1. What is hypnosis? Does hypnosis exist? How and why did the concept of hypnosis evolve?

1.1. Hypnosis arose out of an operator-assisted altered state induction model.

"In the author's experience there can be developed in a person a special state of awareness that is termed, for the sake of convenience and historical considerations, hypnosis or trance.

"This state is characterized by the subject's ability to retain the same capacities possessed in the waking state and to manifest these capacities in ways possibly, though not neccessarily, dissimiliar to the usual actions of conscious awareness.

"Trance permits the operator to evoke in a controlled manner the same mental mechanisms that are operative spontaneously in everyday life."

The late master clinical hypnotherapist, Milton Erickson

Modern theories of hypnosis have drastically changed the way we view this subject. Because the most common popular view of hypnosis is as an altered state of consciousness of some kind (i.e. trance), this will be used as a departure point to explain how hypnosis (1) has been viewed since the 18th century when it was first systematically studied and mass interest first arose, and (2) has been deconstructed as a unitary concept by some modern scientific theorists of the subject.

The most popular traditional view of hypnosis is a sleep-like state induced by a procedure of some kind by an operator and in which certain special behaviors seem to result; particularly extreme responsiveness to suggestions made during the hypnotic process, including physiological responses, and where anomalies of the experience of volition and memory are consistently reported by subjects.

Therapeutic interest in hypnosis results mostly from the fact that response to suggestions apparently includes some increased capacity to access functions which are normally considered outside of conscious control and memory. Popular interest in hypnosis stems from the therapeutic interest, and because of the long associations of hypnosis with spiritual and secular traditions of self-improvement, self-insight, or self-fulfillment. There has also been interest in hypnotic methods in various areas of medical and scientific research.

A truly balanced and comprehensive study of hypnotic phenomena would probably have to include its relationship with neuroscience, cognitive science, models of subjective experience, models of creative thinking processes, theories of psychosocial development, theories of human language and symbol processing, and various philosophical stances that are still of interest today (such as moral and ethical considerations of various conceptions of the human will and responsibility for actions, and such as the legal status of testimony revealed with the help of hypnosis).

Based on a list developed by Zeig in 1988, the following frameworks can be identified:

  1. Janet (and later Hilgard) thought of hypnosis as dissociation, meaning splitting off of aspects of consciousness from each other in some way, with one seemingly being dominant at any given time, but others able to influence behavior at the same time, or to replace the dominant aspect. This is related to certain theories of how Multiple Personality Disorder develops. Traditional theories of spiritualist trances have often involved some notion of dissociation as well.
  2. Sarbin and Coe describe hypnosis in terms of role playing, acting out the expected role of a hypnotized subject in response to the relationship with the hypnotist. Spanos is also a leading proponent of this view.
  3. T.X. Barber defined hypnosis in terms of non-hypnotic behavioral parameters, such as task motivation and the labelling of a situations as 'hypnotic.'
  4. Weitzenhoffer first considered hypnosis a state of enhanced suggestibility, but later a form of interpersonal influence via suggestion.
  5. Gil and Brenmand described hypnosis in psychoanalytic terms as regression in service of the ego. Freud, though not highly important in the history of hypnosis, had great interest in it initially, and concluded, once he deviated from Charcot's neurological theries, that it represented an eroticized dependent relationship between hypnotist and subject.
  6. Edmonston assessed hypnosis as relaxation (based on a Pavlovian theory of sleep as partial cortical inhibition). This is linked historically to various physiological theories of how 'conversion' works in fervent religious activities, such as that of psychiatrist William Sargant.
  7. Spiegel and Spiegel implied that hypnosis was a distinct biological capacity.
  8. Milton Erickson held that hypnosis was a unique, inner-directed altered state of functioning.
  9. Various followers of Erickson's lead have proposed that hypnosis is best defined subjectively and phenomenologically as a process between individuals, and a communications strategy for the achievement of therapeutic goals, with or without recourse to 'trance.'
  10. We should also reserve at least one category for the numerous esoteric, non-scientific, or archaic models which view hypnosis in general as a condition of subtle unidentified or unobservable bodily fluids, a unique electromagnetic field phenomenon, or the result of supernatural influences or contacts, or contact with alternate realms of existence (in a non-metaphorical sense).

1.2. The cultural origins of the concept of hypnosis

The creation of a distinct concept of hypnosis owes its existence mostly to a charismatic 18th century healer named Franz Anton Mesmer (1734-1815).

Mesmer had a deep interest in Paracelsan astrological principles, and the supposed direct influence of heavenly bodies on human health, by means of what were believed by Mesmer and others to be measureable physical forces (as opposed to the subtle forces of later occult doctrines interpreting Mesmerism).

