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Placebos and Hypnosis

Psychosomatic medicine tends to be rather gloomy: psychosocial factors cause stress which causes illness. Fewer studies look at things the other way around and consider how the brain can influence the body for health. But one of the most fascinating ways in which it can clearly be seen that the mind affects the body for good is through the use of placebos. Positive expectations create health.

In 1625 the Prince of Orange was besieged inside the city of Breda by the Spanish general Ambrogio Spinola. The siege dragged on for months, and conditions inside the city grew desperate. As if he didn't have problems enough, the Dutch soldiers were being ravaged by scurvy, and there was little or no fresh fruit and vegetables available to supply the required vitamin C. Nor was there any medicine. And so the Prince devised a cunning plan. With the connivance of the city doctors, he prepared some phials containing a decoction of camomile, wormwood and camphor. This ‘medicine' was no earthly use at all in itself, but the Prince surrounded it with a story of how it had been procured with great danger from the mysterious East, and how it was so effective that just two or three drops in a gallon of water would clear the disease up. And so it did.

The placebo effect was well known in medieval and Renaissance times, before the mind and the body were separated by Descartes; scholars used it to explain the efficacy of charms and talismans. In the nineteenth century, John Elliotson, the protagonist of an earlier chapter, who as a materialist is often accused of ignoring the power of suggestion, occasionally prescribed pills made of bread to his patients, telling them they were opium or calomel. I am reminded of how in the UK some time ago – perhaps in the 1970s – the manufacturers of the analgesic Anadin came up with a slogan for their product: ‘Nothing works faster than Anadin.' Before long the muttered response from many on hearing this line was: ‘So take nothing.'

This halfway decent joke has a serious underlying point. To see
the point we need to know something about placebos. Placebo means, literally, ‘I will please' in Latin – that is, it pleases a patient, rather than offering her anything effective. A placebo is any medical treatment that is not specific for the disorder being treated; thus a placebo may be a totally inert substance, or it may be something that is specific, but not for the ailment in question. As I've said, the effect has been known throughout human history, but serious research on the subject began only in the last century. To researchers' amazement, they found that dummy treatments not only cured or relieved a vast range of ailments, but also produced toxic side effects and the appropriate changes in mood and behaviour. A drug designed to induce nausea cured upset stomachs when the patients were told it would. Evidence is building, to the confusion of conventional medicine, that even some forms of placebo surgery may be effective.

The conclusion to be drawn from this is that we all possess enormous capacities for mental self-healing, if only we could find some way to unlock that potential. In fact, if you buy into the myth of scientific progress, and believe that almost all medicines up to about 1900 were chemically ineffective, it follows that you believe that almost all cures brought about by these medicines were the result of the placebo effect. Patients got better in spite of the treatment they received, not because of it. It has even been said that

The great lesson of medical history is that the placebo has always been the norm of medical practice, that it was only occasionally and at great intervals that anything really serviceable, such as the cure of scurvy by fresh fruits, was introduced into medical practice … [The skill of doctors in the past] was a skill in dealing with the emotions of men. They themselves were the therapeutic agents by which cures were effected.

A certain wave pattern is also noticeable in the history of medicine: a drug comes into fashion, works well for a while, but then ceases to be so effective. Along comes the next drug to take its place. As early as 1833 the French physician Armand Trousseau was urging his colleagues to hurry and use new drugs while they worked. This too suggests that psychological factors, such as belief in the medicine's potency, are as important as pharmacological ones
in curing disease. From this it follows that
all
cures have a placebo component.

