What is hypnosis?

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The induction of an altered state of consciousness
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Indications and Procedures

The term “hypnosis” comes from the Greek word hypnos, meaning sleep. While scientists and researchers do not understand the exact nature of hypnosis, theorists agree that it is an altered state of consciousness occurring on a continuum of awareness. Hypnosis may occur naturally and spontaneously, as in the case of a daydream. The daydreamer is alert and awake but focuses attention inward rather than outward.

The trance state, often synonymous with the hypnotic state, is characterized by an altered psychological state and minimal motor functioning. A trance can be recognized by the individual’s glassy-eyed stare, lack of mobility, and unresponsiveness to external stimuli. A person in a trance state has a heightened receptivity to suggestion. Hypnosis, then, is a natural state that can be induced by another or by oneself (self-hypnosis) for a specific purpose. As a method of treatment, hypnosis, which is often used in conjunction with other approaches to alter psychophysiological states, promotes an understanding that allows for creative problem solving.

In the hypnotic state, the subject is not necessarily docile or submissive and may, because of unconscious processes, reject a suggestion given by even the most expert hypnotist. Four basic types of suggestion have been described: verbal, which includes words and any kind of sound; nonverbal, which applies to body language and gestures; intraverbal, which relates to the intonation of words; and extraverbal, which utilizes the implications of words and gestures that facilitate the acceptance of ideas. Suggestions are also described as being direct or indirect. Suggestibility is a behavior that is not hindered by the individual’s logical processes but is enhanced by the subject’s motivation, expectation, and trust in the operator as well as by the frequency and manner in which a suggestion is given.

Typically, prior to hypnosis, a subject is seated comfortably opposite or alongside the operator. The operator and subject generally have already discussed what will occur during the hypnotic process. The subject is encouraged to talk about his or her attitudes regarding hypnosis and the operator, as well as any previous experience with hypnosis. If the situation is a clinical one, a full psychiatric history and evaluation will already have been completed. For a positive hypnotic experience to emerge, a comfortable and trusting relationship between subject and operator must exist. There must be a willingness to undergo the experience on the part of the subject and a sensitive, observant, and supportive attitude on the part of the operator. Not all subjects are hypnotizable, but it is believed that most individuals, under appropriate circumstances, can respond to simple suggestions.

The induction process can be one of many types, ranging from directing the subject to close his or her eyes and think of a peaceful scene to having the subject gaze at a particular spot, shiny object, or swinging pendulum until the subject’s eyes become heavy and close. Focusing on an object or scene leads the subject to redistribute his or her attention so as to withdraw it from the general surroundings and focus it on a circumscribed area. In the meantime, the subject is encouraged to relax and to allow events to unfold naturally. This induction procedure is sometimes followed, or even replaced, by what are described as "deepening techniques." The direction is given to imagine gradually descending a staircase or elevator or drifting on a boat past a slowly disappearing landscape. Counting forward or backward is another deepening or induction technique. Throughout this procedure, the operator offers comments or suggestions in a slow, repetitive, monotonous voice, exhorting the subject to feel relaxed and calm or to float and drift.

After a period generally lasting from one to several minutes, the operator gives the subject motor and sensory suggestions. For example, the operator may ask the subject to concentrate on the feelings in his or her fingers and hand, to feel the small muscles in the fingers begin to twitch and the arm and forearm begin to feel light. The operator states that these muscles will eventually feel so light that they will lift up off the armrest of the chair and, continually floating upward, ultimately reach the side of the subject’s face. The operator might add that the higher the hand floats, the deeper the hypnosis will become, and the deeper the hypnosis becomes, the higher the hand will float. The operator then adds that when the hand reaches the side of the face, the subject will be deeply hypnotized.

When this point is reached, and the hand and arm have “levitated,” the operator assumes that the subject is well hypnotized and then adds suggestions that are appropriate to the situation. Not all subjects, however, respond to hypnosis to the same extent or at the same rate.

