Hypnosis

Hypnosis 101

Hypnosis is a human condition involving focused attention, reduced peripheral awareness, and an enhanced capacity to respond to suggestion.

There are competing theories explaining hypnosis and related phenomena. Altered state theories see hypnosis as an altered state of mind or trance, marked by a level of awareness different from the ordinary state of consciousness. In contrast, nonstate theories see hypnosis as, variously, a type of placebo effect,  a redefinition of an interaction with a therapist[7] or form of imaginative role enactment.

During hypnosis, a person is said to have heightened focus and concentration. Hypnotized subjects are said to show an increased response to suggestions.  Hypnosis usually begins with a hypnotic induction involving a series of preliminary instructions and suggestion. The use of hypnotism for therapeutic purposes is referred to as “hypnotherapy“, while its use as a form of entertainment for an audience is known as “stage hypnosis“. Stage hypnosis is often performed by mentalists practicing the art form of mentalism.

Hypnosis for pain management “is likely to decrease acute and chronic pain in most individuals.”  The use of hypnosis in other contexts, such as a form of therapy to retrieve and integrate early trauma, is controversial within the medical or psychological mainstream. Research indicates that hypnotizing an individual may aid the formation of false memories,  and that hypnosis “does not help people recall events more accurately.”

Characteristics

A person in a state of hypnosis has focused attention, and has increased suggestibility.

The hypnotized individual appears to heed only the communications of the hypnotist and typically responds in an uncritical, automatic fashion while ignoring all aspects of the environment other than those pointed out by the hypnotist. In a hypnotic state an individual tends to see, feel, smell, and otherwise perceive in accordance with the hypnotist’s suggestions, even though these suggestions may be in apparent contradiction to the actual stimuli present in the environment. The effects of hypnosis are not limited to sensory change; even the subject’s memory and awareness of self may be altered by suggestion, and the effects of the suggestions may be extended (posthypnotically) into the subject’s subsequent waking activity.

It could be said that hypnotic suggestion is explicitly intended to make use of the placebo effect. For example, in 1994, Irving Kirsch characterised hypnosis as a “nondeceptive placebo”, i.e., a method that openly makes use of suggestion and employs methods to amplify its effects.

In Trance on Trial, a 1989 text directed at the legal profession, legal scholar Alan W. Scheflin and psychologist Jerrold Lee Shapiro observed that the “deeper” the hypnotism, the more likely a particular characteristic is to appear, and the greater extent to which it is manifested. Scheflin and Shapiro identified 20 separate characteristics that hypnotized subjects might display:  “dissociation“; “detachment”; “suggestibility“, “ideosensory activity”;  “catalepsy“; “ideomotor responsiveness”;  “age regression”; “revivification“; “hypermnesia“; “[automatic or suggested] amnesia”; “posthypnotic responses“; “hypnotic analgesia and anesthesia“; “glove anesthesia”; “somnambulism”; “automatic writing”; “time distortion”; “release of inhibitions”; “change in capacity for volitional activity”; “trance logic”;  and “effortless imagination”.

Hypnotic induction

Hypnosis is normally preceded by a “hypnotic induction” technique. Traditionally, this was interpreted as a method of putting the subject into a “hypnotic trance”; however, subsequent “nonstate” theorists have viewed it differently, seeing it as a means of heightening client expectation, defining their role, focusing attention, etc. There are several different induction techniques. One of the most influential methods was Braid’s “eye-fixation” technique, also known as “Braidism”. Many variations of the eye-fixation approach exist, including the induction used in the Stanford Hypnotic Susceptibility Scale (SHSS), the most widely used research tool in the field of hypnotism.  Braid’s original description of his induction is as follows:

Take any bright object (e.g. a lancet case) between the thumb and fore and middle fingers of the left hand; hold it from about eight to fifteen inches from the eyes, at such position above the forehead as may be necessary to produce the greatest possible strain upon the eyes and eyelids, and enable the patient to maintain a steady fixed stare at the object.

