Hypnotism

Hypnotism, a term now in general use as covering all that pertains to the art of inducing the hypnotic state, or hypnosis, and to the study of that state, its conditions, peculiarities and effects. Hypnosis is a condition, allied to normal sleep (Gr. ὕπνος), which can be induced in a large majority of normal persons. Its most characteristic and constant symptom is the increased suggestibility of the subject (see Suggestion). Other symptoms are very varied and differ widely in different subjects and in the same subject at different times. There can be no doubt that the increased suggestibility and all the other symptoms of hypnosis imply some abnormal condition of the brain of a temporary and harmless nature. It would seem that in all ages and in almost all countries individuals have occasionally fallen into abnormal states of mind more or less closely resembling the hypnotic state, and have thereby excited the superstitious wonder of their fellows. In some cases the state has been deliberately induced, in others it has appeared spontaneously, generally under the influence of some emotional excitement. The most familiar of these allied states is the somnambulism or sleep-walking to which some persons seem to be hereditarily disposed. Of a rather different type are the states of ecstasy into which religious enthusiasts have occasionally fallen and which were especially frequent among the peoples of Europe during the middle ages. While in this condition individuals have appeared to be insensitive to all impressions made on their sense-organs, even to such as would excite acute pain in normal persons, have been capable of maintaining rigid postures for long periods of time, have experienced vivid hallucinations, and have produced, through the power of the imagination, extraordinary organic changes in the body, such as the bloody stigmata on the hands and feet in several well-attested instances. It has been proved in recent years that effects of all these kinds may be produced by hypnotic suggestion. Different again, but closely paralleled by some subjects in hypnosis, is the state of latah into which a certain proportion of persons of the Malay race are liable to fall. These persons, if their attention is suddenly and forcibly drawn to any other person, will begin to imitate his every action and attitude, and may do so in spite of their best efforts to restrain their imitative movements. Among the half-bred French-Canadians of the forest regions of Canada occur individuals, known as “jumpers,” who are liable to fall suddenly into a similar state of abject imitativeness, and the same peculiar behaviour has been observed among some of the remote tribes of Siberia.

The deliberate induction of states identical with, or closely allied to, hypnosis is practised by many barbarous and savage peoples, generally for ceremonial purposes. Thus, certain dervishes of Algiers are said to induce in themselves, by the aid of the sound of drums, monotonous songs and movements, a state in which they are insensitive to pain, and a similar practice of religious devotees is reported from Tibet. Perhaps the most marvellous achievement among well-attested cases of this sort is that of certain yogis of Hindustan; by long training and practice they seem to acquire the power of arresting almost completely all their vital functions. An intense effort of abstraction from the impressions of the outer world, a prolonged fixation of the eyes upon the nose or in some other strained position and a power of greatly slowing the respiration, these seem to be important features of their procedure for the attainment of their abnormal states.

In spite of the wide distribution in time and space, and the not very infrequent occurrence, of these instances of states identical with or allied to hypnosis, some three centuries of enthusiastic investigation and of bitter controversy were required to establish the occurrence of the hypnotic state among the facts accepted by the world of European science. Scientific interest in them may be traced back at least as far as the end of the 16th century. Paracelsus had founded the “sympathetic system” of medicine, according to which the stars and other bodies, especially magnets, influence men by means of a subtle emanation or fluid that pervades all space. J. B. van Helmont, a distinguished man of science of the latter part of the 16th century, extended this doctrine by teaching that a similar magnetic fluid radiates from men, and that it can be guided by their wills to influence directly the minds and bodies of others. In the middle of the 17th century there appeared in England several persons who claimed to have the power of curing diseases by stroking with the hand. Notable amongst these was Valentine Greatrakes, of Affane, in the county of Waterford, Ireland, who was born in February 1628, and who attracted great attention in England by his supposed power of curing the king’s evil, or scrofula. Many of the most distinguished scientific and theological men of the day, such as Robert Boyle and R. Cudworth, witnessed and attested the cures supposed to be effected by Greatrakes, and thousands of sufferers crowded to him from all parts of the kingdom. About the middle of the 18th century John Joseph Gassner, a Roman Catholic priest in Swabia, took up the notion that the majority of diseases arose from demoniacal possession, and could only be cured by exorcism. His method was undoubtedly similar to that afterwards followed by Mesmer and others, and he had an extraordinary influence over the nervous systems of his patients. Gassner, however, believed his power to be altogether supernatural.

But it was not until the latter part of the 18th century that the doctrine of a magnetic fluid excited great popular interest and became the subject of fierce controversy in the scientific world. F. A. Mesmer (q.v.), a physician of Vienna, was largely instrumental in bringing the doctrine into prominence. He developed it by postulating a specialized variety of magnetic fluid which he called animal magnetism; and he claimed to be able to cure many diseases by means of this animal magnetism, teaching, also, that it may be imparted to and stored up in inert objects, which are thereby rendered potent to cure disease.

