Essays

Hypnoanesthesia

Hypnosis is not used as often as an anesthetic agent as it is to control nonsurgical pain. On at least two occasions, the author was unable to find a local obstetrician who employed hypnosis in deliveries for pregnant women desiring such a referral (both of whom were excellent hypnotic subjects).

Probably the principal reason for this state of affairs has been the development of reasonably safe, rapidly effective chemical changes. It has been estimated that only 25% of the population are capable of developing a sufficient degree of hypnoanesthesia for its use as the sole anesthetic in relatively minor procedures, such as fracture settings, tooth extractions, the changing of burn dressings, or the removal of sutures in frightened children.

Other reasons advanced for reluctance to use hypnoanesthesia include: the amount of time, training, and skill required for a hypnotic induction; the fact that hypnosis may be contraindicted in patients with psychological problems such as psychotics, borderlines, or depressives; and the fact that hypnosis is regarded as Òquasi-scientificÓ in some professional circles

With respect to the contraindication of hypnosis and hypnoanesthia in patients with certain psychological disorders, some clarification is required. There is no absolute contraindication for hypnosis in any patient. Some patients may present a higher risk of developing adverse reactions such as spontaneous regression and aberrations, that are undesirable in a nonpsychotherapy context, and control of these require some skill on the part of the hypnotist. Hence, with these patients, hypnoanesthesia requires a hypnotist who is well trained in psychotherapy. It should not be attempted by a physician who lacks such training. It is unfortunate that physicians in general and anesthesiologists in particular, do not receive more training in psychodynamic concepts and hypnosis, for it is usually convenient to have a psychologist induce hypnoanesthia except in an emergency situation.

If initial hypnotic inductions are performed are performed in a leisurely, unhurried atmosphere and the patient is given the opportunity to develop an anesthesia and experience it tested successfully, his confidence in the adequacy of the procedure will be greater. Patients should be trained to enter a trance state either on a posthypnotic signal or by self-induction to save time in the operating room and render them independent of the presence of the particular hypnotist who trained them.

A patient so trained may be able to have a successful hypnotic delivery under the care of another obstetrician should the one who trained her in hypnosis be available at her delivery. Also, the ability to reenter hypnosis rapidly on a signal is a valuable safeguard should a patient inadvertently awaken during surgery. This contingency is quite unlikely, particularly if the hypnotist instructs the patient not to awaken until directed to and if he or she continues a steady flow of trance maintaining chatter throughout the operation. Preliminary trials of hypnosis may be presented to patients with reservations about the procedure as exercises in relaxation to prevent their fears from producing reactions that may lead to false impressions of their abilities as subjects.

The value of hypnosis may also extend to the prenatal period------It not possible to do successful hypnoanesthia, or for that matter any other hypnotic procedure, unless the therapist takes the time necessary to establish a proper rapport with the patient and the latter develops confidence in the hypnotists ability and concern for his welfare In addition to its use as an anesthetic, hypnosis can be a valuable pre-operative and postoperative adjunct to the care of surgical patients.

J. Barber and Mallin (1977) advocate the use of hypnosis during the fitting of contact lenses and emphasize the careful choice of words in the framing of suggestions. Words that denote the same thing may vary widely in their connotations and implications and thus may not be equally effective in framing suggestions.

Physiological Effects of Hypnosis

A number of common effects of hypnotic induction were described under the rubric of signs of hypnosis. If conventional methods of Induction, utilizing suggestions of relaxation and sleep are used, these effects commonly include slight to profound muscular relaxation, with consequent alterations in facial expression and posture, eye closure, and lack of spon­taneous movement or speech. Other usual concomitants of the hypnotic state Include a literalness and specificity in the understanding of suggestions (mak ing it imperative that the operator carefully phrase suggestions) and in some cases the development of rapport, a condition in which the subject ignores all suggestions except those made by the operator. It is tempting to describe reactions that result from the induction of the hypnotic state per se, or so-called neutral hypnosis, as general responses to distinguish them from those made only in response to specific instructions. This, however, would be mis leading; these reactions, like any other obtained under hypnosis, are most likely made in response to suggestions. In the case of these general responses, the suggestions are being made explicitly or implicitly in the sug gestions used for trance induction. If an individual subject interprets the hypnotist's exhortation to "respond only to the sound of my voice" as meaning the institution of a state of rapport, he will develop one; if not, he will not.

Thus, although the present author agrees with Edmonston (1977b) that re laxation is a common concomitant of hypnosis, he disagrees with his thesis that it is the equivalent of neutral hypnosis. It results simply because of the usual way in which hypnosis is induced—by suggestions of drowsiness and relaxation—and is not essential to hypnosis, as demonstrated by the work of Gibbons (1974, 1976, 1979). The equating of relaxation and neutral hyp nosis is another common misconception and was the reason that Swartz (l982), in a review of the first edition of this book, took exception to the author's statement that, by itself, hypnosis is neither helpful nor harmful, since he (as the author), believes relaxation is valuable in tension-related conditions.

