypno-analysis m ay be a painful experience. M oreover, it is not always necessary nor is it inevitably all revealing or all relieving. This problem is discussed in another chapter. Suffice it to say here that each case must be judged on its ow n merits before a decision is made as to how to treat it. Accepting the clues without critical appraisal, along the carefully laid trail o f the history o f m any a nervous illness could w ell lead to a w rong diagnosis. These m ay be clues to some deeper problem. O r apparent clues m ay be totally misleading

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Hypnosis and could focus a sym ptom on an area w here there is really no problem. Sym ptom s alone should never be taken as diagnostic in any form o f psychotherapy. T h ey are often indications o f some underlying conflict. Unless the therapist maintains an open and enquiring mind throughout the course, he m ay w ell come to grief, or the patient m ay stumble at the diagnostic fences. O n ly by thorough observation, exploration and continuous vigilance m ay treatment using hypnosis be undertaken. O n ly w ith understanding, co-operation and positive m otivation should any patient embark upon treatment. T o the sufferer, neurotic illness is very real, but it is without logic, it is without any physical basis. T h e existence o f the unconscious is an accepted fact, yet the em otional and physical responses to the memories that lie therein are usually incom pre­ hensible, even to the most enlightened. Equally, for the physician the warnings o f Freud in the opening paragraph o f this chapter must be constantly heeded. T h e successful outcom e o f treatment depends not only upon know ledge and application but also upon confidence and rapport, reputation and per­ sonality and that indefinable ‘X ’ factor, that quality which is recognized intuitively, w ith sensory organs as yet not described in any textbook o f medicine or physiology.

It’s All in the Mind The patient should be given to understand that his illness is as real as pneumonia or appendicitis or any other organic or physical condition. He should realize that it is due to some painful or provoking cause, just as the germ that causes pneumonia or the inflammation that is responsible for ap­ pendicitis, but in this case it is part o f his mind called the unconscious w hich is affected by equally painful factors. He must be convinced that the therapist is aware that he cannot ‘snap out o f it’ or ‘pull him self together’ as he is so often exhorted to do, any m ore than he can snap out o f pneum onia or appendicitis without the sort o f treatment that begins at the source o f the trouble. 66

How Hypnosis Begins W e now accept that there are three main levels o f the mind. There is the conscious mind which registers everything o f w hich w e are im m ediately aware in the reality o f our environment. There is that part o f the mind which is sometimes called the preconscious. This is the part w hich stores the memories o f facts and figures from what w e learn at school to the size o f our shoes. O ur powers o f recall depend upon our powers o f retention o f these memories and vary from one individual to another. There also exists a third area w hich is unknown to consciousness, the unconscious. This is not, as is popularly supposed, some previously undiscovered region first revealed by Freud. A m ong theories o f an unconscious part o f the mind was one put forw ard by J. F. Herbart seventy-five years earlier. This theory was developed by Harald Hoffding and W illiam Jam es but it was Freud w ho exploited the idea and subsequently originated those psychodynam ic theories and psychoanalytic techniques which are used today. W ithin the reservoir o f the unconscious mind lie submerged memories o f events w hich have produced emotional responses and from here arises the effect o f these memories, the neurosis. This was the m ajor discovery o f Freud and this is the part o f the mind w hich interests the hypnotherapist. Painful memories can exist in the unconscious, or the ‘back o f the m ind’ and these can be recalled given certain circumstances or ‘stimuli’ . The unconscious mind retains such memories as m ay be inherited or learned during a lifetime and the responses w hich result from these memories are often dominated by emotions such as love, hatred and fear. These emotional feelings are recalled every time the original event is recalled, or any time that something m ay occur which reminds you o f that event. I f that em otion has been sufficiently traumatic, it w ill flood from the unconscious and send out its signals o f love or hatred or fear to the exclusion o f all other emotions. B y the process know n as repression, memories o f unpleasant events, relegated to the unconscious mind lie buried and inaccessible and no longer capable o f direct recall. Y et they w ill have left an indelible mark on the personality which m ay be carried through life. It is these memories, often harmful and 67

Hypnosis even incapacitating, which m ay be brought to the surface by the techniques taught by Breuer and Freud. This is the level, m oreover, at w hich undesirable em otional responses m ay be unlearned and new and m ore acceptable responses relearned, and this is the level w hich the therapist is able to reach through the use o f hypnosis. Certain o f these emotions are protective. For exam ple, the em otion o f fear, because o f its arousing response, m ay alert us to the signal o f danger. But when this reaction o f fear has for some reason been linked to some past harmful stimulus and now no longer serves a useful purpose, then this reaction can becom e pathological and cause the symptom s o f which w e m ay complain. So that memories o f events in the past w hich caused palpitations can send up the blood pressure now , those memories o f being paralyzed w ith fright m ay aggravate a stammer, and those w hich result in increased muscular tension m ay cause ‘tension headaches’ w hich m ight be w ro n gly diagnosed as migraine, and so on.

So How Does Hypnosis Begin? In norm al conditions o f wakefulness, the conscious and uncon­ scious planes o f the mind are awake and alert together, each m onitoring the other, gathering impulses o f fact and em otion from the w orld around, together as a unit, and responding accordingly. These responses are preconditioned by those experiences acquired in one’ s past. U nder hypnosis, the patient is taught— and it should be emphasized that it is something he does fo r himself not what the therapist does to him — to separate the conscious from the unconscious planes. In this state o f altered awareness, the unconscious mind is able to deal w ith those emotional problem s that lie buried within and that are the basis o f the troublesome sym ptom s for w hich treatment is sought. Ainslie Meares talked o f hypnosis as a state in w hich conscious faculties are tem porarily suspended. Here w e m ay be nearer the truth than w e think.

