Sidis Archives Menu
of Contents Chapter
THE THERAPEUTIC VALUE OF HYPNOTIC SUGGESTION
BY FREDERIC HENRY GERRISH, M.D.,
IT is important that hypnotic suggestion should not be confounded with other psychotherapeutic methods—it is only one of various psychic means by which curative results can be attained; and in my advocacy of it as a valuable remedy there is no intention to disparage or belittle any of the other psychotherapeutic methods, or even to institute a comparison between it and them. We ought to have a scientific acquaintance with all of them, so that we can select whatever method is best adapted to any case in which some psychic remedy is needed. It is pertinent to remark at this point that, as hypnotic suggestion is treated in this essay, it will not be included in the topics of the symposium on psychotherapy.
Although the history of hypnotism is intensely interesting, nothing of it will be given here, as our space is quite sufficiently occupied with more important matters. For the same reason the various theories which have been advanced to account for its phenomena will not be rehearsed. My task is to set forth the practical usefulness of hypnotism in the daily routine of medical work, and to clear away many misconceptions which have prevented the general employment of this agency.
We are all amenable to suggestion in greater or smaller degree. The training of the infant is almost wholly by suggestion. To a less but yet to a very important extent the same method is operative on the older child—the example of his associates in the family or out of it is more potent in the formation of his character and habits than are all the precepts that are dinned into him. As one’s years increase the susceptibility to suggestion gradually diminishes, apparently just in proportion to the loss of naturalness and the cultivation of the artificial restraints which convention imposes. Suggestibility is generally commensurate with simplicity of nature. In full maturity we have become so cautious that we involuntarily distrust the suggestions that come to us–an incredulous, perhaps even a cynical, element has crept into our natures, which prompts resistance and demands that reason shall be convinced. And yet some suggestibility remains–the hardest headed of us can be reached by a sufficiently frequent and skilful repetition of a suggestion. This suggestibility is the basis of the benefit that undoubtedly comes to the patient from the cheerfulness of the physician, from his heartening words, from his confident assurance that recovery is ahead, from his strong personality and appearance of wellbeing–for health is, in a measure, catching, as well as disease–from his irradiation of strength, of comfort, and of courage. Now, in the condition which is known as hypnosis, suggestibility is marvelously increased. Suggestions which in the ordinary condition of the personality are unheeded, in the hypnotic state are accepted with avidity. So large is this hospitality that almost any suggestion will be welcomed that is not repugnant to the moral sense of the hypnotized person. This eagerness for suggestion may be taken advantage of in therapeutics. If the patient is the victim of a disease to which the name “functional” is usually applied, and can be hypnotized, he has a good chance of getting relief through the agency of suggestion; if his malady is organic, a cure is not to be expected. (The words “functional” and “organic” are here used in their ordinary sense, as a matter of convenience.) For example, the patient has insomnia, not due to any appreciable structural change. He is hypnotized, and the suggestion is made that he will go to sleep as soon as he goes to bed, and remain in slumber a given number of hours. He is then brought out of the hypnotic state, and experiences no immediate effect of the treatment. Perhaps he is utterly incredulous, and derides the idea that a noticeable impression will follow the process. But, if he is as suggestible as the average, when he goes to bed, he tumbles into sleep, and continues in sleep substantially as predicted; or, if sleep has been suggested for a particular hour, he goes to sleep when the time comes, unless he makes the most strenuous efforts to keep awake and beat off his drowsiness.
The hypnotic state is induced not because it is in itself curative, but because that condition is peculiarly favorable to the reception and retention of suggestions. It is a question of the relation of soil and seed. In the ordinary waking state the seed of suggestion falls on the stony ground of indifference, which is hostile to its development, or on ground where the rank weeds of conventional usage spring up and choke it; but the hypnotic condition furnishes the richest kind of loam for suggestions, and in it they take root and rapidly grow up and bear fruit abundantly.
Hypnosis should not be regarded as an abnormal, a pathologic condition—it is simply unusual. Individuals differ widely in their capacity for hypnotization, for at one extreme are some who cannot be put into that state, and at the other end of the scale are some who seem to be almost hypnotized all of the time.
1. METHODS OF INDUCING HYPNOSIS
Hypnosis may be induced in various ways. That which will be described has proved serviceable. (It is assumed that the patient consents to be hypnotized, and, more than that, is willing to co-operate with the physician.) First, the process is explained to the patient, who probably has hardly a single correct idea on the subject, and needs to have his misconceptions removed. He is told a number of things, such as follow:
1. That all persons are more or less amenable to suggestion in the ordinary waking condition, as is illustrated in many familiar ways, such as gaping involuntarily, even against one’s strenuous attempts to avoid it, on seeing another yawn; beating time unconsciously on hearing the measured throb of martial music; becoming wildly excited for no other reason than that one’s companions are panic-stricken; and, contrariwise, having one’s fears allayed by the tranquil appearance of his associates in a terrible emergency.