In this section we consider what physiological reactions can bemodified by suggestions, direct or indirect. Responses involving the autonomic nervous system (ANS) are of special interest since such responses are normally not under voluntary control and hence cannot be produced directly. However they can probably be altered by the mediating action of thoughts, ideation, or goal-directed fantasies.

Crasilneck and Hall (1959), Gorton (1949a, 1949b), and Barber (1961) 1965) have reviewed the literature on the physiological effects of hypnosis This literature is often in conflict because of the absence of adequate controls, especially in the earlier studies. Thus several studies have reported a decrease in heart rate in neutral hypnosis, while others have reported a rise. Probably both effects occur. Heart deceleration may result from the relaxation instruc-tions used to induce hypnosis and heart acceleration from the idiosyncratic reactions of subjects to the subjective feelings aroused by trance-induction procedures. If the subject is frightened by the prospect of hypnosis, may increase. Gorton (1949a, 1949b) reports that except for a slight low. due to relaxation, cardiac activity is about the same for subjects under hypnosis as it is when they are awake. Cardiac rate is much lower during sleep than in either hypnosis or waking.

Bauer and McCanne (1980b) found no significant differences in decrease in heart rate, alpha activity, skin conductivity, or respiratory rate between six hypnotized female subjects and six female simulators.

Barber (1961b, 1965d) reports that hypnotized and waking subjects can increase or decrease their heart rate in response to specific suggestions to do so, but hypnosis does not enhance this effect. It is not possible to determine whether direct suggestions to vary the heart rate are effective without the help of mediating ideation because it is not possible to control what the subject is thinking. Since the autonomic nervous system (ANS) is not under direct voluntary control, if heart rate is to be controlled by a subject, it probably must be done indirectly by an emotional response to ideation produced gestions. Barber also points out that alterations in respiration rate, which can be made voluntarily, can affect heart rate. However, it is difficult to distinguish the direct effects of suggestions, if any, from the emotional concomitants of mediating ideation, goal-directed fantasies, or simply relaxation.

Barber cites a study by Van Pelt in which the latter appeals to have pro-duced cardiac acceleration in a calm subject while controlling for the level of adrenaline in the blood. Raginsky (1959) produced a cardiac block for a brief period by hypnotic suggestion. He also produced extra systoles in labile jects (Raginsky, 1953). Linton and colleagues (1977) found no evidence concordance of heart rate between subject and hypnotist based on empathy as some have suggested, but found some concordance during induction. Morgan and coworkers (1976) reported that suggestions of heavy work produced no alteration in cardiac rate in either hypnotized or waking subjects, but they were effective in producing an increase in ventilation. Barber found that in neutral hypnosis, muscle tension, measured by electromyograph (EMG), was significantly lower, but pulse rate was unchanged. Hilgard and colleagues (1974) reported a significant difference in heart rate following sug-gestions of analgesia that was unrelated to the amount of subjective pain reduction but no significant rise in heart rate with hypnotically hallucinated Electrocardiogram changes have been reported following emotion-producing suggestions (Bennett and Scott, 1949; Berman, Simonson, and Heron, 1954) Blood pressure is affected by both cardiac rate and the peripheral resis-tance in the arterioles produced by the activity of sphincter muscles under control of the ANS. As in the case of heart rate, neutral hypnosis usually neither raises nor lowers blood pressure, but the relaxation effect may reduce the systolic pressure slightly, and any apprehensions that the subject has may raise it. On the other hand, suggestions can produce marked changes of up to 40 millimeters of mercury systolic pressure and 20 millimeters of mercury effect on the systolic pressure, and suggestions of temperature change primarily affect the diastolic pressure. Suggestions of warmth lower the diastolic pressure, and suggestions of cold raise it. Holroyd, Nuechterlein, and Shapiro 982) found that hypnosis reduced systolic blood pressure when bio-feedback did not, but biofeedback was superior to hypnosis in reducing forehead muscle tension. These effects were independent of subjects' hypnotic susceptibility.

A large number of clinical reports are cited by Crasilneck and Hall (1959) to the effect that bleeding can be increased or decreased by hypnotic sug-gestion, although they report a failure to demonstrate such a relationship experimentally. Some clinical sources describe reduction in bleeding as a concomitant of hypnoanesthesia even in the absence of specific suggestions to this effect. Arons believes that only capillary bleeding can be controlled hypnotically because veins have no sphincter muscles. A research difficulty results from the fact that venous, and certainly arterial, bleeding requires immeditate control, so anything less than immediate and total control over them produced by hypnosis is not likely to be experimentally measurable.

Misconceptions Concerning Hypnosis(continued)

Misconception 4: Hypnosis is an unusual, abnormal, or artificial condition.

