Psychotherapies Without Feeling

by Dr. Arthur Janov

Posted June 2005 on

Chapter 2: The Nature of Hypnosis


Hypnosis currently enjoys widespread acceptance among the public and the scientific community. Hypnotherapy is generally believed to provide significant relief of both physical and psychological symptoms, and its use is on the rise. Of 1,000 psychotherapists surveyed in 1994, 97 percent considered hypnosis a worthwhile therapeutic tool.[1]

There is no question that hypnosis can be useful, particularly in the area of pain control. It is also widely used in treating the symptoms of neurosis including anxiety disorders, insomnia, and addictions, but with little permanent success. This might be explained because the state of hypnosis is similar to an extended but temporary case of neurosis. What I shall try to demonstrate in the following pages is that most of us who are neurotic are simply in a long-term hypnotic trance.

A permanent state of post-hypnotic suggestion can begin early in our lives when authority figures (parents) "suggest" certain behaviors based on the possibility or withdrawal of love. The suggestion is usually not consciously undertaken by the parent; it is simply the parent's unconscious needs translated into expectations and imposed on the child. The child, unaware of what’s happening, slips into the behavior without a scintilla of reflection. Part of him then is asleep or unconscious without his being aware of it.

In fact, you can use the concentrated and condensed neurotic state known as hypnosis to demonstrate the process of neurosis – that is, how neurosis comes into being. Hypnosis does not eliminate the sources of neurosis, nor does it integrate consciousness. Rather, it disintegrates consciousness, thereby achieving dissociation, in which two or three levels of consciousness act independently of one another. Hypnosis demonstrates the interactions of different levels of consciousness in both initiating and maintaining neurosis. Hypnosis and neurosis in fact utilize the same neurophysiological mechanisms. Hypnotic suggestibility is itself contingent upon a pre-existent neurotic state. So when psychotherapies use some form of hypnosis, they misapply the principles of consciousness and, as a result, actually reinforce the neurosis.

The use of hypnosis dates back to man's earliest history. Until recently, it has been shrouded in mystery, magic, and the supernatural, associated with everything from Druidic healers and high priests in ancient Greece to shamans, gods, witches, devils, and quacks. As a therapeutic technique, it predates psychoanalysis by at least a century. Freud used hypnosis therapeutically before discarding it in favor of psychoanalysis. Over time it has gained popular and scientific acceptance, been assimilated into a wide range of therapies, and been applied to most types of medical and psychological problems.

Today hypnosis is used to treat psychosomatic symptoms such as ulcers, migraines, and colitis. It is used to manage pain and in rehabilitation cases where organic damage has occurred. It is used to alter physiological functioning, such as to reduce blood pressure, relieve asthmatic symptoms, and alleviate gastrointestinal distress. It is also used in dentistry and obstetrics. It is used to treat addictions such as overeating, alcoholism, smoking, and drug abuse; to treat phobias and sexual problems; to enhance memory and studying abilities; and even to make warts disappear. It is also used to deal with varying emotional and psychological problems.

 While hypnotherapy is now considered a treatment category of its own, it is almost always incorporated into the particular therapeutic orientation of each therapist. Thus it may be used by therapists from such diverse areas as psychoanalysis, behaviorism, ego psychology, gestalt, and even holistic transpersonal groups.

What is the common factor that makes it possible for one approach to fit into such widely diversified therapies? It seems to be the idea that hypnosis somehow makes the inner person more accessible. When an individual relaxes into a "trance" state, memories, pains, and traumas as well as solutions and potentials supposedly become more available. Hypnosis is viewed as a direct route to the unconscious, where old demons can be exorcised with the least amount of discomfort to the patient. Traumas can be relived and resolved without any conscious participation; symptoms can be relieved without any knowledge of their source; compulsive behavior patterns can be broken without undue effort; defeatist self-images can be overhauled in a session or two.

In effect, hypnotism is based on the belief that the "unconscious" mind can swiftly heal the patient without the "conscious mind" ever being involved. Because of this apparent ease in effecting change, hypnosis has become one of the most popular forms of therapy. It is popular from the patient's point of view because it is like magic. Indeed, hypnotherapy expressly draws one away from the “why” – the reason for the neurotic symptoms in the first place. As a result, hypnotherapy draws patients away from a cure.

History of Hypnosis

The first attempt to explain hypnosis in naturalistic terms came in the 1700s. An Austrian physician named Franz Anton Mesmer (1713-1815) proposed that healing could occur through the transference of "animal magnetism." His procedures became known as mesmerism. People still speak of being “mesmerized.” Mesmer intended to bring hypnosis into the realm of modern science, but his techniques only contributed to its aura of mystery, magic, and charlatanism. Dressed in flowing silk robes, Mesmer would appear before his patients, who were gathered around a tub filled with water and iron filings. These would purportedly help transfer to the patients "the marvelous animal magnetism exuding from [Mesmer]." At some point the animal magnetism would trigger convulsions in the patients, which would remove whatever symptoms had been present.[2] (I suspect the convulsions represented a release of accumulated primal energy, which might well yield temporary relief of the patient’s symptoms.)