It would seem that Mesmer himself was not acquainted with the artificial somnambulism which for nearly a century was called mesmeric or magnetic sleep, and which is now familiar as hypnosis of a well-marked degree. It was observed and described about the year 1780 by the marquis de Puységur, a disciple of Mesmer, who showed that, while subjects were in this state, not only could some of their diseases be cured, but also their movements could be controlled by the “magnetizer,” and that they usually remembered nothing of the events of the period of sleep when restored to normal consciousness. These are three of the most important features of hypnosis, and the modern study of hypnotism may therefore be said to have been initiated at this date by Puységur. For, though it is probable that this state had often been induced by the earlier magnetists, they had not recognized that the peculiar behaviour of their patients resulted from their being plunged into this artificial sleep, but had attributed all the symptoms they observed to the direct physical action of external agents upon the patients.

The success of Mesmer and his disciples, especially great in the fashionable world, led to the appointment in Paris of a royal commission for the investigation of their claims. The commission, which included men of great eminence, notably A. L. Lavoisier and Benjamin Franklin, reported in the year 1784 that it could not accept the evidence for the existence of the magnetic fluid; but it did not express an opinion as to the reality of the cures said to be effected by its means, nor as to the nature of the magnetic sleep. This report and the social upheavals of the following years seem to have abolished the public interest in “animal magnetism” for the space of one generation; after which Alexandre Bertrand, a Parisian physician, revived it by his acute investigations and interpretations of the phenomena. Bertrand was the first to give an explanation of the facts of the kind that is now generally accepted. He exhibited the affinity of the “magnetic sleep” to ordinary somnambulism, and he taught that the peculiar effects are to be regarded as due to the suggestions of the operator working themselves out in the mind and body of the “magnetized” subject, i.e. he regarded the influence of the magnetizer as exerted in the first instance on the mind of the subject and only indirectly through the mind upon the body. Shortly after this revival of public interest, namely in the year 1831, a committee of the Academy of Medicine of Paris reported favourably upon “magnetism” as a therapeutic agency, and before many years had elapsed it was extensively practised by the physicians of all European countries, with few exceptions, of which England was the most notable. Most of the practitioners of this period adhered to the doctrine of the magnetic fluid emanating from the operator to his patient, and the acceptance of this doctrine was commonly combined with belief in phrenology, astrology and the influence of metals and magnets, externally applied, in curing disease and in producing a variety of strange sensations and other affections of the mind. These beliefs, claiming to rest upon carefully observed facts, were given a new elaboration and a more imposing claim to be scientifically established by the doctrine of odylic force propounded by Baron Karl von Reichenbach. In this mass of ill-based assertion and belief the valuable truths of “animal magnetism” and the psychological explanations of them given by Bertrand were swamped and well-nigh lost sight of. For it was this seemingly inseparable association between the facts of hypnotism and these bizarre practices and baseless beliefs that blinded the larger and more sober part of the scientific world, and led them persistently to assert that all this group of alleged phenomena was a mass of quackery, fraud and superstition. And the fact that magnetism was practised for pecuniary gain, often in a shameless manner, by exponents who claimed to cure by its means every conceivable ill, rendered this attitude on the part of the medical profession inevitable and perhaps excusable, though not justifiable. It was owing to this baleful association that John Elliotson, one of the leading London physicians of that time, who became an ardent advocate of “magnetism” and who founded and edited the Zoist in the interests of the subject, was driven out of the profession. This association may perhaps be held, also, to excuse the hostile attitude of the medical profession towards James Esdaile, a surgeon, who, practising in a government hospital in Calcutta among the natives of India, performed many major operations, such as the amputation of limbs, painlessly and with the most excellent results by aid of the “magnetic” sleep. For both Elliotson and Esdaile, though honourable practitioners, accepted the doctrine of the “magnetic” fluid and many of the erroneous beliefs that commonly were bound up with it.

In 1841 James Braid, a surgeon of Manchester, rediscovered independently Bertrand’s physiological and psychological explanations of the facts, carried them further, and placed “hypnotism,” as he named the study, on a sound basis. Braid showed that subjects in “magnetic” sleep, far from being in a profoundly insensitive condition, are often abnormally susceptible to impressions on the senses, and showed that many of the peculiarities of their behaviour were due to suggestions, made verbally or otherwise, but unintentionally, by the operator or by onlookers.

It seems, on looking back on the history of hypnotism, that at this time it was in a fair way to secure general recognition as a most interesting subject of psychological study and a valuable addition to the resources of the physician. But it was destined once more to be denied its rights by official science and to fall back into disrepute. This was due to the coincidence about the year 1848 of two events of some importance, namely—the discovery of the anaesthetic properties of chloroform and the sudden rise of modern spiritualism. The former afforded a very convenient substitute for the most obvious practical application of hypnotism, the production of anaesthesia during surgical operations; the latter involved it once more in a mass of fraud and superstition, and, for the popular mind, drove it back to the region of the marvellous, the supernatural and the dangerous, made it, in fact, once more a branch of the black art.

