Hidden Depths: The Story of Hypnosis (45 page)

These are respects in which Freud personally found hypnosis unsatisfactory, but he also sometimes stated more objective, clinical grounds. First, he found that suggestion fails to produce lasting therapeutic results: ‘I gave up the suggestion technique, and with it hypnosis, so early in my practice because I despaired of making suggestion powerful and enduring enough to effect permanent cures. In all severe cases I saw the suggestions which had been applied crumble away again, and then the disease or some substitute for it returned.' Others too have complained about the erratic nature of hypnosis: it is not always possible to induce trance in a patient or to guarantee that a cure induced by post-hypnotic suggestion will last. Freud's most famous pupil, Carl Gustav Jung (1875–1961), also gave it up before long, although it had been a book by Janet on hypnotism which got him interested in psychology in the first place. But, as he recalls in his famous autobiography
Memories, Dreams, Reflections
, as well as finding it unreliable, Jung was frightened when one of his subjects proved difficult to wake up, and he found it too authoritarian (as indeed it was, as invariably practised in those days); he was more interested in listening to his patients than in telling them what to do.

Freud's second clinical reason for giving up hypnosis was that it can obscure what he called the patient's ‘resistance'. This needs a word or two of explanation. Resistance is when, in the course of analysis, a patient determinedly ignores certain memories and ideas. Having noticed how regularly this happens, Freud was led to further insights into repression. He saw that its function was to weaken emotionally powerful ideas, in order to protect the patient from the painful experience of the emotion. However, despite the fact that hypnosis had led Janet to discover the fact that patients tend to suppress certain memories, Freud came to believe that hypnosis masked the patient's resistance.

Third, he found there was too great a contrast between the grim truth of patients' problems and the rosy-tinted suggestions he felt as a hypnotherapist that he had to make.

Before discussing these objections, another Freudian concept which needs mentioning is that of ‘transference'. This is the evocation by the analyst from the patient, during analysis, of an intense emotional attitude, which could be either sexual, affectionate or hostile in form, and the attachment of these feelings to the analyst. The whole theory of psychoanalysis, according to Freud, was no more than an attempt to explain the two observed facts of resistance and transference, which occur whenever an attempt is made to trace the symptoms of a neurosis back to their source in the past. Freud's mature thoughts on hypnosis led him to define it in terms of transference, as a kind of loving relationship between patient and therapist. It was precisely this that led, at a theoretical level, to his dissatisfaction with hypnotism as a therapeutic technique. It carried with it the danger that its benefits would end as soon as the patient's emotional ties to the therapist ended. Nevertheless, despite his abandonment of hypnosis as a therapeutic technique, throughout his life Freud continued to recommend it as a short-cut procedure in some cases, especially to enable the benefits of analysis to reach the more general lay public.

The first point to notice about these objections by Freud is that he seems to be assuming that hypnosis is the
only
method a therapist would use. On that basis, few psychotherapists would disagree with him – but why make that assumption? Hypnosis may be just one weapon in the therapist's arsenal, in which case Freud's reasons for abandoning it evaporate into mist. Moreover, and more specifically, research since Freud's time has undermined all his reasons for being wary of hypnosis: suggestion
can
bring about permanent cures, and it has proved a very useful tool in the exploration of mental forces, including resistance. It is also worth remembering that the patient can become very attuned to the hypnotist's mind; if Freud was uncertain about hypnosis, that may have communicated itself to the patient, locking Freud into a self-fulfilling cycle within which hypnosis was not as productive as it might have been. The only conclusion possible, considering both Freud's personal and impersonal reasons for abandoning hypnosis, is that he simply wasn't very good at it: his
interests lay elsewhere, so he never explored its potential to its fullest.

