1. Mental Condition as influencing Suggestibility: General Intelligence; Volition and Attention; Faith; Self-suggestion; Behaviour of Spectators-2. Morbid Mental and Physical Conditions: Excitement and Fear; Insanity, Hysteria, etc. — 3. Difficulties arising from Nervous Disease: Attention; Duration of Illness; Self-suggestions—Processes involved in the Methods described —Curative Results due to Repeated Suggestions—Power of Suggestion----Importance of securing the Patient’s Intelligent Co-operation.
In discussing this question, and quoting the opinion of others; it is impossible to avoid using the word hypnosis, but it must not be forgotten that this is only intended to imply a state of increased suggestibility, and not one of artificial sleep. I shall have here to recur to some points that have been touched upon in an earlier chapter.
1. Mental condition. — (a) General intelligence. — Gerster states that fools are the least susceptible to hypnosis, whereas the intelligent man, with well-balanced brain, is more or less easily influenced; Moll, also, finds the dull and stupid difficult; Krafft-Ebing and Bernheim hold similar views (the former states that intelligent subjects can be readily hypnotised, and the latter claims to have succeeded with many highly educated persons); while Forel asserts that every mentally healthy man is naturally hypnotisable. With these opinions I agree; for I have found the stupid and unimaginative more difficult to influence than those possessing fair intelligence.
(b) Volition and attention.—Itis sometimes asserted that feebleness of will facilitates the induction of hypnosis. This Moll declares to be erroneous: the subjects must be able to arrest their thoughts and direct them into a particular channel—an indication of strength, not weakness, of will. This opinion isshared by Krafft-Ebing and Forel, who state that subjects who cannot remain mentally passive, and who analyse their own sensations, are difficult to influence. Braid believed there was a direct relation between the power of concentrating the attention and susceptibility. Fixed gazing alone would not excite hypnosis; the attention must be concentrated on something. Amongst my own patients, I have usually observed that strength of will and power of concentration favoured the induction of hypnosis, while their absence had an opposite effect.
Faith.—Faith alone has apparently little effect on susceptibility. I have failed with subjects who believed they were specially susceptible: on the other hand, I have succeeded with many who were convinced they could not be influenced. Patients frequently say to me: “Don’t think me rude, but youcan’t cure me. I know you have succeeded with others, and that is why my doctor has insisted upon my coming, but my case is hopeless and no power on earth can help me.” Thus, treatment by suggestion is in no sense a “faith-cure.”
Self-suggestion.—Adetermination to resist the operator renders, the induction of hypnosis impossible. Here, the failure is due to conscious self-suggestion. Some of my unsuccessful patients suffered from dipsomania, and afterwards confessed that they bad resisted everyattempt to influence them, as they had only agreed to be treated under pressure from their relatives. The involuntary self-suggestion of the patient is a still more common obstacle; but to this I shall refer when dealing with morbid states.
Behaviour of spectators.—Accordingto Moll, it is important that spectators should maintain silence and refrain from expressing doubt or mistrust in any way, as the least word or gesture may thwart the attempts of the operator., For example, I was asked to hypnotise a patient suffering from long-standing nervous disease. His medical man, in introducing me, assured him that I had the power of compelling him to do whatever I liked, even to making him sign a cheque for £20,000 in my favour. Needless to say, I failed to hypnotise him. The third attempt was more promising; but, at its conclusion, the same medical man remarked to the patient that he was evidently one of those persons whom it was impossible to influence!
2. Morbid mental and physical conditions.— (a) Mental excitement and fear.—Fear, with its attendant mental excitement, usually prevents the induction of hypnosis. In England, at the present day, nearly everyone has read, and been more or less influenced by, various unfounded newspaper stories of the dangers of hypnotism, The public generally has accepted the misleading statement that hypnosis, is characterised by unconsciousness and suspended volition; and, while patients are under the influence of these ideas, it is difficult or impossible to hypnotise them. In such cases, no attempt to induce hypnosis should be made at the first interview. The true nature of the hypnotic state should be explained, and the patient’s fears removed. Above everything, he should be made to understand that he is not expected in any way to give up his own will. Forel, too, holds that mental excitement is unfavourable to the production of hypnosis and fear renders it impossible. Thus, he says, the first attempt to induce hypnosis frequently fails because the patient imagines that extraordinary things are going to happen to him if he yields to the influence.