2. That, in some way, the mental mechanism of which is not thoroughly understood, when a person is hypnotized, he accepts suggestions more readily than when he is in his usual condition; and that hypnosis is induced only for the purpose of taking advantage of this fact, and thus enabling the patient to receive the benefit of suggestions, to which, in his ordinary mental state, he is practically impervious.
3. That no harm to the patient in any direction will result from hypnotizing, either immediately or at any future time.
4. That the patient is not desired to surrender his will, but, on the contrary, is asked to exercise it in co-operation with the physician.
5. That he is not expected to lose consciousness, for the lighter degrees of hypnosis are sufficient for the accomplishment of remedial results in all but a minority of cases.
6. That the word “sleep” in this connection is a term of convenience, and means only that early stage of sleep that is consistent with consciousness: a transitional stage which any one who has analyzed his sensations has recognized as a brief period immediately preceding the unconsciousness of slumber, when by an effort he can become wide-awake, or by lying still and guarding his mind against exciting thoughts can insure speedy and perfect sleep.
7. That there will be nothing unpleasant in the process–no shock, no electric-like thrill, no startling sensation; but that, if the attempt is successful, he will experience a feeling as if tension was relaxed, a mental and physical calm, a soothing drowsiness.
8. That he must not be discouraged by complete failure at the first attempt, as it often happens that the excitement, incident to the novelty of the situation, defeats the efforts of both parties; and that, when he perceives, as he will from observing the process pursued, that there is nothing ungentle or in any way objectionable about it, there will probably be no difficulty in achieving success.
9. That the suggestions will be made more emphatically than will seem to him necessary; for example, if a night’s sleep is desired, it will be suggested that he will get twelve hours, this being on the principle followed by a marksman in putting up his sight for a long shot. If the barrel of the weapon is directed exactly at the bull’s-eye, the force of gravity will draw the projectile downward, and the mark will be hit below the center, if at all. So, too, allowance must be made for the downward deflection of a suggestion in an inveterate or otherwise difficult case. As the sight of the rifle must be raised so that the barrel is aimed above the mark, so the suggestion must be exaggerated, must be aimed high, in order to reach the desired point.
10. That the patient must not contradict or resist, and must not try to open his eyes until permission is given him.
The patient, thus instructed, then lies down on a couch, or seats himself in a lounging chair, in which he has a comfortable rest for his head. He is told to concentrate his attention upon sleep, to try to go to sleep; and, to assist him in this effort by preventing his taking in distracting ideas through his eyes, as they wander around the room and see the pictures, books, and furniture, he is asked to fix his gaze upon some indifferent object, as, for example, the finger of the physician, which is held a foot or so from the face of the patient. He is instructed not to try to keep his eyes open, and not to close them voluntarily, but merely to let the lids go as they will. The physician places his free hand upon the forehead of the patient, and, by a continuous stream of quiet, monotonous talk, encourages the patient in his effort to go to sleep. For example, he says, “Try to sleep, think of nothing but sleep, keep your thoughts fixed upon going to sleep. Your lids are heavy, they are drooping, you are going to sleep. Every moment you are getting more drowsy; you feel the sleep stealing over you. The lids are closing; you are almost asleep. Now the eyes have closed; you have gone to sleep.” Meantime a little pressure has been made upon the brows; and, when the lids slip down and cover the eyes, they are gently stroked. The hand is kept upon the forehead, and the physician enforces his assurances by some such words as these: “You are asleep, though you have not lost consciousness. You hear my voice, the sounds in the house, the noises in the street–and yet you are asleep. You feel the sleep all through you–head, trunk, and limbs are all heavy with sleep. Your nerves are all relaxed, there is no tension anywhere, you are perfectly tranquilized. You will not move a muscle, except to breathe, until I bid you wake.”
This process may take a minute, or it may occupy a quarter hour; but when it is completed the patient is ready for the remedial suggestions—the soil is prepared for the seed. Then the physician makes the necessary suggestions, speaking them plainly, putting them strongly, repeating them, emphasizing them in the most positive and insistent way. Generally he cannot tell how much effect has been produced; but something can be judged by the degree of quietude of the patient. If he is perfectly still, the probability is that all is working well; but certain limited movements are not inconsistent with fine success. A constant quivering of the lids is sometimes observed in the profoundest stage of hypnosis; but swallowing commonly indicates that only a slight degree has been reached.
