Classics in Psychology

Robert H. Wozniak - Bryn Mawr College

Hippolyte Bernheim: Suggestive Therapeutics (1886; English 1889)

In the mid-1860s, a French physician who had been working among the poor in a small village not far fromNancy, published a book on the therapeutic use of a form of sleep variously known as artificialsomnambulism, magnetic, or hypnotic sleep.219 Unlike most of those who had preceded him,220 Ambroise-Augustin Libeault221 recognized the central importance of mental suggestion in the induction of hypnotic sleepand the enhanced susceptibility to mental suggestion that characterized a patient who had been hypnotized.Putting his patients into a light trance, he assured them that their symptoms were being relieved; and whenthey awoke, many found that their condition had improved.

When rumors of Libeault's therapeutic successes reached the University of Nancy, they attracted the attentionof Hippolyte Bernheim,222 the university's renowned professor of internal medicine. In 1882, Bernheim visitedLibeault and became convinced of the efficacy of his treatment methods. Returning to the university, heincorporated Libeault's techniques into the regimen employed at the medical hospital, and refined andrationalized his approach.

In 1884, Bernheim published the first major account of his work, De la suggestion dans l'tat hypnotique etdans l'tat de veille.223 Here he provided an historical and theoretical analysis of the nature of suggestion andthe suggestive nature not only of hypnotic phenomena but of all normal automatic behavior. In 1886,Bernheim revised and expanded this work, adding a section on the application of suggestion to therapeutics.Published as De la suggestion et de ses applications la thrapeutique and translated into English in 1889 asSuggestive Therapeutics. A Treatise on the Nature and Uses of Hypnotism,224 this work is widely consideredto be the classic treatment of mental suggestion.

In Suggestive Therapeutics, Bernheim provided the clearest and most detailed exposition of his theoreticalviews. While these views were not for the most part original,225 they were so effectively articulated and sowell supported by clinical observation and Bernheim was a figure of such high scientific reputation that theyexerted a powerful influence on late 19th and early 20th century psychology. Figures as diverse as SigmundFreud, James Mark Baldwin, and Walter Dill Scott made significant use of Bernheim's views.226

Suggestive Therapeutics also served as the definitive text for what came to be called the 'Nancy School' of'psychotherapeutics.' Following its publication, enthusiasm for the therapeutic application of suggestion beganto gather momentum; and by the turn of the century, the Nancy approach had become widespread, bothwithin Europe and throughout the United States.227

For Bernheim, suggestibility was defined as the capacity to transform an idea directly and automatically into asensation or movement. Sensations and movements so produced were respectively called ideosensory orideomotor automatisms, where an automatism is any simple or complex activity proceeding without consciousmonitoring, without conscious volition.

Suggestibility, Bernheim believed, was a natural state of the normal, healthy individual. Only whenautomatisms were consciously regulated by reason, attention, and judgment was suggestibility reduced. Anycondition that tended to lessen the influence of consciousness, therefore, would tend to increase suggestibility.

Natural sleep was one such condition; so too was the artificial sleep of hypnosis. Hypnosis, on this account,was a state of enhanced suggestibility in which ideas provided to the subject by the hypnotist tended to leadimmediately and directly to sensation or movement. Paradoxically, this state of enhanced suggestibility wasitself induced by suggestion. The susceptible subject, told 'you are getting sleepy, your eyelids are gettingheavy, your vision is becoming blurry,' lapsed into a state in which the conscious monitoring characteristic ofthe waking state was greatly reduced and suggestibility consequently increased.

For Bernheim, then, hypnosis was the result of suggestion rather than a separate and necessary prerequisiteto it. Anyone willing to be hypnotized could be hypnotized; and all of the various hypnotic phenomena-catalepsy, automatic movements, illusions, active and passive hallucinations-could be produced in a willing

subject through the influence of suggestion alone. Although others had hinted at this position, Bernheim wasthe first to take it explicitly and unambiguously.228

Since suggestibility, not hypnotic sleep, was the basic underlying phenomenon for Bernheim, he also arguedthat while hypnosis, and especially the deep sleep of somnambulism, helped eliminate the interference ofconscious reason and judgment and therefore promoted suggestibility, it was not a prerequisite for suggestionto be effective. The influence of suggestion could be observed in the waking state just as it could underhypnosis.