In order for the placebo to work, the patient, obviously, must be unaware of the deceit. (There was an amusing sketch on the British television comedy show
Smack the Pony
in April 2000 in which an inept doctor told her savvy patient that she was prescribing a placebo.) But more abstruse conditions have also been found to help. For instance, a coloured medicine works better than a colourless one, and a flavoured one (especially if bitter) better than a tasteless one. These conditions seem to satisfy patients' expectations about medicines. Also, injection works better than oral intake, perhaps because of the presence of the doctor or nurse, and capsules work better than tablets. Different-coloured capsules or tablets are assumed to have different properties: lavender for a hallucinogenic, yellow or orange for a mood manipulator, white for analgesics, grey or dark red for sedatives. It also helps if the person administering the ‘drug' is female, presumably due to a perception that a woman is more sympathetic. The larger the group of people taking the medicine (fake or real), the better its chances of success, because of the power of suggestion: ‘If it works for them, it must work for me.' If the doctor himself doesn't know that the ‘drug' is a placebo, the effectiveness of the ‘drug' goes up even further: we subtly pick up on his confidence or its lack. If an authority figure says something like ‘Our tests show that this should work well for you', the effectiveness of the placebo improves.

If all this smacks of deception and quackery, the other side of the coin is that placebos already have a proven track record for physiological ailments such as angina, arthritis, asthma, high blood pressure, headaches, migraine, constipation, impotence, hay fever, cold sores and warts, and for psychological or behavioural conditions such as anxiety, depression, insomnia and obesity. If placebos are lies, they are lies that heal, and you could argue on both financial and other grounds that doctors should be giving their patients placebos for these ailments rather than active drugs. Or at least that they should once they had identified a patient as a placebo reactor. It so far defies explanation, but not everyone is a placebo reactor. Estimates vary and the evidence from experiments is ambiguous, but possibly as
many as half the population (with intelligence, gender, age, race, social class and ethnic or religious background being irrelevant) are not reactors. In terms of the brain's functioning, it looks as though placebo reactors are operating with the right, holistic part of the brain, rather than with the left, logical side. If there is a reactor profile, you could say that they tend to be acquiescent and, at the time of presenting for therapy, anxious about their illness. Negatively, one could say that they were gullible; positively, that they have faith, whereas the rest are sceptics. And so we are back to the topic of faith healing, already discussed in
Chapters 3
and
5
. It seems to me that we can all be placebo reactors in the right circumstances, and the inability to be one is not a constant throughout one's life.

If the public think of hypnosis as a magical therapy, then might it not work as a kind of placebo itself? Some people do indeed think that hypnosis is a kind of placebo. These are the people whose views I summarized in the last chapter – the doubters, the non-state theorists, who believe that there is no such thing as hypnosis. For if their views are right, there should be no cures specifically attributable to hypnosis: all the cures attributed to hypnosis should be explained by other factors, such as the effect of mere relaxation. So it worries them that hypnosis does seem to be inexplicably effective in things like the treatment of chronic pain, warts and asthma. They therefore suppose ‘that when hypnotic induction appears to “add” something to therapy, it is a placebo effect; i.e. what it “adds” is a ritual that culminates in some patients
believing
that the treatments will be effective'. However, experiments have shown that whereas hypnosis might act as a placebo for low hypnotizables, its effect on reducing pain in high hypnotizables is far higher than one might expect from a placebo. The same set of hypnotizable subjects in an experiment were hypnotized for relief from pain and given a placebo that they believed to be an analgesic drug; they gained more relief from hypnosis than from the placebo, whereas non-hypnotizable subjects gained roughly the same amount of relief from the hypnotic suggestion to relax as they did from the placebo. It would be rash to generalize either way: hypnosis is not entirely a placebo, nor are its effects entirely independent of the placebo effect. Every successful cure has a placebo component: that is one of the important lessons
we have been taught by placebo research. Hence the effectiveness of hypnosis has a placebo component – but it is not entirely a placebo. And so we return to the message of this chapter: hypnosis works.

I am often asked, ‘Can hypnosis be used for (fill-in-the-blank)?' My response is to promote the idea that hypnosis can be used as a tool in the treatment of
any
human condition in which a person's attitude is a factor. Wherever there is involvement of the person's mind in a particular problem, which is
everywhere
to one degree or another as far as I can tell, there is some potential gain to be made through the application of hypnotic patterns.