Having finished the remedial suggestions, others are made to the effect that the hypnotic state can be induced more readily at each subsequent session, that the patient can be hypnotized whenever he wishes it, and particularly, that he can never be hypnotized by anybody without giving his entire consent. In this way the patient is locked against the attempts of designing hypnotizers, and may successfully defy any efforts to control him in this manner.
All of the suggestions appropriate to the case having been made, the patient is allowed to remain quiet for a longer or shorter time, according to the seriousness of the condition—a few minutes or more than half an hour; and the effect is deepened by a gentle though emphatic repetition of the suggestions. When the time for rousing the patient comes the physician says, “You may wake now.” Sometimes the awakening will be prompt, sometimes slow and reluctant, the latter being more likely when the hypnosis has been profound. If no permission to wake were given, the hypnotic condition would gradually disappear, and the patient would rouse himself as from ordinary sleep.
This method need not be followed in detail; indeed, every hypnotizer develops his individual procedure, and finds his own the best for his purposes. But there are common features in all of them, the essentials—quietude, confidence, gentleness, discreet sympathy, intelligent appreciation–are practiced in various ways.
After a very few successful sessions it becomes unnecessary for the patient to begin the process with open eyes; he is instructed to close them at the first, and the physician gently strokes the forehead and then the eyelids, speaking words which encourage the patient to sleep, and in a few moments hypnosis is effected. More than this, even, in the case of some peculiarly susceptible persons, the spoken command is sufficient for the induction of the desired condition.
In chronic cases it is generally necessary to have many sessions with the patient, and speedier results are attained, if the intervals are short. This method of treatment is comparable with that by medicines–the doses must be given frequently in order to keep the system impressed, as otherwise the effect of one wears off before another is administered.
Much time, great persistency, vast patience, abundant good nature and tact are needed in the inveterate cases. Perseverance in attempts to hypnotize will sometimes be rewarded with brilliant results, even though many early trials have utterly failed.
Having discussed the nature of hypnotism, and described the methods of its induction, we now come to the consideration of the conditions in which it can be advantageously employed.
2. CONDITIONS IN WHICH HYPNOTIC SUGGESTION IS VALUABLE
Some authorities think that it is unscientific to separate functional and organic diseases, that there is no perversion of action independent of an alteration in structure. And yet, a practical discrimination may properly be made without offending pathologic proprieties; and I trust that, for convenience, it is permissible for me to employ the terms in their ordinary signification. Assuming, then, your indulgent forbearance, it may be said that, in a general way, hypnotic suggestion finds its field in the domain of functional diseases of the nervous system. It may be used advantageously in relieving some of the sufferings incident to organic diseases; but in these cases it is only palliative and not curative. It is not claimed that all patients afflicted with such disorders as usually yield to suggestion will be helped by this treatment; but in this respect, as in others, the remedy resembles therapeutic agencies of physical character. It is not reasonable to look for universal success with any agent, or to expect that every patient will respond to any treatment as does the average one. The ailments in which hypnosis is of the most conspicuous value are those characterized by pain, insomnia, abnormal nervous irritability, depression of spirits, phobias, obsessions, neurasthenia, moral obliquity, spasm, nausea, sexual perversions, and drug habits. The cases which will be cited in illustration occurred in my own practice, and are selected almost at random from a vast number. The reports are necessarily limited to the essential features in order to keep this chapter within reasonable bounds.
Pain. A man of 45 years of age had been operated on twice for trifacial neuralgia. After each operation he had experienced a year of comfort, and then the trouble returned violently. The removal of the ganglion was all that surgery offered at that time, and from this he shrank on account of the danger to life; but he was willing to try hypnotism. When he presented himself in my office, and tried to answer a question, the effort threw the muscles of one side of his face into such a spasm, attended evidently with extreme pain, that he motioned to his wife to speak for him. His diet was restricted to liquids, because chewing meant agony; and he was compelled to almost complete silence, because of the direful penalty of speech. He had a treatment twice daily for ten days. From the first day he was measurably relieved, and he had no pain after the fourth day. His wife went home at the end of a week, as she was no longer needed as nurse and interpreter; and he followed on the tenth day, declaring that there was no need of remaining, as he was perfectly well, and he could return at any time if his trouble came back. His abandonment of treatment was against my judgment and advice, for the case was too chronic and severe to justify the expectation that it could be permanently relieved in so brief a time; but he never returned, or reported in any way. But even supposing that there was not a cure, the effect of the treatment illustrates the availability of the remedy and its advantages over physical anodynes, which, in producing an equal effect, would almost certainly establish a drug habit.