There is no evidence to support the view that the operator in hypnosis is able to control the experience and behavior of the subject against the latter’s wishes. It is the subject’s motivation to behave in accordance with the wishes and directions of the operator that creates that erroneous impression. Moreover, there is no evidence to support the idea that a hypnotized subject can transcend his or her normal volitional capacity because of the hypnosis; despite persuasive clinical reports of altered somatic structures in hypnosis, no physiological changes uniquely associated with hypnosis have been demonstrated. Hypnosis is not so much a way of manipulating behavior as of creating increased perception and memory.

Uses and Complications

Because the mind, body, and emotions are interdependent, factors that influence one influence the others as well. The roles of the mind and emotions in functional or psychophysiological (psychosomatic) illness are widely recognized, but in cases of organic illness, their importance is often underestimated.

Regardless of etiology (causes), there are physical and psychological components to all illness. Emotional states that continue over extended periods can produce physiological changes. The fear, resentment, or depression that often accompanies illness may prolong or exacerbate it and interfere with a patient’s willingness or ability to participate in treatment. Addressing such issues through hypnosis can greatly improve the overall medical management of a patient, from the initial diagnosis through all forms of treatment, including the treatment of unconscious and critically ill patients.

One advantage of modern clinical hypnosis is that it requires the practitioner to approach the patient as a whole person rather than as a collection of parts, one or more of which may be diseased. For the physician using hypnosis, a medical history goes beyond a list of past illnesses, allergies, and hospitalizations. A more comprehensive picture is developed that includes an understanding of a patient’s personality, present state of mind, and life history and the positive aspects as well as the stresses and strains of the patient’s present environment.

The use of hypnosis in most, if not all, medical specialties has been well documented. Hypnosis can be used alone or in combination with other approaches to overcome a variety of habit disorders. While some problems, such as thumb-sucking, can be resolved relatively quickly, others, such as overeating, sometimes require extended treatment or a multidimensional approach. Smoking and bed-wetting are examples of habit disorders that may be managed through hypnosis.

There is much evidence that children as a group are more responsive to hypnosis than adults and that infants and young children frequently experience hypnosis as a natural part of their lives. Children can often be helped in a remarkably short period of time. Hypnosis has been used with children in the treatment of such diverse ailments as bed-wetting, soiling, asthma, epilepsy, learning difficulties, some behavioral and delinquency problems, stuttering, and nail-biting.

Hypnosis has been used effectively as an adjunct to the treatment of numerous problems with autonomic (internal) nervous system components. For example, there have been many controlled studies and successful case reports on the use of hypnosis in the treatment of asthma, which is the most common of the psychophysiological respiratory disorders. Through hypnosis, a patient may be helped to break the vicious cycle in which anxiety and emotional upsets can trigger an acute asthma attack, which in turn can produce anxiety and fear of other attacks.

Hypnosis has also been used effectively in the control and relief of pain. Because pain is experienced psychologically as well as physiologically, hypnosis can help people alter the perception of pain. A patient can learn to block pain to specific areas of the body, lessen the sensation of pain, or move pain from one area of the body to another. This ability is useful in the management of many types of pain, including chronic back pain, postoperative pain, and the pain associated with illness, migraine headache, burns, childbirth, and medical procedures.

In addition to being used to treat chronic conditions such as hypertension, hypnosis has been used to provide symptomatic relief of other chronic conditions, including hemophilia and musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, fractures, and bursitis.

Hypnosis has been used in dentistry for the relief of anxiety and pain and has been found to be helpful in teeth grinding (bruxism) and gagging. Modern hypnodontics is not primarily concerned with producing a surgical hypoanalgesia except in rare instances in which chemical anesthesia cannot be tolerated. The dentist is concerned with making visits to his or her office more tolerable and less threatening.

In obstetrics and surgery, hypnosis has been used to induce relaxation and relieve anxiety and to reduce the amount of anesthetic necessary. Occasionally, no anesthetic is required. This is sometimes desirable in childbirth, when the mother prefers to be aware of the birth process, or in surgical procedures in which a minimum of anesthetic is desirable.

