Classification of Methods of inducing Hypnosis: (1) Physical, (2) Psychical, (3) Those of the Mesmerists—Braid’s Methods— Liebeault’s — The Author’s Earlier Methods — His Present Methods.
Modes of inducing hypnosis. — These have been classed as: (1) physical; (2) psychical; (3) those of the mesmerists.
The modern hypnotist, however, whatever his theory, borrows his technique from Mesmer and Liebeault with equal impartiality, and so renders classification impossible. Thus, the membersof the Nancy School, while asserting that everything is due to suggestion, do not hesitate to use physical means. The passes with contact employed by Mesmer were reproduced by Wetterstrand. Fixed gazing generally precedes or accompanies suggestion, and, when such devices fail, Bernheim does not scruple to use narcotics. It is more than doubtful whether physical methods ever succeeded, when mental influences had been excluded and the subjects were absolutely ignorant of the nature of the experiment. No one was hypnotised by looking at a revolving lark-mirror till Luys borrowed that lure from the bird-catchers and invested it with hypnotic power. On the other hand, any physical method will succeed with a susceptible subject who knows what is expected of him.
Braid’s method—Braidtook a bright object, generally his lancet-case, held it in his right hand about a foot fromthe patient’s eyes, and at such a distance above the forehead that it could not be seen without straining. The patient was told to look steadily at it and to think of nothing else. The operator then extended and separated the fore and middle fingers of the right hand, and carried them from the object towards the patient’s eyes. The lids generally closed involuntarily; if this did not happen the process was repeated, and rarely failed.
Later, as Braid found that fixed gazing was frequently followed by slight conjunctivitis, he changed his methods: prolonged staring was abandoned, and the patient instructed to close his eyes at an early stage of the proceedings. Hypnosis was induced as easily as before and without unpleasant symptoms. If the body and mind were at rest, Braid found he could hypnotise as readily in the dark as in the light, and he also succeeded with the blind; these facts induced him to abandon his physical theory and to conclude that the influence was exerted through the mind. He observed that repeated hypnoses increased susceptibility.; this arose from habit, association of ideas and imagination. In such cases, if the patients believed something was being done which ought to produce hypnosis, the state appeared. On the other hand, the most expert hypnotist would exert his influence in vain if the patient did not know what was expected and, at the same time, voluntarily yield to the demands of the operator. Later, Braid asserted that direct verbal suggestion,was the best method for inducing hypnosis and its phenomena; physical methods were simply indirect suggestions, their influence depending upon the mental states they excited.
Liebeault’s method.—The following was Liebeault’s method, as I witnessed it at Nancy:—The patient was placed in an arm-chair, told to think of nothing .and to look steadily at the operator. This fixed gazing was not maintained long enough to tire the eyes; it was simply an artifice for arresting the attention. If the eyes did not close spontaneously, Liébeault told the patient to shut them, and made the following suggestions:—“Your eyelids are getting heavy, your limbs feel numb, you are becoming more and more drowsy,” etc. This was continued for a minute or two; then Liebeault placed his hand upon the patient’s body and suggested the sensation of local warmth.
The Author’s methods.—Thesehave varied widely. At first I attempted to induce hypnosis mainly by mechanical means: at that time I was ignorant of what had been written by Liébeault, and had not observed the methods of others.
After seating the patient in a comfortable chair, I arranged a small movable mirror above his eyes, placed a lamp in such a way as to throw the light upon it, and told him to look fixedly at the mirror as long as he could. Sometimes the eyes closed rapidly and hypnosis followed; in others, even after half an hour’s gazing, there was no result. When this happened, I asked the patient to shut his eyes, and then made passes and suggestions. Hypnosis was induced in every instance, but sometimes much perseverance was necessary, and in one case success was only obtained at the sixty-eighth attempt. At that time the patients were all drawn from my own practice, and the induction of hypnosis, which at first had often been tedious and difficult, became easier with increased experience, and mechanical means were gradually discarded. I held a clinic three times a week, and hypnotised from thirty to sixty patients in an evening. I passed rapidly from one to the other, saying to each in turn: “Look at my eyes! Your eyelids are getting heavy, you cannot keep them open; they are closing now, they are fast!” As the eyelids closed, which they almost invariably did at once, I made an energetic pass in the direction of the patient’s face and said, “Sleep!” With two exceptions, success was obtained in every case, and in nine out of ten in the time necessary to utter the words just quoted. The patients were still nearly all drawn from my own practice, but, unlike my earlier cases, few suffered from severe.illness, and many were hypnotises for operative purposes only.
