Las Alternativas de Elección

Since World War II the intellectual climate concerning hypnosis has radically improved. The Society for Clinical and Experimental Hypnosis was founded in 1949 in the United States, and in 1959 it was expanded into an international society. A second society, The Ameri-can Society of Clinical Hypnosis, was founded in 1957, Originally

divergent, with strong personalities in both groups, these two societies in recent years have grown closer together, holding their first joint scientific section meeting in 1971.

Stature was added to the study of hypnosis in 1958 by a policy statement from the American Medical Association recognizing hyp-nosis as a legitimate treatment method in both medicine and dentistry.

The British Medical Association in 1955 had passed a similar resolu-tion. In 1969 the American Psychological Association created a section for those psychologists concerned primarily with hypnosis.

Rarely today does one find the loss of intellectual perspective that formerly occurred when hypnosis was under consideration and that

saw both advocates and opponents of hypnosis taking extreme posi-tions. Partisan statements picturing hypnosis as a virtual miraculous

treatment are still heard, though less and less from trained persons.

Unfortunately, popular articles may occasionally exaggerate, even though professional publications generally demand high levels of sci-entific observation and statements of realistic conclusions.

The authors feel that the future of hypnosis rests firmly on its being of unique value in three important areas:

1. Hypnosis offers unique opportunities to demonstrate mental mecha-nisms for teaching purposes. Some defense mechamecha-nisms, such as

amnesia, can be dramatically demonstrated to the medical resident or student, to the graduate student in psychology, or to the dentist in training. For example, the concept of regression can be vivified by a demonstration of hypnotic age regression. The use of hypnosis in teaching can bring life to theoretical constructs, and in our experience it has often increased the interest and motivation of

students who witnessed demonstrations of hypnotic technique.

2. Hypnosis has great potential in research, not only into the nature of the hypnotic state itself but also as a means of more controlled

emotional variables in psychological and psychosomatic research.

Psychological factors involved in pain, for example, can be studied without the pharmacological effects of medication. Residents in surgery and anesthesiology may find hypnosis useful as a control in studies evaluating other forms of pain relief, since the hypnotic effects are clearly initiated by psychological means.

3. Hypnosis is of great value in medical, psychological, and dental treatment, both for psychological problems and as part of the treatment of many physical disorders or compulsive habit patterns, such as cigarette smoking by emphysema patients.

After almost two centuries of episodic popularity and abandon-ment, we feel that the use of hypnosis as a standard tool in psycho-therapeutic, medical, and dental treatment now is assumed. Articles on

hypnosis appear not only in the specialized journals devoted to the subject but also in more general scientific journals. More and more, hypnotherapy is being seen as a valuable treatment modality with certain indications and contraindications rather than as a last-resort treatment to be used only in extreme situations. T h e professional American societies devoted to hypnosis, as well as similar organiza-tions in many other countries, offer continuing forums for interchange

among serious workers in the field. These societies are influential bodies whose opinions are respected in the medical, dental, and psycho-logical fields. A growing appreciation of the history of hypnosis is seen in many fine contemporary reviews, such as those of Chertok (1980), Connery (1982), and Servadio (1975).

REFERENCES

Aldrick JM: Hypnosis and the Emmanuel movement: a medical and religious repudia-tion. Am J Clin Hypn 20:224-234, 1978

Breuer J. Freud S: Studies in Hysteria. New York, Basic Books, 1957

Chertok L: From Liebeault to Freud. Historical note. Am J Psychother 22:96-101. 1968 Chertok L: Freud and hypnosis: An epistemological appraisal- J Nerv Ment Dis

165:99-109, 1977

Chertok L; Earty theories of hypnosis, in Burrows GO, Dennerstein L (eds): Handbook of Hypnosis and Psychosomatic Medicine. Amsterdam, Elsevier/Nonh-Holland Biomedical Press. 1980. pp 1-10

Conn JH: Historical aspects of scientific hypnosis. J Clin Exp Hypn 5:17-24, 1957 Connery DS: The Inner Source, New York, Holt, Rinehart & Winston, 1982

Dacquino G: Psychoanalysis and hypnosis in theory and clinical practice. Minerva Med 73:3207-3212, 1982

Freud, S: Turnings in the ways of psychoanalytic therapy, in Jones E (ed): Sigmund Freud: Collected Papers. New York, Basic Books, 1959, pp 392-402

Glasner S: A note on allusions to hypnosis in the Bible and Talmud. J Clin Exp Hypn 3:34-39, 1955

Gravitz MA: Bibliographic sources of nineteenth century hypnosis literature. Am J Clin Hypn 23:217-219, 1981

Gravitz MA, Gerton MI: Polgar as Freud's hypnotist? Contrary evidence. Am J Clin Hypn 24:272-276, 1982

Gruenewald D: A psychoanalytic view of hypnosis. Am J Clin Hypn 24:185-190, 1982 James CD: Mesmerism: a prelude to anaethesia. Proc Roy Soc Med 68:446-44?, 1975 Jensen A, Watkins ML: Franz Anton Mesmer: Physician Extraordinaire- New York,