(b) Insanity, hysteria, etc.—Accordingto Bernheim, it is a mistake to think that the nervous, weak-brained, or hysterical are easy to influence; on the contrary, it is often difficult or impossible to hypnotise those suffering from mental disorders. Moll states that the hysterical are very difficult. This is largely due to the spirit of contradiction which exists in such patients, and the opposing self suggestions that result from it. It is now generally agreed that the mentally unsound, particularly idiots, even if not wholly insusceptible, are much harder to hypnotise than the healthy. Wetterstrand stated that one of the best somnambules he ever saw was remarkable for good health and freedom from nervousness. Further, he invariably found that the most difficult to influence were the hysterical, restless, and egotistical, who were unable to concentrate their thoughts and attention.
Gerster says that while the daily press echoes the statement that it is only the “credulous” and feeble-minded who can be hypnotised, the opposite is the fact. According to Forel, all experienced operators agree that the insane are undoubtedly the most refractory. With patience and perseverance, some of the milder forms of mental disorder may be influenced. In grave insanity, however, owing to the continuous cerebral irritation, and the fact that the attention is fixed exclusively upon diseased ideas, it is almost impossible for suggestion to find an entrance into the mind. As we have seen, Esdaile’s patients were regarded as hysterical, but he pointed out that hysteria was unknown in his hospitals. Braid found patients with very mobile brains difficult to influence, and entirely failed with idiots, despite much perseverance. My personal observations accord with these views.
3. Difficulties arising from nervous disease.— As the existence of nervous disease seems to lessen susceptibility to hypnosis, I propose to consider the different conditions, associated with these affections, which apparently interfere with success.
(a) Attention.— Thecondition of the attention in hysteria, neurasthenia and certain types of insanity forms a serious, though not insuperable, obstacle to the production of hypnosis. It is important, first, that the patient should understand the operator’s description of the phenomena of restfulness, etc., which it is desired to evoke, and, secondly, that he should be able to fix his attention on some monotonous train of thought. In the cases just referred to, this result is particularly difficult to obtain. The patient’s attention is concentrated upon his own diseased condition, and he is constantly watching, analysing and exaggerating his symptoms. Sometimes, as in hysterical melancholia and certain forms of obsession, the patient is a prey to a continued flow of unhappy thought, which he is incapable of arresting. At others, the physical condition renders hypnosis difficult, since the various forms of hysterical tremor and spasm absorb the attention, and make mental quietude impossible. Pain is also an obstacle.
(b) Duration of illness.—Prolonged illness is undoubtedly unfavourable to the production of hypnosis. Here, the morbid symptoms have become ingrained, as it were, while the failure of all previous treatment has rendered the patients hopeless. At the time when my patients were all suitable ones, drawn from my own private practice, curative results were generally rapidly and easily obtained. During the last eighteen years, however, I can only recall two instances where the illness was of recent date when the Patient came to me. One of them, a man of somewhat emotional temperament, but otherwise healthy, had some trouble of a sentimental nature and went to Paris for a holiday. On the evening after his arrival he went to the theatre with some friends and saw an actor play the part of an insane person. The idea instantly came into mypatient’s head that he himself was mad and, when supping afterwards with his friends, he felt that they also were all mad. He recognised the absurdity of this, but at the same time was quite unable to get rid of the obsession. He did not sleep that night, and returned to London the following day. He at once came to see me, and told me that he had been repeating the multiplication table for hours in his vain endeavours to get the obsession regarding insanity out of his head. He recovered after three treatments.
The other patient (Case No. 13, above) bad suffered from a delusion for only four months, and recovered after nineteen treatments.
The patients I now see have generally been ill for one or more years. In one case sent by Dr. Risien Russell, the patient, aged 84, suffered from agoraphobia, and had been unable to cross a road without assistance for sixty-four years I
(c) Self-suggestions.—The conditions just referred to give rise to various forms of self-suggestion antagonistic to the operator. Thus, the failure of other forms of treatment excites the self-suggestion that hypnotism will also prove unsuccessful. The patients who are constantly analysing their own sensations are also self-suggestionists, only interested in themselves. One of my patients, for example, who had suffered from hysterical neurasthenia for twelve years, finally regarded all her symptoms as the result of medical treatment. Thus, pain in the head was due to galvanism, in another part of the body to massage—in fact, a number of localised painful regions were labelled with the names of the medical men who bad attended her. Hypnotism was not more fortunate. Not only did fixed gazing speedily produce headache and nausea, but passes made behind the patient’s back at a distance of 20 feet, though with her knowledge, frequently excited actual vomiting.