From this time onward there took place a gradual differentiation of the “animal magnetism” of the 18th century into two diverging branches, hypnotism and spiritualism, two branches which, however, are not yet entirely separated and, perhaps, never will be. At the same time the original system of “animal magnetism” has lived on in an enfeebled condition and is now very nearly, though not quite, extinct.

In the development of hypnotism since the time of Braid we may distinguish three lines, the physiological, the psychological and the pathological. The last may be dismissed in a few words. Its principal representative was J. M. Charcot, who taught at the Salpêtrière in Paris that hypnosis is essentially a symptom of a morbid condition of hysteria or hystero-epilepsy. This doctrine, which, owing to the great repute enjoyed by Charcot, has done much to retard the application of hypnotism, is now completely discredited. The workers of the physiological party attached special importance to the fixation of the eyes, or to other forms of long continued and monotonous, or violent, sensory stimulation in the induction of hypnosis. They believed that by acting on the senses in these ways they induced a peculiar condition of the nervous system, which consisted in the temporary abolition of the cerebral functions and the consequent reduction of the subject to machine-like unconscious automatism. The leading exponent of this view was R. Heidenhain, professor of physiology at Breslau, whose experimental investigations played a large part in convincing the scientific world of the genuineness of the leading symptoms of hypnosis. The purely psychological doctrine of hypnosis puts aside all physical and physiological influences and effects as of but little or no importance, and seeks a psychological explanation of the induction of hypnosis and of all the phenomena. This dates from 1884, when H. Bernheim, professor of medicine at Nancy, published his work De la Suggestion (republished in 1887 with a second part on the therapeutics of hypnotism). Bernheim was led to the study of hypnotism by A. A. Liébeault, who for twenty years had used it very largely and successfully in his general practice among the poor of Nancy. Liébeault rediscovered independently, and Bernheim made known to the world the truths, twice previously discovered and twice lost sight of, that expectation is a most important factor in the induction of hypnosis, that increased suggestibility is its essential symptom, and that in general the operator works upon his patient by mental influences. Although they went too far in the direction of ignoring the peculiarity of the state of the brain in hypnosis and the predisposing effect of monotonous sensory stimulation, and in seeking to identify hypnosis with normal sleep, the views of the Nancy investigators have prevailed, and are now in the main generally accepted. Their methods of verbal suggestion have been adopted by leading physicians in almost all civilized countries and have been proved to be efficacious in the relief of many disorders; and as a method of psychological investigation hypnotism has proved, especially in the hands of the late Ed. Gurney, of Dr Pierre Janet and of other investigators, capable of throwing much light on the constitution of the mind, has opened up a number of problems of the deepest interest, and has done more than any other of the many branches of modern psychology to show the limitations and comparative barrenness of the old psychology that relied on introspection alone and figured as a department of general philosophy. In England, “always the last to enter into the general movement of the European mind,” the prejudice, incredulity and ignorant misrepresentation with which hypnotism has everywhere been received have resisted its progress more stubbornly than elsewhere; but even in England its reality and its value as a therapeutic agent have at last been officially recognized. In 1892, just fifty years after Braid clearly demonstrated the facts and published explanations of them almost identical with those now accepted, a committee of the British Medical Association reported favourably upon hypnotism after a searching investigation; it is now regularly employed by a number of physicians of high standing, and the formation in 1907 of “The Medical Society for the Study of Suggestive Therapeutics” shows that the footing it has gained is likely to be made good.