With a little thought, readers will be able to think of dozens of examples of spontaneously induced mental states that are highly similar or identical to a hypnotic trance. The common experience of daydreaming while commut ing to work or becoming completely absorbed in a book to the exclusion of everything else going on around you are common examples. There is a con dition called highway hypnosis, which is produced by a driver staring straight ahead on a monotonously straight road, possibly with the added influence of windshield wipers in steady operation. This phenomenon is probably responsible for an unknown number of highway accidents each year. Good human engineering of highways requires taking this phenomenon into account by providing enough turns in a road to break up the monotony of travel. A straight line may be the shortest distance between two points, but It Is not always the best roadway design. Other common examples of spon taneously induced trance states may be found in a person's staring at a television set or reading a book without noticing what he is watching or reading. Most members of a movie audience exhibit many of the characteristics of people in a hypnotic state.

Misconception 5: Hypnosis is a form of sleep.

There are several reasons for this common misconception. First, the word hypnosis Itself is a misnomer (Goldstein, 1982). It derives from Hypnus, the name of the Greek god of sleep. Second, the lack of facial expression and spontaneous movement coupled with slumping of the head or body fre quently seen in hypnotized people is suggestive of sleep. Last, many methods of induction make use of exhortations directing the subject to sleep. Indeed, it is possible to bore a subject to the point where he will actually fall into a real state of sleep instead of hypnosis.

In spite of the superficial similarity between a hypnotic trance and normal sleep, the two states are quite different (Evans, 1977, 1982). During stage 1 sleep (the phase in which vivid visual dreams are most common), the skel etal musculature is effectively paralyzed, and, thus, reflexes like the knee jerk are diminished. However, under hypnosis, there is no paralysis (unless sug gested), and there is no diminution of the basic reflexes or muscle tone.

Electroencephalograph (EEG) patterns are often said to be different for the hypnotic state and for sleep, but during stage 1 sleep, the EEG pattern is similar to the normal waking state except for the presence of rapid eye movements (REMs). Hence, stage 1 sleep is called arousal or paradoxical sleep. In stage 2, sleep spindles appear on the EEG record. Delta waves begin to appear in stage 3, becoming over 50% of the record by the deeper stage 4. None of these events occurs under hypnosis, where the EEG record is consistently similar to the waking state.

Misconception 6: The subject is under the control of the hypnotist and can be made to do things that he ordinarily would not do or to reveal secrets.

This misconception makes it difficult for some subjects to permit them-selves to be hypnotized because they fear loss of control. It is also the subject of much controversy and will be dealt with in more detail later. The weight of the evidence seems to support the notion that if a subject is directly re quested to do something that is objectionable to him, he will simply refuse to do it or in some cases "awaken" from the trance. On the other hand, It may be possible to get a subject to perform an act he would not normally do by deceiving him into believing a situation is different than it actually is. For example, he may be told that a person that he is being asked to attack It about to harm him.

All subjects should be informed prior to an induction that they will be In complete control; and if the hypnotist suggests anything that offends them, they will be free not to follow the suggestion. Such an instruction will allay the fears of the subject and will also serve to protect the hypnotist from charges of misconduct or of exercising undue influence over the subject. There is no legitimate reason in therapy why a subject would ever be asked to do some-thing repugnant to him. Indeed, one of the great advantages of a passive therapist is that he or she permits a patient to limit the production of anxiety-producing material to what the patient feels he can currently tolerate. This is a built-in safety valve. If the therapist is to make the decision about how much anxiety a patient can handle, he or she had better be an extremely good prognosticator or there is a risk of driving the patient out of therapy.

Although a hypnotist does not have complete control over a subject (and, in fact, if he or she did, hypnosis would be a dangerous procedure at best), the hypnotic state creates an atmosphere where suggestions, if ac ceptable to the subject, are more influential than they would be if the subject were not hypnotized. However, it must be kept in mind that people do in­fluence the behavior of other people with words, whether their listeners are hypnotized or not. Although hypnosis does not produce a zombie-like de pendence on a hypnotist, words can be potent and have the power to cure or harm, whether the recipient is hypnotized or awake. The danger lies not in the hypnotic state but in the use made of it. If any method of psycho therapy has the potential to help a patient, it must necessarily also have the power to harm him if not competently handled.

As an example of the misuse of a valid psychological technique, the prac- tice of a certain industrial plant that utilized a psychological screening test to select its employees may be cited. An applicant had to have a certain personality profile on this instrument before being hired. The net result of this selection process was the hiring of an undue number of neurotic employees and the failure to hire many potentially productive people. The reason for this regrettable state of affairs was not that this particular test or psychological tests in general are not useful. In fact, it was a very good test; for if it caused the selection of neurotic candidates, it could just as readily have been used to exclude them. The real difficulty in this case was caused by the incom petent use of a valid test by an untrained personnel manager. The same is true in the case of many examples cited to show the dangers of hypnosis, which are really examples of the danger of its incompetent use.

Misconceptions Concerning Hypnosis

Misconception 1: Hypnosis is a condition induced in the subject by the hypnotist.

This erroneous idea is the natural result of our use of English. We collo quially refer to hypnotizing subjects, and books are written and courses are given to train therapists and others "to hypnotize" subjects. Actually all hyp nosis is self-hypnosis in the sense that any effect produced, including the trance state itself, is produced by the concentration and imagination of the subject, not the operator. The real role of the hypnotist is to guide and teach the subject how to think and what to do to produce the desired result. The operator no more imposes this state on a subject than a teacher learns the content of a course for a student. Both teacher and hypnotist can only fa cilitate the efforts of the student or subject.