Shortly after my demonstration of hypnotic aesthesia at Leeds, on March 28th, 1890, a different class ofpatients consulted me. Most suffered from neurasthenia, hysteria and the like, but, in addition, there were many cases of dipsomania and some of insanity. In all, the illness was of long duration and other methods of treatment bad failed. To my surprise and disappointment, a small percentage alone were hypnotised by the method so successfully employed with my own patients. At first, fresh cases were treated with others already hypnotised; but this, instead of aiding me as formerly, increased my difficulties, as the news patients found the presence of others a disturbing element. Each patient was then taken singly, and fixed gazing at a mirror in a darkened room again resorted to; or I made them look at my eyes while I gave verbal suggestions. I also procured one of Luys’ revolving mirrors, but found it worse than useless. The instrument, driven byclockwork, could not .be stopped until it ran down, and its speed could not be regulated. It made a loud and disagreeable noise, which at times became more marked and irregular, suggesting an “infernal machine” on the point of exploding! I had another constructed without these faults: it also was driven by clockwork, but could be stopped at any time and its speed regulated, while the sound was uniform and soothing. I succeeded with it in easy cases, such as could have been hypnotised in any other way, but it was no help in difficult ones. By one or other of these methods I hypnotised about 75 % of my patients, but, in many instances, only after repeated trials. After a time, mechanical means were again abandoned, and I relied on verbal suggestion and careful study of the patient’s mental condition.
Before describing my later methods, I wish again to draw attention to several points in connection with the so-called hypnotic state. As we have seen, the subject may have his eyes open; and act like a normal individual who is awake. In the lethargic condition, when he appears to be asleep, he still hears all that is said around him. Further, all the phenomena of so-called hypnosis can be induced in the waking state, without the patient having preliminarily passed through any condition resembling sleep. It is to Braid’s earlier work that we owe the theory that it was necessary to induce hypnosis before beginning treatment by suggestion. At first he regarded the condition as an artificial sleep, but pointed out later that only one in ten of those he cured passed into a state even superficially resembling sleep. He proposed, therefore, to abolish his entire terminology, as it misled the public, and made them believe they could not be cured by suggestion unless they had first been put to sleep. With the majority of Braid’s patients there was not even an apparent loss of consciousness—they simply became slightly drowsy, and afterwards remembered all that had happened—while, with others, hypnotic phenomena were induced, without any previous stage in any way resembling sleep. Further, in those cases where sleep had apparently been present, it could be proved that the condition was really a conscious one, as the recollection of all that had occurred could be evoked by suggestion.
Braid’s later observations passed unnoticed, and, until recent times, nearly all operators proceeded on his earlier lines. They suggested artificial sleep, lethargy or drowsiness, and then began treatment. They did not recognise that the artificial or, more correctly speaking, imitation sleep was only one of the phenomena of increased suggestibility, due to suggestion. Given increased suggestibility, any of the phenomena of hypnosis might be evoked as readily as imitation sleep, and the patient cured just as easily when that state had been omitted.
For many years, Liébeault’s methods were similar to Braid’s earlier ones, and he always tried to induce what he called sommeil provoque. Gradually the views of the Nancy School were modified till they resembled Braid’s later theories. Now, Bernheim states that there is nothing in hypnotism but the name. All is “suggestion,” and patients can be cured without the induction of artificial sleep. Bernheim’s statement requires some modification all the phenomena we have been accustomed to call hypnotic are undoubtedly the result of suggestion; but the suggestions must be accepted by the patients before the phenomena can be evoked.
