WHAT IS HYPNOSIS?
Like really – what actually is it? (Ed: A 17-minute read)
Amy says it is a form of socially accepted and acceptable male mental illness; and she’s not referring to the people being hypnotised… she’s referring to the people doing the hypnotising.
Practically every hypnotherapist has a website these days, and almost all of them seem to feature a ‘what is hypnosis?’ page, and almost all of the ones I’ve seen talk a complete and utter load of bollocks. Really, they do. It’s not their fault; they are only regurgitating what they were taught, and what they’ve subsequently read in popular, lay hypnosis books. This page is all about the scientific explanations, from academic authors.
Franz Anton Mesmer. Credit: By Pujos/Legrand – Museum of the French Revolution, CC BY-SA 4.0, WikiCommons.
So, to put this into context, let’s start with the non-scientific (at least given today’s understanding of science), common-all-garden, average hypnotherapist view of hypnosis; and then we’ll focus on the real deal. The typical history of hypnosis from this quarter goes: Mesmer, Braid, Erickson, Elman, NLP. I would suggest that none of these explain what hypnosis is, and that none of them are scientific.
Mesmer was all about the animal magnetism – an invisible force delivered through a mystical, omnipresent, cosmic fluid. Braid thought it was all about tiring the optic nerve, and focusing on a single idea – not bad but overly simplistic. Erickson focused heavily on metaphors and communication – again, not bad, but lacks a mechanism and internal depth. Elman famously claimed it was about bypassing the ‘critical faculty’ (or ‘critical factor’, depending on where you read about it) to access ‘unconscious resources’ – so, yeah, basically a metaphor for a hidden, unexplained, internal mechanism. And NLP authors, Bandler and Grinder, claimed Erickson said it was about bypassing the ‘conscious mind’ to speak directly to the ‘unconscious mind’. They also (hilariously) talked a lot about ‘programming’ and ‘reprogramming’ the human mind, like they were neuroscience surgeons or psychological hackers – which they clearly weren’t. (I mean, as if!)
No, this history of hypnosis is weak and, while it can provide techniques for using hypnosis, it says very little about what hypnosis actually is or how it works.
A much better history goes: James, Janet, Hull, White, Hilgard, Kihlstrom, Bowers; and Barber, Sarbin, Coe, Wagstaff, Spanos, Lynn, Kirsch, Dienes. Why the two lists? Well, the first charts the development of theories that assumed the hypnotic state was a specific thing; and the second charts the development of theories that assumed the hypnotic state was a theoretical invention, the product of imagination, or the result of role-playing, whether the participant was consciously aware or not.
Academic hypnosis researchers are still divided over whether a hypnotic state exists or not, and this debate can be found in James (1890) where he contrasts the suggestion-only approach from the Nancy School of hypnosis (Liébeault and Bernheim) to the trance-approach from the Salpétrière (Charcot):
The painting ‘A Clinical Lesson at the Salpêtrière’, showing Charcot demonstrating hypnosis on a ‘hysterical’ patient. Credit: By André Brouillet – Photo prise dans un couloir de l’université Paris V, Public Domain, WikiCommons.
“The radical defenders of the suggestion-theory are thus led to deny the very existence of the hypnotic state, in the sense of a peculiar trance-like condition which deprives the patient of spontaneity and makes him passive to suggestion from without. The trance itself is only one of the suggestions, and many subjects in fact can be made to exhibit the other hypnotic phenomena without the preliminary induction of this one. …
“All the facts seem to prove that, until this trance-like state is assumed by the patient, suggestion produces very insignificant results, but that, when it is once assumed, there are no limits to suggestion’s power.” (James, 1890)
Janet (1925) introduced the concept of dissociation as the explanation for what happens in the hypnotic state, when participants take suggestions: “According to the dissociation hypothesis, ideas or behavioural patterns that normally occurred together or in sequence could become separated or dissociated from one another” (Spanos and Chaves, 1991). Hilgard (1973) would later develop Janet’s ideas into neodissociation, described in detail in Hilgard, 1991. The central idea was that the part of the mind that was causing a suggestion to happen, was dissociated (hidden) from the part of the mind that was observing behaviour, due to an amnesiac barrier. Hilgard claimed that there was a “hidden observer” that always had access to the dissociated part, but which was unavailable to the participant until, and unless, the hypnotist caused it to be.