In 1784, a committee of inquiry convened by the King of France discredited Mesmer's ideas. The committee found that in fact that no such magnetism existed, and the striking recoveries were due to "mere imagination." Hypnotism was again linked to mysticism and quackery.

Nevertheless, by the 1840s it had spread to various parts of the world. Two surgeons working independently of each other – John Elliotson in London and James Esdaile in Calcutta – discovered that the mesmeric trance could be used for pain control during major surgery. Another 19th-century English physician, James Braid, agreed that Mesmer's techniques could be useful. He dismissed the concept of animal magnetism, however, and introduced the term hypnotism (from the Greek hypnos, meaning "to sleep"). This referred to a "nervous sleep" brought about by a concentration of attention. Braid believed hypnosis was a sleep state, or at least a state of consciousness existing below the level of conscious-awareness. These views divorced hypnosis from mesmerism, and tempered the medical profession’s negative attitude toward the use of hypnosis.

In subsequent decades, two scientific viewpoints on the nature of hypnosis crystallized. In the mid-1880s, Hippolyte Bernheim, a professor of medicine at Strasbourg, saw hypnosis as a normal phenomenon, resulting from a psychological response to suggestion, and not involving any special physical forces or processes. By contrast, Jean Martin Charcot, professor of neurology at the Sorbonne, considered hypnosis a pathological phenomenon which occurred only in hysterical patients and which did involve the physical influence of magnets and metals.

Sigmund Freud stepped into the controversy in the 1890s. A former student of Charcot, he became interested in the use of hypnosis as a therapeutic tool for treating neurotic disorders. Freud found hypnosis useful in helping hysterical patients recall forgotten traumatic events. He also used it as a technique to alleviate physical and emotional symptoms. In an 1893 case study, for example, he described how he used hypnosis to help a woman who was not able to breast-feed her child. After inducing a hypnotic trance, Freud "made use of suggestion to contradict all her fears and the feelings on which all the fears were based: 'Do not be afraid. You will make an excellent nurse and the baby will thrive. Your stomach is perfectly quiet, your appetite is excellent, you are looking forward to your next meal...'" Freud went on to comment about his "remarkable achievement." Hypnotism successfully alleviated the woman's physical symptoms, restored her appetite, and allowed her to nurse her child for eight months.[3]

Later, however, while compiling his book Studies in Hysteria, Freud discontinued the use of hypnosis and instead concentrated on the newly-developed techniques of psychoanalysis and free association. Later, he employed dream analysis as "the royal road to the unconscious."

During World War I, hypnosis was used to treat victims of shell-shock. This once again brought it to the attention of the scientific community. The experimental psychologist Clark Hull finally established hypnosis as an object worthy of controlled and methodical laboratory studies. In 1933 Hull endorsed Bernheim's view that hypnosis might be the result of suggestion and suggestibility. Both World War II and the Korean War contributed to renewed interest in hypnosis. Societies for research and training in clinical and experimental hypnosis were founded. Hypnosis journals published research findings and case materials. Specialty boards licensed practitioners and disseminated information to the public.

The 1970s saw a curious development in the use of hypnosis. The spread of hypnotic "past-life regression" (which had been practiced since the 1860s, if not earlier, in Europe) sparked a new controversy in the field. Adherents of this practice (most of whom lack degrees in psychology or medicine) believe that events and problems in past lives can generate neurosis and other problems in this life. Thus, through hypnosis, one can gain access to past identities, relive past traumas, and eliminate their negative effects on one's present functioning. Although professional hypnosis organizations have condemned past-life regression, it has made its way into Ericksonian hypnotherapy, the school based on the work of Milton Erickson (1902-1980), the pre-eminent hypnotist in recent decades. Some hypnotists have even been able to induce "age progression," in which patients conjure up themselves in the future for ostensible therapeutic benefit.[4]

Today, hypnosis appears to be increasing in acceptability in the scientific community. Erickson's influence has extended beyond traditional hypnotherapy to family therapy and other clinical areas. Nonetheless, there remains no cohesive or compelling theory on the nature of hypnosis. Most agree that hypnotic phenomena are real: People are able to dissociate from pain in their bodies, regress to earlier events in their lives, relive traumatic events and forget them moments later, and experience significant alterations in perception. But what causes these changes? Is hypnosis an altered state of consciousness? Or does it merely active and channel normal processes, skills, and response preferences? This is considered the considered the state-nonstate controversy, and it leads us to the core problem of the nature of hypnosis.