Insomnia. A great affliction, prolonged overwork, and anxiety had so affected a man of 35 years, that his capacity for sleep was seriously reduced. For three months he had slept only two or three hours in the twenty-four, and not only felt ill, but looked haggard and worn. A single hypnotic treatment refreshed him greatly. He was instructed to come daily for a while, as the case was chronic and severe; but a month went by without my seeing him. Then at a chance meeting he was asked to give an account of himself -why he had not come often, as he had promised. He joyously replied, “What’s the good of going to a doctor when one is perfectly well? I slept like a log all that night, and I’ve slept like a log every night since.” Many years have passed, and he has had no recurrence of insomnia.
Nervous Irritability. A young matron applied for relief of pronounced hyperesthesia. Her sensibilities were constantly on edge. The slightest sound, like that attending the lighting of a gas jet, if it came as a surprise, would set her nerves aquiver for an hour. In railway travel she always felt obliged to take the most remote available seat in the last car of the train in order to be as far away as possible from the noise of the bell and the whistle of the locomotive. Life was a series of alarms and distresses. The first attempt at hypnosis was an utter failure–the patient was wrought up to the highest pitch of excitement, and therefore could not concentrate her attention in the needed direction. She was in despair, feeling certain that her last hope of relief had vanished, and no encouraging assurances had any effect. Two days afterward a second visit was made.
The patient was in tears, mourning over the assumed impossibility of being hypnotized. While she was in that state of mind it was plainly useless to attempt hypnosis, so the effort was made to distract her attention from herself. For an hour nothing was said about patient or sickness or anything depressing, and the time was spent in the recital of droll stories and in whatever else might help to divert the self-centered and morbid current of her thought. At what seemed a favorable moment she was told to close her eyes, and she obeyed instantly. The lids were gently stroked, and hypnotization was accomplished in that moment. Suitable suggestions were made, and the cure promptly began, and was finished in a few weeks. Tranquillity succeeded excitement, and life took on a very different aspect.
This case shows that primary failure is no indication of ultimate results. Excitement is inimical to hypnosis, as it is to true sleep; and the patient should not only be willing, but calm enough to be able to concentrate his attention.
Depression of Spirits. A man of 30 years, gifted, well educated, and of fine character but moody disposition, had been afflicted for many months with extreme depression, which he was utterly unable to throw off. He was not a good hypnotic subject; but he was practically restored in a fortnight of daily sessions. He became cheerful, regained interest in his work, liked to mingle with his friends, and now, after many years, is in full enjoyment of life.
Fear of Travel on the Water. A gentleman whose occupation occasionally required him to make little journeys to the islands in the harbor had constitutionally so great a dread of water-travel that sometimes he would leave the steamboat just as it was about to start, abandoning the projected trip, even though he appreciated the urgency of his business, which always involved the interests of others as well as his own. After a few hypnotic sessions he was able to make excursions on the boats, not only without mental disturbance, but even with some enjoyment.
Extreme Timidity. A lady in early middle life gave this account of her case: “Before my marriage I was a teacher, and experienced no trouble in addressing a roomful of people whenever my work required it. But for seventeen years I have never appeared before an audience. To-morrow afternoon I am announced to read a paper before one of the large clubs of women, and I am frightened almost to death at the thought. My paper is a good one, and I am not at all afraid that it will not be satisfactory; but when I try to read it aloud at home and entirely alone, I break down; I cannot help seeing that critical audience, and the thought of it scares me so that I have to stop. Can you not hypnotize my terror out of me, and put courage in its place?” She was an entire stranger to me, and the prospect for success was not flattering. Besides, my time was so engaged that it was impracticable to make an appointment before the next noon. Then, only two hours before the meeting at which she was to perform, she received the hypnotic suggestion which she desired. The next day she called to report. Her face was radiant, and she gave an enthusiastic account of herself, saying, “I had no fear, no difficulty whatever in reading. A lot of the women were moved to tears, and when I was through my friends thronged around me with their congratulations and praised not only my essay but the way in which I read it. But I told them that all the credit for that should be given to hypnotism.” As her name has often appeared in connection with public performances since then, it is fair to suppose that she has had no further difficulty.
This case may strike some as trivial, and so it is as compared with many or most of those with which we have to deal. But it does not seem to me unworthy of the efforts of a physician. The slight ailments need wise treatment, and their correction may prevent serious illness, may even save life. A disturbance such as this woman had may easily enough be the initial step in a series that leads to an asylum; but being corrected, obstacles are removed from the path to happy and successful endeavor.