Garret, 1967

Ludwig AM: An historical survey of the early roots of mesmerism. Int J Clin Exp Hypn 12:205-247, 1964

MacHovec FJ: Hypnosis before Mesmer. Am J Clin Hypn 17:215-220, 1975a

MacHovec FJ: Shakespeare on hypnosis: The Tempest. Am J Clin Hypn 24:73-78,1975b MacHovec FJ: The evil eye: Superstition or hypnotic phenomenon? Am J Clin Hypn

19:74-79, 1976

MacHovec FJ: The cult of Asklipos. Am J Clin Hypn 22:85-90, 1979

Macmillan MB: The carthartic method and the expectancies of Breuer and Anna 0. Int J Clin Exp Hypn 24:106-118, 1977

Manner MJ: Hypnosis in Anesthesiology. Springfield, III, Charles C Thomas, 1959 McDougall W: Outline of Abnormal Psychology. New York. Scribners, 1926

Muses C: Trance-induction techniques in ancient Egypt, in Muses C, Young AM (eds):

Consciousness and Reality. New York. Outerbridge and Lazard, 1972, pp 9-17 Pattie FA: A Mesmer-Paradis myth dispelled. Am J Clin Hypn 22:29-31, 1979

Pulos L: Mesmerism Revisited: the effectiveness of Esdaile's techniques in the produc-tion of deep hypnosis and total body hypnoanesthesia. Am J Clin Hypn 22:206-11,

1980

Rosen G: History of medical hypnosis, in Schneck JM (ed): Hypnosis in Modern Medicine (ed 2). Springfield, II!., Charles C Thomas, 1959

Schneck JM: Freud's "medical hypnotist". Am J Clin Hypn 19:80-81, 1976

Schneck JM: Benjamin Rush and animal magnetism, 1789 and 1812. Int J Clin Exp Hypn 26:8-14, 1978

Servadio E: Hypnosis in history and at present. Minerva Med 66:3811-3817, 1975 Statu HJ, Spanos NP: The Asclepian dream healings and hypnosis: A critique. Int J Clin

Exp Hypn 30:9-22, 1982

Strosberg IM: Hypnosis—Living—Comfort. J Am Soc Psychosom Dent Med 27:2932, 1980

TinterowMM: Foundations of Hypnosis from Mesmer to Freud. Springfield, III., Charles C Thomas, 1970

Tomlinson WK, Perret JJ: Mesmerism in New Orleans, 1845-1861. Am J Psychiatry 131:1402-1404, 1974

Triplet RG: The relationship of Clark L Hull's hypnosis research to his later learning theory: The continuity of his life's work. J Hist Behav Sci 18:22-31, 1982

Watkins JG: Hypnotherapy of War Neurosis. New York, Ronald Press, 1949

Watkins DC: Fraru Anton Mesmer: Founder of psychotherapy. Nurs Mirror 142:66-67, 1976

Weitzenhoffer AM: What did he (Bernheim) say? A postscript and an addendum. Int J Clin Exp Hypn 28:252-260, 1980

Wester WC: The phreno-magnetic society of Cincinnati—1842. Am J Clin Hypn 18:277-281, 1976

Wolberg LR: Hypnosis—Is It For You? New York, Harcourt Brace Jovanovich, 1972, p22

Theories

Many theories of hypnosis have been outlined sucinctly by Wolberg (1962):

For example, there are the hereditary models which conceive of hypnosis as an inherited characteristic Ihat reflects a phylogenetic and regressive group of qualities and traits. Involved here also are the analogical linkages with animal hypnosis . . . t h e r e is a p h i l

-ological model which conceives of hypnosis as a product of or-dered or disoror-dered activity in different portions of the brain, such as areas of Inhibition and areas of excitation, or the action of the reticular activating system- There is an internal environmental

model which deals with the exchanges and interchanges of bio-chemical substances in the neural system throughout the brain.

There is a learning model that conceives of hypnosis as a form of learning, like conditioning. There is a cultural social model which explains hypnosis in terms of contagious suggestibility and role-playing- There is a developmental motivational model which deals

with various interpersonal and intrapsychic dimensions, such as dissociation and ontogenetic regression to earlier modes of think

ing, feeling and behavior, involving an anachronistic revival of the child-parent relationship and related transference phenomena.

17

DEFINITION OF HYPNOSIS

From the beginning of interest in hypnosis, there have been many competing theories to explain the phenomena. Chertok (1980) has reviewed some of the early theories of hypnosis. Before these theories

are examined, however, it is useful to consider varied definitions of hypnosis from current experts in the field. More recently, Chertok (1983) has related psychoanalysis to hypnotic theory, with illustrative case examples.