Once a trance state is induced, the hypnotist may seem to utilize it for whatever result is sought, but even in the area of trance utilization, whatever phenomena occur do so because of the imagination of the subject, not the operator. For this reason the term trance capacity is preferable to the more common term hypnotic susceptibility to refer to the likelihood of a given sub ject's achieving a given trance depth. The latter term implies that the subject is having the state imposed on him, while the former recognizes that the capacity to achieve a given trance level is an ability of the subject, not the operator.

This is not to imply that the hypnotist is not important or does not have to be highly skilled. Self-hypnosis is extremely difficult to achieve without help and training from an external hypnotist in the beginning. Even with experi ence in self-hypnosis, it is always easier to achieve and utilize the trance state with the help of an external operator.

Inexperienced subjects should always be advised that they, not the hyp notist, are responsible for producing whatever results are obtained. This will have the effect of taking the onus of any difficulty in induction away from the operator and preventing the subject from losing the confidence in the hypnotist's ability that is so essential to a successful induction. Also, it is the truth. Some feel it undermines the probability of success in the induction if the hypnotist uses such equivocal language as "We will try to hypnotize I you," or "We will see how deep a state you can attain." They believe that the hypnotist should always speak as though the induction is certain to be successful. If the responsibility for the success of the induction is placed fully on the subject, such unprofessional assurances of success are unnecessary. It is possible to reflect confidence in the subject's success by both word and manner without adopting the unwarranted behavior of a charlatan.

Misconception 2: A hypnotist must be a dynamic, forceful, or charismatic person.

Since the subject and not the hypnotist is ultimately responsible for the induction of the trance state, it follows that the abilities of the subject and his motivation for hypnosis are more important than the personality of the hyp notist—unless this personality is such that it is incompatible with the needs or expectations of the subject. Different subjects require different types of hypnotists or different techniques. Some subjects can respond successfully to a wide range of hypnotists; others may require a specific type of approach to be successful. Certainly if the hypnotist is personable and has a good rap-port with the subject, it is a positive factor. On the other hand, some out standing hypnotists are not very good speakers and often have poor diction or marked accents. These characteristics evidently do not interfere with their success.

Kroger (1977b) makes the point that hypnosis is a "prestige" type of phe nomenon and that it is the belief in the imminence of hypnosis that produces it. Hence, it is an advantage to a hypnotist to be known to the subject as an authority in the field or to have a title like "Doctor," for this will enhance the subject's expectations of success. For this reason, psychotherapists who use hypnosis frequently in their practice would do well to have their diplomas and degrees on exhibition in their office or waiting room.

Misconception 3: Hypnosis involves a battle of wills with the hypnotist, who needs a stronger will than the subject.

This is a common misconception of many subjects that probably came from watching old Bela Lugosi movies. Unless it is dispelled, it can make the induction of hypnosis difficult or impossible since the subject will see it is an admission of inferiority. If a subject comes to the therapist's office with the attitude that he is chal lenging the latter to be able to hypnotize him, he must be informed that there is no contest and if he chooses to resist hypnosis he will, of course, be suc cessful. He must be made to understand that the hypnotic state can be pro duced only with his active cooperation and help. Incidentally, it is possible to achieve a hypnotic state without the subject's being aware that he is being hypnotized. This can be done simply by avoiding the use of the words hypnosis or sleep in the induction procedure, or by saying that what the hypnotist is trying to do is get him to relax deeply. On the surface, this may seem as if the operator is unethically hypnotizing a sub ject without his consent, but bear in mind that no effect will occur unless the subject is willing to produce it. Such a procedure may be justified in the case of a patient who could profit from hypnosis but who cannot get over his fear of being hypnotized because of some unfounded ideas he has about it. A good question to ask at this point is whether there is any real difference be tween a deep state of relaxation as produced by the Jacobson method (see p. 66) and hypnosis? In other words, what is being suggested is that hypnosis often occurs in therapy when even the therapist does not consciously intend to produce it. In any event, this issue deals more with names than with reality. Not only is the ability to be hypnotized not a sign of a weak will, gullibility, or stupidity, but it in fact requires a good degree of intelligence in order to be able to concentrate and to think in the unfamiliar manner that the operator requests. Generally the author has found that bright people make good sub jects, and it is a good idea to so inform subjects prior to induction attempts.

Hypnosis

What is hypnosis? ---It is movement of brain wave states; I say movement because at any point in time an individual can be drifting through multiple brain wave patterns.

These patterns can be measured as a frequency response and can be measure by an EEG machine.

These frequency responses are described as Beta, Alpha, Theta and Delta. The state of hypnosis is typically related to the Theta brain wave response. However in my opinion theta shows constant vacillation with other brain wave states.

