The Old Hypnosis and the New Hypnosis

In roughly the past half-century, the scope of hypnotic interventions has been redefined.  Hypnosis, one of the oldest, best-known, and most thoroughly described phenomena in psychology and medicine, the subject of literally tens of thousands of studies, is one of the most meticulously explored techniques in the healing field, with a track record not only of numerous successes, but of successes in cases otherwise considered hopeless.  Yet it remains under-employed and suspect, an approach of last resort, and its new methods are a subject of controversy within medicine and psychiatry as well as without.  Why?  And how can the new wave of innovative hypnotic applications benefit the public?

Ambiguous Beginnings

Just as modern chemistry grew out of earlier practices such as alchemy, so contemporary hypnosis has grown out of the earlier precursor of ‘mesmerism’.  Hypnotic phenomena have always existed, of course, but it was not until Franz Mesmer (1734-1815) began employing hypnotic procedures within the context of a theoretical overview of his own construction that hypnotic phenomena, now labeled “mesmerism”, began to attract serious scientific attention.  Unfortunately Mesmer’s theories were nonsense.  He believed undefined “magnetical” forces determined physical health, and experimented with magnets to modify the forces and foster healing.  In time he realized he could get the same effects without magnets, merely by moving his hands in “Mesmeric passes” in front of the subject’s body. In 1784, at the request of King Louis the Sixteenth, French scientific committees (one of which included Benjamin Franklin) reviewed both Mesmer’s practices and those of a critical former student of Mesmer’s, Charles d’Eslon, who rejected Mesmer’s theories wholly.  Mesmer’s efforts were declared successful, but so were d’Eslon’s, and results from experiments involving placebo controls were quite as successful too.  The committees concluded that the best explanation was not any sort of “animal magnetism” but rather the “mesmerized” subject’s belief and imaginative cooperation with the ‘mesmerizer’.

Salvaging the Rational Core

Following the French committee’s findings, in 1827 a Scottish academic named Dugald Stewart challenged physicians to salvage what was effective in Mesmerism and replace the dross of “magnetic” theory with an analysis rooted in physiology and psychology. James Braid, a physician, read Stewart and took up the challenge, and developed his own method, called “hypnotism”, as a more rational and “common sense” alternative:

“…by the term Hypnotism, or Nervous Sleep, which frequently occurs in the following pages, I mean a peculiar condition of the nervous system, into which it may be thrown by artificial contrivance… Hypnotism might therefore not inaptly be designated, Rational Mesmerism, in contra-distinction to the Transcendental Mesmerism of the Mesmerists.”

Braid’s rationalist vision of hypnotism had none of the controversy or bravura of Mesmer’s, however, the decline of whose theory of hypnosis tarnished the practice.  Mesmerism had become equivalent to charlatanism as far as many contemporaries were concerned, and Braid’s quest to salvage its rational core was little noticed – until 1860, when French neurologist Dr. Étienne-Eugène Azam translated Braid’s last manuscript, “On Hypnotism”, and brought Braid’s research before the French Academy of Sciences.

Azam’s enthusiasm inspired Ambroise-Auguste Liébeault, a country doctor, to begin what was in effect the first hypnotherapy clinic.  Its successes and popularity further inspired physicians Jean-Martin Charcot and Hippolyte Bernheim, two of the more influential figures in late 19th century French medicine, to incorporate the practice into their own clinics. Charcot subsequently appointed Pierre Janet (1859-1947) director of the psychological laboratory at the Salpêtrière clinic in 1889. Janet went on to develop hypnotic psychotherapy techniques based upon the concept of psychological dissociation and brought the practice to world eminence, attracting a student who would later play a part in leading hypnosis into lengthy eclipse – Sigmund Freud.

A Method without a Framework

Freud visited and studied with Janet, and was at first an enthusiastic advocate of hypnotherapy.  Employing hypnotic regression and abreaction as therapeutic methods, he published with co-author Joseph Breuer the classic “Studies on Hysteria” (1895), considered to be one of the founding texts of psychoanalysis.

However, Freud soon abandoned hypnotism, and discouraged its use. Observing that hypnotic suggestion frequently wore off over time, he argued that hypnosis only made passing, surface corrections to problems.  The better road was to resolve unconscious conflicts by unearthing them through psychoanalytic methods. And as the Freudian paradigm grew to worldwide eminence, the “direct suggestion” approach of hypnotism declined.
Behavioral psychology might have taken up the stick:  American psychologist Clark L. Hull published the first major compilation of laboratory studies on hypnosis, “Hypnosis & Suggestibility” in 1933. But with the rise of Skinnerian operant conditioning, emphasis passed away from internal states and physiological reflexes both, in favor of environmental analysis.  As operant conditioning became the dominant school in American psychology, hypnosis again declined.  And when behaviorism was itself eclipsed by cognitive psychology, whose emphasis on the conscious contents of ideation was not sympathetic to notions of trance or depth states, hypnosis, for yet a third time, seemed to become a subject of merely fringe interest.