Meares (1961) emphasizes the atavistic aspects of hypnosis, i.e., those that suggest a primitive phylogenetic response. He defines hyp-nosis as basically a "regression to the primitive mode of mental functioning in which ideas are accepted uncritically by the primitive process of suggestion." He adds that various psychological mecha-nisms may operate "on t o p " of this basic regression, including iden-tification, interjection, conditioning, dissociation, role-playing, hys-teric defenses, and communication by behavior rather than verbally.

Raginsky (1962) stressed that 'any theory of hypnosis must of necessity be a biological one," although he indicated the importance of other conceptual models, including sociological, anthropological, and physiological models. Raginsky felt that any definition of hypnosis must consider " t h e way in which the hypnotized person moves in the direction of functioning which approaches the most primitive level of psychophysiological existence where an awareness of individual-environment differentiation diminishes toward infinity."

Manner (1959)defined hypnosis as a ''psychophysiological tetrad of altered consciousness" consisting of (1) heightened suggestibility, (2) narrowed awareness, (3) selective wakefulness, and (4) restricted attentiveness.

Erickson (1958) defined hypnosis as "a state of intensified atten-tion and receptiveness and an increased responsiveness to an idea or to a set of ideas."

Schneck (1962) has written that " t h e hypnotic state, in terms of its basic ingredient, is that condition represented by the most primitive form of psychophysiological awareness of individual-environmental differential attainable among living organisms."

Alexander (1972) feels that "hypnosis may be defined as a state manifested by an inward turning of the mind, facilitating an enhance-ment of the creative imagination, favoring inductive over deductive reasoning, and reducing the need for reality testing, thus providing a mental setting in which, with appropriate suggestions, ideas can be

perceived and experienced in such a vivid manner as to allow their revivification to the point of hallucinations."

Conn (1949) has described hypnosis as a multilevel, dynamic, interpersonal relationship with imagination as the essential factor.

Bartlett (1968) defines hypnosis as "a control of the normal control of input (information) for the purpose of controlling output (behavior)."

Zimbardo, Maslach, and Marshall (1972) suggest that "hypnosis (a) is a state in which the effects of cognitive processes on bodily functioning are amplified; (b) enables the subject to perceive the focus of causality for mind and body control as more internally centered and volitional; (c) is often accompanied by a heightened sense of visual imagery; and (d) can lead to intensive concentration and elimination of distractions."

Orne (1972) has devoted careful attention to distinguishing those aspects that define hypnosis as distinct from normal behavior:

T h e presence of hypnosis can be identified by the way in which a subject(s) responds to suggestions. Heuristically, then, hypnosis is considered to be that state or condition in which suggestions (or cues) from the hypnotist will elicit hypnotic phenomena. Hypnotic phenomena can operationally be distinguished from nonhypnotic responses only when suggestions are given that require the S to distort his perception or memory. Accordingly, the hypnotized individual can be identified only by his ability to respond to suitable suggestions by appropriately altering any or all modalities of perception and memory.

In his definition of hypnosis. West (1960) blends both psychologi-cal and physiologipsychologi-cal concepts:

Psychophysiologicaly, the hypnotic trance may be defined as a controlled dissociated state. This state of altered awareness is maintained through parassociative mechanisms mediated by the ascending reticular system . . . when the subject is in the hypnotic

state, alertness is maintained relative to the inhibition or exclusion from awareness of considerable amounts of incoming information that would ordinarily be consciously perceived in the process of reality-testing. Under these circumstances the information in-serted into the restricted area of the subjects' awareness by the hypnotist, through his suggestions, is accepted as reality to a greater or lesser extent, depending upon the subject's dissociation of other information from awareness, moment by moment.

In discussing hypnosis as an adjunct to psychotherapy, Spiegel

(1967) presents an operational definition of hypnosis as " a n altered state of intense and sensitive inter-personal elatedness between hyp-notist and patient, characterized by the p a t i e n t s nonrational

submis-sion and relative abandonment of executive control to a more or less regressed, dissociated state" He emphasizes that in clinical practice the hypnotist structures this regressed state to facilitate achievement of desired goals. Elsewhere, Spiegel (1974) defines hypnosis as "a re-sponse to a signal from another or to an inner signal, which activates a capacity for a shift of awareness in the subject and permits a more intensive concentration upon a designated goal direction. This shift of attention is constantly sensitive to and responsive to cues from the hypnotist or the subject himself if properly trained." This definition is somewhat unique in emphasizing the possible intrapsychic onset of hypnosis.

Gruenewald (1982) has helped to clarify the definition of hypnosis by distinguishing the hypnotic situation from the hypnotic condition.

The hypnotic situation is an encompassing compliance with suggestion, role-caking, and transference: the hypnotic condition or state is char-acterized by alternations of perception and memory with a sense of the

reality of the subjective state. In a recent review. Orne (1980) points to the subjective reality of hypnotic phenomena as an argument against volitional role-playing. He concludes that it is most useful to establish links between hypnosis and other phenomena rather than search for unique psychobiological correlates of hypnosis.