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How Hypnosis Begins Freud taught that the origin o f neurosis is in the unconscious. The therapist is treating, by and large, neurotic illness and so it w ould suggest that hypnosis is the simplest, the obvious and the most likely route to this area. It is essential to understand that in medical hypnosis w e cannot make the patient do anything and this fact cannot be repeated often enough. W e cannot make him do anything that conven­ tion or his moral upbringing w ould prevent him from doing. W e cannot m ake him go out and com m it a crime and then by some melodramatic post-hypnotic suggestion make him forget the fact im m ediately it is done. This is a technique that is reserved essentially for the television script writers and is quite impossible in any reputable medical setting. People are often afraid o f revealing the skeleton in the cupboard, secrets o f youthful dreams or indiscretions, erotic experiences or psychosexual fantasies. Hypnosis is not the great ‘truth d ru g’, a phrase which is in the thoughts and often on the lips o f m any a patient. U nequivocal assurance can be given on these points. The person about to be hypnotized must be certain that he w ill not be rendered unconscious or under the influence o f some irresistible pow er. He w ill, however, be essentially relaxed and able to talk, to discuss, or even argue any point without loss o f control. In fact, one o f the important functions o f hypnotherapy is to teach the patient to regain a control which he has lost so that the symptom or problem fo r which he is ostensibly receiving treatment may be discarded. R em em ber too, that no drugs, no anaesthetics, no injections and no electric shocks are being administered. Provided that the therapist is experienced and w ell practised, he can control the treatment at all times. A n xiety can be contained w ith suggestions o f relaxation; catharsis or abreaction w ith suggestions o f amnesia— that is, telling the patient he w ill forget any experience o f distress during treatment. I f the therapist wishes, the patient can be awakened w ith a post­ hypnotic suggestion o f both amnesia for the episode and complete calmness and control. Post-hypnotic problem s m ay occur as a result o f the activities 69

Hypnosis o f the stage hypnotists, however, and such cases should only serve to emphasize the necessity for the effective legislation against the use o f hypnosis by all but the properly qualified. Indeed, it should also serve as a salutary w arning to the latter that far m ore than a cursory know ledge o f psychiatry is indicated. M oreover, it should be an absolute m axim o f hypnotherapy that nobody should ever open his eyes at the end o f a session without a smile and a feeling o f well-being. I f the patient has seen a demonstration o f hypnosis or experienced it before or read about it, he must forget all that he has seen, experienced or read since methods and techniques used in authentic medical therapy are usually quite different. I f he is expecting something else, this could only add to his anxiety. In particular, hypnosis applied by non-medical practitioners w ill often lay emphasis on the rem oval o f the sym ptom without attention to a possible underlying cause. M edical hypnosis should never ever be looked upon as a demonstration o f some unique pow er, but in the strict ethical setting o f the consulting room under the guidance o f a competent therapist, it is a very pow erful w eapon w ith which to treat certain problems. Absolute assurance can also be given that, w hen used w ith attention to all the factors already mentioned, hypnosis is free from any danger. A n y anxiety aroused by doubt as to the safety o f the technique is entirely the result o f its use by inexperienced or im properly qualified operators.

Some Tests o f Hypnotizability N obo d y w ho uses hypnosis as part o f his regular professional equipment today, w ould wish to introduce doubt into his patient’ s already anxious mind regarding his susceptibility to hypnosis. O nce the condition has been accurately diagnosed and i f it has been decided that treatment w ill be b y hypnotherapy, then the patient is hypnotizable. This is a sine qua non, for i f he is not hypnotizable then the therapist w ill want to think again about the form o f treatment he w ill prescribe, and indeed about the diagnosis itself. Nevertheless, the patient m ay have a very

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How Hypnosis Begins high level o f anxiety or there m ay be certain resistances which first have to be overcom e, and induction m ay only result in a light stage o f hypnosis during the first few sessions. The patient him self m ay w onder i f he is hypnotizable. O r there m ay be something about the relationship, or a lack o f rapport, or a negative transference, that w ill inhibit the process. M uch doubt has been throw n upon so called hypnotizability by those less fam iliar w ith the therapy, and figures varying from 5 per cent to 95 per cent o f success rate are often quoted. A ge range is a consideration, o f course, and children under the age o f seven or adults over seventy should usually be excluded. I f the initial history-taking and assessment o f the patient is accurate and i f he has been accurately selected as suitable for treatment by hypnosis, then as has been said, that patient is hypnotizable. There are certain tests w hich can be applied and, for the record, some o f these are described below. This is certainly not to suggest that they should ever be used before therapy is decided, although in the area o f the experimental psychologist such tests have numerous and valuable applications. I f used in therapy they could be interpreted as a challenge to the patient and as an advance admission o f failure. N o clinical advantage is therefore to be gained and i f in doubt the physician w ould be advised to choose an alternative method o f treatment. A d ­ ditionally, it must be noted that a positive response does not necessarily confirm that a person is a good hypnotic subject. Professor Hans Eysenck, in his book Dimensions o f Personality published in 1947, discusses the suggestibility o f neurotic patients and maintains that repeated suggestion that a certain m ovem ent w ill take place w ill result in that m ovem ent ‘without conscious participation on the subject’s part’. M ost tests o f hypnotizability depend upon this fact, i.e. the relation­ ship o f suggestibility and susceptibility to hypnosis and perhaps the relationship o f suggestibility to neuroticism.

