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MODERN TRENDS
IN HYPNOSIS
DAVID WAXMAN Chairman of the Scientific Program International Society of Hypnosis
London, England
and
M . ANTHONY BASKER British Society of Medical and Dental Hypnosis Westcliff-on-Sea, England
PLENUM PRESS • NEW YORK AND LONDON
Main entry under title: Modern trends in hypnosis.
"Proceedings of the Ninth International Congress of Hypnosis and Psychosomatic Medicine, held August 22-27, 1982, in Glasgow, Scotland" - T.p. verso.
Includes bibliographies and index. 1. Hypnotism- Therapeutic use-Congresses. 2. Hypnotism-Congresses. I. Wax
man, David. II. International Congress of Hypnosis and Psychosomatic Medicine (9th: 1982: Glasgow, Strathclyde) [DNLM: 1. Hypnosis-congresses. W3 IN415 9th 19821 WM 4151612 1982n] RC490.5.M6 1985 616.89'162 84-26432
ISBN-13: 978-1-4684-4915-0 DOl: 10.1007/978-1-4684-4913-6
Proceedings of the Ninth International Congress of Hypnosis and Psychosomatic Medicine, held August 22-27, 1982, in Glasgow, Scotland
(C) 1985 Plenum Press. New York Softcover reprint of the hardcover 1st edition 1985 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013
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No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher
To Eric Wookey, MC, LDS, Honorary Consultant Dental Surgeon of the Royal Free Hospital , Fi r s t President of the London Dental and Medical Society for the Study of Hypnosis. He imparted his enthusiasm and knowledge of hypnosis widely, and thus played a prominent par t in securing the acceptance of hypnosis by profess ional colleagues throughout the United Kingdom.
FOREWORD
The 9th In te rna t iona l Congress of Hypnosis and Psychosomatic Medicine expresses the cont inui ty in the e ffo r t to gain s c i e n t i f i c knowledge of hypnosis and sc i en t i f i c s ta tus for i t , ever s ince the 1s t In te rna t iona l Congress for Experimental and Therapeutic Hypnotism was held in Par i s in 1889, attended by many of the best-remembered psychia t r i s t s and psychologists of the day - men such as Babinski, Bernheim, Binet, Delboeuf, Freud, James, Lombroso, F.W.H. Myers, Ribot, and many others . The cont inui ty was broken by the per iod of reduced i n t e r e s t in hypnosis between the time of the 2nd In t e r
na t iona l Congress for Hypnotism in Paris in 1900, and the rev iva l ofi n t e r e s t shown by the 3rd In te rna t iona l Congress for Hypnosis and Psychosomatic Medicine in Paris in 1965. Since then, the Congresses have met more regular ly, making the one of which t h i s i s the repor t , the 9th.
The programs of these Congresses have become increasingly r i ch through the years , with many of the older problems s t i l l with us but now s tudied more dispassionately in the l i gh t of new knowledge and new sc i en t i f i c methods in the design of inves t iga t ions and the v a l i dat ion of sc i en t i f i c findings.
An examination of the t i t l e s of the papers and the places from which t he i r authors come shows how diverse and widespread the i n t e r e s t s in hypnosis have become, both in the e ffo r t to define the nature of hypnosis and i t s boundaries in r e l a t i on to other categories of behavior and experience, and to explore i t s poten t ia l service in psychotherapy and other soc ia l app l ica t ions , as in forensic medicine.
On the s ide of understanding hypnosis i t s e l f , there are the papers on the nature of hypnotic responsiveness and i t s physiological
v i i
v i i i FOREWORD
co r r e l a t e s , on the subject ive experiences within whatever the hyp not ic condi t ion may be found to be , the nature and consequences of self -hypnosis , and the cha rac t e r i s t i c s of the dissoc ia t ive phenomena manifested i n hypnosis. On the c l i n i c a l s ide there are cases and discussions r e f l ec t i ng the use of hypnotic methods in the t reatment of disorders of se l f - con t ro l , i n obs t e t r ic s , in pain and anxiety reduct ion, i n psychosomatic disorders , in symptoms met i n den t i s t r y, and with problems met in chi ldren and adolescents . Comparative s tud ies r e l a t e hypnosis to meditation and behavior therapy. Hypnosis and the law receives a t t en t i on in several con t r ibu t ions .
One cannot help but be impressed by the ser iousness with which the di rec t ion has been taken to move away from " i t has been my experience ••• " as the way of va l ida t ing hypnotic prac t ices to the i n t e r e s t in comparative and con t ro l l ed s tudies which place hypnosis on the same s t a tu s as o the r medical or psych ia t r i c prac t ices as they are taught and s tudied in our medical schools and univers i ty depar t ments.
The b a t t l e to es t ab l i sh hypnosis on a sound s c i e n t i f i c bas i s has not yet been won; even where i t i s accepted as permiss ible , there are s t i l l too few s c i e n t i s t s among those outs ide i t s ac t ive prac t i t ioners who show any enthusiasm for i t . The gains tha t are being made, however, as these Proceedings show, augur well for i t s fu tu re .
Ernest R. Hilgard
PREFACE
Prac t i t ioners whose i n t e r e s t s extend over the en t i r e spectrum of the healing disc ip l ines assembled in Glasgow from August 22nd to the 27th 1982 to at tend the 9th In te rna t iona l Congress of Hypnosis and Psychosomatic Medicine. They came to l i s t e n to learned addresses , to present papers, of ten the culmination of many years of research and c l in i ca l experience, to pa r t i c ipa t e in workshops and general ly to mark, l ea rn and teach a subject as old as mankind and yet amongst the most recent and sophis t icated of psychotherapies in the mul t i d i sc ip l inary f i e ld of the treatment of psychological i l l nes s .
The exce l len t of the ambiance, the impressive array of speakers and the high qua l i ty of the l ec tures culminated in a meeting which was without doubt a considerable academic success. As a r e su l t the 9th Congress proved an outstanding event, and i t i s hoped, made a r ea l contr ibut ion to the prac t ice of hypnotherapy. The s ign i f i cance of the occasion was addi t iona l ly marked by the j o i n t sponsorship of the University of Glasgow and the Royal Society of Medicine, as well as the warm support of the City of Glasgow.
In these proceedings appear some of the papers which were pre sented a t t h i s meeting. Although there were over 100 speakers, i t
i s regre t t ed tha t in view of the r e s t r i c t i ons of space, only a verycareful ly selected number of these papers could ul t imately be included in the publ icat ion.
Each paper was ra ted independently by a panel of referees and the f i na l se lec t ion represents a wide cross-sect ion of the subject matter out l ined in the program.
ix
x PREFACE
In view of the high qua l i ty of a l l the t a l k s given the referees were faced with a formidable task and i t i s hoped t ha t those speakers whose papers do not appear in t h i s volume wil l in no way f ee l t ha t t he i r e ffo r t s were in vain. Abstracts of a l l papers were published in the issue of The In te rna t iona l Journal of Clin ica l and Experimen t a l Hypnosis of April 1982 and the Edi tor has given h i s kind per mission for t h i s to be used as a c i t ab l e reference.
The pr inc ipa l aim of the Sc ien t i f i c Program was the encourage ment of learning and research in hypnosis both in c l i n i c a l prac t ice and experimental s tudy, wi th the ac tua l par t ic ipa t ion of as many as possible in the wide range of subjects which were offered.
The general s c i e n t i f i c papers consis ted of c l in i ca l reports and experimental f indings covering as extensive an area as time per mitted. The subjects included the neuroses, pathological anxiety and the many incapaci ta t ing symptoms resu l t ing therefrom. Other papers covered the considerable f i e ld of personal i ty problems, the addic t ions and sexual dysfunctions. Hypnosis for the modification of pain and i t s use in obs t e t r i c s and in pedia t r ics was discussed and a f u l l sess ion was devoted to hypnosis in dent i s t ry. Dynamic and behavioral techniques were included and the many l ec tures deal ing with s e l f hypnosis proved very popular. Of par t icu lar in te res t were the ' case h i s to r i e s which provided evidence of the prac t ica l r e su l t s of hypno therapy. One f ac t t ha t has emerged c lear ly over the past few years i s t ha t c l in i ca l hypnosis, however good the r e su l t s , w i l l never be fu l l y accepted unless val idated by experimental studies and sc ien
t i f i c evidence. I t i s es sen t i a l t ha t the c l in ic ian works closelywith the experimental psychologist and the research neurophysiol ogis t . With t h i s in mind, theories explaining hypnotizabi l i ty and sugges t i b i l i t y as well as the neurophysiology of hypnosis were explored and numerous experimental studies were described. The use of hypnosis in criminology occupied several hours of t a l k s as well as the f ina l Plenary Session.
In addi t ion to the sc i en t i f i c papers Special Invi ted Addresses were given by recognized au tho r i t i e s and National Presidents ta lked on t he i r individual spec ia l i t i e s . Other Invi ted Addresses and Spec ia l i ty Seminars were designed to complement the workshops.
In the concluding paper, the President Elect of the In t e r na t iona l Society of Hypnosis, Professor Germain Lavoie combining learned experimental s tud ies with c l i n i c a l f indings, chose as his subject The Clin ica l Relevance of Hypnot izabi l i ty in Psychosis. This presentat ion wi l l undoubtedly prove a valuable contr ibut ion to future research.