Hypnosis has also been utilized by the police in what has been termed “investigative hypnosis.” Witnesses to crimes are interrogated in an effort to improve their memory retrieval.

Hypnosis has also been helpful in increasing athletic effectiveness. It has been utilized by both team and individual athletes to increase self-confidence and other factors such as self-image and the ability to assess the competition. Hypnosis thus applied to maximize performance in sports has been very effective, but the principles involved are essentially no different from those applied to other areas of living, such as increasing the efficiency of performance in the home, school, or workplace.

Since the mid-1970s, there has been much research into immune system functioning. Studies of the effects of stress on immune system functioning are lending scientific support to anecdotal reports that indicate that hypnosis may be effective in altering the disease process in cancer and AIDS patients. Researchers have found that unless treatments for these illnesses are based on the premise that the mind, body, and emotions are all striving to achieve health, physical intervention alone (radiation or chemotherapy, for example) will not be effective.

Perspective and Prospects

Although medical hypnosis is considered to have had its beginnings with the Viennese physician Franz Anton Mesmer (1733–1815) in the latter half of the eighteenth century, hypnosis, or something very similar to it, has been practiced by religious and other healers in various ways for centuries in most cultures. The earliest evidence of its existence was found among shamans, who were also referred to as “witch doctors,” “medicine men,” or “healers.”

In preparation for healing, a shaman adhered to certain practices that allowed his or her powers of concentration to be heightened. Placing himself or herself in isolation, the shaman began a descent into the “lower world.” This often meant visualizing an opening in the earth and a journey downward into that opening. The journey was frequently accompanied by rhythmic drumming, chanting, singing, or dancing. The monotonous rhythm and constancy allowed the shaman’s subconscious mind to become strongly focused, seek out the sick spirit of the patient, make it whole, and bring it back to the patient. The shaman actually engaged in a powerful process of visualization and suggestion during which the shaman willed the sick person to be healed.

In the eighteenth century, Mesmer recognized this ancient healing phenomenon and incorporated it into a theory of animal magnetism. Mesmer believed that a “cosmic fluid” could be stored in inanimate objects, such as magnets, and transferred to patients to cure them of illness.

Mesmer dressed flamboyantly. His consulting rooms were dimly lit and hung with mirrors, and he kept soft music playing in the background. The doctor’s patients sat in a circle around a vat that contained such elements as powdered glass or iron filings. Then the patients grasped iron rods that were immersed in the vat and were believed to transmit a curing force.

Mesmer’s first success was with a twenty-nine-year-old woman who suffered from a convulsive malady, a condition commonly called a “nervous disorder.” Her symptoms consisted of blood rushing to her head and a tremendous pain in her ears and head. This state was followed by delirium, rage, vomiting, and fainting. During one of the woman’s attacks, Mesmer applied three magnets to the patient’s stomach and legs while she concentrated on the positive effects of the “cosmic fluid.” In a short time, her symptoms subsided. When her symptoms resurfaced the next day, Mesmer gave her another treatment and achieved similar results. Mesmer believed that the “cosmic fluid,” stimulated by the magnets, was directed through his patient’s body. Her energy flow was restored, and as a result, she regained her health.

Eventually, Mesmer discarded the magnets. He began to regard himself as a magnet through which a fluid life force could be conducted and then transmitted to others as a healing force. This is what Mesmer described as “animal magnetism.”

Despite the fact that no scientific evidence supported the existence of Mesmer’s “cosmic fluids” or the concept of “animal magnetism,” he had a tremendous rate of success. Thousands flocked to him for treatment. The only explanation for his success is that his patients were literally “mesmerized” into the belief and expectation that they would be cured. “Mesmerism” was a forerunner of the concept of hypnotic suggestion.