Obsession. A young matron from her earliest recollection had been in constant dread of assassination, but had never mentioned the horror until she revealed it to me. Even then she would not have spoken of it but that she had been relieved of neuralgia by hypnotic suggestion, and hoped that her greater trouble could be dissipated by the same means. She was afraid of the dark, even when she had a companion, and she never allowed herself to be left in the house alone. Half a dozen treatments cured her completely.
Neurasthenia. A lady of 43 years for a whole decade had been in a condition of nervous prostration, with marked digestive disturbances. She was under treatment during the whole time, but had received no benefit. She was advised to try the effect of hypnotic suggestion by a physician who had declared to me with great positiveness that hypnotism was justifiable only in absolutely hopeless cases, in which desperate means could be sanctioned. After a prolonged examination the conclusion was reached that no organ was appreciably diseased. She was given treatment every, day for a month, but long before that time had elapsed she was practically well. Her distresses were all banished, her feebleness disappeared, her digestion was restored, and her spirits became buoyant.
Moral Obliquity. A lady applied in deep distress of mind concerning her ten-year-old son, a strong, healthy, genial, little fellow, who had no interest in his school duties, habitually played truant, and lied in the most abandoned manner. His nature was very affectionate, and he was very fond of his mother; but she had exhausted her means of influencing him without avail. She consented to have hypnotism tried on him. In three weeks his parents declared that he was a different boy. He attended school regularly, took good rank in his studies, and was proud of it, and his word could be relied upon implicitly.
Asthma. An old lady who had suffered from asthma for many years and found no relief beyond slight palliation, sent for me when she was having a severe attack. She had never been hypnotized, and her orthopnea forbade her lying down or even reclining, but she could endure for a little while a slight inclination backward, so that the head rested against a pillow. In this position she was quickly hypnotized, and was wholly relieved in a few minutes.
Seasickness. A young lady who had been across the Atlantic several times, and regularly suffered nausea marina, appealed to me for prophylactic treatment. She had deferred the matter until a few days before her voyage, and the attention which it was possible to give her seemed altogether inadequate, but the event was happy. She was not at all disturbed during the journey, and took her meals regularly with enjoyment, all of which was the more remarkable as her room-mate was violently seasick every day of the voyage, and depended upon the ministrations of my patient constantly.
Sexual Perversion. Schrenck-Notzing says that the grossest sexual aberrations, even when they are deeply rooted and have changed the entire personality, are frequently cured by hypnotic suggestion. Krafft-Ebing, in his Psychopathia Sexualis, seems to depend entirely upon this remedy in the cases of which he speaks. It has not been my fortune to have as a patient a person afflicted with any of these maladies. But a case was sent me by a friend, a specialist in neurology, who was unable to help the patient, and, although thinking lightly of hypnotism, desired me to try it in this case. The patient was a medical student, a young man of neurasthenic tendency, who was hyperesthetic sexually, and was troubled especially with priapism. He was hypnotized several times with acknowledged benefit, but ceased his visits before being discharged as cured. One day my neurologic colleague called on me and reported that the patient was apprehensive that the treatment had been carried too far; not only was he relieved of his priapism and other evidences of his sexual over-sensitiveness, but he had positive sexual apathy. Without difficulty the normal equilibrium was found and established.
Drug Addictions. An apothecary, about 30 years of age, had the alcohol habit. He did not drink intoxicants every day, but once in a few weeks he drank persistently until his stomach revolted, and then he was abstinent until the furore for alcohol seized him again. His necessities prohibited abandonment of his work, and his persistence in it kept him constantly in an atmosphere of temptation. No encouragement to expect a cure under these circumstances was given him, but his urgent pleading induced me to try the effect of hypnotic suggestion. After twenty sessions the treatment was given up on account of my absence from town for nearly two months; and while the signs were hopeful, it was highly improbable that he would not relapse into his wretched slavery. But he did not, and years afterward he remained entirely cured.
3. CORRECTION OF MISCONCEPTIONS CONCERNING HYPNOTISM
There is a multitude of errors concerning hypnotism, which are almost as prevalent among physicians as in the non-medical population, and a number of these will be stated and corrected.
It is commonly supposed that a person must lose consciousness in the process. In most cases the patient retains consciousness perfectly. For the production of some results the deepest stage of the hypnotic condition is requisite; but for the ordinary therapeutic effects it is by no means necessary. Brilliant cures are sometimes achieved with patients who are hardly made drowsy by being hypnotized.