Thus a f t e r f ive days of intensive work and study, o f s c i e n t i f i c l ec tures and learned discussion, the 9th Congress was bought to a close. Perhaps i t was because of the considerable amount of well-
PREFACE x i
constructed laboratory invest igat ion, coupled with the c l in i ca l experiences so ably reported by so many devoted therap is t s , tha t the meeting was such a success. Perhaps i t was the Scotch mist, the warmth and generosity of the hosting society or some magnetic in f lu ence, but somehow the purple cloak of Mesmer which had hung over the c i ty of Glasgow tha t August week seemed to have been l i f t e d to allow bright sunshine to penetrate a subject tha t had been shrouded in myth, mystery and misunderstanding for so many years .
As a resu l t i t i s hoped tha t Modern Trends in Hypnosis wi l l influence many to explore fur ther the psychological and neuro physiological understanding of the hypnotic s t a t e and t ha t i t w i l l advance the therapeutic s k i l l s of a l l who read i t for the ul t imate benefi t of the suffer ing.
D.W. P.C.M. M.G. M.A.B.
ACKNOWLEDGMENTS
The ed i to rs wish to express t he i r thanks to the Principal and Court of the University of Glasgow and to the President and Council of the Royal Society of Medicine for t he i r sponsorship of t h i s Congress. Also to the President . Council and Members of the Bri t i sh Society of Medical and Dental Hypnosis and the Bri t i sh Society of Experimental and Clinical Hypnosis. to Professor M.R. Bond. 9th Congress Chairman. to Professor F.H. Frankel. President of the Internat ional Society of Hypnosis. to Professor M.T. Orne and Mrs Emily Carota Orne for the i r invaluable help in assembling the program
as well as to a l l Members of the Committee of the 9th Congress.Thanks are par t icu la r ly due to those hundreds of par t ic ipan ts who made t h i s meeting such a success.
x i i i
Visual Memory Processing During Hypnosis: Does i t Differ From Waking?
H. J . Crawford and S. N. Allen
A Study on the Hypnotic Suscept ib i l i ty of Persons Attempting Suicide: Some Therapeutic Considerations
I . Boncz, L. P. Pal lag and J . Fodor
I I I ELECTROPHYSIOLOGICAL STUDIES
EEG Evoked Poten t ia l , Hypnotic Anosmia, and Transient Olfactory Stimulation in High and Low Susceptible
SubjectsA. P. Barabasz and C. Lonsdale
Depth EEG Recordings in Epilept ic Pat ients During Hypnotic and Non-Hypnotic States
G. De Benedi t t is and V. Sironi
Evoked Poten t ia l Correla tes of Verbal Versus Imagery Coding in Hypnosis
I . Meszaros, E. I . Banyai and A. C. Greguss
Hemispheric Speci f ic i ty and Hypnot izabi l i ty : An
Overview of Ongoing EEG Research in SouthAustral ia C. MacLeod-Morgan
Some Neuromuscular Phenomena in Hypnosis M. Pajn ta r, E. Roskar and L. Vodovnik
IV SELF HYPNOSIS
Representations of Self-Hypnosis in Personal Narrat ives
E. Fromm, A. M. Boxer and D. P. Brown
An Inves t iga t ion in to Audiotaped Self-Hypnosis Training in Pregnancy and Labor
G. P. Davidson, N. D. Garbett and S. G. Tozer
Change in Subjective Experiences During Therapeutic Self-Hypnosis
R. Van Dyck, P. Spinhoven and J . Commandeur
CONTENTS
119
131
139
149
161
169
181
209
215
223
235
V HYPNOSIS AND THE ALLEVIATION OF PAIN
Why i s Hypnosis Effect ive in Pain Control? P. Sacerdote
Hypnosis and Plasmatic Beta-Endorphins G. Guerra, G. Guant ier i and F. Tagl iaro
VI HYPNOSIS AND ADDICTIVE BEHAVIOR
Hypnosis in the Alleviat ion of the Smoking Habit M. A. Basker
The Treatment of Alcohol and Drug Addiction: An
249
259
269
Hypnosis and Sexual Disorders P. C. Misra
Hypnotherapy in Male Impotence K. Fuchs, I . Zaidise , B. A. Peretz and E. Paldi
VIII THE USE OF HYPNOSIS IN CRIMINOLOGY
Hypnosis, Coercive Persuasion and the Law: A His tor ica l Perspect ive
J . -R. Laurence and C. Perry
Hypnosis in Criminal Inves t iga t ion - Ethical and Prac t ica l Impl icat ions
M. Kleinhauz and B. Beran
An Examination of the Effects of Forensic Hypnosis H. W. Timm
Hypnosis and the Law: The Role of Induction in Witness Recall
G. F. Wagstaff
IX HYPNOSIS AND ANXIETY
Effects of Hypnosis on State Anxiety and St ress in Male and Female In te rco l leg ia te Athletes
E. W. Krenz, R. Gordin and S. W. Edwards
291
297
309
317
327
345
359
x v i i i
Resul ts of Anxiety Control Training in the Treatment of Compulsive Disorders
R. P. Snaith
X CASE HISTORIES
On a Case of Urinary Retention Treated by Means of Hypnosis
A. Bot to l i , G. Guantieri and V. Azzini
Hypnosis in the Treatment of a Case of Guil la in-Barre 's Disease
A. Gambacciani and G. Guant ier i
Hypnoanalytic Treatment of Severe Borderline ,Neurosis by Means of Spontaneous Multiple Persona l i t i es : A Case Report
R. Kampman, R. Hirvenoja and H. Karlsson
XI SOME USES OF HYPNOSIS IN DENTISTRY
The Treatment of Dental Phobia with a Meditational and Behavioral Reorientation Self-Hypnosis
G. W. F. Smith
The Diff icu l t Dental Pat ien t J . Gall
Index
CONTENTS
371
379
385
391
401
409
421
SPECIAL ADDRESSES
HYPNOSIS AND PSYCHOSOMATIC MEDICINE
Univers i ty of Glasgow 6 Whittinghame Gardens Glasgow. Scotland
Scots have made very s ign i f i c an t contr ibut ions to both the understanding and prac t ice of hypnosis and psychosomatic medicine.
Most bel ieve tha t the development of animal magnetism by the Austr ian . Franz Mesmer in the 18th century. represented the beginning of i n t e r e s t in t rance s t a t e s . but h i s work was influenced by e a r l i e r thoughts of a Scot . William Maxwell. author of 'De Medicina Magnetica ' .
Perhaps the most well known of a l l Scots involved in the devel opment of hypnosis was James Braid. a Scot t ish Surgeon working in Manchester. Though a grea t scep t ic of Mesmerism a t f i r s t . he changed h i s a t t i t ude completely in 1841 a f t e r at tending a demonstration by ' a magnetiser ' Monsieur Lafontaine. I t was Braid who concluded t h a t the t rance s t a t e was not due to magnetic f lu ids but to heightened sugges t i b i l i t y on the pa r t of the subject and introduced the term ' neuro hypnotism' to descr ibe the s t a t e or condition of nervous s leep t ha t t h i s represented. A year l a t e r he shortened t h i s term to 'hypnot
i sm' . Scots. espec ia l ly James Esdai le . were involved in the development of c l in i ca l uses of hypnosis. especial ly in surgery. throughout the remainder of the 19th century.
The place of hypnosis in medicine in the 20th century has been no l e s s ambiguous than in the previous one. but during the 1914-18 war another Scot. McDougall. demonstrated tha t i t could make a pos i t i v e con t r ibu t ion in the treatment of ' she l l - shock ' and began a fu r ther rev iva l of the medical use of hypnosis which has pers i s ted s ince tha t time.
3
4 M. R. BOND
Scots have been no l ess involved in the development of psycho somatic medicine than of hypnosis and perhaps the most well known contr ibut ion of a l l was tha t made by Dr. John Halliday s t i l l l iv ing in Glasgow, who, as a Public Health Officer in the c i ty, threw new l i gh t on psychosomatic medicine when he published a book en t i t l ed 'Psychosocial Medicine' in 1943. In i t he drew a t ten t ion to the ro le of soc ia l factors in the development and maintenance of i l l nes s . His work and t ha t of other Scots in par t icu lar, Kissen and Aitken, wi l l be discussed in the f i na l sect ion of t h i s paper.*
INTRODUCTION - AN HISTORICAL PERSPECTIVE
Scots played a major par t in the b i r th of the prac t ice of hypno s i s and i t s therapeut ic uses, and also in the development of the
modern concept of psychosomatic medicine. In order to understand whyt h i s prominence was achieved, pa r t i cu l a r l y with regard to hypnosis, i t i s necessary to understand something of the growth of medical education in Scotland up to the ear ly years of the 19th century pr ior to discussing a number of the main characters involved.
In h i s book, 'The Healers , a History of Medicine in Scot land ' , David Hamilton (1981), a surgeon in Glasgow, commented, "Scotland offers almost unique opportuni t ies for medical his tor ians ••• there i s a r ich stock of famous doctors and t he i r discover ies , there are also the contr ibut ions of the ancient Universi t ies and of three equal ly old Colleges of Physicians and Surgeons". I t might be imagined tha t
having four very ancient Universi t ies - St. Andrews, Glasgow,Edinburgh and Aberdeen, they would have long been involved in the education of Scot t i sh doctors , but t ha t i s not the case. A post of 'mediciner ' was establ ished a t King's College, Aberdeen, in 1497 and for a br i e f per iod between 1637 and 1642 there was a Chair of Medi cine in Glasgow but t h i s was suppressed by the Church which, a t tha t t ime, held the re igns of power in the Univers i ty.