The essence of the whole condition, then, is an increased suggestibility; the production of a preliminary imitation sleep is not necessary, and is simply waste of time. In some instances, I tried to induce so-called hypnosis a hundred times before I succeeded. Now, with the method I shall presently describe, I commence curative treatment at once, and obtain quicker results.
Lest my readers may be confused by my asserting, on the one hand, that the hypnotic state—i.e. a condition of sleep—does not really exist, and, on the other, by my talking of inducing hypnosis, I will summarise my views. Every stage of the so-called hypnotic condition is a conscious one. In some instances the subjects have their eyes open and are obviously wide awake, in others their eyes are closed and they appear to be asleep; but, even in the most profound condition, the sleep is only apparent, not real, as the subjects retain consciousness, volition and intelligence. The condition described as the hypnotic is essentially one of increased suggestibility. The artificial or imitation sleep, suggested by the operator, is only one amongst the many phenomena which can be evoked by suggestion. In what is described as the deepest stage—i.e. hypnotic somnambulism, followed by amnesia—when the state is terminated the patients believe they have been asleep, because they do not remember what has happened. This is equally true, whether they have been apparently asleep, or seemingly awake with their eyes open in the “alert “stage. The lost memories of both stages can always be recalled in subsequent hypnosis. Further, it is probable that the amnesia is an artificial one due to the suggestions of the operator. When I use the word hypnosis—and it is almost impossible to avoid doing so until this fresh conception of the condition is accepted—I only mean that I have tried to induce increased suggestibility by methods which I shall presently describe. The condition—i.e. increased suggestibility—is sometimes preceded by drowsiness, but this is often absent, and the patients are voluntarily thinking of some restful monotonous subject during the whole process. Sometimes the patients’ minds are filled with the melancholy thoughts of neurasthenia, or obsessional fears; at others their attention is fixed on their hysterical convulsions or other uncontrollable muscular movements; but, despite this, increased suggestibility is frequently induced. Here there has been neither imitation sleep nor restful monotonous thought, but, nevertheless, brilliant therapeutic results are often obtained in such cases. I will now describe my present methods. In many respects they resemble those I have used for years; the difference between them, more apparent than real, being due to what I believe to be a clearer conception of the so called hypnotic state.
The selection of patients for treatment by suggestion, and the hope of relief or cure held out to them, ought naturally to be regulated by the same principles asthose governing ordinary medical practice. Before treating by suggestion, the first duty of the physician is to make sure that the case is suitable. Patients occasionally consult me for maladies—generally obsessions—for which they have had no previous treatment; this, however, is quite exceptional, and my patients are almost invariably sent to me by other medical men. In most instances a careful diagnosis has been made, checked and confirmed by others; but, if there is any doubt, this ought to be thoroughly cleared up. For example, headaches supposed to be functional are frequently due to local irritation, and I always refuse such cases until the eyes, throat and nose have been examined; in a considerable proportion local trouble is discovered, and its treatment is followed by the disappearance of the headaches. In one striking instance I was unsuccessful with a young man who,’ though active physically and fond of games, had lost all power of intellectual work Later, I detected a nasal obstruction, hitherto unnoticed by myself and others, and sent him to Dr. Herbert Tilley. After operation, all his mental troubles disappeared, and he began to prepare for his university matriculation examination. Further, I refuse to treat patients who are insane, or on the borderland of insanity, unless the friends will allow me to have a consultation with an alienist, and only then if he considers the conditions are favourable.