Freud's dissatisfaction with hypnosis is not unrelated to the fact that he was employing a nineteenth-century authoritarian approach: ‘I held my finger before her and called out “Sleep!”, and she sank down with an expression of stuporification and confusion.' Elsewhere, in his 1921 book
Group Psychology and the Analysis of the Ego
, he talks about the ‘humble subjection' of the subject before the operator, winning compliance from him, but not consensual compliance. Because he was looking for this abject compliance, and because hypnosis fails reliably to produce it, his dissatisfaction increased. But it is precisely when the hypnotist takes on this role, denying the creative participation of the patient in the remedial process, that hypnotherapy is least effective. As a simple example, if a subject is told in a commanding fashion that his body temperature will fall, he may experience the subjective sensations of cold, but nothing objective happens; but if he is allowed to participate – perhaps to create a fantasy of rolling in a snow drift – his body temperature may actually fall.

Freud's reasons for abandoning hypnosis were limited both by his own personality and by the kind of hypnosis that was practised at the time. They do not constitute good reasons for contemporary Freudians and post-Freudians to despise hypnosis and condemn it to the margins of psychotherapeutic techniques. Some Freudians do now combine hypnosis and psychoanalysis as ‘hypnoanalysis', having also found that Freud's original objections are no longer valid. One of the earliest to do so was Lewis Wolberg, whose 1945 book
Hypnoanalysis
is still worth reading. The basic point is this: hypnoanalysis is essentially the same process as psychoanalysis, but hypnosis enables aspects of the unconscious to be expressed and seen by both patient and analyst more quickly than in regular analysis.

There was a sharp decline in interest in hypnotism, in the circles of experimental psychology, at any rate, after the First World War. Freud must take some of the credit (or blame) for this, as his psychoanalytic methods and theories swept the world clear of everything that had gone before it, and seemed to herald not just a fresh start for psychology, but a fresh impetus for the whole of humanity. Many of the lay hypnotherapists who continued working felt rather out of harmony with the prevalent Freudianism anyway, because whereas Freud stressed the negative aspects of the unconscious, such therapists tended to get their patients to heal themselves out of the great positive power of the unconscious. They held that the patient wanted to be cured, and had the internal resources to cure himself, and that their job was simply to bring their patients to the point where they could harness those resources.

There were other factors causing the decline of hypnosis as well. In the first place, there was the great influence of those, like Bernheim in his later years, who said that there was nothing special about hypnosis – that most of the so-called phenomena of hypnosis, and many of its therapeutic benefits, could be gained through suggestion alone, in subjects who are in a state of ordinary wakefulness and have not been put through a hypnotic induction procedure. The obvious response, that even if this is the case, still the state of hypnotic somnambulism is
more
effective than the waking state, since it is characterized by an increase in suggestibility, was not enough to convince pragmatic working clinicians: suggestion could be used on a wakeful or at least hypnoidal patient without all the bother of trying to see whether she was susceptible to hypnotism, and without all the induction procedures.

In the second place, the supposed dangers of hypnotism were much in the air. The focus in the 1900s and 1910s was less on the question of its possible use for criminal ends, as on whether hypnosis weakened the will of the subject, and made her a kind of slave to
the hypnotist. Despite the obvious falsity of this notion, and the fact that any attempt to prove it met with swift rebuttal, the idea did attain a certain popular credence, as in the fictional version of hypnotism in which the hypnotist intones: ‘You are my slave. You will obey my every whim.'

And finally, these were the years when, while Freud was king in the offices of American psychotherapists, behaviourism ruled the roost in the universities. Behaviourism reduces everything to stimulus and response: a poem is merely a patterned set of words, designed to achieve the goal of a lover's kiss; the mind is no more than a series of programmed reactions. There was no room here for hypnosis, which seemed to show that the mind had a will of its own.