Does Hypnosis Even Exist?

But the effectiveness of hypnotism simply would not go away.  Even those committed to the reigning psychological paradigms knew of it, and virtually every solidly grounded psychological education covered the subject and trained the student, to a degree, in its use.  Books and studies continued to be published, even as patients continued to be hypnotized.

But the more the subject received scientific study, the more it puzzled.  Studies of brain waves revealed no unique or exceptional brain states associated with hypnotism at all.  Whatever happened in hypnosis appeared to be no different than whatever was happening outside of it.  This led psychologists to break into three camps – one, called “state” theorists, which considered hypnosis to be a unique mental state (without, as yet, a unique brain state discovered that accompanied it); the next, “non-state” theorists which considered hypnosis not to be a unique mental state but rather a mode of role-playing or a response to social expectations; and a third that argued that there was no non-hypnotic “waking state”:  that all humans are to various degrees hypnotized all of the time.

The theories multiplied.  But the practices, by and large, stayed the same:  direct suggestions that symptoms go away, that bodies heal, that recoveries quicken, and, occasionally, that hands levitate.

Milton Erickson:  Renaissance in Hypnotherapy

The decisive figure in the creation of new paths for modern hypnosis and hypnotherapy is undoubtedly Milton H. Erickson.  A medical doctor and the author of numerous books and papers, Erickson developed a host of new and fresh techniques, including suggestion by presenting analogies, induction through confusion techniques, rapport, embedded commands, double binds, future pacing, and other approaches so innovative as to lead contemporaries like André Weitzenhoffer to question whether what Erickson was doing could even be called hypnosis.

The controversy remains, and remains understandable.  Erickson made numerous innovations, but three meta-practices in particular were so striking as to open entirely new routes for hypnosis and hypnotic methodology.

The first was Erickson’s emphasis on indirect suggestion. Hypnosis prior to Erickson was with very few exceptions “top-down”.  The hypnotist commanded; the subject obeyed.  And if the subject did not obey, continual repetition of the commands would follow till he or she did obey, or till the attempt was abandoned.  Erickson felt that such direct approaches were the worst and weakest ways to hypnotize individuals.  The unconscious mind resented and resisted such direct manipulation, said Erickson.  Effective hypnotism, he felt, needed to present suggestions not coercively and bluntly but indirectly, through metaphor, analogy, hints, questions rather than statements, humor, narrative. The task of the hypnotist was ideally to get the subject’s unconscious mind to entertain an idea without ever presenting it directly, instead influencing the unconscious through circuitous allusions till it might imagine it had spontaneously generated the idea on its own.

The second was Erickson’s readiness to allow the unconscious mind of the subject to make its own decisions and direct its own actions, without necessarily telling the hypnotherapist about its solutions – sometimes, not even informing the therapist about the problem itself. In a hypnotherapeutic session, Erickson might suggest that the unconscious thoroughly consider whatever issue it deemed most critical, generate various ways to address it, and then simply actively address it. Neither hypnotist nor subject need be aware of what the issue might be!

This approach genuinely shocked more traditional, directive hypnotherapists.  In effect, if a husband in a difficult marriage came to an Ericksonian therapist intending to get along better with his wife, the therapist might ask the unconscious to face and resolve the core issue causing the problem.  The unconscious might decide that the true difficulty was latent homosexuality in the husband, and its solution might be to face that fact, opt for divorce, and take up a gay lifestyle. The outcome of the therapy, in other words, might not be anything like what the subject had expected or requested.

The third radical innovation was Erickson’s ready assumption that indirect hypnotic-style suggestions could effectively be addressed to the unconscious, and taken up by it, even outside formal trance.  Classic induction procedures were not necessary: one could plant hypnotic suggestions and elicit hypnotic responses even if the subject was ostensibly in a normal waking state.  Erickson at times seemed to regard hypnosis as any interaction in which suggestions could be made, or even hinted at in the most roundabout manner, and effects noted, even if they were effects that were neither sought or expected.  Formal trance was unnecessary.  Hypnosis could be done as easily – if not better – in casual conversation. Indeed, it might almost be said that to Erickson, hypnosis was not so much a state as a way of using language.

NLP:  New Paths for Hypnosis

Erickson had one more major legacy to pass on.  His therapeutic practices became one of the major models for the syncretic psychotherapy and performance training movement known as NLP, or neuro-linguistic programming.  Initially begun by Dr. John Grinder and Dr. Richard Bandler, NLP started out by selecting what it regarded as the most effective psychotherapists, observing their practices with meticulous attention, and then replicating them and synthesizing those practices with others no less successful.   Erickson received the lion’s share of the attention from Grinder and Bandler, and Erickson’s methods were soon codified into NLP practices in one modified form after the other.