Mesmer first applied magnets to patient's bodies in elaborate theatrical rituals that often resulted in expected spasmodic muscular contractions and collapse, and often the cure of various kinds of illness. Mesmer favored the rationalist views of his time, taking on terms like gravitation and magnetism to originally describe his theories of his healing work, and how the subtle fluids within the body could be influenced by him.

Mesmerism caught on widely, attracting followers to many spiritualist, religious, and scientific variations of mesmerism, as well as to 'mesmerism' as a dramatic form of entertainment for its own sake ('stage hypnosis').

It was highly influential in a number of popular movements, some of which are still very popular today.

The clearest transition between Mesmer's animal magnetism and modern therapeutic hypnosis was represented by Manchester surgeon James Braid, who coined the term hypnosis (from previous use by French researchers) in 1843. The term refers to Hypnos, the Greek god of sleep, because most forms of mesmerism at that time involved the production of an apparently sleep-like condition.

Braid, as many scientists and physicians before and after him, recognized in hypnosis certain legitimate psychological phenomena of interest, but requiring much more systematic investigation to understand. Mesmer had come to believe that it was not physical forces via magnets but he himself that was producing the cures he produced. Others not long after Mesmer soon began to suspect that the human imagination played a much larger role in the process than did any physical forces or capacities of the mesmerist. This was important, because mesmerism went through a number of periods of great disrepute due to associations with occultism and various kinds of blatant charlatanism.

A split arose between those interested in hypnosis as a subject of scientific investigation and as an adjunct to medical treatment, and those who considered it a tool for personal or spiritual fulfillment, or for esoteric investigations of religious or 'magical' nature. Faith healing, mind cure, and Christian Science were all heavily influenced by hypnosis, and derived much of their impetus in the late 19th century from the reputation of Mesmer and later mesmerists. Various followers of the highly influential Theosophical Society and of the Hermetic Order of the Golden Dawn magical fraternity found great affinity for the magnetic theories of mesmerism, which they often interpreted in a semi-metaphorical way rather than as literal electromagnetism.

In the early scientific study, Braid at first thought that hypnotic induction would yield a unique condition of the nervous system that was linked somehow to certain cures by suggestion. He later rejected this, and other physiological explanations of hypnosis, and emphasized "mental" factors almost exclusively. The theory of neural inhibition has never been completely rejected as applicable, however, though often considered insufficient by itself. Ivan Pavlov later greatly expanded on the neural inhibition theory in his concept of the physiology of sleep (as a progressive cortical inhibition, which turns out to be fairly accurate - in general if not in detail).

This neurological explanation of hypnosis was strongly rejected by Charcot, who believed that the best hypnotic subjects were 'hysterics,' and that hypnosis was therefore a manifestation of what was then considered the mental illness of hysteria. His belief turned out to be wrong, and his view of hysteria as a distinct mental illness as well, and his psychopathological view was rejected by the end of the 19th century. Two legacies of the neurological pathological theories of Charcot and the so-called "Paris school" of hypnosis that have endured are cortical inhibition theory and the later development of dissociation theory, though neither one serves as a complete theory of hypnosis on its own.

In the early 20th century, the foundation for most hypnotic theory was laid by the members of the so-called "Nancy school" of hypnosis (such as Liebeault and Bernheim) who elaborated a theory of hypnotic suggestion based on ideomotor action.

This theory had eventually replaced not only the early neuropathological view, but also Braid's early psychological theory, "monoideism," the theory that unconflicted ideas automatically lead to actions. Ideomotor action theory says that ideas suggested by the hypnotist lead automatically to actions, which are then experienced by the subject as unwilled. Ideomotor action is another example of a useful but incomplete model of hypnotic responding. The Nancy school was perhaps most notable in their deemphasis of hypnotic ritual and their strong emphasis on suggestion as a mundane though useful psychological process.

Sigmund Freud had originally studied under Charcot and had a deep interest in hypnosis for much of his life. In 1889, he shifted from Charcot's view to that of the Nancy school's emphasis on suggestion rather than hysteria, believing that patients often remembered repressed memories in a beneficial process under hypnosis. Freud was reportedly a very poor hypnotist, being limited to a simple authoritarian style of induction, and in 1896, he rejected hypnotic induction ritual as unneccessary and too likely to foster unwanted amorous advances by patients ('transference,' and the theory of hypnosis as an eroticized dependent relationship). Freud replaced the hypnotic procedure with simply placing his hand on the subject's forehead to help establish what he believed was the proper social relationship of doctor in dominance over patient.