12
Mind Control

In the 1967 song ‘The Red Telephone', performed by the West Coast psychedelic band Love on their seminal album
Forever Changes
, songwriter Arthur Lee uses the concept of hypnosis as a social metaphor. The hypnotism that disempowers us in the song is meant to be a product of society as a whole. Society has many ways of lulling us to sleep, entrancing us and closing our eyes against the things it doesn't want us to see. Taken to an extreme this is the paranoid view that the TV is a tool of the establishment, whose malignant purpose it is to control our minds.

Oddly, at this point the substrate of popular usage coincides with the most refined studies of the academics. The non-state theorists whose ideas we looked at in
Chapter 10
also license the extended use of the term ‘hypnotism'. In denying that there is such a thing, so that it should always be surrounded by scare quotes, they often digress into the claim that we are always or invariably in some kind of trance anyway. When our sensory awareness is restricted and focused on the TV, we are in a TV trance; when we listen to one conversation in a crowded room to the exclusion of the rest, we are in a party trance, which has perhaps been deepened by a glass or three of wine; when we play solitaire on the computer, we are in a solitaire trance. State theorists, on the other hand, restrict the use of the term to a specific psychological state, and to that state alone. They acknowledge that all trance states share certain features, but they also point to the differences.

By this stage of the book my position is clear, since I have declared myself in
Chapter 10
on the side of the state theorists, and have already on one or two occasions taken to task the people I call ‘hypnotic imperialists', who use the term ‘hypnosis' to refer loosely to almost any kind of trance whatsoever. Of course selective attention is going on all the while – in fact, our sensory apparatus is
designed to filter, not to take in without discrimination – but that does not mean that we are hypnotized. Nevertheless, in this chapter I will consider a number of topics which are more or less closely related to hypnosis, but which all centre around the issue of whether we can be persuaded against our wills, and whether hypnosis might be of help to someone who wanted to try to persuade us against our wills. In America in the 1950s and 1960s, certain government agencies certainly thought it could be, and they poured money into often farcical research to try to create a super-spy. But before turning to this embarrassing episode of American history, we can look at some less extraordinary cases of attempted mind control.

Consensus Trance and Advertising

In his 1986 book
Waking Up: Overcoming the Obstacles to Human Potential
California psychologist Charles Tart coined the phrase ‘consensus trance', and claimed that this trance state is our normal state of consciousness, since we are all hypnotized by our cultures. This book by Tart is a largely successful attempt to update the ideas of the influential Russian mystic George Ivanovitch Gurdjieff (1866–1949), who trenchantly declared that we are each ‘a rather uninteresting example of an animated automaton'. The point of both Gurdjieff's practical teaching, and indeed arguably of all mystical teaching, is to wake us up out of this state of quasi-sleep. An automaton has no free will, no real choice, and cannot really be said to do anything. It doesn't act, but just reacts to incoming stimuli. In this state we are less than fully human.

The idea of cultural hypnotism – of the hypnoidal unreality of so-called real life – is well conveyed in Lars von Trier's 1991 film
Europa
. The film begins with a hypnotic voice saying: ‘When you hear my voice, you will go deeper into Europa. I will count to ten, and at ten you will be in Europa.' A standard relaxation technique follows, in which parts of the body are progressively relaxed, and this is accompanied by the monotonous sight of a railway track
speeding endlessly on under one's gaze. The monotonous voice recurs at several points in the film. ‘Europa' turns out to be Germany just after the Second World War – a time of treachery and uncertainty, ripe for the accusation of unreality which von Trier uses the framing device of hypnotism to achieve. The use of black-and-white photography, except at moments where some intensity of emotion is reached by the hero of the film, adds to the sense of unreality.