Univers i ty medical degrees were not establ ished u n t i l the 18th century and even then most of them were awarded without formal teach ing or examination to medical men of good repute who could find others to sponsor them. The degrees were sought to increase the s ta tus of doctors and a l so to give weight to those who wished to prac t ice medicine i n England where the e a r l i e s t degrees obtained by Scots were ca l led 'Scotch Degrees' in a r a the r derogatory fashion because of the ease with which they could be obtained. In fac t , a ra ther amusing scandal arose in London in which an i l l i t e r a t e London brushmaker obtained an M. D. from Edinburgh and, armed with i t , applied for a post a t the London Hospital .
*Inaugural address by the Chairman of the 9th In te rna t iona l Congress.
SCOTTISH CONTRIBUTIONS 5
Returning to the 17th century, the re were four groups of men involved in the care of the s ick. F i r s t , and most pres t ig ious of a l l , were the physic ians . Although the smal les t group they were dis t ingu i shed by t h e i r wealthy backgrounds, con t inen ta l Univers i ty t r a in ing , and the large fees they demanded. Astrology, which had been cen t ra l to the p r a c t i c e of t h e i r work for a long t ime, faded from use a t t h i s per iod, but in i t s place they subs t i tu ted uroscopy - diagnosis by examination of the urine. This method of diagnosis eased t h e i r profess iona l l i f e considerably as they did not need to examine the pa t i en t . In f ac t , they were prepared to t r e a t by post Their remedies were complex, often involving the use of animal and plan t ex t rac t s and some chemicals. However, they did not adminis ter or de l iver these personal ly but l e f t matters to more lowly beings - the apothecar ies and surgeons. One point of i n t e r e s t and s i g n i f i c ance to those in te res ted in hypnosis and psychosomatic medicine was
t he i r i n t e r e s t i n , and search fo r, a s ingle powder or agent to curedisease , wherein l i e s the germ of the l a t e r development of mesmerism and then hypnosis.
The second group of healers were the apothecar ies and i t only remains to say t h a t they made considerable incomes but , when they began to challenge physicians for pa t ien t s they were, with some d i f f i c u l t y, excluded from the t r a in ing of doctors and the f u l l prac t i c e of medicine by laws which were promoted by the physic ians .
Surgeons were regarded as l e s s e r men than physic ians , though not to such a great extent in Scotland as in England. They were seen as
craftsmen and learned t h e i r t rade by apprent iceship , a method of education which l as ted u n t i l the f i r s t ha l f of the 19th century when Univers i ty degrees and the Medical Act of 1858 regu la r i sed a l l med i c a l t r a in ing .
Barbers were a l so involved in surgery, but regarded as i n f e r i o r to surgeons. Never theless , a t the incept ion of ce r t a i n Colleges they were admitted and t h e i r a c t i v i t i e s were con t ro l l ed . For example, Robert Haries was admitted to the Facul ty, l a t e r the Royal College of Physicians and Surgeons of Glasgow, in 1645 with the s t r i c t ru l ing tha t he should be allowed "only to meddle with simple wounds and not to meddle with physic , tumors, ulcers , dis loca t ions and f rac tures" , (Hamilton 1981). Eventually the barbers were forbidden to en te r the Colleges and to take up any form of medical or surg ica l prac t ice . This bar took place in Edinburgh in 1648, but not u n t i l 1722 in Glasgow.
The dreadful s tandards of care given to the s ick in the 16th century by a l l manner of people, including physic ians , led eventual ly to the formation of bodies or corporat ions which were es tab l i shed to maintain s tandards of s k i l l and pa t ien t care and, of course , the f inanc ia l i n t e r e s t of those who had medical t r a i n ing . Three Colleges were formed and, i n order of foundation, they were the Royal College
6 M. R. BOND
of Surgeons of Edinburgh in 1505, the Royal College of Physicians and Surgeons of Glasgow i n 1599, and the Royal College of Physicians of Edinburgh in 1681. This order i s ra ther curious bearing in mind tha t physic ians had the highest s t a tu s , and tha t Glasgow in the 16th century was a much smal ler town than Edinburgh. The or ig ins of the corporat ions were very di ffe ren t and worth mentioning.
The incorporat ion of surgeons and barbers in Edinburgh took place in 1505 and the terms under which the c ra f t was founded was s imi la r to tha t of others , in other words a body for the protect ion of i t s members and regulat ion of t he i r t r a in ing and conduct. Hamilton t e l l s us t ha t a f t e r apprent iceship the po t en t i a l surgeon was examined in anatomy, had to prove he was able to read and wri te , and t ha t he understood the s igns of the zodiac necessary for the progno s i s of disease by as t ro logy. Entry was l imi ted to the sons and
sons- in- law of craftsmen, sons of the nob i l i t y, or those marrying thedaughter of a surgeon - provided she was a clean virgin The Edinburgh surgeons were given a monopoly to s e l l aqua v i t ae , an ear ly form of whisky, a drink which had not become popular and which was only considered to be a medicine a t t h a t t ime.
In 1599 Glasgow was not a major town. Nevertheless an important medical corporat ion was establ ished a t tha t date , even though the re was only one physic ian, s ix surgeons, one apothecary, and two mid wives, i n Glasgow. The corporat ion 's j u r i sd i c t i on , unl ike tha t of the Surgeons' College in Edinburgh, covered a wide geographical area , including much of West and Central Scotland. In addi t ion to powers
to regu la te medical t r a in ing and prac t ice i t was also empowered toinspect the s e l l e r s of drugs.
The reason for the establishment of the College in Glasgow a t a l l l i e s in the s t a tu r e of the person who was the driving force behind i t s b i r t h . He was Master Pete r Lowe, a Scot, medically t r a ined in France and almost cer ta in ly connected with the p o l i t i c a l a c t i v i t i e s of James I in tha t country. Why he chose to l i ve in Glasgow i s not known but his ear ly awareness of the medical problems of the area , and h i s close re la t ionsh ip with the king, led to h i s gaining a char te r for the establishment of the College. The king was i n t e r e s t ed in medical matters , apar t from his well known d i s l i ke of smoking, which be banned a t Court.
I t i s i n t e r e s t i ng to note t h a t the College was prepared to admit physic ians without examination, but not surgeons
The College of Physicians in Edinburgh was the l a s t corporat ion to be es tab l i shed , and then only with considerable d i ff i cu l ty. Undoubtedly the physic ians sought to control t he i r own numbers, which were increasing qui te rap id ly, an d . i f possible to gain power over the surgeons and apothecaries. , as had happened in London. The surgeons were outraged, the Faculty in Glasgow f e l t threatened, and King's
College in Aberdeen s ta ted tha t the r e s t r i c t i ons proposed would apply to t he i r t ra inees who wished to prac t ice in Edinburgh and thus con t ravened t he i r char te r. Even the Town COuncil of Edinburgh were opposed, no doubt because of the number of surgeons who were members of i t , but perhaps t he i r r ea l fea r was tha t the t r a in ing of physic ians would move away from Edinburgh Univers i ty, which they cont ro l l ed . Eventually, having made several attempts to found the College from 1621 onwards, a charter was granted in 1681, probably because one of the backers had close connections with the Royal Court and also because the apothecar ies were engaged in a dispute with the surgeons and thus supported the proposals for the f i r s t time. Hamilton makes the in te res t ing and ra ther amusing point tha t , a t the time of the f i r s t appl ica t ion of the physic ians , which was to Oliver Cromwell, there was a cer ta in lack of subt le ty on t he i r par t in the framing of t he i r request . Thus, a College was needed because of "the
frequent murders committed universa l ly, and in a l l pa r t s , by quacks,women, gardeners, and others grossly ignorant ••• and the unlimited and unaccountable prac t ice of surgeons, apothecaries and empirics pretending to medicine • • • • a l l these undertaking the cure of a l l diseases without the advice and ass i s tance of physic ians" .
By the 18th century Scotland had a wide reputat ion for the t r a in ing of doctors and was espec ia l ly famous for surgery. The influence of Scot t i sh Colleges and Univers i t ies was such tha t a t the beginning of the 19th century 95% of doctors in Br i ta in with a med i c a l degree t r a ined in Scotland, which had a v i r t u a l monopoly in medical education. For example, in 1815 there were more than a thousand doctors in t r a in ing in Scotland. I t i s not surpr i s ing therefore tha t much of English medical prac t ice was in the hands of Scotsmen or men t r a ined in Scotland and, the re fore , t ha t these men were a t the center of events surrounding the b i r t h of hypnosis. However, the general publ ic was not over impressed with medical care and a t the end of the 18th century doctors were, with good reason, regarded with fear and suspicion. They were s t i l l making grea t use of the pract ices of bleeding and purging and surgery was barbar ic . In addi t ion there was evidence of the prac t ice of the new mysterious cul t s of phrenology (Mill ingen 1837) mesmerism and homeopathy. L i t t l e wonder tha t home remedies abounded and tha t a se l f -he lp move ment centered on the use of ' spa ' therapy developed. Thus, a t the turn of the 19th century the prac t ice of medicine l e f t much to be desired and, apar t from ex te rna l cr i t i c i sms , there were many in te rna l controvers ies and r iva l s , not l e a s t in r e l a t i on to mesmerism, and i t was here tha t Scots were a t the center of the debate and the v i t r i o l i c exchanges tha t abounded.