The constant morbid self-suggestions which are almost invariably present in neurasthenia render these patients very difficult to influence. In many instances they not only observe every sensation and function, but incessantly talk about, them every moment they are awake. Some even record everything they regard as morbid, and the exact moment at which it occurred; then the following day at, notebook in hand, awaiting its re-appearance. When they come to me they do not wish to receive my suggestions, but only to describe their symptoms. While I am treating them they are bursting with impatience for me to stop speaking, in order that they may begin. Here, the first suggestion must be that the patient must cease to talk about himself. It must be clearly explained to him that he is maintaining his own disease, and that he cannot begin to get rid of morbid thoughts and sensations so long as he persists in describing them, as this is always presenting them more and more forcibly to his mind.
The patients who tell you the method by which they ought to be treated are hopeless, until you can convince them that you know more about your own special subject than they do. In earlier days, patients often refused to accept their medical man’s advice to consult me, on the ground that they would not allow anyone to put them to sleep and deprive them of their will-power. Now, they sometimes say they wish to be treated by hypnotism, and not by suggestion, and I often find it almost impossible to remove their preconceived ideas. Recently, a patient told me that she was sure I could not do her good unless I put her to sleep. I carefully explained to her all that I have already written about Braid’s earlier errors, his later theories and those of others, and thought I had convinced her, as she was both educated and intelligent. After the first treatment she remarked: “I suppose I shall begin to improve as soon as you have put me to sleep.” The explanation was again carefully and patiently repeated, and I lent her the typescript giving my recent methods and their explanation. Before her next visit, I received a letter from her saying, “Despite what you tell me, I think it would be better if you put me to sleep.” Next time she came, instead of giving her a treatment, I again tried to convince her, and at last succeeded in finding an argument that appealed to her. I said: “Suppose you went to a surgeon who had been successfully performing a certain operation for twenty years and said, I wish you to operate on me, but not by your usual method. I want you to do it as it was done by another person sixty years ago. If the surgeon,” I said, “explained that the earlier operator had abandoned his method, after employing it for a short time only, and had adopted another— now employedand improved by the man you were consulting—would you continue to make your, request with these facts before you!” I had also carefully explained to the same patient the importance of turning her attention away from my suggestions, and concentrating it upon something restful, and this had been repeated as part of the suggestions given at each treatment. Despite this, after she had been coming for some time, she said: “I always listen to all your suggestions, they are so interesting.”
In cases of purely functional nervous disorder, such as neurasthenia, hysteria and the like, the previous medical treatment has sometimes apparently done more harm than good. The attention has been drawn to the various symptoms of the central nervous malady; these have been treated, maintained and developed, while the disease itself has been left untouched. In a recent case of neurasthenia, with intense depression and excessive morbid self-consciousness, the patient told me he had had slight dyspepsia for several years, and that this had been much worse during the last fifteen months. I found out that this aggravation had begun immediately after a consultation with a medical man who had directed his attention chiefly to the patient’s stomach. He drugged him continuously, and put him upon a restricted, specially prepared dietary. The patient carefully followed this, and the indigestion grew worse and worse; when from home, and unable entirely to follow his dietary, he felt that each departure from it would increase his indigestion, and so it did. The thought of eating was always associated with that of dyspepsia. I explained to him that few people, especially after middle age, were perfectly well. When the mental outlook was healthy, however, the individual neglected minor morbid sensations, no matter of what origin, and went cheerfully on his way. The neurasthenic, however, noticed all his sensations, increased them by concentrating his attention upon them, provoked their recurrence by anticipating them, and so cultivated his own disease. I told the patient to give up all drugs and restricted dietary, and suggested that his indigestion would cease. A few days later, he said he had been enjoying decent meals, and that these had not been followed by indigestion. This improvement has been maintained.
In many instances my patients had had Weir-Mitchell treatment before they came to me. The result had almost invariably been a gain in weight, impaired digestion and an aggravation of the mental symptoms. Isolation had increased introspection, and the patients, deprived of all outside interests, brooded perpetually upon themselves, and so developed their morbid symptoms. Many of them were intelligent enough to recognise this, and bitterly resented what they felt was mistaken treatment. I do not conclude from this, however, that a “rest cure” is invariably bad practice. The patients who come to me are those in whom this form of treatment, as well as many others, has failed, and their mental condition demands occupation and interest, instead of isolation. In neurasthenia, many symptoms which are apparently physical are really nervous in origin, and to treat them by rest-cures, drugs and the like draws the patient’s attention forcibly to them, and makes him believe also that his malady is an organic one. He should be made to understand that his condition is mainly, if not entirely, due to morbid self-suggestions and that these ought to be corrected by healthy ones.