The patient must be made to understand that he is to keep the eyes steadily fixed on the object, and the mind riveted on the idea of that one object. It will be observed, that owing to the consensual adjustment of the eyes, the pupils will be at first contracted: They will shortly begin to dilate, and, after they have done so to a considerable extent, and have assumed a wavy motion, if the fore and middle fingers of the right hand, extended and a little separated, are carried from the object toward the eyes, most probably the eyelids will close involuntarily, with a vibratory motion. If this is not the case, or the patient allows the eyeballs to move, desire him to begin anew, giving him to understand that he is to allow the eyelids to close when the fingers are again carried towards the eyes, but that the eyeballs must be kept fixed, in the same position, and the mind riveted to the one idea of the object held above the eyes. In general, it will be found, that the eyelids close with a vibratory motion, or become spasmodically closed.

Braid later acknowledged that the hypnotic induction technique was not necessary in every case, and subsequent researchers have generally found that on average it contributes less than previously expected to the effect of hypnotic suggestions. Variations and alternatives to the original hypnotic induction techniques were subsequently developed. However, this method is still considered authoritative.  In 1941, Robert White wrote: “It can be safely stated that nine out of ten hypnotic techniques call for reclining posture, muscular relaxation, and optical fixation followed by eye closure.”

Suggestion

When James Braid first described hypnotism, he did not use the term “suggestion” but referred instead to the act of focusing the conscious mind of the subject upon a single dominant idea. Braid’s main therapeutic strategy involved stimulating or reducing physiological functioning in different regions of the body. In his later works, however, Braid placed increasing emphasis upon the use of a variety of different verbal and non-verbal forms of suggestion, including the use of “waking suggestion” and self-hypnosis. Subsequently, Hippolyte Bernheim shifted the emphasis from the physical state of hypnosis on to the psychological process of verbal suggestion:

I define hypnotism as the induction of a peculiar psychical [i.e., mental] condition which increases the susceptibility to suggestion. Often, it is true, the [hypnotic] sleep that may be induced facilitates suggestion, but it is not the necessary preliminary. It is suggestion that rules hypnotism.

Bernheim’s conception of the primacy of verbal suggestion in hypnotism dominated the subject throughout the 20th century, leading some authorities to declare him the father of modern hypnotism.

Contemporary hypnotism uses a variety of suggestion forms including direct verbal suggestions, “indirect” verbal suggestions such as requests or insinuations, metaphors and other rhetorical figures of speech, and non-verbal suggestion in the form of mental imagery, voice tonality, and physical manipulation. A distinction is commonly made between suggestions delivered “permissively” and those delivered in a more “authoritarian” manner. Harvard hypnotherapist Deirdre Barrett writes that most modern research suggestions are designed to bring about immediate responses, whereas hypnotherapeutic suggestions are usually post-hypnotic ones that are intended to trigger responses affecting behaviour for periods ranging from days to a lifetime in duration. The hypnotherapeutic ones are often repeated in multiple sessions before they achieve peak effectiveness.

Conscious and unconscious mind

Some hypnotists view suggestion as a form of communication that is directed primarily to the subject’s conscious mind,  whereas others view it as a means of communicating with the “unconscious” or “subconscious” mind.  These concepts were introduced into hypnotism at the end of the 19th century by Sigmund Freud and Pierre Janet. Sigmund Freud’s psychoanalytic theory describes conscious thoughts as being at the surface of the mind and unconscious processes as being deeper in the mind.  Braid, Bernheim, and other Victorian pioneers of hypnotism did not refer to the unconscious mind but saw hypnotic suggestions as being addressed to the subject’s conscious mind. Indeed, Braid actually defines hypnotism as focused (conscious) attention upon a dominant idea (or suggestion). Different views regarding the nature of the mind have led to different conceptions of suggestion. Hypnotists who believe that responses are mediated primarily by an “unconscious mind”, like Milton Erickson, make use of indirect suggestions such as metaphors or stories whose intended meaning may be concealed from the subject’s conscious mind. The concept of subliminal suggestion depends upon this view of the mind. By contrast, hypnotists who believe that responses to suggestion are primarily mediated by the conscious mind, such as Theodore Barber and Nicholas Spanos, have tended to make more use of direct verbal suggestions and instructions.

