Kleinhauz and Beran (1981, 1984) present six cases of severe and/or chronic reactions to hypnosis, five Involving either Inadequate dehypnotlzlng of the subject by a lay or stage hypnotist and one Involving a dentist ex ceeding his area of competence by treating a patient for smoking without consideration of the dynamic value of the symptom to the patient. One of the patients was reported to be a member of the audience at a stage dem onstration, and another claimed to have stolen a pistol as a result of the misinterpretation of a remark by a stage hypnotist that he should act like a cowboy and crack shot. The present author is skeptical of this latter case since the claim was raised as a defense in a criminal prosecution. The authors con clude that all therapists should inquire about prior hypnotic experiences to discover such influence in the genesis of the patient's condition so that they can provide adequate treatment. They also advocate the outlawing of stage hypnosis and criticize the "contamination" of the relationship with the subject by the hypnotist by using it not for the benefit of the patient but to make him an instrument for the purpose of entertaining an audience.
On the other hand, they do not object to experimental hypnosis because, while the researcher seeks to accomplish research goals rather than help the subject, the latter is aware of this, and the procedures are carefully designed and monitored. This position seems to present a problem in logical consis tency. The subject in stage hypnosis is also aware of the purposes of the hypnotist (often to a greater extent than in experimental hypnosis), and there is usually little concern with the subject in most experimental work but rather a focus on some hypnotic phenomenon. Often researchers are not clinically experienced, and little follow-up work on possible sequelae is undertaken. It is possible that the unstated reason for the belief of the authors that experi mental hypnosis is acceptable while stage hypnosis is not is that the value of the former justifies whatever risks may be involved.
Other reactions to hypnosis reported to have occurred in the course of psychotherapy include a spontaneous 72-hour atypical paranoid reaction, a spontaneous cataleptic reaction, and a spontaneous age regression (Hall, 1984; Kornfeld, 1985a; J. Miller, 1983; D.Spiegel and Rosenfeld, 1984). Although such reactions would be a disaster to a lay hypnotist, when they occur in the course of therapy and are properly managed, they may con tribute to a dynamic understanding of the patient. Certainly anyone under taking to do hypnotherapy needs to be prepared for such atypical reactions. Orne (1965a) suggests that some of the severe anxiety reactions that may occur in therapeutic inductions result from the fact that the patient expects permanent changes in his personality and that he is ambivalent about these changes. This ambivalence is demonstrated by the fact that the anxiety re actions can often be controlled by assuring the patient that the induction is intended simply to test his ability as a subject and that no therapeutic sug gestions will be made during the session. Also, transference and counter-transference issues may contribute to this anxiety. Orne believes that these issues should be dealt with under hypnosis, for if the therapist awakens the patient, the latter may interpret this as meaning that the therapist is unable to deal with the anxiety reaction.
J. Hilgard also reported on the incidence of sequelae in laboratory hypnosis and agrees with Orne's conclusion that most reported cases of serious difficulties with hypnosis arise in clinical rather than laboratory settings (Hil gard, Hilgard, and Newman, 1961; J. Hilgard, 1974). Hilgard concludes that most of the fears expressed concerning reactions to hypnosis are groundless and are based on inaccurate preconceptions of the hypnotist having undue influence over a subject. Untoward reactions obtained from subjects experi encing experimental hypnosis, although theoretically interesting, are not se vere. The 1974 study was undertaken because of a change in the charac teristics of the student body available for research since the study of 1961. It was found that of the 120 university students studied, 15% had some kind of reaction to the hypnotic experience (SHSS, form C) that lasted an hour or longer. This figure rose to 31% if short-term reactions (lasting from 5 min utes to an hour) were included. Thus, she warns against the premature dis missal of hypnotic subjects.
Some of the reactions (e.g., headache, confusion, or anxiety) began dur ing hypnosis and either terminated with it or persisted for a while after the session. The chief short-term aftereffects reported were drowsiness and con fusion (16 of 19 sequelae). Hilgard suggests that these may be regarded as a continuation of the hypnotic state rather than a reaction to it. It is similar to the experience of many people who require a period of readjustment after awakening in the morning.
Longer sequelae were experienced by 18 of 120 subjects in the 1974 study as opposed to only 7 of 220 subjects in the 1961 study. The much higher percentage in the later study may be due to the fact that form A of the SHSS was used in the earlier study, and form C, which includes age regression and dream induction, was used in the later one. Half of the long-term reactions (9 of 18) were a continuation of drowsiness and confusion, but more complex ones were also reported. One delayed response reported involved nocturnal dreaming about hypnosis, but it is not clear whether this response should be considered a sequelae or the hypnosis simply regarded as a day residue that appeared in the dream. Headaches were also reported that lasted from 1.5 to 2 hours but disappeared following sleep. Headaches were interpreted as representing a conflict between the desire to be hypnotized and anxiety con cerning the experience or a desire to avoid it. Little, if any, relationship was lound between hypnotic susceptibility and sequelae. There was, however, a positive relationship between pleasant aftereffects (which were not considered sequelae, such as feelings of relaxation, calm, and well-being) and susceptibility. Although these reactions were always suggested at the termination of hypnosis, only about 60% of the subjects reported experiencing them. It was found that there were wide individual differences in how subjects react fol lowing a hypnotic experience, but, in an experimental setting at least, thert were no alarming sequelae. In the 1961 study, a significant relationship was found between sequelae and adverse childhood experience with anesthesia, the patients was reported to be a member of the audience at a stage dem onstration, and another claimed to have stolen a pistol as a result of the misinterpretation of a remark by a stage hypnotist that he should act like a cowboy and crack shot. The present author is skeptical of this latter case since the claim was raised as a defense in a criminal prosecution. The authors con clude that all therapists should inquire about prior hypnotic experiences to discover such influence in the genesis of the patient's condition so that they can provide adequate treatment. They also advocate the outlawing of stage hypnosis and criticize the "contamination" of the relationship with the subject by the hypnotist by using it not for the benefit of the patient but to make him an instrument for the purpose of entertaining an audience.