The Hull Body-sway Test The subject is asked to stand still w ith eyes closed and to relax. The therapist should then stand in front o f him or im m ediately behind and tell him that he is gently swaying. V ery 71

Hypnosis soon the subject begins to sw ay and as suggestions are increased he m ay fall into the arms o f the therapist. B y this very simple means, Professor Eysenck was able to construct a suggestibility score according to the amount o f sway registered by the patient. The latter o f course could be very impressed by the result and should respond very effectively to hypnotic suggestion.

The Postural Sway Test This is a variation o f the above in w hich the subject is asked to stand to attention and to look at a point directly above him. The therapist takes up a position behind him, places his hands on the subject’ s shoulders and gently rocks him back and forth. A fter a few moments he is asked to close his eyes and then given suggestions that he w ill feel an irresistible force gently pulling him backwards. The subject is safely caught and reassured that he is hypnotizable.

The Hand-clasp Test The subject extends his arms and clasps his hands firm ly together. He is asked to concentrate on his hands and sugges­ tions are given that the grasp w ill tighten as the therapist counts from one to five. A t this point the hands w ill lock together and the subject w ill be unable to release them until the reverse count is given. A m odification o f this test is com m only used by entertainers in order to select susceptible subjects from the audience upon w hom to demonstrate their skills. In the latter case instructions are rapid and authoritarian adding some degree o f confusion to the mind o f any particularly nervous person already bemused by the glam our o f the performer. O bviously those w ho ‘fail’ this initial test are not allowed to participate in the dem on­ stration but remain amongst the audience. T he suggestible clients are then subjected to a further battery o f quickfire tests. It can w ell be imagined the distress that this could cause any highly susceptible person, w ho by the same token w ould also be highly suggestible and m ay well suffer from any o f the neuroses described.

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How Hypnosis Begins

The Hand Levitation Test The subject is asked to place his forearm and hand on the desk and the therapist places his hand over that o f the patient, exerting gentle pressure as he does so. Suggestions are made o f increasing lightness o f the hand and as this is done the therapist im perceptibly relaxes his ow n pressure. As the suggestions continue, the subject is told that his ow n hand w ill gently rise, follow in g that o f the therapist.

A Real Person It is w orth repeating that these tests are neither necessary nor desirable, and rarely i f ever w ould an experienced clinician use them. T h ey are included here as a matter o f interest and from an historical view point only. The best test o f hypnotizability is the assessment and instinct and experience of the doctor, his positive decision to use hypnosis and the co-operation and motivation o f the patient. It has recently been mooted that in psychiatry the patient has become an object o f treatment rather than a subject for treatment. It must be remembered that the problem s for which hypnosis is used are the problem s o f emotional illness, the problems o f the mind. W e are not dealing w ith organic or physical illness which o f necessity requires physical techniques o f treatment. W e are dealing w ith a person, a person w ho is nervous or anxious about something in his mind and w ho is suffering as a result. Hypnosis is the great subjective therapy. It is a very personal treatment.

Resistance There is o f course the problem o f the resistant patient, a problem w hich should be recognized at this early stage. I f the tests o f hypnotizability w ere to be seriously considered, a negative response to them w ould indicate strong resistance. This is almost inseparably bound to the problem for w hich the patient is seeking treatment and is discussed in another chapter. This resistance protects those memories so painfully repressed 73

Hypnosis and is a defence or a defiance o f the unconscious against the emergence o f these traumatic memories. As he gains confi­ dence, the subject w ill low er his defences and so w ill gain a further step forw ard towards the relief o f his symptoms. Simultaneously with the elimination o f defences, the rapport is strengthened and a positive transference can be established which w ill help to penetrate the unconscious in depth and provide a clear area for rebuilding m ore healthy responses.

Rapport and the Transference The Oxford English Dictionary describes rapport as a com m uni­ cation, a relationship or connection. A rapport is established as soon as a person enters the consulting room and hopefully this is reinforced during the process o f history-taking and throughout the first interview. As confidence and trust increases, as problem s are review ed and discussed there develops a sympathy, an understanding and a relationship without w hich no psychotherapy could hope to succeed. This is o f course how hypnosis begins. It is part o f preconditioning and can be described as the beginning o f the induction. A deeper rapport or harm ony exists w ith the hypnotic state itself and this gives invaluable support in the treatment o f neurotic illness. It has been argued that any transference w hich m ay follow , is something to be feared and avoided. H ow ever, in any form o f therapy, in any doctor-patient relationship, from the lowliest medical student seeing his first patient, some transference must exist. Indeed, it can be the doctor’ s most useful weapon. Even with its hidden meanings a strong positive transference need not be feared. A good therapist should recognize and understand it, control, limit and utilize it as a source from w hich the patient can draw renewed confidence. Nevertheless, it should be emphasized that this situation is one w hich can norm ally only be recognized, contained and usefully applied for the ultimate benefit o f the patient by a properly trained and highly skilled practitioner. Finally, it must be remembered that to every patient, the

74

How Hypnosis Begins first experience o f hypnosis is a voyage into the unknown. One o f the objects o f preconditioning is to eliminate the misconceptions and preconceived notions o f hypnosis w ith w hich most patients are armed, w ith which m any are defended and even by which some m ay be defeated. Preconditioning, preparation and explanation should estab­ lish sufficient rapport and confidence to allow the patient to low er his defences whilst in therapy and to kn ow that he can do so w ith perfect safety. Invariably, however, the patient presents w ith his anxiety at a very high level and w ith his threshold to suffering at its very lowest ebb. He must kn ow that he is being treated as a real person w ho lives and feels and responds in a hostile environment w ith symptom s that cause a suffering that is understood by few. He must kn ow that he w ill experience a unique and relaxing and refreshing form o f therapy in which deep inner understand­ ing is the keynote to happiness and the validity o f his identity w ill be securely established.