All this refers to the question of a supposed functional malady being due to, or associated with, organic trouble. In a certain proportion of my cases, however, organic maladies undoubtedly exist. These patients are sent, not for cure, but because their medical men believe there is also a nervous element present, which may be benefited by suggestion. I always frankly explain to them that my treatment cannot cure them; all that I can hope to do is to remove or relieve some of the symptoms. I tell them that there is at most an overlying stratum of functional nervous disturbance, and that there is only a possibility, not a certainty, of this being removed by suggestion. As a rule, the patients sent to me have exhausted all ordinary methods. In these circumstances they come for treatment by suggestion solely, and receive that alone. If, however, all other methods have not been tried, and any of them appear likely to be of use, they are employed as well as suggestion. Further, in certain cases—insomnia, for example—where the patients are dependent upon narcotic drugs, these are not stopped until the curative effects of suggestion are able to replace them.
I rarely begin treatment the first time I see a patient. After having satisfied myself that the case is a suitable one, I make a careful study of the patient’s mental condition, and do my best to remove everything—fears, erroneous preconceived ideas, etc.—which might stand in the way of success. This is an extremely important part of my work, which I shall discuss in the next chapter.
I then explain my methods to the patient; tell him about the secondary consciousness and its powers, and say: “Next time you come we shall not talk about anything until after treatment. You will sit down in an arm-chair and close your eyes. While you are resting I shall make suggestions of two kinds, but I do not want you to listen to them. You will always hear my voice, but I wish it to be a drowsy accompaniment to your restful thoughts. While I am making suggestions, try to concentrate your attention on some restful mental picture; its nature does not matter, as long as it isrestful. This concentration is simply an artifice to turn your attention from my suggestions; the theory being that if your normal consciousness is absorbed in this way, the suggestions more easily reach the secondary one.” I always frankly tell the patient that I cannot explain why suggestion, given in this particular systematised way, often produces results far exceeding those obtained by the suggestions of ordinary life. I also explain that I possess no occult power; that I am simply going to try to arouse forces that are latent in the patient’s own brain, and, further, that I cannot promise to cure him, as, even if the case is suitable, much depends on his ability to carry out my instructions.
The first suggestions refer to the conditions which I wish to create while the patient is in the arm-chair. I tell him that each time he comes he will find it easier to rest, to turn his attention away from me and to concentrate it upon something restful. I have previously explained that’ I do not wish him to go to sleep, but that, if he can get into the drowsy condition which precedes sleep, the suggestions are likely to be responded to more quickly.
The other suggestions are curative and vary with each different case. These are begun at the first treatment, and I tell the patient beforehand that I make them, not because I believe they will be at once responded to, although this does occur in rare instances, but because it is the repetition of the impression, made in this particular way, which gives it its power.
At first, the novelty of the proceeding usually attracts the patient’s attention and prevents him turning his thoughts from my suggestions. After a few treatments, however, he is generally able to keep his attention on some restful mental picture, and often passes into a drowsy, day-dreamy state. Sometimes the condition apparently becomes one of slight natural sleep: the patient ceases to hear my voice for a moment or two, then drifts back to consciousness.
Formerly, not only did the operator attempt to obtain hypnosis, but he also tested its presence by suggesting to the patient that he was unable to open his eyes. Sometimes this succeeded, but if not, the suggestion was repeated until responded to. Doubtless the success of these and of other inhibitory suggestions helped to create the theory of hypnotic automatism, but, as I have frequently pointed out, hypnotic subjects never accept suggestions which are contrary to their moral sense. These experiments are objectionable, however, and I discarded them at a very early date, long before I changed my views as to the nature of so-called hypnosis. Although I suggested hypnosis, I never tested its existence by experiment. As the result of the methods I then used, the patients passed into a restful or drowsy condition and I made curative suggestions. The whole object of suggestive treatment ought to be, I repeat, the development of the patient’s will-power, and of his control of his own organism. That idea, and that alone, should be instilled into his brain, and no experiment, however trivial should be made which could possibly tend to make him believe that the operator was trying to dominate him.
The so-called hypnotic state tends to terminate spontaneously. The members of the Nancy School, who regard the condition as one of sleep, suggest during hypnosis that the subject shall awake at a given signal, as, for example, when the operator utters the word “Awake!” or counts “One, two, three.” The nature of the signal itself is of little importance, the essential point being that the patient understands its import.
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