Ideo-dynamic reflex

The first neuropsychological theory of hypnotic suggestion was introduced early by James Braid who adopted his friend and colleague William Carpenter’s theory of the ideo-motor reflex response to account for the phenomenon of hypnotism. Carpenter had observed from close examination of everyday experience that, under certain circumstances, the mere idea of a muscular movement could be sufficient to produce a reflexive, or automatic, contraction or movement of the muscles involved, albeit in a very small degree. Braid extended Carpenter’s theory to encompass the observation that a wide variety of bodily responses besides muscular movement can be thus affected, for example, the idea of sucking a lemon can automatically stimulate salivation, a secretory response. Braid, therefore, adopted the term “ideo-dynamic”, meaning “by the power of an idea”, to explain a broad range of “psycho-physiological” (mind–body) phenomena. Braid coined the term “mono-ideodynamic” to refer to the theory that hypnotism operates by concentrating attention on a single idea in order to amplify the ideo-dynamic reflex response. Variations of the basic ideo-motor, or ideo-dynamic, theory of suggestion have continued to exercise considerable influence over subsequent theories of hypnosis, including those of Clark L. HullHans Eysenck, and Ernest Rossi.  In Victorian psychology the word “idea” encompasses any mental representation, including mental imagery, memories, etc.

Susceptibility

Braid made a rough distinction between different stages of hypnosis, which he termed the first and second conscious stage of hypnotism;  he later replaced this with a distinction between “sub-hypnotic”, “full hypnotic”, and “hypnotic coma” stages.  Jean-Martin Charcot made a similar distinction between stages which he named somnambulism, lethargy, and catalepsy. However, Ambroise-Auguste Liébeault and Hippolyte Bernheim introduced more complex hypnotic “depth” scales based on a combination of behavioural, physiological, and subjective responses, some of which were due to direct suggestion and some of which were not. In the first few decades of the 20th century, these early clinical “depth” scales were superseded by more sophisticated “hypnotic susceptibility” scales based on experimental research. The most influential were the Davis–Husband and Friedlander–Sarbin scales developed in the 1930s. André Weitzenhoffer and Ernest R. Hilgard developed the Stanford Scale of Hypnotic Susceptibility in 1959, consisting of 12 suggestion test items following a standardised hypnotic eye-fixation induction script, and this has become one of the most widely referenced research tools in the field of hypnosis. Soon after, in 1962, Ronald Shor and Emily Carota Orne developed a similar group scale called the Harvard Group Scale of Hypnotic Susceptibility (HGSHS).

Whereas the older “depth scales” tried to infer the level of “hypnotic trance” from supposed observable signs such as spontaneous amnesia, most subsequent scales have measured the degree of observed or self-evaluated responsiveness to specific suggestion tests such as direct suggestions of arm rigidity (catalepsy). The Stanford, Harvard, HIP, and most other susceptibility scales convert numbers into an assessment of a person’s susceptibility as “high”, “medium”, or “low”. Approximately 80% of the population are medium, 10% are high, and 10% are low. There is some controversy as to whether this is distributed on a “normal” bell-shaped curve or whether it is bi-modal with a small “blip” of people at the high end.[50] Hypnotizability Scores are highly stable over a person’s lifetime. Research by Deirdre Barrett has found that there are two distinct types of highly susceptible subjects, which she terms fantasizers and dissociaters. Fantasizers score high on absorption scales, find it easy to block out real-world stimuli without hypnosis, spend much time daydreaming, report imaginary companions as a child, and grew up with parents who encouraged imaginary play. Dissociaters often have a history of childhood abuse or other trauma, learned to escape into numbness, and to forget unpleasant events. Their association to “daydreaming” was often going blank rather than creating vividly recalled fantasies. Both score equally high on formal scales of hypnotic susceptibility.

Individuals with dissociative identity disorder have the highest hypnotisability of any clinical group, followed by those with posttraumatic stress disorder.

History

Precursors

People have been entering into hypnotic-type trances for thousands of years. In many cultures and religions, it was regarded as a form of meditation. Modern day hypnosis, however, started in the late 18th century and was made popular by Franz Mesmer, a German physician who became known as the father of ‘modern hypnotism’. In fact, hypnosis used to be known as ‘Mesmerism’ as it was named after Mesmer.