The Nature of Hypnosis

Hypnotic trance: a state in which perceptions are altered either spontaneously or as the result of suggestion and in which there is a detachment from the external world.[5]

The elements of a hypnotic trance are well-known. Ernest R. Hilgard (1904-2001), long-time experimental psychologist at Stanford University and a prominent researcher on hypnotic analgesia, developed a profile of a hypnotized individual with characteristics that he felt was "sufficiently consistent" to serve as a definition. Specifically, if instructed, a hypnotized person:

*waits passively for information as to how to behave;

*pays attention only to the hypnotist;

*accepts distortions as reality;

*is highly susceptible to the hypnotist's suggestions;

*will readily adopt a role of being someone else, and

*may forget the hypnotic experience.[6]

Let's assume that these are all aspects of a hypnotic trance. Is there really something special about this state, something that distinguishes it from everyday consciousness (while one is awake or asleep)? Various researchers have given conflicting answers to this question.

Non-State Theories

Theodore Barber, a leading hypnosis researcher is a strong proponent of the non-state theory. For him hypnosis is nothing extraordinary; it is a normal, everyday behavior mistakenly given a special name. So-called hypnotic behavior, according to Barber, can be understood as being the result of interpersonal factors, such as the subject's desire to please the hypnotist by successfully carrying out what is requested of him, much like what often happens between client and therapist in any kind of psychotherapy.

Barber points out that all attempts to define hypnosis to date have involved a semantic merry-go-round: a person is said to behave a certain way because she is hypnotized. But how do we know she is hypnotized? Because she behaves a certain way. Or worse yet: A person is in a trance because she is hypnotized. How do we know she is hypnotized? Because she is in a trance! While the concepts of trance and hypnosis are used to define one another, they are also used interchangeably. According to Barber, proof that hypnosis is a special state of consciousness requires the discovery of behavior other than that used to describe it.

Furthermore, if hypnosis is a special state, shouldn't instruments clearly indicate its difference from a waking or a sleeping state? "For nearly one hundred years," writes Barber, "researchers have been trying to delineate an objective physiological index that differentiates the hypnotic state from non-hypnotic states...The attempt to find a physiological index of 'hypnotic trance per se' has not succeeded."[7] Specifically, physiological measures such as EEG, blood pressure, pulse rates, and body temperature do not demonstrate any variation between a "hypnotic" and "non-hypnotic" state.

Peter Brown, who has studied what underlies the phenomenon of hypnotic communication, modifies Barber's thesis as follows: "Though there are changes in brain functioning during hypnosis, they are not unique to hypnosis nor are they uniform across all subjects...The changes in brain function that occur in hypnosis are similar to the normal ultradian variations in activity and do not appear to differ from changes found in other types of absorbed concentration."[8]  Brown adds that "It is easy to speak of an 'altered state of consciousness' or of 'dissociation,' as if we know precisely what these terms mean. The evidence suggests that the trance state involved substantial changes in cognition, emotion, perception, and physiologic regulation. But these changes do not exist in a vacuum. Intermingled with them will be the surrounding context for the individual: their previous history, current concerns, and the quality of the interaction and degree of rapport they experience with the hypnotherapist."[9]

According to the non-state theory, the vital functions and behavior of someone in a hypnotic trance are not dissimilar to those of someone who is not in a trance. People role-play, act, distort, conceal, fantasize, and imagine themselves as others while awake, and they also do these things while hypnotized. While either in a hypnotic trance or an everyday trance, they are able to consciously or unconsciously focus on a particular stimulus and tune out all others. Moreover, Barber and other non-state theorists say that what happens to people in hypnosis can be explained largely in terms of the relationship between the subject and the hypnotist, based on the subject's psychology, motivations, and drives. As children, they try to please their parents; as students, they seek approval from teachers; and as hypnotic subjects, they do the same.

State Theories

Other researchers see hypnosis as a special or altered state, though currently no research supports their theory. Erickson was the most prominent proponent of this view. Erickson believed that hypnosis was a special state of highly-focused attention. During this state, the conscious mind could be "shifted, transformed, or bypassed with relative ease," making unconscious memories more accessible than during a normal waking state.

Erickson's belief that hypnosis was mainly an inward process set him from apart from many traditional hypnotists. In his view, even though the hypnotic response was facilitated by the hypnotist, it arose out of the subject's own inner dynamics. "The hypnotic trance," Erickson wrote, "belongs only to the subject; the operator can do no more than learn how to proffer stimuli and suggestions to evoke responsive behavior based upon the subject's own experiential past."[10] This explanation is in marked contrast to Barber's view that hypnosis arises as a result of interpersonal dynamics.

 Although Erickson viewed hypnosis as a special state of consciousness, he did not believe it involved extraordinary powers. He contended instead that it used the same abilities and processes we experience ordinarily.  Most hypnotic phenomena – age regression, amnesia, dissociation, hypnotic anesthesia, time distortion – have common everyday correlates. For example, a troublesome toothache is temporarily forgotten during a particularly suspenseful movie. This is an example of what Erickson called a common everyday trance. In his way of thinking, hypnosis is beneficial in that it provides a way to intentionally activate these ordinary processes and use them to direct the hypnosis subject toward a specific goal.