It is a prevalent belief that only the weak-minded, or, at best, the hysteric, are amenable to hypnotic suggestion. Nothing could be farther from the truth. The experienced hypnotizer dislikes to deal with either of these classes of patients; he would rather for every reason have strong men with cultivated minds and disciplined wills. The physician who uses only physical therapeutic means prefers the well-balanced, sensible, intelligent for patients, and so does the one who employs psychic means, and for the same reasons. The hypnotizer asks his patient to exert his will in a specified direction; he wants the intelligent co-operation of the patient, and this requirement is most difficult for the feeble-minded, the untrained, the heedless to meet.
Another mistaken notion is that only a minority of persons can be hypnotized. This is true only if one has in mind the idea that, in order to be hypnotized, one must lose consciousness—which has already been declared to be an error. The great majority of people can be hypnotized to an extent quite sufficient to make them susceptible to remedial suggestions.
A misconception which it is very difficult to displace ascribes to the hypnotizer a peculiar and rare natural endowment. That some men are better hypnotizers than others is unquestionably true, just as some men are more capable than others in any line of activity. He who has a strong and healthy physical organism, a powerful mind, and, perhaps best of all, an engaging presence, has elements that make for success in any affairs where man meets man; and, of course, such a one gets the best results with his medicines, with his surgical operations, with his electrical applications. Why should he not do better than most others in the use of suggestion, hypnotic or non-hypnotic? But while this type is the highest, there are others who, while not quite or nearly as well endowed, are yet capable of excellent work; and as they will pass muster in the other styles of therapeusis, so, too, they will succeed in hypnosis. Any man who has the attributes which every medical practitioner should possess can practice hypnotism. But he must believe in it, and he must declare his belief by the confidence of his bearing. Self-distrust, timidity, uncertainty in the physician inevitably beget reluctance, fear, and antagonism in the patient, whatever the former undertakes to do, and whatever the method by which he essays to do it.
A common fallacy ascribes whatever result is experienced to a mysterious, subtle emanation from the physician which enters and pervades the system of the patient. This error is partly due to the persistence of a theory which was upset long ago; and partly, doubtless, to the likeness which is popularly thought to obtain between hypnotism and electricity. The real explanation is suggestion, pure and simple.
A frequent objection is that, in the hands of an unscrupulous person, great wrong may be perpetrated by hypnosis, and therefore it should not be used. The same line of argument would lead us to abandon treatment by medicines, because it must be admitted that patients have been killed by drugs administered by physicians, and to give up cutting operations in surgery, because many persons have died on account of these procedures. That there are scoundrels and incompetents in the medical profession, as in all others, is a lamentable fact; but they constitute but a small minority, and the danger of their doing harm, maliciously or innocently, by employing hypnotism is exactly on a plane with the peril which attends their practice in any other line. Every real authority on modern hypnotism says emphatically that a suggestion that offends the moral sense of the person hypnotized is either disregarded, or has the effect of rousing the subject immediately. If it were practicable to incite to criminal acts through the agency of hypnotic suggestion, there would be no lack of examples of this fact; but in many years of observation not an authentic cse of the kind has come to my knowledge. The possibilities of such a method in the hands of a skillful romancer are too obvious to escape the attention of novelists, and we know that thrilling tales of absorbing interest have been pivoted on this supposition; but we never encounter such occurrences in actual life, and we may confidently disabuse our minds of this groundless apprehension.
It is objected that hypnosis, especially if often repeated, weakens the will of the patient and makes hint dependent upon the mind of the operator. Such a result is imaginable, but can never occur, if the physician is as careful in using this agency as he always should be when administering drugs or doing surgery. As a matter of fact the will may be strengthened by hypnotic suggestion, and the moral vigor increased in every respect. All of the cases of injury from hypnosis of which I have ever heard have resulted from the reckless employment of it for exhibition purposes, mostly by irresponsible mountebanks. The shows conducted by hypnotizers for the amusement of popular audiences should be sternly repressed. That this treatment has not been their fate is, in my opinion, in considerable degree to be ascribed to the attitude of physicians. Repeatedly I have known doctors to accept and use complimentary tickets to these wretched performances, thus tacitly bestowing their professional sanction on indefensible applications of hypnotism, while at the same time they display a strong disposition to outlaw a fellow practitioner who brings to bear upon his patients the altogether beneficent uses of the same agency. If used discreetly, hypnotism does not induce insanity, does not weaken the mind, does not do harm in any direction.
Hypnotism should be used only by educated physicians, and by them only as a remedy or a means to diagnosis. If it had never been employed outside of its legitimate domain there would be little or nothing of the prejudice against it which is constantly encountered in the community; and the sufferers, for whom it has an easy and effectual relief, would eagerly avail themselves of its help.