75

5 How to Use Hypnosis ♦

‘Hypnotism is not a medical skill since every shepherd boy practises it’. So quoted Freud o f a remark he heard at a Berlin conference. But, before becom ing too enthusiastic, please note his concluding comments that ‘one cannot turn oneself into a medical hypnotist on the spur o f the moment any m ore than into an oculist’. This is not a manual o f instruction, nor is it the purpose o f this chapter to turn every doctor into an instant therapist nor to suggest that hypnosis is a suitable treatment for every patient. It is designed to acquaint the uninform ed w ith the processes o f an hypnotic induction, to emphasize the need o f each therapist to hold a properly recognized medical or psychological qualifi­ cation and to give both doctor and patient an idea o f what happens during the induction phase o f hypnosis.

The Induction o f the Hypnotic State It is not difficult to study and perfect one or tw o methods o f induction. Here, various techniques and their advantages w ill be discussed, together w ith a few additional procedures w hich are occasionally used. Countless methods exist for the production o f the hypnotic state. 76

How to Use Hypnosis These vary from the highly bizarre, the melodramatic and the theatrical (which, i f establishing nothing else, undoubtedly reveal the problems o f the therapist) to the simple, directive and permissive techniques o f progressive relaxation. The latter methods all stress to the patient that the induction o f this altered state o f awareness is something w hich he produces fo r himself thus emphasizing at the outset his personal role in therapy. W hatever the technique o f induction, it is w ell to be concerned w ith the com fort o f the patient. There is no doubt that demonstrations o f hypnosis can be perform ed w ith the subject in every conceivable acrobatic contortion. It must be remembered, however, that this is a therapeutic situation. Physical discomfort, even i f reduced by suggestion as is certainly possible, m ay cause anxiety in the patient and aggravate latent resistances. W arm th, a com fortable armchair or a non-medical couch are the only essential prerequisites. N one o f the clinical features com m on to the doctor’ s surgery are necessary. The absence o f noise helps to avoid distraction. Light should be in keeping with the general decor o f the consulting room. There is certainly never any need for subdued lighting or spotlights as is sometimes suggested. The object o f induction is the focusing o f the attention o f the patient so that some repetitive and monotonous stimulus, i.e. the voice o f the therapist, can be fed into the reticular activating system to the exclusion o f all other sounds or sensations. Hence the abundance o f ‘props’, each one m ore wondrous than the last, that have been adopted by the hypnotist from time im ­ m em orial: the magnetic rods o f the great M esm er him self (although he insisted that they conveyed the ‘ethereal fluid’) and the sw inging pendulum, the gold-topped fountain pen and the ‘hypnotic eyes’ o f the w ould-be hypnotist. O f course, none o f these are necessary. The therapist, i f unable to obtain the hypnotic state w ithout additional charms and amulets, should seriously examine his technique. T he guiding direction o f the voice must be the single line o f com m unication between therapist and patient. This is the course along w hich pure therapeutic suggestion and direction

77

Hypnosis travels uninhibited by external events. This is the closed channel through which the w ords o f the therapist flo w directly into the unconscious o f the patient. W ords w hich m ay uncover, cleanse, sooth, heal and revive by a strictly personal and intimate tw o w ay com m unicating system to the total exclusion o f all other sources o f input. The principal requirement is the concentration o f the patient so that the reticular activating system can be loaded w ith the silent and continuous charge o f calmness and tranquillity. The therapist should remain seated at his desk w here he can be seen and where he can see the patient. A n y position w hich suggests a threat to the patient must be avoided— for exam ple, hovering over him or behind his head. Freud is said to have adopted his classical seat at the head o f the couch sim ply because he was unable to tolerate the stare o f the patient. This position is still occupied by some but is quite unnecessary. The actual technique used at this point w ill vary w ith the therapist. A simple method o f induction w hich excludes any suggestion o f a special pow er possessed by the hypnotist is always preferable. There are those w ho indulge in m any rather absurd ploys in order to contain the attention o f the subject and so to transfer a little o f the mesmeric magic. A ll this is quite unnecessary. Generally speaking, techniques em ployed belong either to the group know n as permissive or guiding or to that w hich is authoritarian or commanding. Here again, the latter attitude is also quite unnecessary, is m ore likely to indicate some defect in the personality o f the hypnotist and m ay even be counter-productive. This also could result in the appearance o f resistances. The only method which should ever be used in treatment is one which is permissive, w hich gently guides the patient into total relaxation whilst increasing confidence and rapport. The hypnotist becomes a hypnotherapist and is allowed to probe the highly personal and sophisticated mechan­ ism o f the unconscious mind o f his patient w ho is now w illing and anxious to rid him self o f his problem . Suggestions must be given w ith a simple flo w o f words; w ords w hich the patient understands and w hich are easy for him to follow and to accept w ithout the production o f some mental conflict. These words 7«