Induction of Hypnosis.—It has now been abundantly proved that hypnosis can be induced in the great majority of normal persons, provided that they willingly submit themselves to the process. Several of the most experienced operators have succeeded in hypnotizing more than 90% of the cases they have attempted, and most of them are agreed that failure to induce hypnosis in any case is due either to lack of skill and tact on the part of the operator, or to some unfavourable mental condition of the subject. It has often been said that some races or peoples are by nature more readily hypnotizable than others; of the French people especially this has been maintained. But there is no sufficient ground for this statement. The differences that undoubtedly obtain between populations of different regions in respect to the ease or difficulty with which a large proportion of all persons can be hypnotized are sufficiently explained by the differences of the attitude of the public towards hypnotism; in France, e.g., and especially in Nancy, hypnotism has been made known to the public chiefly as a recognized auxiliary to the better known methods of medical treatment, whereas in England the medical profession has allowed the public to make acquaintance with hypnotism through the medium of disgusting stage-performances whose only object was to raise a laugh, and has, with few exceptions, joined in the general chorus of condemnation and mistrust. Hence in France patients submit themselves with confidence and goodwill to hypnotic treatment, whereas in England it is still necessary in most cases to remove an ill-based prejudice before the treatment can be undertaken with hope of success. For the confidence and goodwill of the patient are almost essential to success, and even after hypnosis has been induced on several occasions a patient may be so influenced by injudicious friends that he cannot again be hypnotized or, if hypnotized, is much less amenable to the power of suggestion. Various methods of hypnotization are current, but most practitioners combine the methods of Braid and of Bernheim. After asking the patient to resign himself passively into their hands, and after seating him in a comfortable arm-chair, they direct him to fix his eyes upon some small object held generally in such a position that some slight muscular strain is involved in maintaining the fixation; they then suggest to him verbally the idea or expectation of sleep and the sensations that normally accompany the oncoming of sleep, the heaviness of the eyes, the slackness of the limbs and so forth; and when the eyes show signs of fatigue, they either close them by gentle pressure or tell the subject to close them. Many also pass their hands slowly and regularly over the face, with or without contact. The old magnetizers attached great importance to such “passes,” believing that by them the “magnetic fluid” was imparted to the patient; but it seems clear that, in so far as they contribute to induce hypnosis, it is in their character merely of gentle, monotonous, sensory stimulations. A well-disposed subject soon falls into a drowsy state and tends to pass into natural sleep; but by speech, by passes, or by manipulating his limbs the operator keeps in touch with him, keeps his waning attention open to the impressions he himself makes. Most subjects then find it difficult or impossible to open their eyes or to make any other movement which is forbidden or said to be impossible by the operator, although they may be fully conscious of all that goes on about them and may have the conviction that if they did but make an effort they could break the spell. This is a light stage of hypnosis beyond which some subjects can hardly be induced to pass and beyond which few pass at the first attempt. But on successive occasions, or even on the first occasion, a favourable subject passes into deeper stages of hypnosis. Many attempts have been made to distinguish clearly marked and constantly occurring stages. But it seems now clear that the complex of symptoms displayed varies in all cases with the idiosyncrasies of the subject and with the methods adopted by the operator. In many subjects a waxy rigidity of the limbs appears spontaneously or can be induced by suggestion; the limbs then retain for long periods without fatigue any position given them by the operator. The most susceptible subjects pass into the stage known as artificial somnambulism. In this condition they continue to respond to all suggestions made by the operator, but seem as insensitive to all other impressions as a person in profound sleep or in coma; and on awaking from this condition they are usually oblivious of all that they have heard, said or done during the somnambulistic period. When in this last condition patients are usually more profoundly influenced by suggestions, especially post-hypnotic suggestions, than when in the lighter stages; but the lighter stages suffice for the production of many therapeutic effects. When a patient is completely hypnotized, his movements, his senses, his ideas and, to some extent, even the organic processes over which he has no voluntary control become more or less completely subject to the suggestions of the operator; and usually he is responsive to the operator alone (rapport) unless he is instructed by the latter to respond also to the suggestions of other persons. If left to himself the hypnotized subject will usually awake to his normal state after a period which is longer in proportion to the depth of hypnosis; and the deeper stages seem to pass over into normal sleep. The subject can in almost every case be brought quickly back to the normal state by the verbal command of the operator.

The Principal Effects produced by Suggestion during Hypnosis.—The subject may not only be rendered incapable of contracting any of the muscles of the voluntary system, but may also be made to use them with extraordinarily great or sustained force (though by no means in all cases). He can with difficulty refrain from performing any action commanded by the operator, and usually carries out any simple command without hesitation. Any one of the sense-organs, or any sensory region such as the skin or deep tissues of one limb may be rendered anaesthetic by verbal suggestion, aided perhaps by some gentle manipulation of the part. On this fact depends the surgical application of hypnotism. Sceptical observers are always inclined to doubt the genuineness of the anaesthesia produced by a mere word of command, but the number of surgical operations performed under hypnotic anaesthesia suffices to put its reality beyond all question. A convincing experiment may, however, be made on almost any good subject. Anaesthesia of one eye may be suggested and its reality tested in the following way. Anaesthesia of the left eye may be suggested, and the subject be instructed to fix his gaze on a distant point and to give some signal as soon as he sees the operator’s finger in the peripheral field of view. The operator then brings his finger slowly from behind and to the right forwards towards the subject’s line of sight. The subject signals as soon as it crosses the normal temporal boundary of the field of view of the right eye. The operator then brings his finger forward from a point behind and to the left of the subject’s head. The subject allows it to cross the monocular field of the left eye and signals only when the finger enters the field of vision of the right eye across its nasal boundary. Since few persons, other than physiologists or medical men, are aware of the relations of the boundaries of the monocular and binocular fields of vision, the success of this experiment affords proof that the finger remains invisible to the subject during its passage across the monocular field of the left eye. The abolition of pain, especially of neuralgias, the pain of rheumatic and other inflammations, which is one of the most valuable applications of hypnotism, is an effect closely allied to the production of such anaesthesia.

