PRESENT DAY METHODS OF HYPNOTIZATION

Though various methods of producing the hypnotic sleep are in use, the rule is now that, in the course of a hypnotizer's experience, less and less external auxiliaries of any kind are needed, and more and more dependence is placed on the bringing about of mental rapport between the active and passive agencies in hypnotism by persuasion and command. If the hypnotic sleep has once been obtained, usually all that is necessary is a few gentle words, and then the command to sleep. It is at the initial attempts to hypnotize a particular person somewhat refractory to the condition that auxiliaries are needed. In these cases it is often well to tire the eyes of the patient. This is done by directing them to the fingers of the operator held well above the patient's head. After a minute or two of effort the distinct fatigue which occurs may induce forgetfulness of everything else and cause absorption in the single idea of attending only to the hypnotizer's suggestions. This constitutes the beginning of hypnotism. Occasionally the flash of a bright object, or a revolving mirror, may be used, but these are only adjuncts and may be dispensed with entirely if the operator has the patience and the time to give to the subject.

Accessories.—Some operators use a mirror on which a ray of light is cast for the purpose of concentrating the attention and bringing about tiredness of the eye muscles. In so far as it has a more universal application, sight is certainly the best sense to act upon. Other senses may be appealed to, as I suggest later. Instead of a mirror, a polished match-box or pencil-case may be used, but as a rule the less artificiality enters into it and the simpler the procedure, the better. One of the inconveniences of using the flash of a bright object is that occasionally patients who are very susceptible may, after they have had a number of hypnotic experiences, be thrown into a hypnotic condition by the flash of a light in the street, or by the reflection of light from a mirror in their own homes. These conditions of facile auto-hypnotism constitute one of the serious dangers of the practice on susceptible subjects. Whatever good may be accomplished by hypnotism will probably be reached during the first half dozen seances. To proceed with the treatment beyond this, if it is employed at regular and short intervals, is almost sure to result in harm rather than good.

Sensations.—Besides sight, sounds have sometimes been used for the purpose of inducing hypnotism. The ticks of a watch, for instance, placed at a little distance and listened to very intently, have been known to assist in securing the hypnotic state. Sometimes the sound of a gong, or an imitation of a cathedral chime, have been used in the same way. Soft music has also been used by operators with decided advantage. It is necessary that the sounds should be of a kind that do not disturb, but only attract attention to one sensation, and then, as concentration on this is secured, the hypnotic condition results. Practically any other sensation may be used in the same way. Touch is often employed. Mesmer stroked his patients gently, and others have used the same process with advantage. Some of the French workers in hypnotism have claimed that there were special portions of the body the stroking of which was likely to produce this favorable effect. They have called these regions zones hypnogenes—areas that give rise to hypnotic conditions. Strokings of the forehead, of the cheeks, of the hands, are favorite locations for these auxiliary touches. In this, as with regard to sound, the main thing is to concentrate attention on some one sensation without producing disturbing thoughts.

Stroking.—Stroking seems to affect many people and to easily induce a sort of hypnoidal condition. It is done very naturally to a child when one wants to console or encourage or admonish slightly but kindly. In older people it is a familiar gesture among those who think much of one another, and represents a very natural tendency. Even in the midst of physical discomfort its effect is quite soothing, and it is evident that something resembling hypnotism is at work. Evidently, what really happens is a concentration of attention on the sensation thus produced, which concentration prevents distracting thoughts from making themselves felt and permits the words of the one who does the stroking to produce a deeper effect on the mind than would ordinarily be possible. This seems to be nature's method of making suggestion more effective. It has been adopted, quite spontaneously, by many of the pioneers in hypnotism as the result of their observations upon its efficacy. Lloyd Tuckey calls attention to an illustration of this practice, which makes clear its effectiveness and at the same time shows how naturally it suggests itself as a mode of using mental influence. He says:

Among the medical men who have come to watch some of my cases was a gentleman who seemed much struck at seeing the method I adopted with a rather refractory subject. I held his hand and stroked his forehead while at the same time suggesting the symptoms of sleep. The gentleman told me afterward the reason why he was so interested. It appears that he had a few months previously been in attendance on a very severe and protracted case of delirium tremens. The patient could get no sleep, and the doctor was afraid of death from exhaustion. On the third evening he resolved to make a strong effort to produce sleep, and, if necessary, to sit up all night with the patient. He told the man that he would not leave him until he slept, and sitting down by the bedside, he took his hand in one of his own, and with the other gently stroked the forehead. At the same time he talked quietly and reassuringly to him. In less than half an hour he was rewarded by seeing the restlessness entirely cease and the man drop off into a quiet sleep. That sleep, the doctor told me, lasted fourteen hours, and the patient awoke out of it weak, but cured. Manipulation about the head has in many persons a most soporific effect, and several persons have told me that they always become drowsy under their barber's hands.