During this same period, a new slant on Mesmer’s theories was introduced by one of his disciples, the marquis de Puységur. He believed that the “cosmic fluid” was not magnetic but electric. This electric fluid was generated in all living things—in plants as well as animals. Puységur used the natural environment to fill his patients with the healing electric fluid that was expected to end their suffering. His clinic was held outdoors, where the sick were received under an elm tree in the center of the village green. Puységur believed that the tree had an innate healing power and that the force would travel through the trunk and branches to cords that he hung from the tree. At the foot of the tree, patients sat in a circle on stone benches with the cords wrapped around the diseased parts of their bodies. They were “connected” to one another when they touched their thumbs together, which made it possible for the “fluid” to circulate from person to person and to heal.

During this activity, Puységur noticed a strange phenomenon. Some of the patients entered a state of deep sleep as a result of being mesmerized. In this state, the patient could still communicate and be lucid and responsive to the suggestions of the mesmerist. The marquis had discovered the hypnotic trance but had not identified it as such.

In the mid-nineteenth century, the hypnotic trance was used to relieve pain. An eminent London physician, John Elliotson (1791–1868), reported 1,834 surgical operations performed painlessly. In India, a Scottish surgeon named James Esdaile (1808–59) performed many major operations, such as amputation of limbs, using mesmerism (or, as he called it, “magnetic sleep”) as the sole anesthetic. One procedure involved conditioning the patient weeks prior to surgery. This was accomplished by inducing a trance state in the patient and offering posthypnotic suggestions to numb the part of the body on which the surgery was to be performed. In a second method, the hypnotist attended to the patient in the operating room, inducing a trance state and suggesting disassociation from any pain. It was possible for the patient to be completely lucid during this state and also to be oblivious to pain, as though completely anesthetized.

Mesmerism continued to provoke new theories and uses. During the late nineteenth century, an English physician, James Braid (1795–1860), gave mesmerism a scientific explanation. He believed mesmerism to be a “nervous sleep” and coined the word “hypnosis,” which was derived from the Greek word hypnos, meaning sleep. Braid showed that hypnotized subjects are often abnormally susceptible to impressions on the senses and that much of the subjects’ behavior was caused by suggestions made verbally.

Soon, other theories began to emerge. Jean Martin Charcot (1825–93), a neurologist who taught in Paris, explained hypnosis as a state of hysteria and categorized it as an abnormal neurological activity.

In France, Auguste Ambroise Leibeault (1823–1904) and Hippolyte Bernheim (1837–1919) were the first to regard hypnosis as a normal phenomenon. They asserted that expectation is the most important factor in the induction of hypnosis, that increased suggestibility is its essential symptom, and that the hypnotist works on the patient by means of mental influences.

As hypnosis began to receive serious study and be explained rationally, it began to gain acceptance in the scientific community. It was no longer relegated to the realm of the bizarre.

Sigmund Freud became interested in hypnosis at this same time and visited Leibeault and Bernheim’s clinic to learn their induction techniques. As Freud observed patients enter a hypnotic state, he began to recognize the existence of the unconscious. Although he was not the first to make this observation, he was the first to recognize the unconscious as a major source of psychopathology. Early in his research, however, Freud rejected hypnosis as the tool to unlock repressed memories, favoring instead his technique of free association and dream interpretation. With the rise of psychoanalysis in the first half of the twentieth century, hypnosis declined in popularity.

Then, a reversal occurred. During World War II, interest in hypnosis was regenerated by the need for short-term therapy (often applied in cases of “battle fatigue”) and by the combination of hypnosis and more traditional analytic approaches. Mind-control and “brainwashing” techniques that surfaced during the Korean War again sparked interest in the power of suggestion, especially when the subject was under duress. In the late 1960s and early 1970s, with the rise of public interest in alternative forms of mental health (such as Transcendental Meditation, biofeedback, and yoga) and ways of coping with the stress of the modern world, hypnosis experienced a rebirth. Researchers found new and potent uses for it in therapy, and the trance state began to be recognized as a highly effective tool for modifying behavior and for healing.


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