In simplified terms these brain wave states can be measured on a graph. The amplitude or height of the response is indicative of how are mind is functiong. Beta brain waves show a very active mind and therefore they spike the highest on a graph. This the brain wave state that would describe daily activity

Alpha state is slightly meditative; almost a feeling of melancholy if anybody is in to yoga it is the feeling you get right at the end of the class when you take shabasa. You’re not asleep but just floating on that cusp.

We then come to Theta, which is the highly responsive part of the brain that is associated with hypnosis

This state of hypnosis shows less amplitude on our graph due to the fact that the conscious mind is in a state of hibernation. The sub conscious is still hyperactive and very open to suggestion. The conscious mind although in hibernation still knows what is going on but is quite happy to kick back and observe ---If conflict occurs with its personal values it will quickly revert to an active conscious state.

Do not

Although as simple as these sounds this is the best way to think about hypnosis. Far to many people intellectualize the state of hypnosis and subsequently prevent them from experiencing it.

Delta describes a deep deep state of relaxation—This is the brain wave state where we heal and recuperate, where we charge our engines for the following day. It is often difficult to get an individual to awaken from this state. The conscious mind will step in, but it does not like to----It is self-preservation, it knows that it needs deep rest. Do not ignore this restorative state or you will end up physically and emotionally exhausted

As a hypnotist I remove the way of communicating between Beta and Theta. The way we access hypnosis is to travel through alpha- It is the bridge to the hypnotic state. With your permission you allow me to guide you across this bridge –In essence my voice becomes the bridge that carries you to the highly receptive hypnotic state

Although all hypnosis is self-hypnosis autohypnosis for most is still difficult. The need to have a therapist or facilitator takes away the thought process allows for a more successful experience.

Understanding basic brain wave patterns gives a better handle of what hypnosis is. An incredible self-development tool that can have a profound effect on every aspect of our life. Keep hypnosis simple stupid and sit back and reap the rewards.

If you need further information on the subject do not hesitate to call me at 1(760)635-7785 or go to my web page at www.barryjones.com

Hypnoanesthesia

Hypnosis is not used as often as an anesthetic agent as it is to control nonsurgical pain. On at least two occasions, the author was unable to find a local obstetrician who employed hypnosis in deliveries for pregnant women desiring such a referral (both of whom were excellent hypnotic subjects).

Probably the principal reason for this state of affairs has been the development of reasonably safe, rapidly effective chemical changes. It has been estimated that only 25% of the population are capable of developing a sufficient degree of hypnoanesthesia for its use as the sole anesthetic in relatively minor procedures, such as fracture settings, tooth extractions, the changing of burn dressings, or the removal of sutures in frightened children.

Other reasons advanced for reluctance to use hypnoanesthesia include: the amount of time, training, and skill required for a hypnotic induction; the fact that hypnosis may be contraindicted in patients with psychological problems such as psychotics, borderlines, or depressives; and the fact that hypnosis is regarded as Òquasi-scientificÓ in some professional circles

With respect to the contraindication of hypnosis and hypnoanesthia in patients with certain psychological disorders, some clarification is required. There is no absolute contraindication for hypnosis in any patient. Some patients may present a higher risk of developing adverse reactions such as spontaneous regression and aberrations, that are undesirable in a nonpsychotherapy context, and control of these require some skill on the part of the hypnotist. Hence, with these patients, hypnoanesthesia requires a hypnotist who is well trained in psychotherapy. It should not be attempted by a physician who lacks such training. It is unfortunate that physicians in general and anesthesiologists in particular, do not receive more training in psychodynamic concepts and hypnosis, for it is usually convenient to have a psychologist induce hypnoanesthia except in an emergency situation.

If initial hypnotic inductions are performed are performed in a leisurely, unhurried atmosphere and the patient is given the opportunity to develop an anesthesia and experience it tested successfully, his confidence in the adequacy of the procedure will be greater. Patients should be trained to enter a trance state either on a posthypnotic signal or by self-induction to save time in the operating room and render them independent of the presence of the particular hypnotist who trained them.

A patient so trained may be able to have a successful hypnotic delivery under the care of another obstetrician should the one who trained her in hypnosis be available at her delivery. Also, the ability to reenter hypnosis rapidly on a signal is a valuable safeguard should a patient inadvertently awaken during surgery. This contingency is quite unlikely, particularly if the hypnotist instructs the patient not to awaken until directed to and if he or she continues a steady flow of trance maintaining chatter throughout the operation. Preliminary trials of hypnosis may be presented to patients with reservations about the procedure as exercises in relaxation to prevent their fears from producing reactions that may lead to false impressions of their abilities as subjects.

The value of hypnosis may also extend to the prenatal period------It not possible to do successful hypnoanesthia, or for that matter any other hypnotic procedure, unless the therapist takes the time necessary to establish a proper rapport with the patient and the latter develops confidence in the hypnotists ability and concern for his welfare In addition to its use as an anesthetic, hypnosis can be a valuable pre-operative and postoperative adjunct to the care of surgical patients.

J. Barber and Mallin (1977) advocate the use of hypnosis during the fitting of contact lenses and emphasize the careful choice of words in the framing of suggestions. Words that denote the same thing may vary widely in their connotations and implications and thus may not be equally effective in framing suggestions.