While I am wholly sympathetic to Gurdjieff's ideas and to the pressing need to wake up, I am not at all sympathetic to Tart's saying that we are in a permanent hypnotic trance. If we are in a hypnotic trance now, then what are we in when someone hypnotizes us? Is that state no different from our everyday state? Tart himself would be the first to acknowledge that the hypnotic trance is different, and he points out some of the differences, including the temporary nature of the hypnotic trance, and the fact that it is entered into voluntarily, whereas consensus trance is more or less forced on us as we become attuned to our culture during our formative years. Nevertheless, he thinks that there are enough similarities to warrant his calling the consensus trance a form of hypnosis.

Leaving this controversy aside, since if pursued it may well turn out to be no more than a quibble about words, I want to focus on the central point of Tart's describing us as in a permanent trance. This is that we have been and constantly are in a passive state of being manipulated by the authorities around us. We feel in control of our lives, but in many respects we aren't. Newspapers tell us what to think; canned laughter on TV prompts our laughter. Radio announcers appeal to the lowest common denominator and encourage us to belong to the herd. Propaganda of all kinds bombards us, especially in times of war: someone once said that in war the first victim was truth. Nowadays politicians employ spin doctors and make extensive use of TV and other media to present themselves and their policies in a favourable light. States and Churches use various forms of indoctrination to perpetuate what seems to them at any given time to be the correct set of views. One of the main ways in which we lack control is our subservience to advertising. Countless tests have shown that advertising works, and in America alone $200 billion a year is spent on it. When we walk into a shop we are
not quite free agents: we buy the products the advertisers and packagers want us to buy.

What all these techniques – propaganda, advertising and so on – have in common is that they appeal to our emotions. We like to think we are rational creatures who weigh up issues and come to a considered opinion. Advertisers are well aware that this is an illusion. Louis Cheskin, the head of a Chicago research firm in the 1950s which carried out studies for merchandisers, said:

Motivation research is the type of research that seeks to learn what motivates people in making choices. It employs techniques designed to reach the unconscious or subconscious mind because preferences generally are determined by factors of which the individual is not conscious. Actually in the buying situation the consumer generally acts emotionally and compulsively, unconsciously reacting to the images and designs which in the subconscious are associated with the product.

What Cheskin is saying is that advertising is not just about remembering the brand name. An advertiser would put nothing more than a brand name on a poster or screen, without any imagery or other peripheral effects, only if he was trying to appeal to an educated sector of society who would say to themselves: ‘We don't need all that hype.' This pleasant feeling of self-importance would then become associated with the product. So even this kind of advertising uses the same technique of appealing to our unconscious motivations. We want to feel sophisticated and witty, and we are led to believe that drinking a certain brand of coffee will help us to do so. This same brand of coffee is advertised with background music dating from the halcyon days of our youth. And so on: it is obvious how it goes, but its obviousness does not stop it from being a potent force, just as a lightly hypnotized subject is in the ambiguous position of seeing through the operator's suggestions, but going along with them anyway.

Advertisers well know how to tweak our subconscious motivations, our vulnerabilities and hidden insecurities, to get us to buy their clients' products. Even children are regarded as ‘consumer trainees', and therefore as legitimate targets of advertising campaigns. They have to aim for the subconscious, because surveys show time
and again that we don't know our conscious minds, or even that we lie. For instance, a brewery asked consumers which of their products they preferred, the light beer or the regular beer. The reply was overwhelming support for the light beer – despite the fact that the brewery sold nine times as much of the regular beer. In another survey, people were asked whether they liked kippers, and most people said that they didn't – but then it turned out that over a third of the people in the survey had never tasted a kipper.

A practical reason why manufacturers from the 1950s onwards had to find more powerful ways of advertising was simply that they had the means, with increasing automation, of massive overproduction. They therefore had to generate what euphemistically came to be called ‘psychological obsolescence', which is to say that they had to persuade the public that last year's product was not what they really wanted, as compared with this year's, whether or not last year's was in fact ready for the dustbin. But we are not so stupid. At a conscious level we would protest this Machiavellian manoeuvre. So advertisers bypass our conscious thinking.