What qualified acceptance of hypnosis in medicine that we have today is largely due to the efforts of pioneers in the experimental study of hypnosis, starting in the 1920's and 30's. Foremost early researchers were Clark Hull and his then student, Milton Erickson. Hull's 1933 discussion of scientific research into hypnosis (Hypnosis and Suggestibility) is still considered a classic.

Erickson later came to disagree with Hull on the important issue of fundamental approach, stressing the complex subjective inner processes operating in hypnosis, rather than the measureable correlates and standardized procedures promoted by Hull. Hull went on to make important contributions in learning theory, while Erickson went on to become the name most closely associated with clinical hypnosis today.

Milton Erickson died in 1980, but left a legacy of often zealous followers, a number of important contributions to the field, and several offshoot schools of applied psychology based on his core principles of indirect strategic therapy and suggestion, and based on hypothetical unconscious processes and indirect forms of human communication. Examples include Jay Haley's strategic model of therapy, the MRI Interactional model, the Erickson-Rossi hypnotic theories, Neurolinguistic Programming (NLP), and a number of later frameworks such as that of Lankton (1983) and Gilligan (1987). The 'Ericksonian' models deliberately blur the traditional distinction between hypnosis and other forms of therapy, and share this basic idea with the 'skeptical' view of hypnosis, which we will consider in the next section.

In addition to Erickson and Hull, modern scientific research into hypnosis is often associated with a period of intense experimental research in the late 1950's and early 1960's by notables such as J.P Sutcliffe, T.X. Barber, M.T. Orne, E.R. Hilgard, R.E. Shor, and T.R. Sarbin. The work of these researchers had been particularly influential on the current scientific view of hypnosis, especially as viewed in medicine.

1.3. The scientific deconstruction of hypnosis

The 'skeptical' modern conception of hypnosis was pioneered by Theodore Sarbin in 1950, as a social-psychological alternative to the views that (1) a single distinctive neurological and psychological state underlies all hypnotic phenomena (Paris school), and (2) that suggestions somehow mechanically produce responses without the participation of the subject (Nancy school).

Sarbin instead saw hypnosis as a social encounter, in which the hypnotist and subject play out pre-determined roles. Sarbin's role theory was influenced by R.W. White, who in his "A Preface to a Theory of Hypnotism," in The Journal of Abnormal and Social Psychology in 1941 discussed various serious limitations of both the ideomotor action and dissociation theories. He pointed out that the responses of hypnotic subjects are too complex to consider them as automatic results of suggestions, that subjects often creatively and actively improvise a performance based on their interpretation of suggestions. Thus for just about the first time posing hypnotic behavior as creative and goal directed, rather than mechanical.

In addition to the use of social role theory to replace mechanistic theories of hypnotic response, 'skeptical' theories of hypnosis often refer to empirical research to illustrate that hypnotic subjects do not in fact transcend the behavioral capabilities of non-hypnotic subjects. The empirical objective approach to hypnosis, effectively introduced to the study of hypnosis by Clark Hull in the 1930's, involves an implicit mistrust of verbal reports of subjective experience, and the use of quantifiable response indicies.

Key questions remaining in the modern study of hypnosis within active role theory and other non-special-state frameworks include: (1) whether a hypnotic procedure is neccessary (first studied by T.X. Barber in the late 1960's and in the 1970's); (2) in what specific ways active cognitive functioning might be altered in hypnotic contexts (studied by Orne and by Shor starting in the late 1950's), and (3) the degree to which dissociation of aspects of consciousness actually occurs in each of the various hypnotic phenomena (Janet, Prince, later E.R. Hilgard).

All this leads to the crucial theoretical distinction of whether it is meaningful and useful to postulate such a thing as unconscious goal directed activity, and the global psychological questions of what exactly are the nature of volition, compliance, belief, and imagination.

Graham Wagstaff of the University of Liverpool expresses the non-special-state view of hypnosis:

"... studies of hypnosis have drawn our attention to a number of mundane yet fascinating phenomena that do beg for explanations, even though, as I have pointed out, a theory of hypnosis per se doesn't need to provide such explanations.

"For example, we need to know how a placebo works; how suggestions can affect dermatological responses; how imagination can produce the experience of a dry mouth, an itch, or nausea; how coping strategies can affect the experience of pain; and so on.

"However, I would consider these phenomena to be best investigated without any reference to 'hypnosis' because placing them in a context called 'hypnosis' probably serves only to confound them with extra demand characteristics."

At another point, Wagstaff acknowledges the practical consideration:

"... for some patients there may actually be unique advantages to defining a context as 'hypnosis,' for example, 'hypnotic amnesia,' if only pretended is a potentially useful device not only for saving face but also for providing a legitimate context for controlling the vivid remembering of traumatic experience."

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