How to Use Hypnosis must be used w ith confidence and must also give the patient confidence in the therapist. The words ‘you w ill’ should always be avoided. Instead the patient is invited to allow him self to relax, to experience the accom panying sensations o f w arm th and com fort which are usually suggested, to allow the hypnotic state to deepen and so on, so that he is always aware that he is never being made to do anything. The patient must believe in what w ill happen and so must the therapist. There is no doubt that the subjective feelings o f the therapist w ill transmit to the patient. Nervousness, uncertainty, inexperience or ignorance w ill result in feelings o f anxiety which w ill convey themselves from one to the other. The patient w ill lose faith and belief and m ay even be incredulous o f the hypnotherapist’ s methods. This could cause a fear that might prejudice the attempted induction. B e lief w ill neutralize fear and confidence w ill allow the patient to concentrate whilst the suggestions o f the therapist are being channelled to the unconscious, so achieving the state know n as hypnosis. N orm ally, four phases o f induction m ay be considered: 1. The preparation o f the patient by full discussion and explanation o f the hypnotic state, rem oval o f doubts and fears o f loss o f control and the establishment o f rapport. 2. The induction o f the state o f hypnosis until eye closure. 3. Deepening o f hypnosis. 4. Special deepening techniques, i f necessary. Each phase should flo w sm oothly into the next, each suggestion must be tailored individually to suit the personality and the problem o f the patient, and each patient should be scrupulously observed during the procedure in order to estimate the response. Perm issive techniques o f induction are first described but for the sake o f the record some intermediate and authoritarian methods are also mentioned, although the latter are o f historical interest only. Phase tw o m ay now begin.

79

Hypnosis

Permissive Techniques i. Eye fixation with progressive relaxation W hen all the initial stages have been completed, the patient, relaxed, w arm and com fortable in the armchair or on the couch, is asked to fix his gaze on any point o f his ow n choosing, on the w all im m ediately opposite him. The reason for this is explained to him; concentration o f the gaze helps to concentrate the mind and the thoughts. O therwise the patient m ay be distracted by a picture on the w all or a bow l o f flowers, or by some feature o f the therapist himself. He is asked to ignore any sounds other than the voice o f the therapist and to allow no thoughts to intrude other than those which concern the suggestions made. Usually, actual induction is commenced by counting, say, one to five or one to ten and he is asked to allow his eyes to close at the final number. The patient is now in a light stage o f hypnosis where the alpha rhythm w ould be recorded on the elec­ troencephalogram (see chapter 2). There is no direct command. The subject is guided and advised and finally ‘eyes closed and com pletely relaxed’ . He is not told ‘your eyes w ill close’ or ‘close your eyes’ . Sim ply, ‘eyes closed and com pletely relaxed’ . In other words, it is left to the subject— ‘let your eyes close i f you w ant’. A positive com mand w ill be a direct challenge to him. I f he does not accede to this invitation to close his eyes, this is a confrontation w ith the therapist, indicating anxiety. It should never happen. I f it does, the fault lies w ith the therapist. In some w ay he has not adequately prepared his patient. A lthough immediate eye closure w ill inspire confidence (a necessary factor in any induction procedure) a certain hesitancy is often exhibited w hich should cause no concern. The patient m ay be assisted in making up his mind with reassuring w ords such as ‘let your eyes close, fine, w ell done’ and so on. The above description outlines the basic induction technique w hich I have practised over m any years. It is entirely permissive and non-authoritarian. It is applicable to patients o f any age. It requires a m inim um o f physical activity on the part o f the therapist and a m axim um o f co-operation and concentration on the part o f the patient. B y the induction stage o f the proceed80

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7bajs ces fiffu / jc saicjeu'ix ft if ^ec/iaurie ParD ore. ^ Dan* sort' /7r/ /nesnfaisanf 1/ n cv pcnn/ ih rircvt' E f m (rrere / fu / p ris vour f71, 1978. White R .W ., ‘ A Preface to the Theory o f Hypnotism’, Jou rnal o f Abnormal Psychology, 36, pp. 4 7 7 -5 0 5 , 19 41. W olberg L .R ., M edical Hypnosis, Vols. I and II, Grune and Stratton, N e w Yo rk, 1948. W o lff H .G ., Stress and Psychiatric Disorder, edited by J.M . Tanner, Blackwell, O xford, i960. W olpe J., Psychotherapy by Reciprocal Inhibition, Stanford University Press, Stanford, California, 1958. W olpe J. and Lazarus A . A ., Behaviour Therapy Techniques, Pergamon, London and N e w Yo rk, 1966. W yk e B .D ., ‘Neurological Aspects o f Hypnosis’, Proceedings o f the Dental and M edical Society fo r the Study o f Hypnosis, 19 57 and i960.

Index —

♦—

Addictions 123-5

bleeding, excessive 131, 135, 136 blood pressure 109 blushing 101, 112, 122 body and mind, inter-relationship between 2, 3, 9, 29, 30, 43 Bosch (Posch), Anna von 4-5 Braid, James 14-15, 16, 25, 44 brain 2, 23, 30, 31, 32, 37-42, 141; see also electroencephalogram Breuer, D r Josef 18-19, 2 0 -1, 27, 43, 4.4-5, 47, 68, 118 British Medical Association (BMA): Psychological Medicine Group Committee of, report by 143, 144,

Adventures o f Philip, The (Thackeray)