The period between about 1915 and 1945 saw flat years for hypnotism, both in the popular domain and in the groves of academe. There was little knowledge or practice of hypnosis, and even less research into it. Janet lived long enough to see this decline, and he remarked in a book published in 1919 that hypnotism was almost defunct, but would rise again. Once more, it was up to the stage hypnotists to fill the breach – to act as a kind of underground stream until hypnosis should be revived and put to more constructive uses. An index of the decline is that when Robert Lindner wrote his famous 1944 book
Rebel Without a Cause
(on which the 1955 film of the same name starring James Dean and Natalie Wood was loosely based) he felt the need to write an introductory chapter defending hypnoanalysis both in itself and as a tool in the particular case he was writing about – the treatment of a young psychopath.

The only real shaft of light in the otherwise dull climate was Clark Hull's 1933 book
Hypnosis and Suggestibility
. The importance of this book is that it applied recent advances in experimental psychology to hypnosis, and so made hypnosis a suitable study for laboratory experiments. Previously research had been carried out almost entirely by therapists on their patients, with all the consequent dangers of bias. I mean, what conclusions might Charcot have reached about hypnosis if he had not made hysterical women his subjects? Or if he had used a proper control group against which to check his results? But from Hull's time onward it has become more usual to make your research subjects normal people – if the university students who constitute the main pool of subjects can be said to be normal! Hull also gave impetus to the later desire among many psychologists to deny the existence of a special state which may be called the
‘hypnotic trance'; he was in favour of trying to explain hypnotic phenomena by reference to more normal psychological mechanisms, especially suggestibility.

Since about 1960, however, there has been such academic interest in hypnosis that Gauld considers it a ‘golden age'. The USA is the main centre of research, helped by a number of thriving societies and their journals, and by good university departments and research laboratories. Especially worth mentioning are the Society for Clinical and Experimental Hypnosis, the American Society of Clinical Hypnosis, the International Society of Hypnosis, and Division 30 of the American Psychological Association. Since gold is a heavy metal, the epithet is appropriate in view of the weight of the material written on the subject, mostly designed to bewilder the unwary researcher. Hundreds of learned papers and books have been published, many to support, basically, one of two different views. The proponents of one view proclaim that a hypnotized person is in a distinct state, an altered state of consciousness, while the others stridently assert that there is no such thing as hypnosis, no special state, and that the word ought properly to be put in scare quotes to indicate this.

The debate is important, and not least because the debunking view is commonly reflected at a popular level: ‘Hypnosis? A load of superstitious mumbo-jumbo, isn't it?' But before we get into the details of this controversy, I must introduce a man, once a student of Clark Hull, who fits neither in time nor in character into the neat parcels a non-fiction writer likes to use to order his book.

In his time, Milton Erickson (1901–80) was the most respected and famous hypnotherapist in the world, and since his death a great many books and articles have been written about him, his techniques and their applications. His influence has been enormous, and in some quarters there has been a tendency almost to deify the man. But he had to battle against the odds to win his reputation. In his
late teens he was badly affected by polio, so that he was more or less a cripple, and by the end of his life he was confined to a wheelchair. In his middle age, he was so mistrusted for his apparently miraculous cures and his unorthodox methods that the American Medical Association tried to revoke his medical licence. This was the paranoid 1950s and they simply didn't understand him.

Erickson was a superlative therapist with or without hypnosis. He liked to be extremely flexible in his approach – whether he chose to use hypnosis, whether the sessions were long or short, whether they met at his office in Phoenix, Arizona, or somewhere else. He could be aggressive or gentle, direct or indirect. Once, in a highly dramatic instance, he cured a man who had been paralysed for a whole year after a stroke, unable to move or speak, by insulting him so drastically that he forced him to respond, first verbally, and then by getting up and leaving the room so that he didn't have to hear any more. This is typical of his therapeutic methods, in the sense that he would never leave a symptom alone, but would bring about a change in it – a change of intensity, of frequency, of location, anything. He used to say that it takes a lot less effort to channel a river in a new direction than it does to dam it up.