But we’re getting a little ahead of ourselves. Hull (1933) is regarded as the first hypnosis researcher to study the field with the use of statistics and controlled studies. Before Hull, researchers typically recorded case studies, or one-off, qualitative descriptions of single participants, in attempts to explain how hypnosis would affect others. By switching to studies of multiple participants, divided into separate test conditions, with results analysed using maths, Hull changed the face of hypnosis research from one of narrative and anecdote, to one of rigour and repeatability.
Gravitz claimed, “Hull was an academic psychologist at the University of Wisconsin who designed a series of ingenious laboratory experiments to test some of the fundamental questions of hypnosis.” (Gravitz, 1991)
Clark L Hull is regarded as the first hypnosis researcher to study the field with the use of statistics and controlled studies. Credit: By Smithsonian Institution from United States, No restrictions, WikiCommons.
Hull’s most famous student was Milton Erickson – yes, the guy who inspired a generation of hypnotherapists and on whose work the hypnotic side of NLP was based! Isn’t it a crying shame that Bandler and Grinder ignored all the work of Hull, Erickson’s supervisor, and reverted to the old-fashioned and questionable (by today’s standards) approach to research? Had they followed his lead and tested their ideas with controlled studies and stats, they might have discovered (as Kirsch and others did later) that the techniques of NLP do not actually work (or, at least, are not statistically significant or clinically relevant).
Sarbin & Coe (1972), Barber (1976), Wagstaff (1981) and Spanos (1991) argued very compellingly that maybe this hypnotic state is a nonsense – a socially accepted and acceptable form of male mental illness as Amy said! – and that all responses to suggestion could be accounted for by normal cognitive functions. Wagstaff (2004) stated that the sociocognitive theories have in common the following:
Hypnosis is best construed as a culturally devised role; thus although subjects may experience changes in consciousness as they play this role (as most people do when they close their eyes, relax, focus attention, etc), it is actually misleading and unhelpful to conceptualize hypnosis in terms of some special biologically based state or trance condition.
Hypnotizable subjects are actively cognising agents who adapt their behaviour to the demands of the situation; they are not passive respondents automatically displaying the phenomena associated with a special hypnotic state.
Hypnotic behaviour and experience are best explained in terms of concepts and processes drawn from everyday psychology without the postulation of special hypnotic processes. (Wagstaff, 2004)
Wagstaff (2004) further stated that hypnotic response was role-play, based on a three-stage ‘expectation, strategy, compliance’ (ESC) approach:
They will work out what is appropriate to the role.
They will apply ‘normal’ cognitive strategies to make the experiences veridical or believable, in line with existing expectations and what is explicitly or implicitly demanded in the suggestions.
If the application of normal strategies fails, is not possible, or is deemed inappropriate in the context, they will behaviourally comply or ‘sham’. (Wagstaff, 2004)
This does not, as detractors often claim, mean that sociocognitive theorists think all hypnotic participants are playing along, or consciously role-playing. The second bullet point of ESC, that of strategy, is key to a full understanding of this perspective. The claim is not that all participants are cheating, it is that the mechanisms at play are normal cognitive strategies rather than special, spooky or mystical ones. Gorassini (1999) stated that these strategies could simply be a form of wilful self-deception:
“According to the cognitive-behavioral model of self-deception, people possess expertise in the subskills of self-deception, which include a facility for acting decisively on first impressions and an adroitness at remaining inside and responding in accord with compelling (even if false) realities. […] People who exhibit hypnotic responses tend to use a self-deception process to experience their suggested responses as involuntary; the induction of self-deception attempts in unhypnotizable individuals results in responses to suggestions being experienced as involuntary.” (Gorassini, 1999)
William James (1842-1910), known as “The Father of American Psychology” and right about a lot of things. Credit: By Notman Studios (photographer) – [1]MS Am 1092 (1185), Series II, 23, Houghton Library, Harvard University, Public Domain, WikiCommons.