10-11 Aladjalova 36 Alcoholics Anonymous 125 alcoholism 54-5, 102, 123, 124-5 amenorrhoea 127 amnesia 101, 119 -2 1, 142; post­ hypnotic 25, 69, 90, 92, 94, 96 anaesthesia 11, 13, 25, 44, 57, 91, 92, 131, 134, 138-9 analgesia 90, 131, 133-4, 137-40 passim anger 43, n o , 135; suppression o f 12 animal magnetism 2 -15 passim, 16, 17, 25, 31, 139, 149 ‘Anna O ’ (Bertha Pappenheim) 19, 20, 44-5 anorexia nervosa 102, 127 anxiety 12, 40, 53, 69, 85-7, 93, 101, 10 2 -7 passim, 108, 109-42 passim,

145 British Medical Journal 144, 146-7 Broca 41 Brody 11 Bucy, Paul 41, 43 Burg win, Susan 33

147 d’Artois, Count (later Charles X o f France r. 1824-30) 5 Asclepius (god) 1 Aserinsky, Eugene 32 asthma 57, 65, 86, u o - n Atavistic Theory 2 6 -7 Australia 145 aversion therapy 54-5

Calcutta Mesmeric Hospital 13 Canada 145 cancer n - 1 2 , 116 -18 catalepsy: eyelid 90, 97; general 24, 92,

147 catharsis 20, 45, 53, 60, 91, 93 Caton 31 central nervous system 37—9, 107 Charcot, Professor Jean Martin 16-17, 18, 19, 20, 21, 44, 92, 95, 118 Chenevix, Richard 7, 9, 13 Chertok, L. 34 childbirth see labour children 49, 50, 71, 83-4, 131, 132, 134, 140 chloroform n , 139 Churchill, Sir Winston Leonard Spencer 141 compulsive eating 126-7 conditioning 23-4, 25, 48, 49 Cooper 11 Cooper, Sir Astley 8

Backache 86, 113 Barber, Rosina 12 Barber, D r T. X. 27 Barker, W ayne 33 Beecher, H. K. 139 behaviour therapy 52-3, 55, 60, 115, 118 Behaviour Therapy Techniques (J. Wolpe and A. A. Lazarus) 59 behaviourism 48-9; see also Pavlov, I. P. Berger, Hans 31 Bernheim, Professor Hippolyte-Marie 15 -16 , 17, 20, 9 5-6

156

Index cortex 3 8-9 counter transference 46 crime detection 102, 142 Crisp, Professor Arthur 127 Crouch, David 149

entertainment see stage hypnosis enuresis (bed-wetting) m - 1 2 epilepsy 10, 16 Erickson, Milton H. 81 Esdaile, James 13, 25, 44, 92, 139 d’Eslon, D r Charles 5, 7 ether n , 139 ethereal fluid 2, 4, 6, 14 Eysench, Professor Hans 71, 72

Dahl, D r Nikolai 21 Dalhousie, Earl of, Governor-General o f India 13 Davidson, J. A. 138 D e la Suggestion (Suggestive Therapeutics)

15 delusions 104 dentistry 25, 57, 81, 83, 90, 102, 131-5 depression 21, 102, 108, 114, 125, 126, 128, 129-30, 136, 140, 141, 146,

147 desensitization 49-54, 56-7, 60, 61, 68, 91, 109, 113 -14, 115, 122, 128, 129, 132, 133, 134, 137-8, 139, 142 diagnosis 7, 9 -10, 44, 64—6 diarrhoea 111 Dickens, Charles (1812-70) 11 Dimensions o f Personality (Eysenck) 71 dissociation 17—18, 20 dreams and dream interpretation 20, 32, 46—7, 60 drugs 40, 125, 147; addiction to 102, 103-4, 123, 125, 147; and sleep 14 0-1; therapy 21, 64, 103, 108, 118, 136 (anti-depressants 108, 114, 126, 127, 130, 140, 141; tranquillizers 103-4, 108, 109-10) Dupotet, Baron 9, 10 Dynes, J. B. 32 Eczema 112 EEG see electroencephalogram ego 57 ego-assertive retraining 57—60, 61, 97, 106, 107, 109, 113, 122, 127, 128 electroencephalogram (EEG) 3 1-6, 38 Elliotson, John 7 -13, 14, 44, 95, 139; quoted xviii, 13 emotional illness see neurotic illness emotional responses 40, 4 1-2, 43, 49, 59, 67, 68, 102-3, n o , 116, 135; see also anxiety; fear; limbic system Encyclopaedia Britannica, The quoted 145 Engeldue, D r quoted 13

Faria, Abbe Jose Custodia di 7, 9, 13, 1$ fear 67, 68, 86-7, 103, 109, n o , 114 -16, 128-9, I3 I? J32 _ 3 Ferenczi, Sandor 22 fibrosistis see backache Fontaine, Charles de la 14 food, and anxiety 50, 126-7 Forel, Professor August 16, 20 Frankau, Gilbert quoted 99 Franklin, Benjamin (1706-90) 6 free association 21, 47—8, 60 French R oyal Academy o f Sciences quoted 149 Freud, Sigmund (1856-1939) 9, 15, 16, 18, 19-22, 27, 42-3, 44, 45-8, 66, 67, 68, 69, 78, 95, 115, 118; quoted 62, 76 freudian interpretations 20, 48, 115, 123, 127, 131, 133 freudian techniques 20, 45, 53, 60, 61, 78, 91, 114 frigidity 102, 128-9 fugue states see amnesia Gagging 131, 134 Galen o f Pergamum (129-199 AD) 2 Gall, Franz Joseph 9 Gamblers Anonymous 126 gambling 125-6 gastro-intestinal system, and anxiety 86,