Another reason was increasing standardization. Advertisers have to try to make their product stand out, because otherwise it wouldn't. In the old days, when every shopkeeper made his own goods or foodstuffs, there were presumably noticeable differences in quality and character. Nowadays, there is hardly any difference between buying the product of one manufacturer or another, except presentation and packaging. And so advertisers have to work hard to make such a difference in our minds. That the difference doesn't exist in reality is clear. Blindfold people and ask them to tell which is the brand of cigarettes or soft drink they always ask for in the shops, and they fail miserably. But if the shopkeeper is out of their particular brand, they get upset. Clearly, advertising has touched some emotional point inside them. Modern marketers such as Scott Bed-bury talk of ‘emotional leverage': ‘Nike, for example, is leveraging the deep emotional connection that people have with sports and fitness. With Starbucks, we see how coffee has woven itself into the fabric of people's lives, and that's our opportunity for emotional leverage.'

Repetition has been a feature of advertisements since their inception in a recognizably modern form in the nineteenth century.
It is a proven way of bypassing our critical faculties and appealing to the emotions. There are other methods, such as an appeal to authority (remember the men in white coats looking serious in a toothpaste laboratory?), or making us feel that we are not in with the in-crowd if we don't drink a particular drink, but repetition is simple and effective. But at a deeper level all advertising – probably all propaganda – follows the same threefold pattern. First, you have to gain someone's interest (‘Wow! She's gorgeous!'). Then you have to make an emotional appeal (‘I'd like to belong to the kind of group where such gorgeous women hang out'). Finally, you have to offer some way for the victim to resolve the conflict (‘If I drink that brand of cocktail, I'll belong to the group').

From every point of view, then, it looks as though advertisers employ subliminal manipulation. They do not target our conscious minds, but our unconscious minds.

Subliminal Messaging

The most notorious attempt by advertisers to manipulate an audience was the use of subliminal messaging. Here is how bestselling author Vance Packard blew the lid off that particular game:

The London
Sunday Times
front-paged a report in mid-1956 that certain United States advertisers were experimenting with ‘subthreshold effects' in seeking to insinuate sales messages to people past their conscious guard. It cited the case of a cinema in New Jersey that it said was flashing ice-cream ads onto the screen during regular showings of film. These flashes of message were split-second, too short for people in the audience to recognize them consciously but still long enough to be absorbed unconsciously.

A result, it reported, was a clear and otherwise unaccountable boost in ice-cream sales. ‘Subthreshold effects, both in vision and sound, have been known for some years to experimental psychologists,' the paper explained. It speculated that
political indoctrination might be possible without the subject being conscious of any influence being brought to bear on him.

It should be added that this was a carefully controlled experiment. On some evenings, the subliminal messages were not flashed on the screen, and on those evenings ice-cream sales did not go up. At much the same time as these experiments in advertising, it was reported that
Playboy
magazine had been conducting its own experiments in
subliminal messaging, by printing the word ‘sex' too small for the eye consciously to detect, to stimulate sales.

Not all subliminal messaging is as provocative as the Gilbey's Gin advertisement with which Wilson Bryan Key begins his book
Subliminal Seduction
, which provided, on analysis, about a dozen clues suggesting relaxation after a sex orgy, starting with the word ‘sex' half visible on ice cubes in the glass of gin. Nor is all of it as obvious, even when analysed and pointed out; in fact, you might think that Key and his like at times read too much into things, like the story of the man who tells a suggestive joke, and when his audience sniggers accuses them of having the dirty minds, not him. Admen themselves have had a laugh at Key's expense: Absolut Vodka's 1990 campaign displayed a glass of vodka on the rocks with the word ‘Absolut' on the ice cubes. But there is no doubt in my mind that advertisers do employ subliminal techniques – that for all the scandal about subliminal advertising that followed the publication of Packard's book
The Hidden Persuaders
in 1957, we are still constantly being bombarded by such messages, especially by advertisers.

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