And it is this sensation of involuntariness that is at the centre of the debate over whether there is a hypnotic state – a special process, as Spanos called it – some form of biological function – or not. The state theorists (James, Hull, Hilgard, Kihlstrom, etc) highlighted this sense of involuntariness (the classic suggestion effect) as the hallmark of a process that could not be self-directed. It was absolutely inconceivable that a person could trick themselves, or deceive themselves, into experiencing a self-directed action as involuntary.
But we should not forget the ideomotor effect (James, 1890) – if you imagine a pendulum that you are holding is rotating, then it will begin to rotate; and if you stop imagining that, it will stop. The perceived effect is that, other than imagining, you aren’t doing anything, although you must be – short of magic, there are no other mechanisms for making the pendulum move. Ultimately, your imagination causes your muscles to make the small, but important, movements that cause the pendulum to move, but these actions are hidden from you.
Is that dissociation? Or neodissociation? Or is that a normal cognitive process that does not rely on a hypnotic state?
Another consideration when trying to understand hypnosis, and particularly the hypnotic state, is whether the state is needed at all. In the 1960s, tests of hypnotizability were devised – participants would be hypnotised and then given, one by one, 12 hypnotic suggestions (in the Stanford scale; other scales had different numbers of suggestions). The number of suggestions they accepted defined their hypnotizability. Sounds reasonable, right?
Piccione, Hilgard and Zimbardo (1989) showed that hypnotizability is a stable trait over 25 years. If you measure someone today and then you measure them again in 25 years, there is a strong chance that they will return the same number of accepted suggestions. So, hypnotizability is relatively constant? – there are two issues with this.
The first is that researchers (notably Kirsch), showed that you can achieve the same results without the induction! In other words, if you just establish a hypnotic context (ie, “We’re now going to do some imaginative exercises”, for example), then participants would score practically the same on the hypnotic scale as if you did the full-blown hypnotic induction. What does this mean for the induction? Well, it kind of shows it is irrelevant.
But more importantly, what does it mean for hypnotizabilty? Kirsch et al (2011) defines hypnotizability, based on Hull (1933), as the increase in responsiveness to suggestion following a hypnotic induction. If the hypnotic induction doesn’t change the responsiveness, then what does hypnotizability even mean? The conclusion was that hypnotic scales are actually suggestibility scales, except that doesn’t really make sense because it implies the participants are suggestible, whereas it would be more correct to refer to the participants responding to suggestion, rather than being suggestible.
The second issue is that, in contrast to what Piccione et al found, responsiveness to suggestion is actually modifiable! Gorassini and Spanos (1986, 1999) and Gorassini (2004) describe methods of increasing the responsiveness to suggestion. The Carleton Skills Training Program (CSTP) is a 75-minute training course that improved the behavioural responses of 50% of low responders so that they achieved sufficient suggestions to be considered ‘high’ responders. The experiment was repeated numerous times (see Gorassini, 2004, for references) with similar results.
Woman rolls her eyes at hypnotists still trying to make ‘state’ A Thing. Oh, no – actually ‘Hypnotic Séance’ by Richard Bergh, 1887! Credit: By Richard Bergh – Nationalmuseum, Public Domain, WikiCommons.
In attempts to appease detractors (state theorists), the experiments were repeated using a scale that measured not only the participants’ responsiveness to suggestion, but also their beliefs of how involuntary the effects felt. Again, it showed that the training did not make ‘fake highs’ but instead modified response to suggestion, such that they were indistinguishable from ‘natural highs’.
Gorassini (2002) distilled the active ingredients of the CSTP into a four-minute Brief Training, that achieved similar results. If it is so quick and simple to modify responsiveness to suggestion, this must imply that this responsiveness is not a trait, not a biological function, but simply a thinking style, and one that can be manipulated through brief training.
But what of the state? What of the special process? What of the biological function? Well, that was put to bed in the latest of the evidence-jousting that hypnosis academics indulge in. For those uninitiated, in the academic hypnosis field, researchers would produce books of the current state (pun intended) of hypnotic knowledge, and these would lean in the direction of the editors’ own beliefs and persuasions. But then, other editors – other researchers – would produce competing books, that showed the evidence leaning towards their views. And this has gone on for decades.