THE RISE OF MESMERISM
For centur ies there was a be l i e f t ha t cer ta in substances and man-made objects l i ke amulets possessed curat ive powers, espec ia l ly
8 M. R. BOND
when made under the influence of magic. The mysterious a t t r ac t ive powers of magnets led to the bel ie f t ha t they could a ff ec t the body by v i r tue of imperceptible emanations and. in fac t . a Scot. William
Maxwell. author of De Medicina Magnetica. was hounded by academic.re l ig ious and medical men fo r h i s theor ies in t h i s area. In a s imi l a r way e l e c t r i c i t y. which could ac tua l ly be seen passing from a generator to the human body. was also held to have curat ive proper t i e s . However. in the l a t e 18th century these matters were of r e l a t i ve ly l i t t l e i n t e re s t u n t i l the dramatic appearance on the medical scene of Franz Anton Mesmer.
I t was Mesmer who was a t the center of heated disputes tha t raged over h i s theory of animal magnetism which s t imulated James Braid. a Scot. to examine i t s various aspects . to def ine hypnotism and to es tab l i sh the prac t ice of medical hypnosis on an acceptable
bas i s .
Mesmer was a Swiss, born in 1734. He took a medical t r a in ing in Vienna and in 1766 wrote a t r ea t i s e based on his i n t e re s t i n a s t ro logy en t i t l ed 'The Influence of The Planets on the Human Body'. This was f a r from being a new topic and the work was greeted with amuse ment. Mesmer was hea r t i l y r idiculed and. as a r e su l t . became much more secre t ive and myst ical in his i n t e re s t s and works thereaf te r - a f ac t which probably contributed fu r ther to his condemnation. His theory was founded upon the assumption of the existence of a subt le element or essence prevading a l l nature . o r what Newton ca l led ' t he e t h e r ' . At f i r s t Mesmer thought t h i s might be e lec t r i c i ty but l a t e r
re jec ted the idea in favor of magnetic emanations. This idea he may have taken from the Je su i t Professor of Astronomy in Vienna. Maximilian Hell.
Using magnetised rods Mesmer put theory in to prac t ice . t r ave l l ing widely in Europe and effect ing a number of miraculous cures. Later he gave up the use of rods bel ieving t ha t the f l u id they con ducted from h i s body to the pa t ien t could be t r ans fe r red equal ly wel l by repeatedly passing h i s hands from the p a t i e n t ' s head to his legs j u s t in f ron t of the body. Believing h i s power to be due to t r ans mission of a magnetic f lu id he coined the term 'animal magnetism' to d i ff e ren t i a t e i t from mineral magnetism. In medical c i r c l e s Mesmer was regarded as an imposter and continued c r i t i c i sm was heaped upon him. At l a s t he reached Par i s where he generated great emotions. l a rge numbers of pat ien ts . a great deal of money. and the wrath of the sc i en t i f i c and medical establishment. The l a t t e r eventual ly se t up a commission. the f i r s t of three. to invest igate Mesmer's work. I t was headed by Benjamin Franklin and included Lavois ier and Dr. Gui l lo t in . I t s report of 1784 made two important poin ts . Fi r s t . tha t imagination played an important par t in the cures achieved. and second tha t evidence for a magnetic f l u id was lacking. I t did not damn Mesmer's work out of hand but the comments were loudly acclaimed as a r e j ec t i on of a l l t ha t Mesmer stood for. Although increasing
pressure forced Mesmer to leave Par i s h i s work was car r ied on by numerous pupi l s , including D'Eslon, who was the f i r s t of many mes meris ts to v i s i t Br i t a in i n the l a t e 18th, and ear ly 19th century. However, mesmerism was overshadowed for several years a t the begin ning of the 19th century by i n t e r e s t i n phrenology - them method of r e l a t i ng mental and moral a t t r i bu t e s to the shape and contours of the heat and proposed by the German, Franz Gall , and his pupi l and d i s c ip l e , Johann Spurzheim (Cri tchley 1979). Apparently Dr. Gall was a b r i l l i a n t anatomist and dissec tor who, despi te the fa i lure of h i s system of phrenology, contr ibuted very s ign i f ican t ly to understanding of the anatomy of the bra in and cran ia l nerves and who was a fo re runner of those who have s ince sought to l oca l i s e bra in functions in what might be termed, a new sor t of phrenology. In i t s heyday the cul t of phrenology was represented by no fewer than 29 soc i e t i e s in Bri ta in . One of those who was an avowed phrenologis t was the Scot,
Dr. John El l io t son of University College, London. He was edi tor ofthe Zoist , a per iod ica l which commented upon phrenology and which wil l be mentioned l a t e r . He was also f i r s t President of the London Phrenological Society and a number of other famous people were a l so supporters of the cu l t , including Thomas Wakely, Editor of the Lancet.
El l io t son , a l so in te res ted in mesmerism, was regarded as an overact ive eccen t r ic . In fac t , one of h i s eccen t r i c i t i e s was the use of the stethoscope which he introduced in to Br i t i sh medical prac t ice Nevertheless, he held the Chair of Prac t i ca l Medicine a t University College, London, and was President of the Royal Medical and
Chirurgical Socie ty the re . In 1837 h i s i n t e r e s t in mesmerism wasra i sed to fever p i t ch by the v i s i t of a famous French mesmerist, Baron du Potete , and, as in everything e lse he did, El l io t son plunged i n to experiments and treatments with a cer ta in lack of caut ion, cha rac t e r i s t i c of him. Wakely, Editor of the Lancet, was vio len t ly opposed to mesmerism and in an e f f o r t to convince him of i t s worth El l io t son made the f a t a l mistake of attempting ear ly experiments a t Wakely's house using two g i r l s , the Okey s i s t e r s , who were unstable , highly suggest ible young women, prone to pe t ty fraud and considerably exhibi t ionism. The experiments fa i led miserably and the f u l l venom of Wakely f e l l upon El l io t son who l a t e r , because of h i s many unortho doxies, became disc red i ted and was removed from h i s professor ia l post . However, he remained in pr iva te prac t ice , continued h i s i n t e r es t in mesmerism and remained an ac t ive ed i to r of the quarter ly magazine, The Zoist , from i t s f i r s t publ icat ion in 1843 u n t i l he died in 1856. This journal served to co l l ec t and di ffuse an enormous volume of information about mesmerism and cerebra l physiology and was very i n f luen t i a l , espec ia l ly amongst lay people.
A second Scot, not a doctor but a lawyer, J . C. Colquhoun (1836). made a more reasoned approach to the nature of mesmerism in his two volume work ' I s i s Revelata - An Inquiry in to the Origins , Progress and Present Sta te of Animal Magnetism.' With a c l a r i t y of
10 M. R. BOND
mind possessed by the bes t l ega l brains he constructed a pos i t ive case for the r e a l i t y of the phenomena associated with animal magnet ism. He c r i t i c i s e d scept ics for ignoring the huge mass of fac t s ava i lab le to them and commended the subject for s c i e n t i f i c inves t iga t ion . He was unconvinced by the arguments for a magnetic process or f lu id but much impressed by the powerful effec ts the mind could have on the body and vice versa .
The prac t i ca l value of mesmerism was c lear ly demonstrated by a pragmatic Scot in the Indian par t of the Colonial Service. Dr. James Esdai le (1846) appalled by the pain and suffer ing of his pa t ien ts and impressed by the powers of mesmerism to induce t rance, used i t in many successful surg ica l operations, mostly of a minor nature . I t should be borne in mind t ha t the sentiments of the day regarding pain di ffe red from our own. They were summed up in Esda i le ' s quote from a
Dr. Copland who s ta ted t ha t , "pain i s a wise provis ion of nature , andpa t i en t s ought to suffe r pain while t he i r surgeon i s operat ing; they are a l l the be t t e r for i t and recover be t t e r " . In one per iod of eight months Esdaile operated upon 73 pat ien ts and in the same period t rea ted 18 medical cases , most having neurological or what we would c a l l psychia t r ic disorders . Pragmatism, a strong feature of the Scot t i sh persona l ity even today, led him to several basic conclusions which were, f i r s t , the operator should not put too much emphasis on carefu l se lec t ion of subjects ; second, fa i lure to respond to mes merism in heal thy people did not mean t ha t when possessed by the des i re to overcome an i l l n e s s they would remain r e s i s t an t to i t and, l a s t , t ha t the e ff ec t s of mesmerism were similar to ce r t a in nat ive
myst ical treatments for i l l nes s , an effec t commented upon by others , notably Colquhoun and Braid.
The Scot who made the grea tes t and most l a s t i ng contr ibut ion to the debate on mesmerism was James Braid (Dingwall 1968). He was born in 1795, son of a landowner in Fife , and was educated a t Edinburgh University. He reconci led many of the conf l ic t s surrounding mes merism by care fu l experimentation and thoughtful l i t e r a ry contr ibu t ions , of which the bes t known i s 'Neurypnology or the Rationale of Nervous Sleep considered in re la t ion with Animal Magnetism' (Waite 1899). The work, hypnotism, i s h i s own shortened form of the term, neurophypnotism which he derived from neurypnology.