Drugs.—A number of drugs and related substances have been used as aids to hypnosis, but in nearly all of these cases it is doubtful whether it is true hypnotism that results and whether the suggestions in these states have much therapeutic value. One of the drugs most frequently administered by hypnotists is cannabis indica, which has long been used in the East for a similar purpose. After this, chloroform is most popular. Schrenck-Notzing even ventured to employ alcohol as an aid in hypnosis, and claims that he has succeeded at times in making intoxication pass into the true hypnotic condition. Bernheim and many others of the French school have used chloral and morphine. These substances are, however, liable to great abuse. Whenever they have to be employed it means that the patient is but little susceptible to hypnotic influence. These aids are employed only because hypnotists do not want to confess that a very considerable portion of humanity is not directly susceptible to the hypnotic influence.

Serious harm may be done by the employment of these drugs. A physician, who hoped that he would be able to overcome a drug addiction that had been the bane of his existence for a long while, went to a well-known hypnotist physician with the idea that perhaps the miracle of hypnotism would be worked in his case. He was one of these flighty mortals whom it is extremely difficult to have fix their minds upon any one idea for a definite time. As it was impossible to bring him into anything like a hypnotic condition by ordinary means, a large dose of chloral was administered. He already had an idea that his heart had been affected by his previous drug-taking habit, but the chloral was administered to him before he realized what it was. When he came out of the sleep it induced, he was in an agony of solicitude and anxiety lest his heart should have been further hurt by the chloral. He went back for no more doses of that kind of hypnotism.

The use of drugs seems to be a confession of failure to secure true hypnotism, so that it is doubtful whether their employment is justified. Suggestions received while in the more or less comatose state induced by drugs, instead of having a strengthening effect on the patient's will, rather tend to produce the idea of the impossibility of effectively using his own will, or even exercising his will when helped, as he supposes, by the will of the operator. The real value of hypnotism consists in the concentration of mind upon a particular idea without any distractions, which enables the subject to make firm resolutions and then to have his mind help his body as much as possible by directing his energy to the accomplishment of one end. When drugs are employed, they have a diffusive rather than a concentrating influence, so that the real purpose of hypnotism is entirely missed.

PRACTICE OF HYPNOTISM

In the ordinary practice of hypnotism now, the patient is placed sitting on a comfortable chair and the operator on one side facing prepares the mind of the subject by proper assurances. The patient must be brought into a thoroughly assured and comfortable state of mind and must be quite ready to submit to hypnotism. Then in most people, if the finger is held rather close to the patient and well above the line of sight, requiring special effort on the part of the superior recti muscles as well as of the power of convergence, a tired feeling will come over the subject with a tendency of the lids to droop. When this happens the subject is asked to allow the lids to drop and to quietly concentrate the attention on the idea of sleep so as to permit the drowsy feeling gradually to increase. On a first seance this may take ten minutes, subsequently much less time will be needed, and, as a rule, in five minutes the subject is quite predisposed to sleep. In more difficult cases a much longer time may be needed, and repeated efforts may have to be made. Great patience is required. The operator soon learns to adjust himself to certain peculiarities of individuals in predisposing them to the hypnotic condition.

Hypnotism Simple, Natural, Not Mysterious.—The most important thing to know about hypnotism is the fact that any one who wishes can hypnotize. There may be need for favoring circumstances, but there is no need for any special faculty in the operator. If he has confidence in himself so as to take up the question of hypnotizing seriously, if the subjects are reasonably susceptible and if they are persuaded that they may be hypnotized, or even if they are not, so long as they take the operator seriously a hypnotic state will result. Nothing is more surprising to the operator himself, the first time he succeeds, than his success. This at once gives him renewed confidence, and future hypnosis becomes a comparatively simple matter. To have this idea widely diffused would do much good, since it would at once strip the charlatans, who abuse hypnotism, of most of the mystery that surrounds them. The general diffusion of such knowledge would also do good in another way. It would expose the supposed wonderful power that some people are presumed to possess. Hypnotism works no wonders; it is a mere natural manifestation not unlike sleep, and probably not a whit more mysterious.

Stages.—A number of divisions of the hypnotic state have been suggested, but probably the simple division into three stages is the best for ordinary teaching purposes, and helps to the understanding both of the conditions themselves and of many things that are written about hypnotism.

The first stage consists of a subdued, dreamy condition, in which the patient is not asleep and yet not thoroughly awake to all that is going on around him. He has his mind so concentrated on certain thoughts that he is preoccupied, and suggestions are much more efficient than under ordinary circumstances. This is really only a state of intense attention to the suggestions that are being made, with the banishment of all distracting thoughts. It is rather difficult for any one to keep from being distracted, and whenever this is accomplished, the ideas that then enter the mind penetrate more deeply and, above all, seem to affect the will more forcibly than when they are merely superficially considered. This first stage of hypnotism would not be considered hypnotic by most people who associate the idea of sleep with hypnotism.

In recent years it has been found that most of the good that is accomplished, especially for nervous people, by hypnotic suggestion, can be attained almost, if not quite as well, in this first stage, and without the hypnotic trance. The first stage is much less liable to the dangers of hypnotism in many ways, and it represents one of the most interesting phases of psychotherapy.