Hypnosis - Hallucinations Continued

Barber (1964e) concluded that the research failed to demonstrate that hypnosis produces auditory or visual hallucinations that are the same as per ceptions or different from imagination. Erickson (1938a; 1938b), on the other hand, took the position that often hallucinations are quite real and reported that suggestions of negative auditory hallucinations, or deafness, could not be distinguished from organic deafness by ordinary means. His subjects dis played no startle response to an unexpected loud sound, failed to raise their voices in speaking when background noise was increased, or failed to blush to auditory stimuli that would normally produce such a response in a particular subject. He also found that a conditioned finger withdrawal response to an auditory-conditioned stimulus disappeared during hypnotically suggested deafness and reappeared after the hypnosis. Black and Wigan (Barber, 1964c) found a similar result with an autonomic nervous system response not under conscious control as a finger flexion is. Pattie (1935) reported the failure to produce uniocular blindness in a small group of subjects as disclosed by ster eoscopes, filter, and Flees box tests. To reconcile these conflicting views, it will be necessary to sample a number of lines of research.

Barber and Calverley (1964;) report that suggestions of deafness were ef fective in 15 hypnotized and 15 nonhypnotized subjects. However, if these subjects were subjected to delayed auditory feedback where the sound of their own voices was delayed slightly, they reacted as do typical subjects with normal hearing by stuttering, mispronouncing words, increasing vocal inten sity, and talking more slowly.

Barber (1964c) reports that in hypnotically suggested deafness in one ear, subjects who display positive results still report hearing a beat note if stimu lated with slightly different frequencies in each ear. Weitzenhoffer criticized this study on the grounds that the frequency applied to the "deaf" ear could have reached the other by bone conduction, but it is interesting to note that the one subject who did not experience the beat note was a physics major presumably familiar with the phenomenon of beat notes. In a study providing results analogous to the common finding that hypnotic pain control has little effect on physiological measures correlated with pain, Sabourin, Brisson, and Deschambault (1980) found that hypnotically in duced deafness did not influence a conditioned heart rate response or the response time in a key-pressing task to an auditory stimulus in subjects re porting a positive subjective effect.

Spanos, Jones, and Malfara (1982) found that high-susceptibility subjects reported greater deafness than low-susceptibility subjects in response to suggestions of unilateral deafness but did not differ objectively in impairment from the latter as measured by responses to words presented in dichotic pairs. Crawford, MacDonald, and Hilgard (1979) found that reduction in hearing in response to hypnotic suggestion correlated 0.59 with hypnotic suscepti bility but the "hidden observer" technique (see p. 116) disclosed that covert hearing was at least 20% greater than reported overtly by the subjects. Subjects who are instructed to hallucinate a background (which normally produces an optical illusion effect) over a figure do experience such an illusion but not as strongly as they would with a real picture of the background added and no more than nonhypnotized subjects instructed to imagine the back ground (Barber, 1964e). Miller, Hennessy, and Leibowitz (1973) found that if such an illusion-producing background was negatively hallucinated away, the Ponzo illusion did not disappear. Hypnotic subjects capable of negatively hallucinating portions of visual stimuli showed varying degrees of ability to attenuate the Tatchner-Ebbin-ghaus circles illusion posthypnotically (Blum, Nash, Jansen, and Barbour, 1981). Miller and Leibowitz (1976) found that a hypnotically produced re-striction of the visual field produced behavior no different from that obtained from a group of simulators. Similar results were reported by Leibowitz, Lundy, and Guez (1980). Leibowitz, Post, Rodemer, Wadlington, and Lundy (1980) found that the amount of visual field narrowing occurring in response to in-structions to simulate such narrowing was a function of the method of mea surement, with direct measurement by perimetry yielding the most effect. Dorcus (1937) found no pupillary reflex in response to suggestions of light intensity change. He also found that the postrotational eye movement (nystagmus) produced in four subjects after hypnotic suggestions that the subject was rotating in a chair were voluntary and not the same as the eye movement produced by the same subjects when actually rotated. Also, falling responses following rotation suggestions did not appear unless the subjects had prior experience actually being rotated, and when produced under these circum stances, they were in the wrong direction for the rotation direction suggested.

Wallace (1980) reports that perceived autokinetic movement of a hyp notically hallucinated light was a function of hypnotic susceptibility as mea sured by the HGSHS. Since the subjects were all psychology students, it is not possible to confirm the present author's opinion that performance was also a function of the subject's knowledge of psychology. The suggestion of a hallucinated light in a dark room is an indirect suggestion to produce au- J tokinetic motion to a knowledgeable subject. Erickson (1939b), using very deeply hypnotized subjects, produced some degree of color blindness as measured by the Ishihara plates. Barber and Deeley (1961) report producing color-blind responses in nonhypnotized sub jects by instructing them to "concentrate away from red and green." Cunningham and Blum (1982) and Harvey and Sipprelle (1978) found significant differences between the subjective experience reported by subjects success fully experiencing hypnotically suggested color blindness and the behavior of people with congenital defects in color vision.