Braid regarded mesmerism, or hypnotism, as a ser ious subject and bel ieved t ha t i t s use in the treatment of i l l nes s should be confined to doctors . He proved to h i s own sa t i s fac t ion and tha t of others t ha t magnetic f lu id was non-exis tent and emphasized tha t hypnotism involved the use of considerable powers of suggestion by the hypno t i s t , together with a need for sugges t ib i l i ty on the par t of the pat ien t . He concluded, i n h i s own words, tha t " a l l I claim for hypnotism i s now wil l ing ly admitted by the great major i ty of scien t i f i c men who have invest igated the subject without previous preju dice in favor of mesmerism". In addi t ion to h i s work on hypnosis
Braid a l so dea l t f irmly with a number of o the r i s sues , for example he disproved the exis tence of many of the phenomena assoc ia ted with cla i rvoyance, proved t h a t the c u l t of elect robiology was e s sen t i a l l y the process of hypnotism induced by the use of zinc and copper discs , and showed tha t severa l phenomena assoc ia ted with mesmerism were sub jec t ive , t h a t i s of the mind's invent ion and not a r e s u l t of magnetic forces or f l u i d . I n t e r e s t i n g l y, a t an e a r l i e r s tage Bertrand, in France, had come to a s i m i l a r conclusion.
Despite Bra id ' s work the prac t ice of mesmerism continued (Townsend 1844) and indeed E l l i o t s o n , through the medium of the Zois t attempted to d i s c r e d i t him on severa l occasions. A Mr. William Davey (1862), ac tua l ly es tab l i shed a Scot t i sh Curat ive Mesmeric Associa t ion in 1853 wel l a f t e r the publ ica t ion of Bra id ' s book, and he was jo ined in t h i s venture by Gregory, the Professor of Chemistry a t the Univer
s i t y of Edinburgh, who became President of the Society. I t wassupported by a number of eminent Scots in the c i t y, inc luding the President of the Royal Socie ty of Edinburgh, S i r Thomas Brisbane .
As far as Scotland was concerned the i n t e r e s t shown in mesmerism and hypnotism faded and the dominant features of the medical scene in the l a t t e r ha l f of the 19th century were re la ted to the discovery of anaesthes ia and the con t ro l of surg ica l seps i s , together with the rapid development of the s p e c i a l i t i e s of surgery and pathology in both Glasgow and Edinburgh.
The l i n e of hypnosis was not dead. Bra id ' s work was quickly
taken up in France where the Nancy and Par i s i an Schools of Hypnosis were es tab l i shed and i t was to Par i s tha t Sigmund Freud went to l ea rn more of hypnosis from the French neuro log i s t , Charcot, who bel ieved tha t hypnosis could be induced in neuro t i c p a t i e n t s and t h a t the suscep t i b i l i t y to hypnosis was a s ign of hys te r ia .
Freud i s the l i nk between the 19th century and between hypnosis and psychosomatic medicine, because i t was in the ear ly years of the 20th century tha t h i s pupi l s e s tab l i shed the formal study of psycho somatic disorders .
HYPNOSIS AND PSYCHOSOMATICS IN THE 20TH CENTURY
I n t e r e s t i n hypnosis for the f i r s t 50 years of the century was almost non-exis tent in Scotland and p r i o r to the 1950s i t s use was seldom mentioned except in r e l a t i on to t reatment of she l l shock in the 1914/18 War by a Scot , Dr. John McDougall.
In the 1950s f r e sh i n t e r e s t was genera ted in hypnosis and was re f lec ted in the fac t tha t Professor Ferguson Rodger, then the Pro fessor of Psychologica l Medicine in Glasgow, headed a group which on behalf of the B r i t i s h Medical Associa t ion inves t iga ted the claims of
12 M. R. BOND
the prac t i t ioners of hypnosis. The Commission concluded t ha t i t had a usefu l ro le in pain control and psychotherapy and t ha t i t should be taught to medical and dental s tudents . At the same time Dr. David
Fisher. both a doctor and dent i s t . establ ished several hypnotherapyc l in i c s in Glasgow and was a lso the moving force behind the found a t ion of the Scot t i sh Divis ion of the Br i t i sh Medical and Dental Hypnosis Society - the parent body of which had been founded by the fus ion of the Medical and Dental Societ ies in 1952. Much more re cent ly the Br i t i sh Society of Experimental and Clin ica l Hypnosis was founded and has two branches in Scotland. Thus. in the l a s t 30 years there has been increasing i n t e re s t in hypnosis in Scotland and. a t presen t . i t s prac t ice i s both f lour ishing and expanding.
Psychosomatics i s a term covering i n t e re s t in the r e l a t i on between physical and emotional aspects of disease. This has a long
his tory and the term. psychosomatic, appears to have been used f i r s t a t the beginning of the 19th century in Germany by Heinroth. How ever, formal study of diseases , regarded as spec i f ica l ly psychoso matic , d id not begin u n t i l the ear ly pa r t of the 20th century when pupi ls of Freud firmly establ ished the study of psychosomatic d i s orders l inking cer ta in conditions of the mind with par t icu lar physi ca l symptoms or diseases .
The most outs tanding contr ibut ion in Scotland to t h i s f i e ld of medicine was made by Dr. John Hall iday, an epidemiologist and Medical Off ice r of Health in Glasgow. In the 1930s and 40s Dr. Halliday became impressed by, and studied the effec ts of , soc ia l fac tors upon i l l nes s . In h i s book. 'Psychosocial Medicine' , published in 1948 he ref ined the concept of a psychosomatic disorder as follows: "A psy chosomatic affec t ion i s a disease which complies with the psychoso matic formula and whose prevalence r i s e s or f a l l s in accordance with the r i s e or f a l l of communal upset t ing events , tha t i s , in accordance with the pressure of environment in i t s psychological aspects" . This seems to have been a forerunner of l a t e r i n t e re s t in the subject of l i f e events and t h e i r r e l a t i on to emotional d i s t r e s s and mental i l l nes s . Dr. Hal l iday ' s inves t iga t ions revealed tha t disorders f i t t i n g t h i s pat te rn . included pept ic ulcera t ion and g a s t r i t i s . exopthalmic go i t r e , hypertensive disorders including hypertension, coronary thrombosis. angina and cerebrovascular disorders . and psy choneuroses. including anxiety s t a t e s and hys te r ia . There are many others deta i led in h i s book and h i s work was warmly received. e s pec ia l ly in the United States where one of the founders of the psy chosomatic school in tha t country. Dr. Flanders Dunbar (1946) acknow ledged h i s contr ibut ion a t length in her book. 'Emotions and Bodily Change. a l i t e r a t u r e survey of 1910-1945'. Dr. Halliday was the f i r s t President of the Glasgow Psychosomatic Society. which remains one of only two in Bri ta in and which was founded in 1959 a t the ins t iga t ion of the l a t e Drs. David Kissen and Astor Sclare . This Society continues to f lour i sh .
Another Scot who made a s ign i f ican t contr ibut ion to psychoso matic medicine was the l a t e Dr. David Kissen who, pr ior to h i s un t imely death in 1968, carr ied out a ser ies of s tud ies , some with Professor Hans Eysenck of London University, upon the re la t ion of psychological and physiological aspects of personal i ty and proneness to malignant lung disease. Professor Cairns Aitken of the Univers i ty of Edinburgh, current ly ed i to r of the Journal of Psychosomatic Re search and Professor of Rehabi l i ta t ion Medicine a t Edinburgh Univer s i t y, has made s ign i f ican t contr ibut ions to our understanding of anxiety, as an aspect of psychosomatic medicine, and one of his close assoc ia tes , Dr. Lorna Cay, has provided much information about emotional aspects of heart disease and the rehabi l i ta t ion of vict ims of myocardial in fa rc t ion .
To conclude, the psychosomatic approach to medicine f lourishes
and continues to grow in Scotland. I t i s appropria te to concludet h i s paper with the hope tha t the present t rend towards a wider use of the psychosomatic approach and in tegra t ion of hypnosis and a l l i e d techniques in to the treatment programmes for those with a combination of psychological and physiological symptoms wi l l continue.
REFERENCES
Colquhoun, J . C., 1836, Animal magnetism, in : I s i s Revelata - "An Inquiry in to the Origins, Progress and Present Sta te of Animal Magnetism," (Vol I ) , I s i s Revelata, ed. ,Maclachlan Stewart, Edinburgh.
Cri tchley, M., 1979, "The Divine Banquet of the Brain," Raven Press , New York.
Davey, W., 1862, "The I l l u s t r a t ed Prac t i ca l Mesmerist," (6th ed . ) , J . Burns, London.
Dingwall, E. J . , 1968, "Abnormal Hypnotic Phenomena - a Survey of 19th Century Cases," (Vol.IV), United Sta tes of America and Great Bri ta in , J . & A. Churchill Ltd . , London.
Dunbar, F. , 1946, "Emotions and Bodily Change," (3rd ed . ) , Columbia University Press , New York.
Esdai le , J . , "Mesmerism in India and i t s Prac t i ca l Application in Surgery and Medicine," 1846, Longman, Brown, Green & Longman, London.
Halliday, J . L. , The incidence of psychosomatic affec t ions in Bri ta in ," 1945, Psychosom.Med., 7:135-146.
Halliday, J . L. , 1948, "Psychosocial Medicine: A Study of the Sick Society," Heinemann Medical Books, London.
Hamilton, D., 1981, "The Healers, A History of Medicine in Scot land," Canongate, Edinburgh.
Millingen, J . G., 1837, "Cur ios i t i es of Medical Experience," (Vols. 1 and 2) , Richard Bently, London.
Townsend, C. H., 1844, "Facts in Mesmerism," (2nd. ed . ) Bai l l i e r e , London.