Unlike Erickson, however, the NLP developers soon took those practices outside the therapeutic situation.  Despite solid roots in the academic world, NLP rapidly joined the likes of ESTas fixtures in the personal development field.  Workshops and trainings replaced controlled studies and peer review, and NLP farther and farther away from scientific community, developing its own internal systems of certifications.  Whether that is a good thing or not has been debated, but what is not debatable is that NLP has taken many of the hypnotic methodologies of Milton Erickson and applied them to an immense variety of human interactions, including business, marketing, teaching, health, writing, even seduction; and, not without intermittent success.  For wherever language usage or conversation is possible, Ericksonian-style hypnotherapeutic communication is possible; and where that is possible, hypnotherapeutic results may be secured as well.

The New Hypnosis

The gradual transition of hypnosis from the “commands-while-in-a-trance” model, to that plus an “indirect-suggestion-while-in-conversation” model, has been a curious evolution.  The standard model persists and always will, simply because it works.  As David Spiegel of Stanford University noted In a presentation at a joint conference involving the Royal Society of Medicine, the British Society of Clinical and Academic Hypnosis and the British Society of Medical and Dental Hypnosis, “There is solid science behind what sounds like mysticism and we need to get that message across to the bodies that influence this area.” He also observed that hypnosis served as an effective treatment conditions ranging from allergies, high blood pressure, pain and more, adding “It is time for hypnosis to work its way into the mainstream of British medicine.”

While the new model is being successfully used by medical, psychiatric and therapeutic professionals, it is often also being used by nonprofessionals picking techniques up at workshops and through books and videos.  While the impact is more widespread, the results are more difficult to track, particularly since one of the emphases in Ericksonian hypnotherapy is not to specify results at all, but rather to let the unconscious determine them as best it can.  But does it have value?  Is it effective?  Where performed by qualified professionals, the track record of numerous successful interventions says yes.  Where performed by independent practitioners, evidence is largely anecdotal.  But the anecdotes are too numerous to dismiss.

Spiegel, Herbert and Spiegel, David. Trance and Treatment. Basic Books Inc., New York. 1978. ISBN 0-465-08687-X
Braid, J. (1843) Neurypnology.
Braid, (1853) Hypnotic Therapeutics.
Waterfield, R. (2003). Hidden Depths: The Story of Hypnosis. pp. 36-37
Sigmund Freud, Lines of Advance in Psychoanalytic Therapy, 1919
Sarbin, T.R. & Coe, W.C. (1972). Hypnosis: A Social Psychological Analysis of Influence Communication.
Alladin, A. (2008). Cognitive Hypnotherapy.
Chapman, R.A. (ed.) (2005). The Clinical Use of Hypnosis in Cognitive
Behaviour Therapy: A Practitioners Casebook
Wolpe, J. (1958) Psychotherapy by Reciprocal Inhibition.
Hull, C.L. (1933). Hypnosis & Suggestibility.
Yapko, Michael (1990). Trancework: An introduction to the practice of
Clinical Hypnosis. NY, New York: Brunner/Mazel. pp. 28.
André M. Weitzenbhoffer. The Practice of Hypnotism 2nd ed, Toronto, John Wiley & Son Inc, Chapter 16, p. 583-587, 2000 ISBN 0-471-29790-9
Erickson, Milton. Collected Papers on Hypnosis: Volume 1 – Nature of Hypnosis and Suggestion  (Ernest L. Rossi, Editor)
Erickson, Milton. Collected Papers on Hypnosis: Volume 3 – Hypnotic Investigation of Psychodynamic Processes  (Ernest L. Rossi, Editor)
Erickson, Milton. Collected Papers on Hypnosis: Volume 4 – Innovative Hypnotherapy  (Ernest L. Rossi, Editor)
Erickson, Milton. Seminars, Workshops and Lectures of Milton H. Erickson Volume 1 – Healing in Hypnosis  (Margaret O. Ryan & Florence Sharp, Editors)
Erickson, Milton. Seminars, Workshops and Lectures of Milton H. Erickson Volume 2 – Life Reframing in Hypnosis  (Florence Sharp, Editor)
Erickson, Milton.  Seminars, Workshops and Lectures of Milton H. Erickson Volume 3 – Mind-Body Communication in Hypnosis  (Ernest L. Rossi, Editor)
John Grinder & Richard Bandler.  Patterns of the Hypnotic Techniques of Milton H.Erickson: Volume 1.
John Grinder & Richard Bandler. Patterns of the Hypnotic Techniques of Milton H.Erickson: Volume 2.