Most of the patients I treat have more or less lost their will-power. Dipsomania, morphinomania, neurasthenia, hysteria, obsessions, involuntary muscular movements, all show lack of self-control. In some instances the illness came on suddenly, as the result of shock or overstrain, but in many others it was the culminating point in a life characterised by lack of discipline and self-control. Convulsions or spasms, which the patients are now incapable of influencing by their volition, have often had countless forerunners in tricks of gesture, bursts of passion, petulance, emotion, or the like, which they could have learnt to control. The central object in all treatment by suggestion ought to be the development of the patient’s control of his own organism. It should be plainly pointed out to him that his disease frequently demonstrates the feebleness of his volition: he desires, for example, to stop .drinking, but cannot; he wishes to escape from an obsession, but is unable to do so. The treatment by suggestion, which enables him to carry his wishes into effect, does so by increasing, not diminishing, his voluntary control of his own organism. He should be taught to apply this increased power for himself, not only in the immediate instance for which he seeks relief, but also on other occasions, should fresh troubles arise. While attention is given to physical culture, the emotional side is too often neglected; but much disease would be prevented if we could control moral states, just as an athlete controls physical states.
Three distinct processes are involved in the methods I have described:
The study of the patient’s mental condition, the attempt to remove erroneous ideas, and the explanation of methods.
The employment of suggestion to produce concentration of thought, and a restful condition of body and mind.
The treatment of disease by.suggestion, as shown in the various medical cases already cited.
1. Undoubtedly, the subsequent cure is often made easier, especially in cases of purely functional nervous disorder, if the patient understands that his malady is due to his own morbid self-suggestions. Many instances show, however, that this preliminary work is not the essential part of the treatment. For example, patients suffering from obsessions are often in good physical health, and recognise the absurdity of their ideas. They cannot, however, abolish these by any effort of volition; they recognise that their will-power is in default, and that drugs cannot restore it. Again, many patients suffering from neurasthenia recognise that their symptoms are dependent upon their mental state, and that these have been made-worse, instead of better, by ordinary medical treatment. In such cases, when recovery results, it is undoubtedly due to the suggestions given under the conditions already described. Further, some who understand about suggestion and admit that it can cure others, deny the possibility of its doing them good, as they believe their condition to be hopeless. Despite this, a large proportion of such patients do recover when treated by suggestion. These cases, however, are generally very difficult, and treatment has often to be continued for weeks before there is the slightest improvement. In one such case—melancholic neurasthenia— every time the patient came to see me she said: “I am immeasurably worse than I was yesterday. You think it is only my nerves that are wrong, but I know that my brain is gone, and that I am insane. I have lost all affection for my husband and children, and nothing seems real or natural. God can’t want me to live in this awful state, and I shall commit suicide. You will never see me alive again.” After two months’ apparently fruitless treatment, this patient rapidly recovered, and has since had many years of thoroughly good health.
In some cases the patients were not intelligent enough to understand the value of treatment by suggestion, but, despite this, good results were obtained. The following is an example:—
No. 73. Mr. --, aged 60; May, 1900. Had always been a light sleeper, but this had never been a serious trouble to him. His health had been good till 1895, when he gave up business. Immediately afterwards insomnia appeared; this grew worse, despite medical treatment and much exercise in the open air. For a time narcotics helped him, but soon lost their effect, although changed frequently. From 1896, he had never had three consecutive good nights, and often passed many with an average of two hours’ sleep. His dread of insomnia became an obsession; he feared going to bed and would not do so unless someone shared his room’: The patient was sent to me by Dr. Herbert Tilley, whom he had consulted for aural trouble. I was quite unable to make him understand the influence of the mind upon the body, and the possibility of his being cured by suggestion instead of by drugs. At first he would open his eyes and arrest the process of suggestion to assure me that he was perfectly certain that speaking to him in that way could have no effect. After a few sittings, however, although he did not become drowsy or even restful, the suggestions took effect, and he began to sleep better. In a month he was well and had abandoned all drugs. Recovery confirmed by later reports.
Here, obviously, the result was not due to the previous mental impression, but to the systematically repeated suggestions.
2. If the patient can, concentrate his attention upon something restful, and turn it away from the operator, this apparently plays an important part in the results obtained. A typical example of this has already been cited (Case No. 63 above). The patient, Professor --, believed in treatment by suggestion, and was acquainted with the literature of the subject. He told me this, but said, “I haven’t the least idea whether I shall be susceptible, but I will do exactly what you wish.” His recollection of what happened is correct, with the exception that I did not tell him that I wanted him to go to sleep, but only wished to get him into the drowsy condition that precedes sleep. He had three treatments, and it was only during the second that he was at all drowsy. Yet, not only did he entirely recover from his insomnia, but he also developed a remarkably useful power of self-suggestion.