To some the practice of hypnotism is objectionable, because there are many charlatans who employ it or advertise to do so. Those who argue thus, to be consistent and logical, should abandon the use of all medicines, all hygienic measures, everything, indeed, by which they try to affect their patients, for there is nothing that the quacks do not exploit. One can hardly look at a daily paper or a popular magazine without having forced upon his attention some flamboyant announcement of a drug, a method of exercise, a kind of battery, a drink, a food–something presented with an attractive picture and an adroitly worded statement, which, it is promised, will positively put disease to flight, prolong life to the ripest old age, and supplant misery with exuberant happiness. But none of us are so disgusted with these mendacious advertisements that we think it necessary to throw away the pharmacopoeia, cease to recommend physical culture, give up electricity, forbid the use of alimentary remedies. We continue to employ whatever means we think will benefit those persons who honor us with their confidence by seeking our advice and skill. Why, then, should we select one particular kind of agent, and avoid it on the ground that it is used by pretenders? The breadth of mind which we like to believe characterizes our profession should enable us to welcome any agency, whatever its origin, however unwisely or dishonestly it is used by others, whatever compromising associations it has previously had, provided only that it will enable us more readily, more agreeably, more perfectly, to diminish suffering, prevent disease, or restore health. Therefore, when one hears hypnotism likened to any of the popular mind-cure movements, which to his trained intellect are manifestly unscientific and illogical, let him ascribe the statement to ignorance, and enter upon the investigation of this form of psychotherapy with confidence that the more he learns about it the greater will be his respect for it.
It has been alleged that a belief in the remedial virtues of hypnotism would do away with the necessity for diagnosis. Nothing could be wider of the mark. The physician who includes this agency in his armamentarium does not change his attitude toward pathology, etiology, or physical diagnosis. He sees, as plainly as one can, that the first thing is to find out what is the matter, to ascertain the character of the malady, and he does not use hypnotic means in treatment unless his investigation persuades him that the trouble is of a kind to which this remedy is scientifically applicable.
One of the commonest criticisms of hypnotism is to the effect that the ailments which it relieves are all imaginary. If a patient is said to have been freed from pain, some astute skeptic asks, “Was the pain real?” To such the answer should be: “When a patient comes to you complaining of pain, do you distrust his word? After he has taken the anodyne which you administer, and declares to you that his pain has disappeared, do you question his veracity? You cannot prove by the evidence of any or all of your senses that either statement was true or false, for his symptom is absolutely subjective. But you do know your patient, and have no reason to doubt his truthfulness in this matter any more than in any other; and so you do not hesitate to give him the remedy that your experience has taught you is suitable to his condition. Now, suppose such a patient is treated with hypnotic suggestion, and the suffering is promptly abolished, is there any sense, reason, or fairness in thinking that his pain was imaginary, and not as real as that which was relieved by your drug?”
It has been charged that hypnotism is not scientific; but it is difficult to perceive upon what ground this opinion is based. Tested by any of the rules which we apply to the remedies which we all employ it is not found wanting; and it is not just to subject it to severer tests than we think sufficient for all the others. If it is objected that we do not know the mental mechanism by which hypnosis is induced, it is fair to remind the critic that he cannot explain the mechanism of memory, a fundamental and comparatively simple intellectual process. If it is alleged that there is a large empirical element in hypnotic treatment, it is proper to ask if, in this respect, it is on a lower plane than our usual method of using drugs.
It has been alleged that the therapeutic effects of hypnotic suggestion are but transient: that, if any benefit results from it, in a short time the patient will relapse into his former condition. Nobody acquainted with the facts could possibly make this criticism. The effects of no remedy, with which a comparison can fairly be made, are more enduring than are those of hypnotic suggestion.
Equally inapplicable is the comment that groups hypnotism with methods of treatment in which prominence is given to a mystical element, which appeal to the superstitious, which associate theology and therapeutics, which demand faith in a dogma. The psychology on which hypnotic suggestion is based is as far removed from mysticism or religion in any form as is physiology—indeed, it may be said to be physiology applied to mental processes. The hypnotist is not spiritistic in any sense of the word; he asks his patient for no faith, save that which every physician has a right to expect in any person who confides health and life and reputation to his care. In treatment by any method it is universally recognized that confidence in an expected, or even hoped for, result is a helpful factor. No well-informed person that doubts that wonderful cures are sometimes wrought under the ministrations of the most dishonest charlatans, as the result of religious exaltation, in consequence of absorbing belief in absolutely senseless doctrines; and he knows, too, that these beneficent effects are as abundantly manifested among the worshippers of idols and the practisers of obscene and degrading rites as among the people of his own creed. That expectation is desirable in hypnotic treatment, as in any other, must be manifest; but in none is it less essential. Particularly may it be insisted that in hypnotism there is no occult or esoteric element, there is nothing to conceal, there is no desire to take advantage of credulity, or to play upon the confiding nature of the ignorant and superstitious.