The Hypnotic Trance

The first characteristic of a hypnotic trance is what Hilgard called a loss of the “planning function.” This means that, rather than initiating any activity on their own, subjects wait for instructions from the hypnotist. "Redistributing attention" – the second characteristic – is when subjects select only what they are instructed to notice. Thus, people on stage may become oblivious to the audience while they hear and see only the hypnotist.

Third, "reality testing" is reduced while "reality distortion" becomes acceptable. Fourth, "suggestibility" is increased, meaning that a person will more readily act according to what the hypnotist suggests. Fifth, a person will more easily enact unusual roles. Hilgard explains: "When told to adopt a role, such as being someone else, the hypnotized subject will commonly do so and will carry out complex activities related to that role."

Finally, "posthypnotic amnesia often occurs." Upon instruction, the subject forgets events that happened during the hypnotic experience. These memories can then be retrieved by a "release signal." The hypnotist may scratch his nose, light a cigarette, or bend his elbow in a certain way in order to make the person remember what he has temporarily forgotten.[11]

If these characteristics – passive waiting for instructions, susceptibility to suggestions, role playing, and so on – exclusive to the hypnotic state? I do not believe they are. Later I shall show how these very same characteristics serve also as the defining qualities of neurosis.

Variations in Depth and Type of Trance

Both Hilgard and Erickson believe that there are definite, varying levels of hypnotic trance. For example, there is a stuporous trance – a state in which, according to Hilgard, spontaneous thinking stops and the self becomes "meaningless." In Hypnosis in the Relief of Pain, Hilgard maintains that the notion of depth in hypnosis cannot really be measured and can only be described by the person experiencing it. Still, he gives this description of a person in an hypnotic stupor:

Relaxation of the body increased for a time, but he [the subject] eventually no longer felt identified with his body. It was as though it was a "thing" left behind, so that it no longer made sense to ask him further about body relaxation. Relaxation of the body was succeeded by a peacefulness of the self, but beyond a certain depth this concept also became meaningless, because the self was no longer present. The environment also faded progressively, until finally a state was reached in which the only part of the environment that remained present was the hypnotist's voice. Time passed more and more slowly, finally reaching a point at which it ceased to be a meaningful concept. Spontaneous mental activity declined until it finally reached zero.[12]

Another kind of trance is a somnambulistic one, in which mental and physical capacities apparently remain normal. Erickson made frequent use of the somnambulistic trance both for demonstration and for therapeutic purposes. I’ll now describe an example where Erickson had called upon one individual to demonstrate the somnambulistic state. He then pretended to conclude the demonstration and dismiss the subject. But he continued, hoping to observe genuine "hypnotic behavior" rather than behavior designed to please the hypnotist.

Knowing about the subject's fondness for sweets, Erickson told her that as a reward for her performance she could choose from a platter of homemade candy. With the subject “still in the somnambulistic state," she was asked to name her favorite candy, and "expressed a marked preference for divinity fudge, and even as she spoke she was noted to salivate freely in anticipation." The hypnotist went into another room, called back with satisfaction that there was indeed some divinity fudge, and asked her whether she wanted to help herself to it at once or later. "So far as divinity fudge is concerned, immediately is scarcely soon enough," she reportedly replied. Erickson then returned to the room bringing napkins, pretending that he had a platter of candy in his hands, and saying that the platter contained a variety of candies in case those present had different preferences. Next he approached the subject and told her to go ahead and select the largest pieces of divinity fudge.

With the juvenile directness, earnestness, and simplicity so characteristic of behavior in the somnambulistic state, she replied she would. After scrutinizing the imaginary platter carefully, she made her choice of a piece and, upon urging, a second and a third, but she explained that she was taking only a small piece for the third.

The imaginary platter was passed among the group. Each person pretended to take a piece of candy and eat it. The subject then became restless, wandered around the room, and finally sat in a chair next to the table where the imaginary platter had been placed. Subsequently, "in the manner of a small child who wishes another helping of candy," she looked furtively back and forth between the imaginary platter and the hypnotist, until:

...with a slight gesture of resolution she learned forward, scrutinized the platter carefully, and proceeded to go through a performance of selecting carefully and eating several pieces of candy, now and then glancing in a hesitant manner.

The platter was passed around again. When it was her turn, the subject again selected and ate imaginary pieces of candy. Erickson notes that, throughout the performance, two "medically-trained members unobtrusively watched the subject" and independently observed her "increased salivation and swallowing," as well as her use of the napkin to wipe her fingers. Then Erickson concluded the demonstration and awakened the subject.[13]

Thus, we have stuporous trances in which the environment, the body, and the self become meaningless concepts, and we have somnambulistic trances in which hallucinatory fudge is merrily eaten with the context of normal group interaction. How can these states be possible? Are these reports mere fantasy or actual descriptions of altered neurological functioning? And if the latter is true, which brain structures mediate hypnotic trance states?