111 Gilles de la Tourette syndrome 123 goal directed fantasy 27—8 goal-directed striving 24—6 Guillotin, D r Joseph 6 gynaecology 102, 135-8; see also labour menstruation; pregnancy Hallucinations 36, 92, 104 Hand-clasp Test 72

157

Hypnosis Hand Levitation Test 73 Harding, Clagett 146 Hart, J. T. 35 Hartland, D r John 57, 58 Harveian Oration (Elliotson) 139; quoted xviii Harvey, E. N. 31 Harvey, William 12-13 headaches 52, 57, 68, 86, 107-9 heart attack 10 9 -10 Hell, F r Maximilian 3, 4 Herbart, J. F. 67 Hilgard, Professor J. R . 27, 146 Hippocrates (460-377 BC) 1-2 Hobart, G. 31 Hoffding, Harald 67 Hohenheim, Theophrastus Bombastus von (Paracelsus) 2 homosexuality 129 Hull Body-sway Test 71-2 hypnoanalysis 20, 45, 46, 48, 65, 91,

135 hypno-aversion therapy 54-5, 60, 124, 125, 129; see also desensitization Hypnos (god) Plate 1 hypnotherapist: how to find 63; qualities and qualifications to be 62, 64, 76, 99, 143-4, 145; relationship o f with patient 13, 20, 21, 22, 24-5, 27, 40, 43, 45-6, 63, 65, 66, 68, 74, 77-9, 95, 124-5, 144, 146 hypnotherapy 16, 53, 48, 63-75 passim, 93-4; abuse and misuse o f 69-70, 143, 145-9; and the law 143-5, 148-9; pre-conditioning for 70, 75; when to use 21, 9 9-142 passim; see also hypnoanalysis hypnotic behaviour, theories o f 24-8 hypnotic coercion 14, 69 hypnotic state 1; awakening from 97-8; deepening o f 84-8, 87-8, 89, 9 0-1; definition o f 15, 43, 134; degrees o f depth o f 88-94; induction o f 15, 52, 63, 71, 74, 76-84, 8 7-8; proof o f 94-7; theories o f 13-18 passim, 2 1 - 9 passim, 30-7, 40-1, 42-3, 53, 68, 92 hypnotism (term), origin o f 14 Hypnotism Act (1952) 31, 144

hypnotizability 35, 70-4; tests o f 71-3 hysteria 4, 5, 16-17, 18-19, 20, 2 1 , 92, 95, 101, 118 -2 1, 127 ‘ideomotor signal’ 54 impotence 102, 113, 128 induction see techniques Influence o f the Planets on the Human Body, The (Mesmer) 4

infraslow oscillations 36 insight-directed psychotherapy 45, 60, 122, 123, 127 insomnia 57, 102, 140, 14 1-2 International Journal o f Clinical and Experimental Hypnosis 14

interpretation, process o f 45, 60 Jacobson, Edmund 51-2 James, William 67 Janet, Professor Pierre 17-18, 19, 44 Jones, M ary C over 50 Journal o f Abnormal Psychology 24 Journal o f Nervous and Mental Disease

145 Kamenetsky 36 Kinnoull, Earl o f 149 Kirchir, Athanasius 2 Kleinsorge, Professor H.148 Kleitman, Nathaniel 32 Kluver, Heinrich 41, 43 Kramarz, P. 34 Labour 102, 136-8 Lancet 10 Lavoisier, Antoine 6 Law Society’s Gazette, The 148

Lazarus, Arnold A. 59 learning theory 49; see also desensitization; hypno-aversion therapy Leibovitz, M. P. 35 Liebeault, D r Ambroise-August 15, 16,

17 limbic system 38-9, 41, 43 Liston, R obert 11 ‘Little A lbert’ 49, 54 ‘Little Hans’ 115 Little Prince, The (Saint Exupery) quoted 124

158

Index Neurypnology or The Rationale o f Nervous Sleep Considered in Relation with Animal Magnetism (James

London, P. 35 Loomis, A. L. 31 Louis XVI, king o f France (r. 1774-92)

6

Braid) 14 Newton, Sir Isaac (1642-1727) 2, 4 North London Hospital (later University College o f Physicians) 8

Lumleian lectures 9 magnetism see animal magnetism Magoun, H. W . 37 Mainauduc, J. B. de 7 Meares, Ainslie 26-7, 68 Medical and Dental Hypnosis (John Hartland) 57 Medical Hypnosis (Lewis Wolberg) 27 Medical Journal o f Australia 27 medical jurisprudence 8

Obesity 102, 126-7 obsessional illness 101, 116—18, 126 obstetrics see labour; pregnancy Oesterline, Fraulein 4 Okey, Elisabeth 10, 12 Okey, Jane 10, 12 Orne, Professor Martin 139, 142 Oswald, Professor Ian 140-1

Medical Times 146

menstruation 136 mental disorders, classification o f 10 1-2 Mesmer, Franz Anton (1734-1815) 3-7, 9, 99, 118 Mesmeric Hospital 11 Mesmerism (Mesmer) 99 mesmerism see animal magnetism migraine see headaches Mills, Professor Ivor H. quoted 105, 120 mind 9, 10; conscious 18, 20, 45, 67, 68; preconscious 67; unconscious 9, 18, 20, 43, 45-8 passim, 6 6 -9 passim, 74, 114; see also body and mind miracle cures 1, 3 Moran, 125-6 Morton, 11 motivation, o f patient 24, 27, 40, 56, 61, 63-4, 73, 79, 124, 128, 129 Mozart, Wolfgang Amadeus (1756-91) 5