14 M• . R. BOND
Waite, A. E. , 1899, Braid on hypnotism, in : "Neurypnology or the Rationale of Nervous Sleep etc . ,"Redway, London.
Abstrac t
Fred H. Frankel
Beth I s r ae l Hospital and Harvard Medical School 330 Brookline Avenue Boston, MA, 02215, USA
The or1g1ns of hypnosis a re indisputably c l i n i c a l , but i t s current accep tab i l i ty and recogni t ion stem l a rge ly from the high ca l ib re of academic investment and the findings in experimental l abora to r ies in recent years . What we know has been accumulated in the context of a r igorous adherence to f ine ly developed research methods, construct ive scept ic ism, and cold fac t s . Cl in ica l r e s u l t s , on the other hand, demand f l e x i b i l i t y, imaginative phrases , deep
fee l ings , and even l o f t y thoughts. The poetry and the science areboth e s se n t i a l fo r su rv iva l .
INTRODUCTION
I have wondered in common with many of you I am sure , about the appropr ia te nature of a pres iden t ia l address . I t c e r t a i n ly i s poorly timed for a p o l i t i c a l statement because i t comes toward the end of the term of off i ce , and the l i n e of succession has already been es tab l i shed for the coming s ix years . I f I were fo r tuna te enough to be able to make some ex t raord inar i ly valuable pronouncements today in
the hope of re turning to off ice in 1989, you wi l l sure ly a l l have forgot ten them by then. On the other hand, the address might be considered to be something akin to a Sta te of the Nation Address - a review of where the Society has been, where we a re a t , and where we a re headed.
* Pres iden t ia l Address by the Pres ident of the In te rna t iona l Society of Hypnosis.
15
16 F. H. FRANKEL
I f i t were to follow the theme cur ren t ly predominant in most i n s t i t u t i ons in the United Sta tes including hospi ta l s and academic cen te rs , i t would be l i ke an address to the shareholders - a business report tha t would be f i l l e d with f i s ca l ly re levant s ta tements and an eloquent bottom l ine .
I mean no disrespect to p o l i t i c s , to the presidency of my adopted country, or to big business. I bel ieve I recognize the importance of a l l three. However, in the hope tha t the re a re other prerogat ives open to the president of a socie ty such as ours , I wi l l choose ye t another format. With your indulgence I wil l use the occasion, unashamedly, to e laborate on a personal perspect ive on hypnosis t ha t i s admittedly ne i ther wholly or ig ina l nor unique. I wish a t the outse t to acknowledge the many contr ibut ions of my col leagues, some of whom are i n t h i s audience or on t h i s podium. I
wi l l , I fear, have to depend, in my presentat ion, on those con t r ibut ions , and wi l l t ry to avoid shaping t he i r findings to my own ends.
I come not as a t heo r i s t , grappling with formulae to r e l a t e the psychological to the physiological , although I might wish tha t I were. I come not as an exper imental is t with a keen ins igh t in to methodology and t ha t enviable ease with s t a t i s t i c s tha t resembles the s k i l l s of the t rapeze a r t i s t grabbing supports out of nowhere, although I might wish t ha t I did. I come ra ther as a c l in ic ian and c l i n i c a l teacher who has t r ave l led the highways and byways of c l i n i ca l and academic psychiat ry on two cont inents for more than th ree decades. I t seemed to me t ha t i f I did not use t h i s opportunity to
confront some of what I have gathered along the way, I probably never would lay claim openly to my own ambivalence. Having spent most a of my time as a c l in ic ian , and some as an inves t iga tor, I bel ieve I am general ly regarded as a c l in i ca l inves t iga tor. On the other hand, I might a lso qual i fy as an inves t iga t ive c l i n i c i an , or even as a curious one. Which a l l somewhat resembles the con f l i c t t ha t many of us seem to have as we grow older. I n i t i a l l y having preferred to see ourselves as l i be ra l s with a conservative leaning, we now f ind t ha t we are r ea l l y conservatives with, perhaps, a l i be ra l bent .
I be l ieve the essence of what I wish to address i s the unavoid able complexity, uncer ta in ty, and ambiguity in our f ie ld as I see i t , and the need for us to to le ra te the s i t ua t i on while we s t i l l s t ruggle to understand what i t i s t ha t we accomplish with the use of hypnosis. As we wel l know, close vis ion while v i t a l to the pursui t of any d e t a i l s , tends to bl ind us to the view of the whole. In our impatience to fo s t e r ideas tha t we personal ly cher ish, our nemesis lurks in a tendency to be cava l ie r about what others do.
As a c l i n i c a l psych i a t r i s t I am no s t ranger to complexity and ambiguity. Doubts, uncer ta in meanings, and the need to l i ve with a combination of in te rpre ta t ions are a way of l i f e in the f i e ld t ha t has nurtured me for most of my profess ional l i f e . How e l s e can one
HYPNOSIS - BOTH POETRY AND SCIENCE 17
be of help, for example, to a pat ien t to rn by angry feel ings toward an e lder ly paren t , o r a dying spouse? Moral and psychodynamic absol u tes a re of l i t t l e value. Directed by the moral imperat ive , I could say to him, "How can you be so vicious or unkind toward someone who i s dying?" Or wi l l I help him psychodynamically, do you th ink, i f I t e l l him tha t he has every r i gh t to be angered by the fac t t ha t h i s l i f e i s being eroded by the demands and the needs of his suffe r ing re la t ive? Should I say then, "You go ahead, and l e t them know?" Perhaps what I might ul t imately do t ha t might be more usefu l , i s to s i t sympathet ical ly, saying l i t t l e , but making i t c lear tha t I , too, know the human condi t ion to be a tough one, and tha t I wi l l t ry to help him cope with whatever i r reconc i lab le and i r r a t iona l feel ings a r i s e in him.
How should I bes t respond to the needs of a pat ien t who rec i t e s
a l i s t of physical complaints for which her physic ians can uncover nophysiological cause. As she recounts them, I de tec t a hin t of sad ness in her voice . On an i nv i t a t i on to her to share her feel ings with me, she descr ibes a se r i e s of deep personal losses , the deaths of close family members tha t immediately preceded the onset of her symptoms. Should I t r e a t her be encouraging her to t a lk about the hurt of her gr i e f , or should I prescr ibe medication t ha t i s aimed a t helping to l i f t her depression? Will I be wiser yet to use a combi nat ion of both methods; have her f i r s t r eca l l her feel ings and then wait for an opportune time to introduce medication in addi t ion. Perhaps I wi l l se lec t t ha t path. but i t should be noted tha t the re i s a l i t e r a t u r e and a body of profess ional opinion in favor of each
pos i t ion . p re fe r r ing e i t he r one approach or the other, r a the r than a combination. How should I regard physical symptoms t ha t respond to bio log ica l remedies, but t ha t never theless or ig ina te in the emotions - in the anguish of tha t curious mixture of physical and psychologi ca l discomforts tha t Lindemann (1945) described as the "g r i e f r e ac t ion" .
Although on more so l id ground in some areas than we were twenty f ive years ago. psychiat ry s t i l l has more quest ions than answers - but we offer no apologies . We have a growing body of knowledge derived from our c l i n i c a l experience and our laboratory s tud ies ; some of our dearest concepts have stood the t e s t of t ime. In moments of c r i s i s our col leagues , even those who are c r i t i c a l , know t ha t they must c a l I o n us because. l imited though we might be, we s t i l l know more about the management and treatment of dis t ressed and psychot ic behavior and su i c ida l depressions than they do. When t he i r pa t i en t s on the medical and surg ica l f loors and in the emergency wards behave i r r a t i ona l ly they c a l I o n us. Both burdened and armed with knowing how ambiguous i s our t r ade , we go fo r th . Because our data are for the most par t s o f t . not hard. and because we cannot re ly on an impressive ba t te ry of unequivocal laboratory t e s t s , we have to re ly on a modicum of good sense and a demonstration of good manners. We aim to be recept ive but not passive . caut ious but not cowered, and
18 F. H. FRANKEL
r e a l i s t i c but not cava l ie r. We know t ha t the f i na l so lu t ion to dis turbed behavior has ye t to be wri t ten . But we have learned tha t we are more l ike ly to be successful i f we remain f l ex ib l e , non judgmental, and open to suggestion as we proceed with our interviews and our t rea tment plans . Subsequent events are of ten open to var ious in te rpre ta t ions as we s t ruggle to balance the demands of the psycho log ica l and the physical , of the r a t i ona l and the emotional. We l ea rn when to prescr ibe a p i l l , when to explore fee l ings , and when to off e r reassurance. Sometimes we prudently wait to discover the course of ac t ion t ha t i s bes t . I have said we go fo r th both burdened and armed with the knowledge of the ambiguit ies inherent in our ca l l i ng . Burdened, because i t i s bothersome not to know many of the answers, but armed because without being aware of the uncer ta in t ies in our work we might well do more harm than good.