The Neurology of Hypnosis

With the discovery of the brain's hemispheric laterality (See the work of Gazzanaga and Bogen as well as: Psychology Today, May 1985, p. 43), the terms right brain/left brain have become virtual household concepts. The brain is divided into two halves, with each half mediating qualitatively different processes: the right brain mediates non-rational functions and holistic perceptions, while the left brain mediates the rational and specific. The right is holistic while the left is analytic. The right is internally oriented, while the left is externally focused.

Another recent neurological discovery is that of the "triune brain," where the division is concentric rather than lateral. Less well known than the concept of hemispheric laterality, the discovery of the triune brain may be more significant.

Based on Paul Yakovlev's research, the triune brain model describes the brain as organized concentrically into three zones or "neuropils."[14] Each zone consists of an interrelated network of nerve cells with its own biochemical composition. Each zone has its own storehouse for consciousness and memory. The three zones or levels of the brain develop chronologically in the fetus and newborn just as they did in human evolution. At birth and in primitive animals only the first level is operative, mediating visceral and body activity. By the sixth month of life the second level of brain development emerges to mediate the limbic processes of feeling and emotion. There is some evidence that in evolution this began with the turtle, which shows some limbic structure. The third or cortical level, which mediates all cognitive functions, is the last to develop and in its full development is uniquely human.

How does this relate to hypnosis? The dissociation so critical to all hypnotic phenomena hinges upon a disengagement of the third level of consciousness. It is precisely this third level that predominates in relation to the outer world. This part of the brain perceives, reflects, reasons, rationalizes, and comprehends. Its task is to process and evaluate information, to know what is: what the temperature is, the conditions of the environment, if danger is near, whether the body needs food or sleep, and so on. For hypnosis to be effective, it must disengage the third level, so that the individual is no longer able to independently process information.

A trance state occurs when the person operates from the emotional (second) or physical (first) level of consciousness without the benefit of the critical intellect (third level). In this state, no cognition is employed to determine whether internal and external conditions coincide, whether how one feels and acts is reality based. This is why children are generally more responsive to hypnosis. They do not have the well-developed evaluative functions of the adult. Childish complaisance is the neurotic feature in the adult which enables the trance to occur and sustain itself.

Notice two key phrases in Erickson's report of the woman in the somnambulistic trance: "with...juvenile directness, earnestness, and simplicity," and "in the manner of a small child." I believe his demonstration uncovered the woman's latent childish tendencies rather than inducing them. The subject's pre-existing complaisance allowed for even further dissociation (from what she ordinarily experienced) so that even external clues would not disrupt her trance.

Erickson's demonstration points up another crucial aspect of the hypnotic state. Unencumbered by personal embarrassment and social restraints, the subject was free to act as childishly as she was. Under normal circumstances repression defends against the admission of neurosis. Under hypnosis, with the last remnant of rational perception suppressed, neurotic people can allow themselves to be as dependent, childish, and hurting as they really are. The hypnotic procedure reveals what the self-censorship of repression conceals: the essence of the neurotic self. It does so, however, by avoiding full conscious experience, for it is this experience that provokes feelings of Pain. Clearly, we cannot get well through unconsciousness because that is the definition of neurosis.  It takes full conscious/awareness to become whole.

Thus, the attraction of hypnosis is the apparent opportunity to have it both ways: you can show who you are without feeling the concomitant Pain. And this, as I shall explain later, is exactly why hypnotherapy cannot in the end be therapeutic.

Inducing Unconsciousness

It is indeed remarkable that a few words traveling through the air, penetrating the ear as sounds, even monotonous gibberish, can cause a person to effectively lose consciousness and fall into a trance. These sounds apparently pick up a meaning in the brain which radically reduces the highest (cortical) functions of the nervous system. Once these sounds acquire meaning, they begin to exert a biochemical and neuroelectric force to shut down transmission among many nerve cells. Consciousness is severely restricted and the person pays attention to a very narrow range of stimuli. This is no different from what happens to a young child who is being admonished by a parent and told to behave differently. Those words can cause the child to alter her feelings about herself and to change how she behaves, all unconsciously.

In other words, ideas can shut off, distort, and alter aspects of consciousness. This happens, however, only if the person giving the ideas has authority in the eyes of the person accepting them and is the dealer of love and the remover of possible Pain. It is what occurs when a charismatic individual convinces someone to believe in outlandish ideas. Thus, there may be little difference between a cult leader talking to a disciple, a parent talking to a four-year-old child, and a hypnotist talking to her subject. In each of these situations it is possible to render the person unconscious in a selective way. One sure way is to manipulate need—unfulfilled need—for love, safety, protection, direction and guidance, warmth and against whatever the future may hold. Someone who has imprinted terror needs to find someone who will stave off the “demons” whoever they may be.  Someone who will pave the way and make our journey in life safe.