Some subjects who are instructed to hallucinate colors either under hyp-nosis or task-motivational instructions report the occurrence of negative af-terimages. Barber (1964c, 1959b) suggests that such reports do not occur in subjects who are naive concerning the phenomena of negative color after-images, but if they do occur, the afterimage colors reported are those com monly described in elementary psychology texts—that is, the complementary color of the one hallucinated (e.g., red-green, blue-yellow) instead of the somewhat different (more pastel) colors usually reported in actual negative afterimages. Similarly, if an actual color was shown and the subject was told it was different, the actual color, not the hallucinated one, determined the nature of the afterimage (Barber, 1964d).

In view of the foregoing studies, the question arises about which view point, Barber's or Erickson's, is correct concerning the reality or validity of positive and negative hypnotic hallucinations. In the view of the author, both are correct. Erickson is right that these are real experiences; Barber is right that hallucinations are different from ordinary sensations. Hypnotic blindness or deafness is not the same as organic blindness or deafness any more than hysterical blindness or deafness is. Of course, negative afterimages do not occur in subjects not familiar with this phenomenon. How could they? A negative afterimage produced by a real external stimulus is a retinal phenomenon produced by the differential fatigue of different visual receptors. A hallucinated color does not result from retinal activity but from suggestions reaching the cerebral cortex. Sensations or physiological responses in sense organs are not modified in hypnotic hallucinations; perceptions or higher-level mental processes are.

An afterimage produced to a hallucinated color is as much a suggested effect as the color Itself. It is an excellent example of an indirect suggestion. This does not mean that it is not experienced. The real question asked when we inquire about the reality of a hypnotically Induced hallucination is, How vivid is it, or How similarly does the subject experience it to a real external stimulus? This is an unanswerable question. Trying to render the question answerable by equating "real" with similarity to a sensory experience in a physiological sense only introduces confusion. In spite of their rather divergent views, the work of Barber (1958d) and Erickson (1944) seems to support the general conclusion that subjects given hypnotic suggestions of deafness or blindness for a particular person or object behave as though they are trying to avoid perceiving that person or object. Subjects try to avoid focusing or looking at the subject of the negative hal lucination or report perceiving it vaguely. A similar result is reported by Hil-gard and colleagues for negative hallucinations of pain in that a subjectable to ignore the suffering aspects of pain will still report experiencing the sen sations in some manner if he is instructed that there is a hidden observer who can report these sensations (Hilgard, Morgan, MacDonald, 1975).

Barber claims that to get a subject not to experience the object of a negative hallu cination, it is necessary to convince him of the objective truth of the exper imenter's statement that the object is no longer present. Thus, if a subject is told that a chair is no longer present, he will try to look away from it but will not bump into it if it is directly in his path of travel. If, on the other hand, noises are made simulating the removal of the chair while the subject's eyes are shut, he will act as though he really does not see it at some level and will walk directly into it. Erickson reported a similar effect when a subject acted at though he really did not see one negatively hallucinated person but did show some signs of perceiving another for whom the suggestions were made more recently. He ascribed this difference in reactions, in accordance with his characteristic view that a very deep trance is required for this effect, to the fact that it takes time for the suggestions to become fully effective.

Although it seems clear that a positive hallucination of a complex sense modality like vision originates in the cortex, not in a sense organ, some of the easier-to-elicit tactile hallucinations may, partially at least, involve paying attention to a certain amount of dermal stimulation normally present and customarily ignored.

Hypnosis - Hallucinations

A hallucination is defined as a perception in the absence of a real external stimulus. Usually the occurrence of a hallucination is a symptom of a psychotic disorder, but under certain circumstances, normal people may hallucinate. These situations include conditions of sensory deprivation, extreme hunger or thirst, fever, drugs, REM sleep (nocturnal dreams), and, in some cases, scrying (crystal ball gazing). Normal people may also hallucinate under the influence of suggestions, hypnotic or otherwise.

Psychotic hallucinations in general have both a characteristic sensory mo dality and a characteristic content that vary between diagnostic categories. For example, schizophrenic hallucinations are predominantly auditory and have a characteristic obscene or self-critical content. Most psychotic hallucinations are accompanied by a delusional belief in their objective reality that is often absent in the hallucinations of normal people. This phenomenon is not intrinsically unreasonable, for psychotic hallucinations tend to be consis tent with past experience. For example, a hallucinated image will usually ob scure parts of real images lying in back of it in the visual field, and it will cast a reflection in a mirror. All of his life the patient has been correct in believing the information his sense organs have communicated to him about the ex­ternal world, and there is no reason why he should not believe in the ver-idicality of these images when they are hallucinated.