It has often been stated that in hypnosis the senses may be rendered extraordinarily acute or hyperaesthetic, so that impressions too faint to affect the senses of the normal person may be perceived by the hypnotized subject; but in view of the fact that most observers are ignorant of the normal limits of sensitivity and discrimination, all such statements must be received with caution, until we have more convincing evidence than has yet been brought forward.

Positive and Negative Hallucinations are among the most striking effects of hypnotic suggestion. A good subject may be made to experience an hallucinatory perception of almost any object, the more easily the less unusual and out of harmony with the surroundings is the suggested object. He may, e.g., be given a blank card and asked if he thinks it a good photograph of himself. He may then assent and describe the photograph in some detail, and, what is more astonishing, he may pick out the card as the one bearing the photograph, after it has been mixed with other similar blank cards. This seems to be due to the part played by points de repère, insignificant details of surface or texture, which serve as an objective basis around which the hallucinatory image is constructed by the pictorial imagination of the subject. A negative hallucination may be induced by telling the subject that a certain object or person is no longer present, when he ignores in every way that object or person. This is more puzzling than the positive hallucination and will be referred to again in discussing the theory of hypnosis. Both kinds of hallucination tend to be systematically and logically developed; if, e.g., the subject is told that a certain person is no longer visible, he may become insensitive to impressions made on any sense by that person.

Delusions, or false beliefs as to their present situation or past experiences may be induced in many subjects. On being assured that he is some other person, or that he is in some strange situation, the subject may accept the suggestion and adapt his behaviour with great histrionic skill to the induced delusion. It is probable that many, perhaps all, subjects are vaguely aware, as we sometimes are in dreams, that the delusions and hallucinations they experience are of an unreal nature. In the lighter stages of hypnosis a subject usually remembers the events of his waking life, but in the deeper stages he is apt, while remembering the events of previous hypnotic periods, to be incapable of recalling his normal life; but in this respect, as also in respect to the extent to which on awaking he remembers the events of the hypnotic period, the suggestions of the operator usually play a determining part.

Among the organic changes that have been produced by hypnotic suggestion are slowing or acceleration of the cardiac and respiratory rhythms; rise and fall of body-temperature through two or three degrees; local erythema and even inflammation of the skin with vesication or exudation of small drops of blood; evacuation of the bowel and vomiting; modifications of the secretory activity of glands, especially of the sweat-glands.

Post-hypnotic Effects.—Most subjects in whom any appreciable degree of hypnosis can be induced show some susceptibility to post-hypnotic suggestion, i.e. they may continue to be influenced, when restored to the fully waking state, by suggestions made during hypnosis, more especially if the operator suggests that this shall be the case; as a rule, the deeper the stage of hypnosis reached, the more effective are post-hypnotic suggestions. The therapeutic applications of hypnotism depend in the main upon this post-hypnotic continuance of the working of suggestions. If a subject is told that on awaking, or on a certain signal, or after the lapse of a given interval of time from the moment of awaking, he will perform a certain action, he usually feels some inclination to carry out the suggestion at the appropriate moment. If he remembers that the action has been suggested to him he may refuse to perform it, and if it is one repugnant to his moral nature, or merely one that would make him appear ridiculous, he may persist in his refusal. But if the action is of a simple and ordinary nature he will usually perform it, remarking that he cannot be comfortable till it is done. If the subject was deeply hypnotized and remembers nothing of the hypnotic period, he will carry out the post-hypnotic suggestion in almost every case, no matter how complicated or absurd it may be, so long as it is not one from which his normal self would be extremely averse; and he will respond appropriately to the suggested signals, although he is not conscious of their having been named; he will often perform the action in a very natural way, and will, if questioned, give some more or less adequate reason for it. Such actions, determined by post-hypnotic suggestions of which no conscious memory remains, may be carried out even after the lapse of many weeks or even months. Inhibitions of movement, anaesthesia, positive and negative hallucinations, and delusions may also be made to persist for brief periods after the termination of hypnosis; and organic effects, such as the action of the bowels, the oncoming of sleep and the cessation of pain, may be determined by post-hypnotic suggestion. In short, it may be said that in a good subject all the kinds of suggestion which will take effect during hypnosis will also be effective if given as post-hypnotic suggestions.

Theory of the Hypnotic State.—Very many so called theories of hypnosis have been propounded, but few of them demand serious consideration. One author ascribes all the symptoms to cerebral anaemia, another to cerebral congestion, a third to temporary suppression of the functions of the cerebrum, a fourth to abnormal cerebral excitability, a fifth to the independent functioning of one hemisphere. Another seeks to explain all the facts by saying that in hypnosis our normal consciousness disappears and is replaced by a dream-consciousness; and yet another by the assumption that every human organism comprises two mental selves or personalities, a normal one and one which only comes into activity during sleep and hypnosis. Most of these “theories” would, even if true, carry us but a little way towards a complete understanding of the facts. There is, however, one theory or principle of explanation which is now gradually taking shape under the hands of a number of the more penetrating workers in this field, and which does seem to render intelligible many of the principle facts. This is the theory of mental dissociation.