The Neurology of Unconsciousness

Key structures in the limbic-emotional system, or the second-line consciousness, mediate in what occurs in both hypnosis and in the neurotic trance. The amygdala and the hippocampus are involved in making feelings conscious and in making feelings repressed and unconscious – dissociating feelings from acknowledgment. The hippocampus can retrieve emotions and with the help of the thalamus, can keep them out of consciousness. It is what accomplishes entrance into the hypnotic state; Peter Brown notes that the limbic hippocampus is heavily responsible for the disconnection from conscious awareness. The amygdala can activate emotions and can keep current input from triggering off those emotions. The thalamus and basal ganglia, Brown writes, help by refusing to relay certain information from below to higher levels. In that way, too, we remain dissociated.

There is yet another system that keeps us alert and consciously vigilant, and that is the reticular activating system of the brain stem. If that system is blocked we are less alert and critical. Some sleeping pills work directly here. In the lulled, parasympathetic state of a beginning trance, it is that alerting system that goes off service.

But it is primarily the limbic system, where the emotional level of consciousness is organized, that "decides" whether to make a feeling fully conscious. It is here that dissociation can take place. It is here that the rhythms of the brain can be slowed down into the theta (slow) rhythms indicating the predominance of a lower or second line level of consciousness at work. Here is where the input from the hypnotist enters and is accepted unquestioningly. As the brain rhythms slow even more into the delta range, down to 2 or 3 cycles per second, the person can enter a deep trance where even suggestion no longer enters. She is "out," no longer in this world; she is rigid and unyielding. She is operating on the first-line only, where survival functions dominate. The left hemisphere of the brain, with its severely diminished activity, is now practically useless. There is no critical capacity whatsoever. Attention is narrowed only to the voice of the hypnotist and what he is suggesting, and even that is at a minimal level.

All of this is no different from discussing the various levels of consciousness operating in neurosis, and how imprints of trauma can occur on the two lower levels of consciousness which for a lifetime thereafter drive our behavior and symptoms.  No hypnotist in the world can overcome or erase a first-line or second-line imprint because early trauma is impressed into the neurophysiologic system as a permanent memory. Those imprints which alter our brains and our physiology must be addressed in any psychotherapy. Therefore, there is no hypnotist who can "cure" any neurosis. A hypnotist can, perhaps, attenuate symptoms, by combatting the imprint with suggestion after suggestion day after day. That can have some effect, but it is not permanent. Manipulating the first or second-line is not the same as imprinting an event. Hypnosis can have short-term effects which endure because of other factors such as reward, external motivation, punishment, etc. Nonetheless, one cannot imprint suggestion. It takes a very high valence or force of an event, something that threatens our life or our integrity to be imprinted. Imprints occur during the critical period when need must be fulfilled. When we are not loved or held in the first months of our life on earth that will be imprinted, together with the changes in certain hormones of love such as oxytocin and vasopressin. There will alerations in the hormones of stress and they will reman as permanent souvenirs until we go back and redo and undo the imprint that caused so many deviations in various of our systems.

All of this is not meant as any exhaustive discussion of the neurology of hypnosis, which is well beyond my purview. It is only to show that the same mechanisms involved in neurosis are the mechanisms involved in hypnosis. Hypnosis, in short, is a condensed and circumscribed, temporary neurosis. It involves dissociation as a sine qua non. It involves disconnection and blind obedience. It involves uncritical behavior as if one were on automatic. And in neurosis one is on automatic, automatically running off the program laid down by one's caretakers in childhood. If we were never close during the formative months of infancy it will be imprinted so that later we will be unable to form permanent emotional attachments to others.

The Psychological Climate of Hypnosis

What psychological elements are involved in hypnosis? First of all, one could say that we have already been partially hypnotized through our preconceptions and expectations before we visit the hypnotist. We anticipate going through a process which the reputation of hypnosis has already preordained. When the hypnotist obliges us, these elements are immediately reinforced. Even more important than these anticipations is the desire to be hypnotized. What motivates this desire to surrender one's critical mind? To understand this motivation, I believe, is to understand how hypnosis works.

A person's desires are not only motivated by healthy drives but also by neurotic processes that result from unmet childhood needs. Barber says that a subject goes into a trance because of his desire to please the hypnotist, to make the hypnotist look good, to be thought special and be complimented, and so on. Barber might as well have described the everyday motivations of the common neurotic. The profound implication of Barber’s viewpoint is that hypnotic success is dependent upon pre-existing neurotic motivations. This is further support for the proposition that hypnosis and neurosis involve the same mechanisms.

To many people, hypnosis appears inexplicable or magical. In reality, what is called dissociation in hypnosis is really the everyday state of the neurotic. All the classic hypnotic phenomena – amnesia, time distortion, age regression, hallucinations, anesthesia, and catalepsy – depend on dissociations in consciousness. What trances of different depths have in common is a certain amount of dissociation, or disconnection within the self, such as when we repress traumatic emotional pain for years, or temporarily stop feeling a sore throat or headache.