In the case of the hypnotically suggested hallucination, the modality and the contect of the hallucination are functions of the suggestions made. Hallucinations can be suggested in any sense modality; the ones most commonly used are vision, audition, olfaction, gustation, touch, heat, and cold. : hallucinations may be suggested in specific modalities or it may produce multimodality effects. For example, the hallucinated fly in the Stanford test (SHSS:A) may produce visual, auditory, fects. In addition to positive hallucinations, negative hal-the subject fails to perceive some real external stimulus, ted. These are analogous, if not identical, to the everyday >erson is looking directly at an object that he is searching :e it. Those portions of the external environment that are lotic suggestions are generally perceived accurately if not (Orne, 1962d).

Hallucinations in general are difficult to elicit under hypnosis, and there is ilty between the various sensory modalities. Tactile hallucinations are comparatively easy to produce. Suggesting to a group of nons that they should notice that their noses are beginning to in effect in many of them. So will reading a paragraph iing that might be used in making such a suggestion. The rises of olfaction and gustation are also more amenable to ! more highly developed senses of audition and vision.

Orne (1962d) points out that when a visual hallucination is suggested In a subject he may react in a variety of ways. He may act as though he sees 1 what has been suggested or seem disturbed because he does not experience it. In the former case, if he is questioned after the experience, he may say that (1) he saw nothing but felt compelled to act as if he did; (2) he expeFrienced a visual image but knew it was unreal; (3) he experienced a real external image but it had illogical aspects to it (e.g., he could see a chair j through a hallucinated person); or (4) he experienced an image indistinguish able from reality. Thus Orne categorized the subject's subjective experience into one of four categories. He considers only the last two as true halluci nations. In actuality, there is probably an infinite series of gradations of subject responses, and individual investigators differ in what they define as a positive | response to a suggested hallucination.

Another point needs to be made: there is no way for an experimenter to observe the subject's hallucination directly. Hence he or she must rely on the subject's verbal report of his or her experiences. Thus it is possible, and in deed probable, that one subject who experiences a hallucination more vividly than another may report it as less vivid because of individual differences in the use of language and subjective standards of what the term vivid means. This is the same problem experienced by dream researchers who purport to be studying dreams but are actually studying verbal reports of dreams. The only hallucinations that an investigator can observe directly are his or her own, and these are necessarily individual and atypical. The question about the relative subjective experiences of two different subjects reporting their own hallucinations, no matter how similar or different their verbal descriptions, is as unanswerable by observation as is the question of whether two subjects describing the same stimulus as blue are having the same or radically different subjective experiences.

Such questions are philosophical, not scientific, ones. Although the degree of the apparent reality of a hallucination can only be estimated by a verbal report, Orne (1962d) attempts to distinguish effects that are actually experienced from those that are simulated by subjects motivated to produce what the experimenter wants them to by the use of stimulating subjects. These are subjects who have not been hypnotized but have been instructed to act as if they have been and to attempt to deceive the experi menter making the behavioral observations (who is not told which subjects are actually hypnotized). Simulators are usually informed that if the experi menter discovers that they are simulating, he or she will halt the procedure; hence, its continuation lets the simulator know he is successful in efforts at deception. The logic behind the use of simulating subjects is that both hyp notized subjects and simulators are equally motivated to produce the sug gested behavior, but if only the hypnotic subjects actually experience the ef fects suggested, their behavior may be different to some degree from that of the subjects who are faking an effect. The lack of knowledge on the part of the experimenter of the real or simulating status of a subject eliminates experimenter bias and prevents any unconscious systematic differential treatment of the two types of subjects.

There are behavioral differences between real subjects and simulators. If a subject is told to hallucinate the experimenter sitting in a chair and is then told to turn around and look at where the experimenter really is, he will often appear surprised and report seeing him twice. He may not know which image is real. (Some subjects will distinguish the real from the hallucinated image by having the hallucinated one raise his hand.) Simulating subjects will usually deny seeing the experimenter when looking at him because they believe they are not supposed to.

If a negative hallucination is suggested so that the subject is told he can no longer see a chair and then is asked to walk in a direct line with the chair, hypnotized subjects will avoid bumping into the chair, while simulators will Usually walk into it. Spanos, Churchill, and McPeake (1976) found that a cooperative attitude toward hypnosis and involvement in everyday fantasy were each positively correlated with the ability of a subject to experience visual and auditory hal lucinations. Visual hallucinations were more difficult to produce than auditory hallucinations, but they found that the abilities to produce these two types of hallucinations were correlated. They reported no sex difference in the ability to hallucinate. A large majority of their subjects reported their experiences as Imagined rather than seen or heard. Ham and Spanos (1974) report that with 60 male and female subjects equally assigned to hypnotic and task-motivational groups, the task-moti vated subjects performed better in response to suggestions of visual or au-ditory hallucination. Spanos, Mullens, and Rivers (1979) in a 2 x 3 factorial study compared hypnotic and task-motivated subjects in performance of vis ual and auditory hallucinations in response to brief suggestions, long sug gestions, and suggestions providing an imaginary context. Task-motivated subjects performed better than hypnotic subjects on auditory hallucinations, I and the authors report a "trend toward significance" in this direction on visual hallucinations. Both long and image-involving suggestions were equally more effective than short suggestions for auditory hallucinations but were not sig nificantly different for visual hallucinations.