Nail biting 122-3 Napoleon Bonaparte, emperor o f France (1804-15) 141 Nesbitt, William 146 neuroses 9, 42, 67, 69, 93, 100, 101, 102-21, 118 neurotic illness and behaviour 2, 4, 5, 9, 16-17, 18, 19, 42, 53, 63, 65-6, 69, 93, 100, 107-30 passim, 140-2; see also amnesia; anxiety; hysteria; obsessional illness; phobias; psychosomatic illness

159

Pain relief 57, 102, 138-40 palpitations 10 9 -10 Papez, James 41, 42, 43 Pappenheim, Bertha see ‘Anna O ’ Paracelsus see Hohenheim, Theophrastus Botnbastus von Paradis, Marie-Therese 5, 118 Pavlov, Ivan Petrovic (1849-1936) 23-4, 48, 49 Pendennis (Thackeray) 10 Penfield, W ilder 42, 43 Perry, Campbell 14 personality problems 57, 101-2, 12 1-7 phobias 57, 101, 104, 114 -16, 121, 131,

,

132 133 Phobias. Their Nature and Control (S. Rachman) 58 phrenology 9 physical illness 2, 64, 128, 136, 141, 146, 147 planets, affect o f 2 Postural Sway Test 72 pregnancy 57, 102, 109, 113, 127, 136-8 Primer o f Hypnosis, A (S. R o y Smith) 84 Progressive Relaxation (Edmund Jacobson) 52 pruritis 112 psoriasis 112 -13 psychoanalysis 20, 21, 22, 46, 47, 67, 136 psychodynamic approach 45, 60, 61, 67, 114; see also freudian techniques Psychological Healing (Janet) 18 psychosexual problems 102, 109, 113 -14, 127-9

Hypnosis psychosomatic illness 101, 104, 107-14, 121, 136, 146; see also hysteria psychotherapy 44, 46, 52, 64, 66, 122, 144, 147, 149; see also hypnotherapy Psychotherapy by Reciprocal Inhibition

(Joseph Wolpe) 53 Puysegur, Marquis Chastenet de 7, 91 Rachman, D r S. 57-8, 59 Rachmaninov, Sergei (1873-1943) 21 Rapid Eye Movement (REM) 32 rapport 27, 65, 66, 74-5, 78-9 R A system 38-40, 78 Rayner, Rosalie 49, 54 recall 42, 43, 45, 60, 67, 90, 142 regression 19, 27, 44-5, 53, 60, 91, 92, 93, 105, 114, 118 relaxation 13; in hypnosis 21, 35, 43, 5 1-2, 61, 80, 85, 105, 107, 112, 113, 114, 115, 120, 122, 123, 127, 128, 129, 132, 134-8 passim REM see Rapid Eye Movement repression 27, 47, $2, 53, 67-8, 114 resistance 28, 47, 73-4, 77, 78, 82, 96, 97 retrospective counter-conditioning 55, 60 role-playing 27-8 Rozhnov, V. E. 36 Salivation, excessive 131, 135 Salpetriere Hospital 16, 18, 19, 20 self-hypnosis 56-7, 60, 61, 106, 107, h i , 113, 115, 120, 128, 132, 133, 1 3 7 , 1 3 8 , 142

sensory deprivation 40 Sergeant A 93 sexual symbolism 20, 46, 47 sexual deviations 102, 128, 129 Simpson, n skin 57, 112 -13, 117 sleep 3 1-5, 36, 40, 14 0 -1; god of; lucid 13-14 ; nervous 14; REM 32; see also hypnotic state, theories of; insomnia Sleep (Ian Oswald) 140 sleep temples 1 Smith, S. R o y 84 smoking 123-4 social disabilities 121-3

somnambulism and somnambulistic state 7, 9, 10, 35, 36, 9 1-4, 134, 139 Spanos, Nicholas 27 stage hypnosis 31, 69-70, 72, 82, 92,144-8 stammering 101, 122 Stengel, Erwin (1902—73) 100 stress 12; see also anxiety; tension Studies on Hysteria (Breuer and Freud) 20, 118 suggestion and suggestibility 3, 13, 14, 15-16, 18, 2 0-3 passim, 26-7, 28, 44, 47, 7 1-3, 87, 122; post­ hypnotic 92, 95-6, 98 Techniques: to awaken 97-8; to deepen hypnotic state 84-5, 87-8, 89, 9 0 -1; o f induction 78-84, 87-8; see also freudian techniques tension 12, 52, 85-6, 107-8, 109 terminal illness 139-40 Thackeray, William Makepeace (1811-63) 10 -11 thalmus 38—9 Three Faces o f Eve, The (Drs Thigben and Cleckley) 120 ‘tics’ 101, 123 tooth grinding (bruxism) 131, 135 transference 20, 45-6, 57, 60, 71, 74-5, 144 Ulett, Professor 35 unconscious see under mind United States o f America 145 University College Hospital and its Medical School: a History

(Merrington) 10 University College (New) 8 urticaria 112 Ventilation 19, 45, 60, 90, 91, 93, n o , 113, 114, 118, 119, 122, 127 Waking state 35-6 Wakley, Thomas 10 Watson, John B. 48, 54 White, R obert 24-6, 27 Wolbcrg, Lewis 27 W olff, H. G. h i W olpe, Joseph 52-3, 54, 59 W yke, Professor Barry 34 Zoist, The n , 13

160