This fact, together with the observation that both negative (inhibitory) phenomena such as paralysis andsystematized anesthesia and positive (excitatory) phenomena such as ideomotor actions and hallucinationscould be elicited in the subject through suggestion led Bernheim to the realization that suggestion could beturned to good effect in relieving subjects of unhealthy symptomatology. This was the method of suggestivetherapeutics and it was to the elucidation of this method that Bernheim devoted the last section of his book.

After providing a short historical review of the various ways in which therapeutic use had been made ofsuggestion in the past, even when the effective mechanism was unknown to those who employed it,Bernheim presented almost 200 pages of detailed observations taken from his own clinical use of thistechnique. These case studies documented the use of suggestion in the treatment of diseases of the nervoussystem, hysteria, neuropathy, neuroses, paralyses, pain, rheumatism, gastrointestinal ailments, and menstrualdisorders. Coupled as they were with a brilliant theoretical analysis of suggestibility, Bernheim's observationsprovided both a persuasive argument for the use of suggestive therapeutics and a manual for how to proceed.

219 Libeault, A-A. (1866). Du sommeil et des tats analogues, considrs surtout au point de vue de l'actiondu morale sur le physique. Paris: Victor Masson et fils; Nancy: Nicolas Grosjean.

220 By 1866, the therapeutic use of artificial somnambulism already had a long history, beginning with itsdiscovery in 1789 by Amand-Marie-Jacques de Chastenet, Marquis de Puysgur. While most of those involvedin the therapeutic application of artificial somnambulism subscribed to one or another version of Franz AntonMesmer's physical fluid theory, a few, such as Abb Faria, Alexandre Bertrand and Gnral Noizet, had early onrecognized the importance of mental suggestion in the production of therapeutic effects. For a lovelydiscussion of this history, see Ellenberger, H.F. (1970). Discovery of the Unconscious. The History andEvolution of Dynamic Psychiatry. New York: Basic Books.

221 1823-1904. For biographical information on Libeault, see Renterghem, A.W. van (1898). Libeault en zijneSchool. Amsterdam: F. Van Rossen.

222 1840-1919. For biographical information on Bernheim, see Huard, P. (1973). Hippolyte Bernheim. In C.C.Gillispie (Ed.). Dictionary of Scientific Biography (Vol. 2). New York: Scribner's, pp. 35-6.

223 Bernheim, H. (1884). De la suggestion dans l'tat hypnotique et dans l'tat de veille. Paris: Octave Doin.

224 Bernheim, H. (1886). De la suggestion et de ses applications la thrapeutique. Paris: Octave Doin; theEnglish translation, from the second revised edition, is Bernheim, H. (1889). Suggestive Therapeutics. ATreatise on the Nature and Uses of Hypnotism. New York: G.P. Putnam's Sons.

225 Not only did Bernheim derive much of the content of his views from Libeault, who had, in turn, profitedfrom the work of those mentioned in footnote 220, he was also anticipated by the British physiologicalpsychologist, William B. Carpenter, who published a seminal paper on suggestion in 1852: Carpenter, W.B.(1852). On the influence of suggestion modifying and directing muscular movement, independently of volition.Proceedings, Royal Institution of Great Britain, 1, 147-53.

226 For Freud, see Chertok, L. & De Saussure, R. (1979). The Therapeutic Revolution. From Mesmer toFreud. New York: Brunner/Mazel; for Baldwin, see Baldwin, J. M. (1930). James Mark Baldwin. In C.Murchison (Ed.), A History of Psychology in Autobiography (Vol. 1). Worcester, MA: Clark University Press,pp. 1-30; for Scott, see Kuna, D.P. (1976). The concept of suggestion in the early history of advertisingpsychology. Journal of the History of the Behavioral Sciences, 12, 347-53.

227 Renterghem, op. cit.

228 In doing so, Bernheim placed himself in direct opposition to the great Paris neurologist, Jean-MartinCharcot, who argued that hypnotic susceptibility was pathological, closely linked to hysteria, and that hypnoticphenomena emerged in a strictly defined, physiologically determined series of stages. For a discussion of thisinteresting controversy, see Ellenberger, op. cit.

Extracted from Classics in Psychology, 18551914: Historical Essays ISBN 1 85506 703 X Robert H. Wozniak, 1999

Classics in Psychology, 18551914 Historical Essays - Contents