It is clear that a theory of hypnosis must attempt to give some account of the peculiar condition of the brain which is undoubtedly present as an essential feature of the state. It is therefore not enough to say with Bernheim that hypnosis is a state of abnormally increased suggestibility produced by suggestion; nor is it enough, though it is partially true, to say that it is a state of mono-ideism or one of abnormally great concentration of attention. Any theory must be stated in terms of physiological psychology, it must take account of both the psychical and the nervous peculiarities of the hypnotic state; it must exhibit the physiological condition as in some degree similar to that obtaining in normal sleep; but principally it must account for that abnormally great receptivity for ideas, and that abnormally intense and effective operation of ideas so received, which constitute abnormally great suggestibility.

The theory of mental dissociation may be stated in purely mental terms, or primarily in terms of nervous structure and function, and the latter mode of statement is probably the more profitable at the present time. The increased effectiveness of ideas might be due to one of two conditions: (1) it might be that certain tracts of the brain or the whole brain were in a condition of abnormally great excitability; or (2) an idea might operate more effectively in the mind and on the body, not because it, or the underlying brain-process was more intense than normally, but because it worked out its effects free from the interference of contrary or irrelevant ideas that might weaken its force. It is along this second line that the theory of mental dissociation attempts to explain the increased suggestibility of hypnosis. To understand the theory we must bear in mind the nature of mental process in general and of its nervous concomitants. Mental process consists in the interplay, not merely of ideas, but rather of complex dispositions which are the more or less enduring conditions of the rise of ideas to consciousness. Each such disposition seems capable of remaining inactive or quiescent for long periods, and of being excited in various degrees, either by impressions made upon the sense-organs or by the spread of excitement from other dispositions. When its excitement rises above a certain pitch of intensity, the corresponding idea rises to the focus of consciousness. These dispositions are essential factors of all mental process, the essential conditions of all mental retention. They may be called simply mental dispositions, their nature being left undefined; but for our present purpose it is advantageous to regard them as neural dispositions, complex functional groups of nervous elements or neurones. The neurones of each such group must be conceived as being so intimately connected with one another that the excitement of any part of the group at once spreads through the whole group or disposition, so that it always functions as a unit. The whole cerebrum must be conceived as consisting of a great number of such dispositions, inextricably interwoven, but interconnected in orderly fashion with very various degrees of intimacy; groups of dispositions are very intimately connected to form neural systems, so that the excitement of any one member of such a system tends to spread in succession to all the other members. On the other hand, it is a peculiarity of the reciprocal relations of all such dispositions and systems that the excitement of any one to such a degree that the corresponding idea rises to consciousness prevents or inhibits the excitement of others, i.e. all of them are in relations of reciprocal inhibition with one another (see Muscle and Nerve). The excitement of dispositions associated together to form a system tends towards some end which, either immediately or remotely, is an action, a bodily movement, in many cases a movement of the organs of speech only. Now we know from many exact experiments that the neural dispositions act and react upon one another to some extent, even when they are excited only in so feeble a degree that the corresponding ideas do not rise to consciousness. In the normal state of the brain, then, when any idea is present to consciousness, the corresponding neural disposition is in a state of dominant excitement, but the intensity of that excitement is moderated, depressed or partially inhibited by the sub-excitement of many rival or competing dispositions of other systems with which it is connected. Suppose now that all the nervous connexions between the multitudinous dispositions of the cerebrum are by some means rendered less effective, that the association-paths are partially blocked or functionally depressed; the result will be that, while the most intimate connexions, those between dispositions of any one system remain functional or permeable, the weaker less intimate connexions, those between dispositions belonging to different systems will be practically abolished for the time being; each system of dispositions will then function more or less as an isolated system, and its activity will no longer be subject to the depressing or inhibiting influence of other systems; therefore each system, on being excited in any way, will tend to its end with more than normal force, being freed from all interferences; that is to say, each idea or system of ideas will tend to work itself out and to realize itself in action immediately, without suffering the opposition of antagonistic ideas which, in the normal state of the brain, might altogether prevent its realization in action.

The theory of mental dissociation assumes that the abnormal state of the brain that obtains during hypnosis is of this kind, a temporary functional depression of all, or of many of the associations or nervous links between the neural dispositions; that is, it regards hypnosis as a state of relative dissociation. The lighter the stage of hypnosis the slighter is the degree of dissociation, the deeper the stage the more nearly complete is the dissociation.