Unexpected though i t might seem, t o l e r a t i ng uncer ta inty i s notpecu l ia r to only those of us who t o i l in the behavioral sc iences . Closer examination of the hard sciences impresses us with the fac t t ha t even the re , beyond a ce r t a in poin t , a sse r t ions are l e s s f i n i t e . The Alber t Einsteins and the Niels Bohrs provide us with notable examples. What should be c lea rcu t i s f requent ly not so. Those i l l u s t r i o u s individuals had the a b i l i t y to acknowledge the value of more than one theory of l i g h t . Theirs i s a sober reminder of how the grea t l ea rn to l i ve with ambiguity. Einstein (1924) wrote, "We now have two theor ies of l i g h t , both indispensable , but , i t must be admitted, without any l og i ca l connection between them, despi te twenty years of co lossa l e ffo r t by theore t ica l phys ic i s t s . " Bohr (1934) in
h i s evaluat ion of the apparently contradic tory wave and pa r t i c l etheor ies to explain the propagation of l i g h t , suggested more d i r ec t l y tha t opposite viewpoints under the circumstances are not only i nd i s pensable, they are complementary. In other words, ra ther than being mutually exclusive , they can be mutually enhancing.
Hypnosis in Mesmer's Time
Moving now c loser to home, to our own f i e ld of endeavor, we might ponder how Franz Anton Mesmer. the acknowledged fa ther of hypnosis. might have f e l t had he sensed the poten t ia l and the com plex i ty of what he bequeathed to us. To what extent could he have apprecia ted tha t his prac t ices would. on the one hand. contr ibute to the development of an important re l ig ious i n s t i t u t ion (Podmore. 1963) and on the other lead to some of the most sophis t icated methodology in the study of the behavioral sciences? To what extent could he have been aware tha t h i s work heralded a new perspect ive - tha t i t lay on the threshold of a dialogue between the psyche and the soma - and t ha t i t would pave the way to sweeping psychological theor ies (Ellenberger. 1910) tha t would i n i t i a l l y reveal more questions than answers. Could he have even vaguely recognized t ha t among those who showed an i n t e re s t in h i s work would be some dedicated to the accumu-
l a t i on of f ac t s , and yet others whose primary commitment was to the exercise of fantasy.
I t seems tha t in whichever di rec t ion one follows hypnosis, one encounters t h i s jux tapos i t ion of two seemingly contradic tory perspec t ives - a kind of dualism tha t seeks to expla in the phenomenon in the i r reduc ib le terms of one or another system. Is i t phys ica l , or a l l psychological? I s i t r a t i o na l , or a l l emotional? I s i t f ac t , or a l l fantasy?
There i s l i t t l e to suggest tha t e i t he r Mesmer or the s p i r i t of h i s time could have apprecia ted the pervasiveness of the purely psychological , the impact of the emotions, or the inf luence of fantasy. Mesmer wrote tha t the explanation of what he accomplished resided in h i s Fluid Theory (Mesmer, 1774) in the physical r e a l i t y of
a magnetic f lu id t h a t could pass through the body of the magnetizerto the pa t i e n t . As the world was being opened up a t t h a t s tage in his to ry by the dramatic discover ies of modern physics , i t comes as no surpr i se tha t the important answers were assumed to l i e i n t h a t realm. I t i s i n t e r e s t i ng to note however, tha t desp i t e Mesmer's wri t t en commitment to a physical explanat ion tha t he hoped would be acceptable to sc ience, he was not above performing an elaborate and t hea t r i c a l r i t u a l in h i s c l i n i c a l prac t ice , obviously aimed a t what we today would regard as the psychological s e n s i b i l i t i e s of his pa t i en t s . His method of magnetizing, we a re to ld , was choreographed with color and sound. Looking in to the rea r mirror of his to ry we must wonder whether he r e a l l y did s e t t l e fo r an amalgam of poetry and
science - or whether, despi te the s c i e n t i f i c pretensions of h i s Fluid Theory, he was not e s s en t i a l l y a poet - a committed 18th century prototype of the modern science f i c t i on w r i t e r, perhaps with l e s s personal ins igh t .
I t i s usefu l to note t h a t in our t ime, in the f i e ld of hypnosis, the contes t i s l ined up in a way tha t bears the mark of two cen tur ies of c l i n i c a l work, and a ha l f century of modern laboratory i n v e s t i gat ion. We are confronted by the fac t t h a t unbridled c l i n i c a l experience with hypnosis i s now being p i t t e d against the log ica l findings of soph is t i ca ted methodology. Perhaps the grea tes t cha l lenge to the f i e ld of hypnosis a t t h i s time l i e s in how we resolve the differences between a r i ch ly imaginative c l i n i c a l focus and the fac t s tha t emanate from the laboratory, between the poetry on the one hand and the science on the other. Are they i r r educ ib ly d i f f e r en t , o r a re they interdependent? Are they mutually exclusive , o r in the words of the p hys i c i s t s , are they complemetary?
Modern Hypnosis
I t might be usefu l to take stock again of the a r t i s t r y tha t has been an in tegra l par t of the prac t ice of c l i n i c a l hypnosis s ince i t s
20 F . H. FRANKEL
incept ion. Mesmer's purple cape, the music, and the general mil ieu surrounding the event in h i s time had a d i s t i nc t ly t hea t r i ca l qual i ty. To t h i s day. many c l in ic ians in the induction procedures assume the s tudied pose o r the voice i n f l ec t i on of the "hypnot izer." Their behavior i s d i s t inc t ly manipulative. Whether over t ly con t ro l ing or permissive. the tempo of the di rec t ions i s slow. and the speech monotonous. quie t ing . and reassur ing. Pat ien ts are offered a "very enjoyable" or even "momentous" experience; they are perhaps encouraged to bel ieve they are "ent i t l ed" to the reward of a deep sense of re laxat ion. They are persuaded to disconnect or disengage from the workaday world, and to soar with the images tha t are suggested d i r ec t ly. or encouraged. Existence becomes purple prose or sheer poetry. I t i s onto t h i s subs t ra te tha t the se lec ted the ra peut ic s t ra tegy i s graf ted - the numb feel ing to displace the pain . the image of the blood vesse l s expanding to allow a grea te r degree of
body heat to reach the f ingers or the toes a ff l i c t ed by a r t e r i a lspasm, or the wondrous sense of a grea t confidence l i ke a p i l l a r of l i gh t growing within oneself . Colorful language. vivid imagery, and a voyage to a make-believe world are closely woven in to the whole experience.
Some c l in i c i ans prefe r to s t r i p the event of these embel l ish ments; however, even when the induct ion procedures are pedestr ian. such as "close your eyes . count to ten and re lax" . the s t ra tegy must s t i l l depend on imagination for i t s energy. This can be fostered by allowing a spontaneous unfolding of fantasy; i t might be brought on by asking the pat ien t to use whatever images he chooses to c rea te the
numb fee l ings . or the warm feel ings. or the sense of increasing se l f confidence. This l a t t e r approach i s general ly favored by those who graduate to c l i n i c a l work through a previous involvement in i nves t i gat ive studies in the laboratory. Many c l in ic ians seem to show l i t t l e preference for t h i s pa le r vers ion of hypnosis, while s t i l l o thers assume a s ty le of pract ice t ha t l i e s somewhere in between. There are few i f any dependable s tud ies repor t ing on the incidence of the d i f f e r en t s ty l e s or on t he i r comparable eff icacy. My own i n c l i nat ion has been to deemphasize the t hea t r i ca l in hypnosis, and to come down on the somewhat conservative s ide of my ambivalence. Both my prac t ice and my teaching r e f l ec t t h i s . My pa t ien t s a re often inv i ted to pa r t i c ipa t e in the event. motivated not only by the wish to get wel l . but also by a s p i r i t of adventure and cur ios i ty.
I be l ieve I chose to follow t h i s l i ne because of my respect and continued admiration for the inves t iga t ive s tudies tha t have emerged in recent decades. By cas t ing hypnosis in a casual mould. s t r ipped of i t s magic and mystique, inves t iga tors have made i t r ea l ; t he i r work with s tandardized procedures has led to major developments. With the refinement of the hypnot izabi l i ty scales and an increasingly impressive methodology. they have uncovered several parameters of hypnosis - some of which might have been suspected while others came as a surpr i se . Working l a rge ly with volunteers from the col lege
s tudent popula t ion in a f r i end ly but very prosaic manner compared with tha t in the c l i n i c a l s i t ua t i ons , inves t iga to rs have shown tha t hypnot izab i l i ty i s not universa l ly d i s t r i bu t e d , tha t women a re not on average more hypnotizable than men, and t h a t the l eve l of general education has no e ff ec t on the degree of responsiveness. They have demonstrated these f a c t s , and many more (Hilgard, 1965).
A major consequence of t h i s i n t e l l e c t u a l and determined pursu i t of the phenomenon of hypnosis has been the d i s t i l l a t i o n of what i s bel ieved to be i t s essence - the a l t e r a t i o n of percept ion. This might be associa ted with a l te red cogni t ion and even a l t e r ed memory, but wi thin t h i s conceptual framework the a l t e r e d s t a t e of awareness measured primari ly in terms of the sub jec t ive experience of the hypnotized individual i s the hallmark of hypnosis.