In many instances the nature of the illness prevents the induction of any restful, drowsy condition. In cases of neurasthenia and obsession there is often a continued turmoil of painful thought that the patients are unable to control, while in clonic muscular spasm, hysterical convulsions, incessant hiccough and the like, the muscular movements render repose impossible. In such cases, however, satisfactory results are often obtained, as, for example, in Case No. 17. At first the patient had violent generalised convulsions every time she was brought for treatment, and when these ceased there were continuous involuntary movements of all the muscles on one side of her body. Despite this, the symptoms soon commenced to improve under suggestion, and the patient rapidly recovered.
These and similar facts apparently indicate that the curative results are due to the repeated suggestions, and, in many instances, to these alone. As we have seen, the preliminary explanations were not required in some instances; in others they were not accepted by the patient. Further, in certain cases there was neither concentration of attention nor rest of mind or body.
One more point remains for consideration, and it is an important one. Suggestion had already been employed, but without effect, in nearly every case of mine. Many of these patients had been informed, and had believed, that a particular kind of treatment would cure them. Others had been told that their morbid symptoms were only imaginary, and that they could get rid of them by exercising their willpower. Children addicted to bad habits had been punished, but this did not cure them, despite the suggestion of its repetition. One of my patients lost, through drink, health, Money and friends; he had also, on three different occasions, voluntarily spent a year in a retreat. All this involved the suggestion that he should stop drinking Finally, his wife left him, and doubtless, before doing so, made many emphatic suggestions: these were of no avail, yet he rapidly recovered when treated by suggestion.
As Myers pointed out, the operator directs the conditions upon which the phenomena depend, but does not create them. Professor Bernheirm’s command, “Feel pain no more,” is no more a scientific instruction hownot to feel pain, than the prophet’s “Wash in Jordan and be clean” was a pharmacopceial prescription forleprosy. In the so called hypnotic state the essential factor is not the means used to excite the phenomena, but the peculiar state which enables them to be evoked. I do not in the least know why suggestions, given in this particular way, should often produce such marvellous results, and I always frankly admit my ignorance to my patients. Even in cases where there is apparently no deviation from the normal, and where neither concentration of attention nor restfulness has been obtained, some change must have taken place in the patient’s brain which rendered him more suggestible. Apparently, the main factor is systematically repeated suggestion, but just what gives it its value I know not. Of analogous cases treated in this way by the same operator, some will recover and some will be uninfluenced. Again, while using identical methods, one person may succeed in a given case and another fail in an exactly similar one. Further, operators whose methods are widely different may be equally successful. Possibly the most important thing is not so much the method as the man behind the method—his power to increase the suggestibility of the patient, and thus enable him to carry out suggestions, by the development of his own will-power.
The methods I now use, different as they are from those I employed at the commencement of my hypnotic work twenty years ago, vary very little from those I have been constantly using for the last eighteen years. The change consists not so much in the method employed as in a truer conception of the conditions evoked. I hypnotise my patients now as much as I have ever done, and as much as anybody else who still holds my earlier views. We none of us ever produce sleep in the sense of unconsciousness, and I produce now just what I produced formerly, an increased suggestibility. As Bernheim truly said, the hypnotised subject is conscious in every stage; and he also pointed out how, owing to ignorance of this, the Salpêtrière School fell into the error of attributing various phenomena to physical agencies. The results, however, were really evoked by the conscious, or unconscious, suggestions of the operator, which were heard and responded to by patients erroneously supposed to be asleep.
The majority of my patients, sooner or later, pass into a restful, drowsy state, which would be described as slight hypnosis by those who do not share my views. Again I insist, these patients are conscious of everything that is passing around them, and are not, in the proper sense of the word, asleep.
In two directions, I believe my methods have improved: (1) I now attach more importance to the intelligent co-operation of the patient. I instruct him more fully and clearly how he should concentrate his attention upon some restful, monotonous train of thought. I also tell him, when his attention becomes tired, to allow his thoughts to wander, if possible, in a day-dreamy fashion. Very frequently a drowsy condition follows, but this is not really essential. Thus, for example, in a case of grande hystierie (No. 16 above) the patient never became drowsy at all; on every occasion he mentally repeated verses of his favourite poets. Notwithstanding this, his vomiting ceased after the first treatment and he made a rapid recovery.
(2) I now often succeed with a class of patients who formerly baffled me. These are oftwo kinds: (i) those in whom uncontrollable muscular movements make physical repose impossible, and (ii) those in whom the turmoil of painful thoughts and emotions renders mental rest impossible. Of the first, No. 17 (above) is a striking example, while the second group includes the worst types of neurasthenia and certain other mental cases. In these instances the patients cannot even imitate sleep or repose until suggestion has done its curative work.
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