It is not essential that the theory should explain in what change this stage of dissociation consists, but a view compatible with all that we know of the functions of the central nervous system may be suggested. The connexions between neural dispositions involve synapses or cell-junctions, and these seem to be the places of variable resistance which demarcate the dispositions and systems; and there is good reason to think that their resistances vary with the state of the neurones which they connect, being lowered when these are excited and raised when their excitement ebbs. Now, in the waking state, the varied stimuli, which constantly rain upon all the sense-organs, maintain the whole cerebrum in a state of sub-excitement, keep all the cerebral neurones partially charged with free nervous energy. When the subject lies down to sleep or submits himself to the hypnotizer he arrests as far as possible the flow of his thoughts, and the sensory stimuli are diminished in number and intensity. Under these conditions the general cerebral activity tends to subside, the free energy with which the cerebral neurones are charged ebbs away, and the synaptic resistances rise proportionally; then the effect of sensory impressions tends to be confined to the lower nervous level, and the brain tends to come to rest. If this takes place the condition of normal sleep is realized. But in inducing hypnosis the operator, by means of his words and manipulations, keeps one system of ideas and the corresponding neural system in activity, namely, the ideas connected with himself; thus he keeps open one channel of entry to the brain and mind, and through this one open channel he can introduce whatever ideas he pleases; and the ideas so introduced then operate with abnormally great effect because they work in a free field, unchecked by rival ideas and tendencies.

This theory of relative dissociation has two great merits: in the first place it goes far towards enabling us to understand in some degree most of the phenomena of hypnosis; secondly, we have good evidence that dissociation really occurs in deep hypnosis and in some allied states. Any one may readily work out for himself the application of the theory to the explanation of the power of the operator’s suggestions to control movement, to induce anaesthesia, hallucinations and delusions, and to exert on the organic processes an influence greater than can be exerted by mental processes in the normal state of the brain. But the positive evidence of the occurrence of dissociation is a matter of great psychological interest and its nature must be briefly indicated. The phenomena of automatic speech and writing afford the best evidence of cerebral dissociation. Many persons can, while in an apparently normal or but very slightly abnormal condition, produce automatic writing, i.e. intelligibly written sentences, in some cases long connected passages, of whose import they have no knowledge, their self-conscious intelligence being continuously directed to some other task. The carrying out of post-hypnotic suggestions affords in many cases similar evidence. Thus a subject may be told that after waking he will perform some action when a given signal, such as a cough, is repeated for the fifth time. In the post-hypnotic state he remains unaware of his instructions, is not conscious of noting the signals, and yet carries out the suggestion at the fifth signal, thereby proving that the signals have been in some sense noted and counted. Many interesting varieties of this experiment have been made, some of much greater complexity; but all agreeing in indicating that the suggested action is prepared for and determined by cerebral processes that do not affect the consciousness of the subject, but seem to occur as a system of processes detached from the main stream of cerebral activity; that is to say, they imply the operation of relatively dissociated neural systems.

Many authorities go further than this; they argue that, since actions of the kind described are determined by processes which involve operations, such as counting, that we are accustomed to regard as distinctly mental in character and that normally involve conscious activity, we must believe that in these cases also consciousness or psychical activity is involved, but that it remains as a separate system or stream of consciousness concurrent with the normal or personal consciousness.

In recent years the study of various abnormal mental states, especially the investigations by French physicians of severe forms of hysteria, have brought to light many facts which seem to justify this assumption of a secondary stream of consciousness, a co- or sub-consciousness coexistent with the personal consciousness; although, from the nature of the case, an absolute proof of such co-consciousness can hardly be obtained. The co-consciousness seems to vary in degree of complexity and coherence from a mere succession of fragmentary sensations to an organized stream of mental activity, which may rival in all respects the primary consciousness; and in cases of the latter type it is usual to speak of the presence of a secondary personality. The co-consciousness seems in the simpler cases, e.g. in cases of hysterical or hypnotic anaesthesia, to consist of elements split off from the normal primary consciousness, which remains correspondingly poorer; and the assumption is usually made that such a stream of co-consciousness is the psychical correlate of groups and systems of neurones dissociated from the main mass of cerebral neurones. If, in spite of serious objections, we entertain this conception, we find that it helps us to give some account of various hypnotic phenomena that otherwise remain quite inexplicable; some such conception seems to be required more particularly by the facts of negative hallucination and the execution of post-hypnotic suggestions involving such operations as counting and exact discrimination without primary consciousness.

Supernormal Hypnotic Phenomena.—The facts hitherto considered, strange and perplexing as many of them are, do not seem to demand for their explanation any principles of action fundamentally different from those operative in the normal human mind. But much of the interest that has centred in hypnotism in recent years has been due to the fact that some of its manifestations seem to go beyond all such principles of explanation, and to suggest the reality of modes of influence and action that science has not hitherto recognized. Of these by far the best attested are the post-hypnotic unconscious reckoning of time and telepathy or “thought-transference” (for the latter see Telepathy). The post-hypnotic reckoning and noting of the lapse of time seems in some instances to have been carried out, in the absence of all extraneous aids and with complete unconsciousness on the part of the normal personality, with such extreme precision that the achievement cannot be accounted for by any intensification of any faculty that we at present recognize or understand. Thus, Dr Milne Bramwell has reported the case of a patient who, when commanded in hypnosis to perform some simple action after the lapse of many thousands of minutes, would carry out the suggestion punctually to the minute, without any means of knowing the exact time of day at which the suggestion was given or the time of day at the moment its performance fell due; more recently a similar case, even more striking in some respects, has been carefully observed and described by Dr T. W. Mitchell. Other reported phenomena, such as telaesthesia or clairvoyance, and telekinesia, are hardly sufficiently well attested to demand serious consideration in this place.