I maintain that hypnosis is not an altered state in relation to the common neurotic condition, but it is altered in relation to what is healthy. The isolated consciousness of hypnosis is only a circumscribed demonstration of how neurosis works. The difference is that neurosis is set down during the critical period when the brain is forming and hormones are achieving their set points. It is then a permanent state. Hypnosis is a temporary one by redirecting one’s behavior through the manipulation of conscious/awareness. It is an unconscious input that attempts to stem the primal tide; to block the effects of the imprint. It does not change the imprint, ever.  One can stop smoking with hypnosis but the need to do so never changes. The price we pay for lying to ourselves is a premature breakdown of the system sooner or later.  Psychotherapy addresses the left frontal brain while the hypnotist bypasses it and seems to input the right frontal brain, the emotional, inwardly focused brain.

Neurosis as a Hypnotic or Post-Hypnotic State

I have maintained that hypnosis can be understood by looking at neurosis. In fact, neurosis is the sine qua non for hypnosis. Now let's see if we can just as easily understand neurosis by looking at hypnosis. Is there any fundamental difference between the two? Hypnosis is an intentional procedure, voluntarily submitted to for a distinct purpose. Neurosis is a global state, involuntary developed as an adaptive response to emotional trauma very early in life. It can be argued that neurosis is a post-hypnotic state, maintained by constant reinforcement of repression and dissociation. Hypnotic procedures can easily tap into that state to produce definite and recognizable post-hypnotic episodes.

What do I mean when I say that neurosis is a hypnotic or post-hypnotic state? It is apparent that in order to feel, the human brain requires the full use of its consciousness. Yet, as we have seen, the brain possesses the capacity to shut down part of itself to defend against the full conscious experience of Pain. The left brain can be disconnect ed from the right so that one side doesn’t know what the other is doing or feeling. This ability is brought into play when the naïve and vulnerable system of the developing child is faced with more Pain that it can handle – when for example the child is rejected, abused, or abandoned. The child's mind represses the Pain by functionally detaching much of conscious awareness from the lower brain functions (such as emotion and sensation) where the Pain is stored. We call this state a split, dissociation, or disconnection. The behaviors which arise to maintain it we call neurosis.

The dissociated person is left with a host of unresolved primal needs which, from their obscured position of repression, exert a continuous but unconscious force. This force directs a person into symbolic attempts to fulfill primal need. The person becomes an intellectual because that is what the parents' expected: a smart student who got good grades and whose main interest was books. Being an intellectual can be a symbolic route to feeling loved and to having one's other needs met. Yet this neurotic diversion plagues him with all manner of symptoms such as migraines and compels him to act in ways which maintain the disconnection, living in his head totally detached from his feelings. Only thoughts guide him. He therefore makes the wrong choices of partners in life because he is out of touch with himself and his real needs. An adult grows up around the unfulfilled child whose urgent needs remain the dominant preoccupation. He continuously seeks fulfillment while attempting to avoid experiencing the reality of deprivation.

In a piece published a few years ago in the American Journal of Clinical Hypnosis,[15] Edwin describes an experience of his own which reflects the way unmet childhood need affects adult functioning and generates its own ongoing repression:

I came home from an exhausting day and asked my first wife to fix me a cup of coffee (or a drink). She had had a bad day too, and retorted something like "fix it yourself." I experienced an unbridled rage that was so out of proportion to the provocation, and so unlike me that I felt I had to analyze it.

He then used self-hypnosis to "home in on" a distant, repressed memory, a memory which "came in as clearly as if I were there." On the 12th day of his life, the day he was taken off breast feeding, he "was in a similar childlike rage at being denied what I felt entitled to." From this revisiting of his past, Edwin had an insight: "The allegory of the woman in my life denying me liquid refreshment is obvious." He later consulted medical records in order to confirm the memory; his mother had had to stop breastfeeding him due to a breast abscess.

Edwin uses this case report as evidence of the accuracy of memories retrieved under hypnosis, even memories of events going all the way back to birth. He adds that, through connecting his "out of proportion" rage in a current circumstance to a repressed childhood deprivation, he was able to change his behavior in similar situations. Rather than flying off the handle, he might say, "Oh, you had a bad day too? Let's talk about it."

In subsequent chapters I will discuss whether hypnotherapy really can lift repression and eliminate neurosis. Suffice it to say for now that clearly remembering a forgotten event in the distant past is not the same as truly reliving it; nor will remembering it cure decades of neurosis. Neurosis is a way of life. By virtue of dissociation from prepotent inner realities, all neurotics are to some degree in a trance. This is why so many people seem to be "out of it," "not all there," or "spaced out." The neurotic's brain seldom works optimally on matters at hand because so much of her mind is preoccupied. She does not react or respond spontaneously to what is around her, or else she does so in a manner "out of proportion to the provocation."  Neurosis divorces one from proper perception and narrows it to a more and more reduced field. Here is the confluence of hypnosis and neurosis. The pre-hypnotic neurotic is already in a hypnotic state. She doesn't have far to go.