That hypnotism is often but little understood by men to whom the profession has a right to look for enlightenment in such matters is frequently demonstrated. Some of the high priests of neurology are the greatest sinners in this direction; but none, probably, have displayed their incompetence and ignorance quite as conspicuously as has Dubois, the author of a book on the psychic treatment of nervous disorders. This has been translated into English and has evidently deeply influenced many physicians and awakened a wholesome interest in a certain form of psychotherapy. His treatment by persuasion has undoubted merit, though little novelty; but it is pitiful that he should assume the attitude which he does toward hypnotism-an attitude which reveals at once ignorance, narrowness, prejudice, and inconsistency. He girds at hypnotism, at every opportunity, he holds it up to ridicule and contempt; and yet he admits that, on occasion, he uses it, as he certainly should not, if it is the evil thing that he would have us believe. In doing this he unconsciously pays it the highest tribute. Let me quote a passage:
“This is one of those exceptional cases where I would not fear to have recourse to hypnosis, although the attitude of the wonder-worker that one has to take is so repugnant to me that it brings a blush to my cheeks when I decide to use it.”
“Wonder-working” to him evidently means rapidity of effect, for in another paragraph he says:
“The practice of hypnosis has accustomed one to immediate success, to theatrical effects.”
Are we to refrain from employing any method because its results are prompt? We have been accustomed to consider speed in attaining a desired end a decided merit. The motto on the seal of this society, “Curare cito, tuto, et jucunde,” which we adopt from the ancient Asclepiades, is universally acclaimed as the ideal rule of action; and hypnotism fulfils all of these conditions, for it does cure quickly, safely, and pleasantly. Apply the objection to another class of cases: a patient comes to a physician with a chronic irritative cough. Examination reveals a relaxed uvula dangling onto the tongue and constantly tickling the pharynx. Does anybody advocate the cutting off of the sixteenth of an inch a day for the sake of avoiding the suddenness of cure effected by complete ablation? But the method by which instant and permanent relief is afforded is open to the criticism of being theatrical. Dubois objects to “wonder-working,” if the quick cure is brought about by hypnosis, as if one appealed to the thaumaturgy of the ancient magician; and yet he says:
“The art of the physician lies just in choosing in each case the most rapid and powerful means of improvement.”
Can inconsistency go further? If his vaunted method achieves an immediate result, it is praiseworthy; but, if hypnotism does the same thing, it is damnable.
To show how utterly ignorant of the principles of hypnotic treatment this author is, one more sentence may be quoted: “What is more absurd than to fall asleep by daylight, when one has no need of sleep, by stupidly yielding to the command of the hypnotizer?”
It seems almost incredible that a physician who poses as a neurologist and a psychotherapist, should not know that the purpose of the hypnotizer in inducing the sleep is solely to put the patient into a more suggestible condition. When a man of the eminence of Dubois is capable of so humiliating an exhibition as this, we may look with more charity and patience upon the men who constitute the rank and file of the profession, when they, as a result of dense ignorance, declare hypnotism to be dangerous, foolish, quackish, fraudulent, necromantic, and altogether unjustifiable.
It ought to be unnecessary to say that the employment of any form of psychotherapy is not incompatible with the use of physical agents of any description. In many cases it is important to associate different kinds of therapeutic agents, which are not psychic, as we all know; the case in which a psychic method is desirable makes no exception. Psychotherapy should be regarded as an additional means of promoting the welfare of the patient, whatever other kind of treatment has been instituted.
In this essay I have not attempted an exhaustive treatment of my subject, but I have tried to show as well as possible in the time allowed what hypnotism is, and what can be done with it by any well-educated, competent physician for the benefit of the sick and. suffering; and, finally, I have endeavored to make it clear that the objections to its use are not based upon knowledge, but upon ignorance and prejudice. The points touched upon are those about which questions are most frequently asked or adverse criticism made, and the answers and explanations are founded upon a large observation of the practical workings of the method.
I have no expectation of effecting a wholesale conversion of opponents to these views—I know too well the ingrained conservatism of our profession regarding psychic remedies; but I entertain a little hope that what I have said will arouse in some minds an intelligent interest in the subject; and I am confident that no open-minded physician can look into it fairly, as he would into any other therapeutic method, without being persuaded that in hypnotic suggestion are possibilities for good, which our profession should no longer neglect.