A brief list of such books charts this journey:
• Theories of Hypnosis, Current Models and Perspectives (ed Lynn, S J and Rhue, J W), 1991;
• Contemporary Hypnosis Research (ed Fromm, E and Nash, M R), 1992;
• Clinical Hypnosis and Self-Regulation (ed Kirsch, I, Capafons, A, Cardeña-Buelna, E, Amigó, S), 1999;
• The Highly Hypnotizable Person (ed Heap, M, Brown, R J and Oakley, D A), 2004;
• The Oxford Handbook of Hypnosis, Theory, Research and Practice (ed Nash, M R and Barnier, A J), 2008; and
• Handbook of Clinical Hypnosis (ed Lynn, S J, Rhue, J W and Kirsch, I), 2010.
In this final book, Oakley and Halligan (2010) review the biological (fMRI, PET, etc) evidence for the existence of the hypnotic state; literally the differences between ‘unhypnotised’ people and ‘hypnotised’ people. As researchers coming from the state side of the academic split, they are relatively accommodating of the evidence as it was presented in 2010:
“Recent advances in paradigm design and combined uses of EEG, PET, and fMRI provide a fresh opportunity to look again at the question of a distinct hypnotic state and to explore the relationship of that state to suggestion. We anticipate that further refinements in imagining technologies (e.g., MEG, MSI, fDTI), and experimental designs will offer a greater understanding of both hypnosis and the wider aspects of modulating conscious awareness.” (Oakley and Halligan, 2010)
Wagstaff, David, Kirsch and Lynn (2010) in the same book (chapter 7 vs chapter 4) dismiss this as evidence against the existence of a hypnotic state:
“No specific physiological markers of the hypothesised hypnotic states have been found (Lynn, Kirsch, Knox, & Lilienfeld, 2006; see also chap. 4, this volume).” (Wagstaff et al, 2010)
Ultimately, those on the state side of the debate would like to take any evidence, however weak and scant, to prolong the search for physiological markers (biological signs) of a hypnotic state that James (1890) already highlighted theory against, Wagstaff (1981, 2004) produced evidence against, Kirsch et al (2011) accepted was unnecessary, and Gorassini and Spanos (1986, 1999) and Gorassini (1999, 2002 and 2004) implied was entirely unnecessary or irrelevant.
Woman grows weary from humouring this whole mesmerism/hypnotism scam for so long. Credit: By Wellcome, CC BY 4.0, WikiCommons.
On the other side of the debate, Wagstaff, David, Kirsch and Lynn (2010) evaluated the same evidence from Oakley and Halligan as explicitly (in a Bayesian fashion) as evidence against the hypothesised hypnotic state.
But what of the ‘What is hypnosis?’ question? Well, the best description (IMHO) is that of Dienes’ and Perner’s (2006) Cold Control Theory. It dovetails well with Gorassini’s (1999) self-deception model and basically describes participants taking suggestions by modifying, deleting or ignoring all the higher order thoughts (HOTs) that would contradict the acceptance of the suggestion. In essence, the participant enacts the suggestion, but removes their conscious awareness of this enactment in order to experience the effects as involuntary. It’s about the most succinct and concise description of how suggestions are accepted, without having to imagine parts of minds that no one has evidence for, or imagine brain signatures of biological functions that no one has ever actually seen.
If I was to sell you a theory of hypnosis (ie, response to suggestion) it would be Cold Control Theory by Dienes and Perner. It’s the best there is, and not just because Dienes’ first name is Zoltan! Or in our frame, ‘The Amazing Zoltan’! Amy has already suggested to him that he should rename hypnosis to Zoltanism!
References
Barber, T X (1976). Hypnosis, A Scientific Approach. Power Publishers, Inc, Orange.
Dienes, Z and Perner, J (2006). Executive Control without Conscious Awareness: The Cold Control Theory of Hypnosis. Conscious Awareness.
Gravitz, M A (1991). Early Theories of Hypnosis: A Clinical Perspective. Theories of Hypnosis, Current Models and Perspectives (ed Lynn, S J and Rhue, J W). The Guildford Press, New York.