If the hypnotic trance is only a specialized demonstration of the neurotic state, then its depth corresponds to the degree of neurosis. Rather than descending into a trance, as the word "depth" implies, hypnosis makes plain just how far down the levels of consciousness neurosis exists.

The illusion is that the trance is "achieved" by hypnosis, when in fact it is only illustrated by it. We will see this more clearly as we examine the nature of suggestion and suggestibility, on which hypnosis inevitably depends, and which utilize the neurotic split in consciousness rather than dialectically integrate it. Here again, there is no dialectic process, as it must be whenever a symptom is take for THE problem instead of a manifestation of a problem. There is of course here no mention of pain or motivation for the addiction of smoking. It is simply a given to be stamped out. It is purely a mechanical approach.

I explore hypnosis in some detail because it has a lot to do with our understanding of the nature of reality. For if a hypnotist puts a cold coin on your hand and suggests that it is hot, and you then develop a blister, where is reality? In your head, your hand, or in the mind of the hypnotist?  Is reality what we think?  Can you change reality by what we think? Can we therefore think our way to health. Is sickness all in our head? (as my friend says, “Where else would it be?”)

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[1]_Michael D. Yapko, Suggestibility and Repressed Memory of Abuse: A Survey of Psychotherapist's Belief. American Journal of Clinical Hypnosis, Vol. 36, No. 3, January 1994, pp. 163-171.

[2]Ernest R. Hilgard and Josephine R. Hilgard, Hypnosis in the Relief of Pain. Los Altos, CA: William Kaufmann, 1975, p. 2.

[3]Freud, S. (1893). A case of successful treatment of hypnotism. In J. Strachey (Ed. and Trans.), Sigmund Freud: Collected Papers (Vol. 5, pp. 33-46). New York: Basic Books, 1959, p. 36.

[4]See, for example, Jonathan Venn, Hypnosis and the Reincarnation Hypothesis: A Critical Review and Intensive Case Study, The Journal of the American Society for Psychical Research Vol. 80, October 1986, pp. 409-425; Robert A. Baker, The Effect of Suggestion on Past-Lives Regression, American Journal of Clinical Hypnosis, Volume 25, Number 1, July 1982, pp. 71-76; Peter B. Bloom, Some General Comments About Ericksonian Hypnotherapy, American Journal of Clinical Hypnosis, Volume 33, Number 4, April 1991, pp. 221-224.

[5]See Heap, Michael and Dryden, Windy, Eds., Hypnotherapy: A Handbook. Philadelphia: Open University Press, 1991.

[6]See Ernest R. Hilgard, Richard Atkinson, and Rita Atkinson, Introduction to Psychology (New York: Harcourt Brace, 1971, fifth edition), p. 173.

[7]Theodore X. Barber, Hypnosis: Scientific Approach (New York: Van Nostrand Reinhold, 1969), p. 7.

[8]Peter Brown, The Hypnotic Brain: Hypnotherapy and Social Communication. (New Haven and London: Yale University Press, 1991), p. 175.

[9]Brown, The Hypnotic Brain, p. 241.

[10]Milton H. Erickson, "Further Experimental Investigations of Hypnosis: Hypnotic and Nonhypnotic Realities," Collected Papers of Milton H. Erickson on Hypnosis, Edited by Ernest L. Rossi (New York: Irvington, 1980), pp. 18-82, Vol. 1. Originally published by The American Journal of Clinical Hypnosis, October, 1967, 10, 87-135.

[11]Ernest R. Hilgard, Richard Atkinson, and Rita Atkinson, Introduction to Psychology (New York: Harcourt Brace, 1971, fifth edition).

[12]Ernest R. Hilgard and Josephine R. Hilgard, Hypnosis in the Relief of Pain (Los Altos, CA: William Kaufmann, 1975), p. 21.

[13]Milton H. Erickson, "Experimentally Elicited Salivary and Related Responses to Hypnotic Visual Hallucinations Confirmed by Personality Reactions," Collected Papers of Milton H. Erickson on Hypnosis, Vol. 2, Edited by Ernest L. Rossi (New York: Irvington, 1980), pp. 176-177. Originally published in Psychosomatic Medicine, April, 1943,5, 185-187.

[14]P. Yakovlev, The Structure and Functional 'Trinity' of the Body, Brain, and Behavior. Current Research in Neurosciences. Edited by H.T. Wycis (New York: Karger, Basel, 1970).

[15]Edwin, Many Memories Retrieved with Hypnosis are Accurate, American Journal of Clinical Hypnosis, 36:3, January 1994, pp. 174-176.