On the other hand, they do not object to experimental hypnosis because, while the researcher seeks to accomplish research goals rather than help the subject, the latter is aware of this, and the procedures are carefully designed and monitored. This position seems to present a problem in logical consis tency. The subject in stage hypnosis is also aware of the purposes of the hypnotist (often to a greater extent than in experimental hypnosis), and there is usually little concern with the subject in most experimental work but rather a focus on some hypnotic phenomenon. Often researchers are not clinically experienced, and little follow-up work on possible sequelae is undertaken. It is possible that the unstated reason for the belief of the authors that experi mental hypnosis is acceptable while stage hypnosis is not is that the value of the former justifies whatever risks may be involved.
Other reactions to hypnosis reported to have occurred in the course of psychotherapy include a spontaneous 72-hour atypical paranoid reaction, a spontaneous cataleptic reaction, and a spontaneous age regression (Hall, 1984; Kornfeld, 1985a; J. Miller, 1983; D.Spiegel and Rosenfeld, 1984). Although such reactions would be a disaster to a lay hypnotist, when they occur in the course of therapy and are properly managed, they may con tribute to a dynamic understanding of the patient. Certainly anyone under taking to do hypnotherapy needs to be prepared for such atypical reactions.
Orne (1965a) suggests that some of the severe anxiety reactions that may occur in therapeutic inductions result from the fact that the patient expects permanent changes in his personality and that he is ambivalent about these changes. This ambivalence is demonstrated by the fact that the anxiety re actions can often be controlled by assuring the patient that the induction is intended simply to test his ability as a subject and that no therapeutic sug gestions will be made during the session. Also, transference and counter-transference issues may contribute to this anxiety. Orne believes that these issues should be dealt with under hypnosis, for if the therapist awakens the patient, the latter may interpret this as meaning that the therapist is unable to deal with the anxiety reaction.
J. Hilgard also reported on the incidence of sequelae in laboratory hypnosis and agrees with Orne's conclusion that most reported cases of serious difficulties with hypnosis arise in clinical rather than laboratory settings (Hil gard, Hilgard, and Newman, 1961; J. Hilgard, 1974). Hilgard concludes that most of the fears expressed concerning reactions to hypnosis are groundless and are based on inaccurate preconceptions of the hypnotist having undue influence over a subject. Untoward reactions obtained from subjects experi encing experimental hypnosis, although theoretically interesting, are not se vere. The 1974 study was undertaken because of a change in the charac teristics of the student body available for research since the study of 1961. It was found that of the 120 university students studied, 15% had some kind of reaction to the hypnotic experience (SHSS, form C) that lasted an hour or longer. This figure rose to 31% if short-term reactions (lasting from 5 min utes to an hour) were included. Thus, she warns against the premature dis missal of hypnotic subjects.
Some of the reactions (e.g., headache, confusion, or anxiety) began dur ing hypnosis and either terminated with it or persisted for a while after the session. The chief short-term aftereffects reported were drowsiness and con fusion (16 of 19 sequelae). Hilgard suggests that these may be regarded as a continuation of the hypnotic state rather than a reaction to it. It is similar to the experience of many people who require a period of readjustment after awakening in the morning.
Longer sequelae were experienced by 18 of 120 subjects in the 1974 study as opposed to only 7 of 220 subjects in the 1961 study. The much higher percentage in the later study may be due to the fact that form A of the SHSS was used in the earlier study, and form C, which includes age regression and dream induction, was used in the later one. Half of the long-term reactions (9 of 18) were a continuation of drowsiness and confusion, but more complex ones were also reported. One delayed response reported involved nocturnal dreaming about hypnosis, but it is not clear whether this response should be considered a sequelae or the hypnosis simply regarded as a day residue that appeared in the dream. Headaches were also reported that lasted from 1.5 to 2 hours but disappeared following sleep. Headaches were interpreted as representing a conflict between the desire to be hypnotized and anxiety con cerning the experience or a desire to avoid it. Little, if any, relationship was lound between hypnotic susceptibility and sequelae. There was, however, a positive relationship between pleasant aftereffects (which were not considered sequelae, such as feelings of relaxation, calm, and well-being) and susceptibility. Although these reactions were always suggested at the termination of hypnosis, only about 60% of the subjects reported experiencing them. It was found that there were wide individual differences in how subjects react following a hypnotic experience, but, in an experimental setting at least, thert were no alarming sequelae.