Gorassini, D R (1999). Hypnotic Responding: A Cognitive-Behavioral Analysis of Self-Deception. Clinical Hypnosis and Self-Regulation, Cognitive-Behavioral Perspectives (ed. Kirsch, I, Capafons, A, Cardeña-Buelna, E and Amigó, S). American Psychological Association, Washington.
Gorassini, D R (2002). Brief Hypnotic Suggestibility Training: A Confirmation of its Effectiveness and a Test of Self-Report Validity. Imagination, Cognition and Personality, Vol 22(3) 291-302.
Gorassini, D R (2004). Enhancing Hypnotizability. The Highly Hypnotizable Person, Theoretical Experimental and Clinical Issues (ed Heap, M, Brown, R J and Oakley, D A). Brunner-Routledge, East Sussex.
Gorassini, D R and Spanos, N P (1986). A Social-Cognitive Skills Approach to the Successful Modification of Hypnotic Susceptibility. Journal of Personality and Social Psychology, Vol. 50, No. 5, 1004-1012.
Gorassini, D R and Spanos, N P (1999). The Carleton Skill Training Program for Modifying Hypnotic Suggestibility: Original Version and Variations. Clinical Hypnosis and Self-Regulation, Cognitive-Behavioral Perspectives (ed. Kirsch, I, Capafons, A, Cardeña-Buelna, E and Amigó, S). American Psychological Association, Washington.
Hilgard, E R (1973). Dissociation Revisited. Historical Conceptions of Psychology (ed Henle, M, Janes, J, & Sullivan, J). Springer, New York.
Hull, C L (1933). Hypnosis and Suggestibility, An Experimental Approach. Appleton-Century Crofts, Inc.
Hilgard, E R (1991). A Neodissociation Interpretation of Hypnosis. Theories of Hypnosis, Current Models and Perspectives (ed Lynn, S J and Rhue, J W). The Guildford Press, New York.
James, W (1890). The Principles of Psychology, vol 2. Harvard University.
Janet, P (1925). Psychological Healing. Crowell-Collier & Macmillian, New York.
Kirsch, I, Cardeña, E, Derbyshire, S, Dienes, Z, Heap, M, Kallio, S, Mazzoni, G, Naish, P, Oakley, D, Potter, C, Waters, V, Whalley, M (2011). Definitions of Hypnosis and Hypnotizability and their Relation to Suggestion and Suggestibility: A Consensus Statement
Oakley, D A and Halligan, P W (2010). Psychophysiological Foundations of Hypnosis and Suggestion. Handbook of Clinical Hypnosis (ed Lynn, S J, Rhue, J W and Kirsch, I). American Psychological Association, Washington.
Piccione, C, Hilgard, E R, and Zimbardo, P G (1989). On the Degree of Stability of Measured Hypnotizability Over a 25-Year Period. Journal of Personality and Social Psychology, Vol. 56, No. 2, 289-295.
Sarbin & Coe (1972). Hypnosis, A Social Psychological Analysis of Influence Communication. Holt, Rinehart and Winston, Inc, USA.
Spanos, N P (1991). A Sociocognitive Approach to Hypnosis. Theories of Hypnosis, Current Models and Perspectives (ed Lynn, S J and Rhue, J W). The Guildford Press, New York.
Spanos, N P and Chaves, J F (1991). History and Historiography of Hypnosis. Theories of Hypnosis, Current Models and Perspectives (ed Lynn, S J and Rhue, J W). The Guildford Press, New York.
Wagstaff, G F (1981). Hypnosis, Compliance and Belief. St Martin’s Press, Inc, New York.
Wagstaff, G F (2004). High Hypnotizability in a Sociocognitive Framework. The Highly Hypnotizable Person, Theoretical Experimental and Clinical Issues (ed Heap, M, Brown, R J and Oakley, D A). Brunner-Routledge, East Sussex.
Wagstaff, G F, David, D., Kirsch, I and Lynn, S J (2010). The Cognitive-Behavioral Model of Hypnotherapy. Handbook of Clinical Hypnosis (ed Lynn, S J, Rhue, J W and Kirsch, I). American Psychological Association, Washington.