Mesmer held the opinion that hypnosis was a sort of mystical force that flows from the hypnotist to the person being hypnotized, but his theory was dismissed by critics who asserted that there is no magical element to hypnotism.

Before long, hypnotism started finding its way into the world of modern medicine. The use of hypnotism in the medical field was made popular by surgeons and physicians like Elliotson and James Esdaile and researchers like James Braid who helped to reveal the biological and physical benefits of hypnotism.  According to his writings, Braid began to hear reports concerning various Oriental meditative practices soon after the release of his first publication on hypnotism, Neurypnology (1843). He first discussed some of these oriental practices in a series of articles entitled Magic, Mesmerism, Hypnotism, etc., Historically & Physiologically Considered. He drew analogies between his own practice of hypnotism and various forms of Hindu yoga meditation and other ancient spiritual practices, especially those involving voluntary burial and apparent human hibernation. Braid’s interest in these practices stems from his studies of the Dabistān-i Mazāhib, the “School of Religions”, an ancient Persian text describing a wide variety of Oriental religious rituals, beliefs, and practices.

Last May [1843], a gentleman residing in Edinburgh, personally unknown to me, who had long resided in India, favored me with a letter expressing his approbation of the views which I had published on the nature and causes of hypnotic and mesmeric phenomena. In corroboration of my views, he referred to what he had previously witnessed in oriental regions, and recommended me to look into the Dabistan, a book lately published, for additional proof to the same effect. On much recommendation I immediately sent for a copy of the Dabistan, in which I found many statements corroborative of the fact, that the eastern saints are all self-hypnotisers, adopting means essentially the same as those which I had recommended for similar purposes.

Although he rejected the transcendental/metaphysical interpretation given to these phenomena outright, Braid accepted that these accounts of Oriental practices supported his view that the effects of hypnotism could be produced in solitude, without the presence of any other person (as he had already proved to his own satisfaction with the experiments he had conducted in November 1841); and he saw correlations between many of the “metaphysical” Oriental practices and his own “rational” neuro-hypnotism, and totally rejected all of the fluid theories and magnetic practices of the mesmerists. As he later wrote:

In as much as patients can throw themselves into the nervous sleep, and manifest all the usual phenomena of Mesmerism, through their own unaided efforts, as I have so repeatedly proved by causing them to maintain a steady fixed gaze at any point, concentrating their whole mental energies on the idea of the object looked at; or that the same may arise by the patient looking at the point of his own finger, or as the Magi of Persia and Yogi of India have practised for the last 2,400 years, for religious purposes, throwing themselves into their ecstatic trances by each maintaining a steady fixed gaze at the tip of his own nose; it is obvious that there is no need for an exoteric influence to produce the phenomena of Mesmerism. […] The great object in all these processes is to induce a habit of abstraction or concentration of attention, in which the subject is entirely absorbed with one idea, or train of ideas, whilst he is unconscious of, or indifferently conscious to, every other object, purpose, or action.

Avicenna

Avicenna (980–1037), a Persian physician, documented the characteristics of the “trance” (Hypnotic Trance) state in 1027. At that time, hypnosis as a medical treatment was seldom used; the German doctor Franz Mesmer reintroduced it in the 18th century.

Franz Mesmer

Franz Mesmer (1734–1815) believed that there is a magnetic force or “fluid” called “animal magnetism” within the universe that influences the health of the human body. He experimented with magnets to affect this field in order to produce healing. By around 1774, he had concluded that the same effect could be created by passing the hands in front of the subject’s body, later referred to as making “Mesmeric passes”. The word “mesmerize”, formed from the last name of Franz Mesmer, was intentionally used to separate practitioners of mesmerism from the various “fluid” and “magnetic” theories included within the label “magnetism”.