For some c l i n i c i ans deeply invested in the use of hypnosis,immersed in the r i ch metaphors in frequent use, and involved in the in tense re la t ionsh ips t h a t mark the therapeut ic encounter, t h i s simple explanation i s somewhat dul l and not a l toge ther re levan t . I t i s seen a t bes t as a disappointment, and a t worst as a be t raya l . They regard i t as leaving l i t t l e j u s t i f i c a t i o n for the imaginative prac t ices and in tense re la t ionsh ips tha t surround t h e i r use of hyp nos i s . Although the re la t ionsh ip between the hypnot izer and the sub jec t , and the sub j ec t ' s consenting p a r t i c i pa t i on are seen as necessary for the development in the laboratory of the a l t e r ed per cept ion or a l te red awareness, the phrase i t s e l f " a l t e r ed perception" by i t s very nature diminishes the importance of the overtones so dear
to the hear t s of c l i n i c i an s who prefe r more co lor fu l prac t ice and phraseology. The crea t ive s ty l e and the imaginative terms they use add to the psychological impact of the procedure. Perhaps because the words are o f ten purposeful ly obscure and the content r i ch in metaphor, the whole lends s t a t u r e to the c l i n i c i an and enhances his procedures. He says: " I am about to make contact with your deeply unconscious mind, to help you communicate with a par t of you t h a t has been hidden from you u n t i l now. Deeply unconscious pathways w i l l lead you to the psychological forces wi thin you t h a t w i l l enable you to r e s i s t the urge to reach for a c iga re t t e . "
Despite the rese rva t ions of these who c r i t i c i z e the laboratory de f in i t i on , t h i s ornate phraseology leads prec i se ly to the experience of an a l t e r e d percept ion. The hypnot izer, with the a id of important sounding language, encourages the pa t i e n t to experience what he, the pa t i en t , perceives to be deeply hidden s t rengths . Even though they might not be so deeply hidden tha t only the the rap is t can provide access to them, they can be made to seem so inaccess ib le in order to have them be tha t much more i n f l uen t i a l when they emerge.
What i s not immediately conveyed by the b r i e f phrase , "a l t e r ed percept ion" , perhaps, i s the a r t i s t r y, the poetry. and the tendency c l i n i c a l l y to encourage the impression t h a t th ings in hypnosis a re
22
l a rge r than l i f e . This l a t t e r aspect hypnotic s i t ua t i on , than to hypnosis. in the language, and in the ambience.
proceed.
F. H. FRANKEL
seems to belong more to the I t i s car r ied in the s ty l e , Let me t ry to explain as I
In a great s p i r i t of compromise, or possibly complementarity, the l a t e Ronald Shor described hypnosis as possessing th ree dimen s ions (Shor, 1962). The experience of the a l te red percept ion or t rance i s but one. The other two include the important and spec ia l re la t ionsh ip between the subject and the individual carrying out the procedure, and the sub jec t ' s i n t e r e s t in and motivation to p a r t i c i pate in hypnosis. This in terpersonal i n t e r ac t i on , and the inner preparedness to respond to the hypnosis exer t considerable inf luence on the way in which the hypnosis proceeds.
In the c l i n i c a l se t t i ng these dimensions are pa r t i cu l a r l y complex, involving many other psychodynamic forces , the a t t i t ude of the pa t i en t to his i l l n e s s , h i s expecta t ions of hypnosis, the environ mental fac to rs - a l l of which inf luence the p a t i e n t ' s ul t imate response to hypnosis and his symptomatic response to the therapy. I t should be remembered tha t these two fac tors , namely the re la t ionsh ip and the motivat ion, are equally re levan t to the progress of any other form of psychotherapy. We who use hypnosis are not a lone. All who prac t ice psychotherapy depend, for the effect iveness of t he i r methods, on the s t reng th of the re la t ionsh ip and the p a t i e n t ' s deep i n t e r e s t in improving.
I t i s unfor tunate tha t the t heo re t i c a l and inves t iga t ive concept of the a l t e r e d percept ion, useful as i t i s , when examined out of context conveys a predominantly i n t e l l ec tua l i n t e rp re t a t i on of the event of hypnosis. While t h i s does an i n ju s t i c e to the idea as i t was o r ig ina l l y formulated (Orne, 1959) the re i s no escaping the inhosp i t ab le reac t ion to i t among many c l in ic ians . Perhaps i t i s because the other fac tors contr ibut ing to the hypnotic s i t ua t i on appear to receive short s h i f t in comparison. Perception i s d i s cussed, descr ibed, and measured. Even though sub jec t ive i t qua l i f i e s as sc ience. On the o ther hand the importance of the in terpersonal re la t ionsh ip involved in hypnosis, the rapport , o r the t ransference, and the sum t o t a l of the psychodynamic forces which inf luence motiv a t i on , acknowledged though they be, s t i l l appear to be re legated to a minor ro le . They are es sen t i a l l y the der iva t ives of fee l ings , ubiqu i tous , and challenging to any would-be s c i e n t i s t . They promote the i l l u s ions and give l i f e to the metaphors; and as such they are the poetry.
Few c l i n i c i ans w i l l deny the importance of the therapeut ic re la t ionsh ip , whether they regard ' i t merely as rapport , or whether they inves t i t with the complexit ies t h a t make up the psycho-analytic t ransference. The psych ia t r i c l i t e r a t u r e i s rep le te with references to the phenomenon. We know i t has much to do with the emotional
l ives of the two people involved. Something ine ffab le , i t i s yet cruc ia l to, the ca l ib re of the therapy and of the hypnotic experience. The re la t ive ly l ack lus t re outcome with s e l f hypnosis learned from books confirms t h i s view. The phenomenon has, however, thus f a r def ied measurement, and in the laboratory publ icat ions i s given l i t t l e a t t en t i on .
I t wi l l come as no surpr i se to you now to hear t ha t the sc ien t i s t in me of ten succumbs to t h i s other 've ry c l in i ca l s ide of the ambivalence. I am, however, reassured in my surrender by the fac t tha t the role of imagination in hypnosis was dea l t with only cursori ly in inves t iga t ive work u n t i l the importance of imaginative involvement emerged from c l in i ca l observation (Hi1gard, 1970). I submit tha t the a ff ec t in hypnosis i s also an idea whose time in the laboratory has come. Although the l e s s fas t id ious have regarded
every aspect of the hypnotic in te rac t ion as hypnosis, others among ushave d i f f e r en t i a t ed between the essence of hypnosis - the a l te red perception - and the other forces in the hypnotic s i tua t ion . I t i s time now to turn our a t ten t ion to the l a t t e r , to examine them, to t ry to measure them i f we dare , and to l ea rn to l i ve with them.
Even though t h i s ser ious dialogue between the poetry and the science i s only now about to dawn, a glimmer has been seen for some time. We might fashion discussions in the future on the format of those current ly in vogue. Two examples immediately come to mind: hypnot izabi l i ty in both the laboratory and c l in i ca l contexts , and the value of memories recal led in hypnosis. Perhaps a b r i e f review of
these two areas and of how the varying viewpoints can be and have been thus fa r reconci led, wi l l remind us tha t contradictory view points are not necessa r i ly mutually exclusive; they can in fac t complement each other.
Hypnot izabi l i ty Measure
As already indicated by me, c l in ic ians have of ten been incl ined to disregard the laboratory measurements as inappl icable to the c l i n i c a l scene. Contrasting the populat ions , one young and heal thy, the other suffer ing and represent ing several age groups, they con clude tha t laboratory hypnosis and c l i n i c a l hypnosis are not compar able e n t i t i e s . When requested to apply to measures developed in the laboratory to pat ien ts , these c r i t i c s demur on the grounds tha t the t e s t s are lengthy and in t rus ive (Sacerdote, 1982), or t ha t they would in te r fe re with the course of treatment were they to be introduced in to the c l in i ca l s i t ua t i on . There i s evidence to the contrary (Frankel e t a l . , 1979), indicat ing tha t the laboratory sca les can indeed be appl ied to pat ien ts without creat ing the havoc tha t has been prophesied by the c r i t i c s ; furthermore s tudies reveal i n t e r e s t ing cor re la t ions between high scores and spec i f ic types of psychi a t r i c disorders (Frankel and Orne, 1976). But t ha t i s not the focus of
t h i s presentat ion.
24 F. H. FRANKEL
What i s a t s take here i s the apparent contradict ion between the ex ten t of the hypnotic response on the hypnot izabi l i ty scales and the degree to which pa t i en t s respond symptomatically to therapy involving hypnotic procedures. While these individual react ions are re la ted in severa l ways, they are not i den t i ca l . The response to a hypnotic induct ion procedure i s not equivalent to the response to a the ra peut ic procedure. In f ac t , pa t i en t s who are highly hypnotizable might show no therapeut ic response to a treatment involving hypnosis i f the secondary gain from t he i r symptoms i s such t ha t they are loa th to give them up. Secondary gain i s a v i t a l force in the perpetuat ion of symptoms. We know well the extent to which a t t en t i ve and sympath e t i c r e l a t i ve s can unwit t ingly prolong the behavior of i l l n e s s . Pain c l in i c s have a remarkable accumulation of data to support tha t . Furthermore, and i n cont ras t , pa t ien t s who respond poorly to t e s t s of hypnot izab i l i ty might ye t show a pos i t ive therapeut ic response to
procedures involving hypnosis, for the simple reason tha t theyrespond to the se t t i ng in which hypnosis takes place even though they might not be hypnotizable. They respond to the therapeut ic inf luence of the ambience, the encouragement, and the re laxa t ion tha t con t r i bute to the s i tua t ion in which the hypnosis i s encouraged to take place , even when the hypnosis per se f a i l s to occur.
We are here again ta lking about the hypnotic s i t ua t i on . I t i s , i n t ru th , inescapable , and we come f u l l c i r c l e . The poor hypnotic subjec t s gain r e l i e f from t he i r symptoms very often from the reassur ance, the t r u s t , and the expecta t ions t ha t are inherent in a l l acknowledged c l i n i c a l procedures. The mystique surrounding hypnosis,
unre l iab le though i t be, might well add to the e ff ec t s . The b

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