Medical Applications of Hypnotism.—The study and practice of hypnotism is not yet, and probably never will be, regarded as a normal part of the work of the general practitioner. Its successful application demands so much time, tact, and special experience, that it will probably remain, as it is now, and as it is perhaps desirable that it should remain, a specialized branch of medical practice. In England it is only in recent years that it has been possible for a medical man to apply it in his practice without incurring professional odium and some risk of loss of reputation. That, in certain classes of cases, it may effect a cure or bring relief when all other modes of treatment are of no avail is now rapidly becoming recognized; but it is less generally recognized that it may be used with great advantage as a supplement to other modes of treatment in relieving symptoms that are accentuated by nervous irritability or mental disturbance. A third wide field of usefulness lies before it in the cure of undesirable habits of many kinds. Under the first heading may be put insomnia, neuralgia, neurasthenia, hysteria in almost all its many forms; under the second, inflammations such as that of chronic rheumatism, contractures and paralyses resulting from gross lesion of the brain, epilepsy, dyspepsia, menstrual irregularities, sea-sickness; under the third, inebriety, the morphia and other drug habits, nail-biting, enuresis nocturna, masturbation, constipation, facial and other twitchings. In pronounced mental diseases hypnotism seems to be almost useless; for in general terms it may be said that it can be applied most effectively where the brain, the instrument through which it works, is sound and vigorous. The widespread prejudice against the use of hypnotism is no doubt largely due to the marvellous and (to most minds) mysterious character of the effects producible by its means; and this prejudice may be expected to diminish as our insight into the mode of its operation deepens. The more purely bodily results achieved by hypnotic suggestion become in some degree intelligible if we regard it as a powerful means of diverting nervous energy from one channel or organ to others, so as to give physiological rest to an overworked organ or tissue, or so as to lead to the atrophy of one nervous habit and the replacement of it by a more desirable habit. And in the cure of those disorders which involve a large mental element the essential part played by it is to drive out some habitually recurrent idea and to replace it by some idea, expectation or conviction of healthy tendency.

It seems clear that the various systems of “mind-curing” in the hands of persons lacking all medical training, which are now so frequently the cause of distressing and needless disasters, owe their rapid spread to the fact that the medical profession has hitherto neglected to attach sufficient importance to the mental factor in the causation and cure of disease; and it seems clear, too, that a more general and more intelligent appreciation of the possibilities of hypnotic treatment would constitute the best means at the disposal of the profession for combating this growing evil.

The Dangers of Hypnotism.—Much has been written on this head of late years, and some of the enthusiastic advocates of hypnotic treatment have done harm to their cause by ignoring or denying in a too thoroughgoing manner the possibility of undesirable results of the spread of the knowledge and practice of hypnotism. Like all powerful agencies, chloroform or morphia, dynamite or strong electric currents, hypnotic suggestion can only be safely used by those who have special knowledge and experience, and, like them, it is liable to abuse. There is little doubt that, if a subject is repeatedly hypnotized and made to entertain all kinds of absurd delusions and to carry out very frequently post-hypnotic suggestions, he may be liable to some ill-defined harm; also, that an unprincipled hypnotizer might secure an undue influence over a naturally weak subject.

But there is no ground for the belief that hypnotic treatment, applied with good intentions and reasonable care and judgment, does or can produce deleterious effects, such as weakening of the will or liability to fall spontaneously into hypnosis. All physicians of large experience in hypnotic practice are in agreement in respect to this point. But some difference of opinion exists as to the possibility of deliberately inducing a subject to commit improper or criminal actions during hypnosis or by post-hypnotic suggestion. There is, however, no doubt that subjects retain even in deep hypnosis a very considerable power of resistance to any suggestion that is repugnant to their moral nature; and it has been shown that, on some cases in which a subject in hypnosis is made to perform some ostensibly criminal action, such as firing an unloaded pistol at a bystander or putting poison into a cup for him to drink, he is aware, however obscurely, of the unreal nature of the situation. Nevertheless it must be admitted that a person lacking in moral sentiments might be induced to commit actions from which in the normal state he would abstain, if only from fear of punishment; and it is probable that a skilful and evil-intentioned operator could in some cases so deceive a well-disposed subject as to lead him into wrong-doing. The proper precaution against such dangers is legislative regulation of the practice of hypnotism such as is already enforced in some countries.

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