In 1784, at the request of King Louis XVI, a Board of Inquiry started to investigate whether animal magnetism existed. Among the board members were founding father of modern chemistry Antoine LavoisierBenjamin Franklin, and an expert in pain control, Joseph-Ignace Guillotin. They investigated the practices of a disaffected student of Mesmer, one Charles d’Eslon (1750–1786), and though they concluded that Mesmer’s results were valid, their placebo-controlled experiments using d’Eslon’s methods convinced them that mesmerism was most likely due to belief and imagination rather than to an invisible energy (“animal magnetism”) transmitted from the body of the mesmerist.

In writing the majority opinion, Franklin said: “This fellow Mesmer is not flowing anything from his hands that I can see. Therefore, this mesmerism must be a fraud.” Mesmer left Paris and went back to Vienna to practise mesmerism.

James Braid

Following the French committee’s findings, Dugald Stewart, an influential academic philosopher of the “Scottish School of Common Sense“, encouraged physicians in his Elements of the Philosophy of the Human Mind (1818)  to salvage elements of Mesmerism by replacing the supernatural theory of “animal magnetism” with a new interpretation based upon “common sense” laws of physiology and psychology. Braid quotes the following passage from Stewart:

It appears to me, that the general conclusions established by Mesmer’s practice, with respect to the physical effects of the principle of imagination (more particularly in cases where they co-operated together), are incomparably more curious than if he had actually demonstrated the existence of his boasted science [of “animal magnetism”]: nor can I see any good reason why a physician, who admits the efficacy of the moral [i.e., psychological] agents employed by Mesmer, should, in the exercise of his profession, scruple to copy whatever processes are necessary for subjecting them to his command, any more than that he should hesitate about employing a new physical agent, such as electricity or galvanism.

In Braid’s day, the Scottish School of Common Sense provided the dominant theories of academic psychology, and Braid refers to other philosophers within this tradition throughout his writings. Braid therefore revised the theory and practice of Mesmerism and developed his own method of hypnotism as a more rational and common sense alternative.

It may here be requisite for me to explain, that by the term Hypnotism, or Nervous Sleep, which frequently occurs in the following pages, I mean a peculiar condition of the nervous system, into which it may be thrown by artificial contrivance, and which differs, in several respects, from common sleep or the waking condition. I do not allege that this condition is induced through the transmission of a magnetic or occult influence from my body into that of my patients; nor do I profess, by my processes, to produce the higher [i.e., supernatural] phenomena of the Mesmerists. My pretensions are of a much more humble character, and are all consistent with generally admitted principles in physiological and psychological science. Hypnotism might therefore not inaptly be designated, Rational Mesmerism, in contra-distinction to the Transcendental Mesmerism of the Mesmerists.

Despite briefly toying with the name “rational Mesmerism”, Braid ultimately chose to emphasise the unique aspects of his approach, carrying out informal experiments throughout his career in order to refute practices that invoked supernatural forces and demonstrating instead the role of ordinary physiological and psychological processes such as suggestion and focused attention in producing the observed effects.

Braid worked very closely with his friend and ally the eminent physiologist Professor William Benjamin Carpenter, an early neuro-psychologist who introduced the “ideo-motor reflex” theory of suggestion. Carpenter had observed instances of expectation and imagination apparently influencing involuntary muscle movement. A classic example of the ideo-motor principle in action is the so-called “Chevreul pendulum” (named after Michel Eugène Chevreul). Chevreul claimed that divinatory pendulae were made to swing by unconscious muscle movements brought about by focused concentration alone.

Braid soon assimilated Carpenter’s observations into his own theory, realising that the effect of focusing attention was to enhance the ideo-motor reflex response. Braid extended Carpenter’s theory to encompass the influence of the mind upon the body more generally, beyond the muscular system, and therefore referred to the “ideo-dynamic” response and coined the term “psycho-physiology” to refer to the study of general mind/body interaction.

In his later works, Braid reserved the term “hypnotism” for cases in which subjects entered a state of amnesia resembling sleep. For other cases, he spoke of a “mono-ideodynamic” principle to emphasise that the eye-fixation induction technique worked by narrowing the subject’s attention to a single idea or train of thought (“monoideism”), which amplified the effect of the consequent “dominant idea” upon the subject’s body by means of the ideo-dynamic principle.


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Hypnosis

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