He was often unconventional; for instance, he cured a young man of terrible acne by having his mother take him on holiday and ensure that there were no mirrors around for the whole two weeks. Where hypnotic induction is concerned, he found that imaginary devices were more effective than real objects. Rather than getting his clients to stare into a real crystal ball, for instance, he got them to stare into an imaginary one. This is because it was always Erickson's purpose to get to his client's unconscious, which he believed contained the resources and knowledge needed for a cure. Harnessing the imagination is a quick way to the unconscious.

Believing that everyone is hypnotizable, and that a failure to induce hypnosis reflects the inabilities of the hypnotist rather than those of the subject, he adapted his techniques of induction to the patient, rather than following a limited repertoire. And it is indeed arguable that those researchers who claim that a certain percentage of people are not hypnotizable have used more or less the same technique on their experimental subjects, rather than drawing on the
kind of flexibility for which Erickson was famous. Erickson's colleague Ernest Rossi would add that a hypnotist should be sensitive to his subject's natural rhythms of energy and rest, and that his chances of hypnotizing the subject are greatly increased if he times the induction to coincide with the resting period of her cycle.

Erickson was such a skilled hypnotist that he raises again the question whether it is possible to hypnotize a person against her wishes. But his life and practices cannot give us an answer. He was seeing patients who knew that he was a hypnotist, and so they had, at some level, already given their assent. I still maintain what I said in an earlier chapter, that a person cannot be hypnotized against his will, and cannot be made to do things he would not otherwise do.

A lot of Erickson's techniques involved the distraction of the subject's conscious attention and barriers. So, for instance, the ‘myfriend-John' method had Erickson imagining that there was another person, John, in the room with him and his subject. Erickson would describe what a good hypnotic subject John was, and go through all the phases and stages of a fictional past trance induction with John – until the subject himself or herself was in a trance. Whereas this and most other techniques used nowadays involve the use of words, Erickson could put someone into a trance merely by means of actions. In fact, he defined hypnosis as a cooperative experience dependent on the communication of ideas by whatever means are available. Rapport with the subject – with the subject's unconscious especially – was crucial. So on a couple of occasions, as a demonstration, he hypnotized subjects who spoke no English simply by pantomiming the gradual induction of a trance.

One of his well-known methods is the ‘confusional technique': by confusing tenses and bringing in non sequiturs and small talk, a sense of frustration builds up in the subject until he is actually looking forward to clear suggestions to which he can respond; at that point Erickson would introduce a clear suggestion for entering or deepening the trance. The patient escapes from confusion into trance. A similar method for engaging the subject's curiosity was his use of pauses and hesitation to build up the subject's expectancy and undermine his alertness. A non-verbal parallel is the interrupted handshake: by holding out his hand as if for a handshake, but then
stopping and doing various ambiguous things with his hand instead, he was able to induce arm catalepsy in a subject, who thereby showed that he had gone into a trance.

Nobody appreciated the importance of trust better than Erickson. One of his most common induction techniques was simply to begin by telling his client truths, as a method of induction. ‘You are sitting comfortably in the armchair' – quite right, nothing to resist there. ‘Your hands are resting on the arms of the chair' – undeniable, Dr Erickson. ‘You can feel your feet on the floor and the weight of your seat in the chair'. And so on. After half a dozen of these truths, Erickson would reach the point of saying: ‘Your eyelids are feeling heavy' or whatever, and the patient was prepared to accept it because Erickson had won his trust by telling him truths for so long. Not only had he won credibility; by pointing out things which were true but unconscious until he drew attention to them, Erickson had accustomed the client to altering his state of consciousness, and so prepared him for the shift into hypnotic trance. Erickson understood that winning trust is more than half the battle; if you trust a person in authority, his suggestions carry weight. One of the main nonverbal methods Erickson used for gaining trust was subtly mirroring his patients' body language, rate of breathing, intonations and so on.