The second stage of hypnotism is the hypnotic sleep. The patient loses consciousness of his surroundings, though his senses are still open to suggestion from the operator. Practically all that happens in the room apart from what is brought to the subject through the operator's direction remains unnoticed. If the sleep is very deep, even the suggestions of the operator do not penetrate after a time, so it may be quite difficult to awaken the subject. It may be even some hours before the person hypnotized will come out of the lethargy which has been induced in these cases. Under these circumstances, this second stage partakes somewhat of the nature of the deeper trance condition that characterizes the third stage.

The third stage of hypnotism consists of a profound trance-like condition in which there is catalepsy—that is, firm contracture of muscles all over the body—and as the extensors are stronger than the flexors, this contracture takes place in the extended position. The cataleptic condition is really a nervous spasmodic seizure rather than a true stage of hypnotism. It is probably always harmful for the patient to have it induced. Its occurrence as one manifestation of hysteria, apart from hypnotism, shows its real character. It is with this stage of hypnotism that professional hypnotists, who give exhibitions, make their demonstrations—that is, of course, when their demonstrations are really hypnotic and are not merely, as is often the case, performances by actors trained for the purpose. Catalepsy is entirely pathological; experiment with it then is eminently undesirable, and certainly should not be undertaken except under the most careful precautions and by a physician. One of its dangers was very clearly pointed out by the death of a young man, who in a cataleptic condition was subjected to certain strains upon his thorax which brought about the rupture of an aortic aneurism. Catalepsy never permits of suggestion in such a way as to be helpful to the patient. It always leads to further functional deterioration of the nervous system, and yet it has unfortunately come to mean for many people the most essential characteristic of hypnotism. Its production is supposed to represent the acme of skill in the hypnotist. Nothing could possibly be less true nor be more likely to do harm.

Susceptibility.—As to the number of people who are susceptible to hypnotism, there are great differences of opinion. Liebault declared that practically every one is susceptible in the hands of a patient operator. In a carefully made series of cases his failures were less than three per cent. Van Rentergehem and Van Eeden, in a series of over 1,000 persons, failed only with fifty-eight, or little more than five per cent. Schrenk-Notzing's statistics, collected from many countries, seem to show that only about six per cent. were uninfluenced. Bernheim, at Nancy, was not nearly so successful as Liebault, his master, and his failures amounted to twenty-five per cent. at the beginning and at least twenty per cent. later. I remember that when I was at the Saltpêtrière fifteen years ago, they were inclined to discount the enthusiasm of the Nancy school with regard to the value and significance of hypnotism. They insisted that probably not more than one out of two of the persons presenting themselves at a nervous clinic could be hypnotized to the extent that is ordinarily associated with the word—could be brought beyond the drowsy stage. There are other workers in the subject who have insisted that not more than one out of three ordinary individuals can be so deeply hypnotized as to exhibit the ordinary symptoms. These symptoms consist of complete neglect of surroundings and absolute absorption in the suggestions of the operator.

Some people can be hypnotized to the extent of being thrown into sleep and yet walk and talk under the absolute control of the operator. These are so-called somnambules, the class of persons who are exhibited by professional hypnotizers who want to attract popular attention, and, indeed, the class usually exhibited by physicians before medical societies, and even by professors before their classes. This extreme susceptibility is, however, quite rare. Even the most ardent advocates of hypnotism and of the susceptibility of humanity to it do not claim that more than one in ten of average individuals can be influenced to this degree. There are milder degrees of hypnotism than this, until we reach a state in which all the patients feel is a certain dreamy sense of well-being and a heaviness of the eyes, with a readiness to respond to suggestions. Most people who think of the somnambulistic stage as representing hypnotism would not consider these latter to have been at all subjected to the hypnotic state.

Repeated Efforts .—As to this question of susceptibility, much depends on how often the operator has tried to hypnotize the particular subject, for susceptibility develops with repeated trials, not only where there is a manifest impression at first, but also where there is not. It is not uncommon to find that a patient who cannot be brought at all under the influence of hypnotism in the first or second or third trial, will, at the fifth or sixth trial, yield to the suggestion to go into a hypnotic sleep. A dozen unsuccessful efforts may be followed by the development of a very satisfactory hypnosis. Those who have practiced hypnotism much tell of having tried a score or even two score of times before finally bringing on a hypnotic condition. Dr. J. Milne Bramwell, one of the English authorities on hypnotism, tells the story¹⁹ of having tried sixty or more times to hypnotize patients before finally succeeding. It is this persistence that enables successful hypnotic operators to accomplish results where less confident physicians fail. It is also the frequency of trial that makes all the difference in the statistics as to the susceptibility of patients to hypnotism in the hands of different individuals. There must be the confidence of the patient in the physician's power to hypnotize, but, above all, there must be the physician's own confidence in his power to bring on the hypnotic sleep so that he tries and tries again, even to seventy times.