Erickson could win over even a patient who was determined to resist, either out of stubbornness or anxiety. In fact, this was his specialty, and he devised a number of techniques (called ‘techniques of utilization', because they make use of whatever behaviour the subject presents to the operator) to overcome resistance without appearing to do so. In all his therapeutic strategies, he was concerned to intervene, but to do so subtly, in order to enhance the healing with empowerment of the autonomy of the individual. He was directive and manipulative in dealing with his patients' symptoms, but left the choice of how to live after those symptoms were resolved entirely up to each individual.

Here is a description of one of Erickson's most famous coups, involving a typical technique to overcome resistance, the ‘double bind':

A resistant subject once said to Milton Erickson, ‘You may be able to hypnotize other people but you can't hypnotize me!'
Erickson invited the subject to the lecture platform, asked him to sit down, and then said to him, ‘I want you to stay awake, wider and wider awake, wider and wider awake.' The subject promptly went into a deep trance. The subject was faced with a double-level message: ‘Come up here and go into a trance,' and ‘Stay awake.' He knew that if he followed Erickson's suggestions, he would go into a trance. Therefore he was determined not to follow his suggestions. Yet if he refused to follow the suggestion to stay awake, he would go into a trance.

Erickson got his way, but it was a self-chosen act; he undermined the patient's resistance while preserving his autonomy.

He also developed a simple but powerful way of overcoming resistance to therapeutic suggestions. He would intersperse therapeutic suggestions between suggestions for trance maintenance. In this way, before the subject could begin to contradict the therapeutic suggestion, his attention was diverted on to maintaining the trance. Likewise, if Erickson saw that for therapeutic purposes it was important for a patient to do something he would not want to do, he would not ask him directly to do that thing. Instead, he asked him to do something else, something which the patient would be even more reluctant to do. In that way, the patient would freely choose to do the thing which Erickson wanted him to do in the first place.

If you go to a hypnotist today, she will talk a lot – gently, persuasively. It was Erickson above all who perfected this conversational technique of hypnotic induction. Erickson's use of language was probably natural and instinctive, but by now it has been extensively analysed. It would take too long to cover all the nuances, but here are a few samples of the art of conversation according to Erickson and his followers.

Certain key words occur time and again – ‘and', for instance. By connecting even logically unconnected statements with ‘and', Erickson could take a client deeper into the hypnotic state. ‘You are sitting on the chair
and
your arms are resting on the arms of the chair [two undeniable truths]
and
your eyelids are getting heavy
and
you are feeling sleepy
and
now you can hardly keep them open…' Another technique is to ask questions that require the answer ‘yes', so that
the patient assents to the process of hypnotic induction. ‘It's nice to be calm and relaxed, isn't it?' ‘You'd like all your problems to dissolve, wouldn't you?' Assent and trust are, to repeat, critical. Questions are often more powerful than direct statements anyway, because they seem to leave the decision up to the client: ‘Can you tell me what it's like to go into deep sleep?' encourages sleep without seeming to be a command. ‘Did that surprise you?' opens the patient's mind to surprise and the possibility of change. Disguised questions may also be used: ‘I don't know how deeply you want to go into hypnosis.' Commands might also be hidden, embedded in a seemingly innocuous statement: ‘I don't want you to
become more relaxed
as you listen to my voice.' By subtly emphasizing the italicized words with a change of tone or pitch, they become a suggestion, aimed at the unconscious.

Once this degree of trust and lethargy have been reached, the Ericksonian hypnotist might introduce some forcing words – ‘must', ‘impossible', ‘can'. ‘As you go deeper and deeper into the trance state, you will not be able to open your eyes. No matter how hard you try, it is impossible to open your eyes. You are so relaxed, so very relaxed [repetition is another good Ericksonian technique], that you find you must sleep … You cannot raise your arms…' A similar technique is to use attention-grabbing words such as ‘now' and ‘obviously', perhaps with a slightly more emphatic tone of voice: ‘Now you are feeling sleepy; you obviously know how to relax; you can begin to go deeper into hypnosis now.' John Grinder and Richard Bandler explain the thinking behind whether the Ericksonian therapist uses forcing words or something rather vaguer: