REALITY AND PERCEPTUAL AWARENESS
The current psychiatric literature postulates that there are two “minds,” the conscious and the unconscious (subconscious). “Consciousness” is defined as awareness of one's own existence, self, and actions. It requires effort and is invariably referred to as the part of the brain which maintains critical faculties. It accounts chiefly for the cognitive aspects of most mental functioning. “Consciousness” and its associated mental states all involve discriminatory activities and are, of necessity, dynamic functions heavily dependent on the cortex.
The other portion of the brain is “nonconscious” and, at its lowest levels, is devoid of awareness even though it is never inoperative, either during sleep or wakefulness. Thought influenced by the neural centers below the cortex is egocentric, dreamy, and wishful. Its functioning depends largely on the activity of subcortical structures, which, as already described, play a role of equal or even greater importance in cognitive functioning.15
However, subcortical structures are not in continual strife, at lower levels, with the cortex. Since these subcortical centers apparently lack discriminative ability, they initiate rather than attempt to control the goal-directed activities of the organism. This reciprocal and dynamic interaction of the two arbitrary divisions of the brain makes up the experiential background of the individual—past and present. Without the subcortical centers, the cortex could not receive memories or current percepts. On the other hand, without the cortex, the lower centers cannot receive the necessary information essential for validating reality.
When any one of the senses is stimulated, the information is first received in the lower centers and then forwarded to the cortex for correlation with data from the other senses. After the information has been validated as reality, the original percept is then filed as information in the subcortical centers. Later, when a similar percept is received, these centers transmit not only this information to the cortex for validation, but the memory of percepts related to the original reality situation. This forms the basis for convictions. Incoming percepts may differ, so as to require different convictions, but earlier convictions influence the current ones. As past convictions accumulate, they become available for consideration of current problems as these relate to reality.
Hence, thought is the association of new percepts with past data, and past convictions afford possible solutions to new situations. In other words, reality is based on sensorily received information, which of necessity has to be continually validated against previously stored memories. Convictions result from acceptance of reality and, unless new reality situations are introduced, the older sensory impressions cannot be changed.12 One might say the brain is guided by reality as it perceives reality, but this freedom is limited by past and present realities.
Studies in perception indicate that awareness of reality comes from within us, not from our environment.9 This would fit in with the operational definition that hypnosis is a subjective phenomenon processed out of previously invoked beliefs which create a readiness to believe. All perceptual awareness in hypnosis is altered by compounding of beliefs, and this leads to conviction independent of reality.
PSYCHOPHYSIOLOGIC MECHANISMS IN HYPNOTIC PHENOMENA
The phenomenon of posthypnotic amnesia depends upon the type and degree of cortical inhibition. During deep hypnosis, the cortex is not even “aware” that such memories are accessible. Posthypnotic amnesia does not actually eliminate the memories but merely prevents information processed out of what constitutes reality for the subject from reaching the mnemonic data in the higher sensorium. In other words, instead of reality, there is unreality. It must be emphasized, however, that any sensory distortion negates reality for only that particular posthypnotic suggestion, that is, the amnestic material. The conviction of amnesia is brought about first by the reality of hypnosis, and then this is followed by the belief that amnesia will occur.
Posthypnotic suggestions that are carried out successfully are those capable of instilling convictions at variance with the previously invoked beliefs. However, conviction can be accepted without question even at nonhypnotic levels; this is noted in religious faith-healing and in the blind trust of children. Such conviction, deduced through normal thought processes, is, of course, subject to change unless altered by other information.
Hence, the function of all ideational activities is to process sensory information for the most useful combinations possible out of our experiential background. The importance of understanding the psychophysiologic basis of hypnosis as a phenomenological experience is set not only by what information the brain contains, but also by what it will receive in terms of awareness or “consciousness.”* Kline states:
… when one studies hypnotism and when one works with it, he is working with an important element for controlling and determining aspects of consciousness.10
He believes that more than the element of suggestion is involved, and emphasizes that “one must not confuse the hypnotic state with hypnotic behavior and with the nature of neuropsychologic processes in the hypnotic state.”
It has been emphasized previously that words have the power to produce associative conditioning, that belief is based on experiential conditioning, and when the sensory spiral of belief is cumulative, it leads to hypnotic conviction. As the author stated in a publication, “Conviction of hypnosis leads to hypnosis.”11
Some psychosomatic disorders may be due to increased susceptibility of the cortex induced by partial cortical inhibition. This is brought about by the inability of the integrating centers to interpret correctly new sensory information or data. This can occur whenever repetitive destructive conditioning activates faulty associations or whenever the resultant harmful emotional responses ultimately lead to adverse somatization reactions based on conviction. In the former, the beliefs can be changed only by correcting the faulty information through reeducation; in the latter, deeply ingrained convictions can be reversed best by implanting constructive conditioning through meaningful suggestions. Such reconditioning to alter the disturbed cortical dynamics is more readily achieved under hypnosis.
RELATIONSHIP OF BELIEF AND CONVICTION TO HYPNOTIC PHENOMENA
After the production of hypnosis, the need for reality testing is obviated. West states:
When there occurs a marked narrowing of focus of awareness on a particular aspect of reality, to the exclusion of much of the rest (as in the initiation of a hypnotic trance), then sensory data (verbal suggestions) taken in through an open channel (rapport) become effective because they are not subjected to ordinary reality testing.17
It is precisely for this reason that posthypnotic suggestions can be carried out. The degree of effectiveness of a posthypnotic suggestion is based on the degree of suspension of cortical discrimination. Arnold states:
The connection of the hippocampal action circuit (which seems to be the repository of neuronal mechanisms that preserve the stream of consciousness) which mediates recall of the memory image together with the diffuse thalamic system allows the inhibition of irrelevant impulses from the visual area and thus prevents a correction of the hallucinations by the visual impression—as long as the singleminded concentration lasts he is incapable of seeing any incongruity either in his actions or perceptions.
Thus, if a suggestion seems to be a certainty because of belief and conviction, it has the power to effect an appropriate response in the organism. Conviction consists of two types, one of which is based on pooling present and past information. In this type, the brain functions logically because the validation results from past and present circumstances which are real. The other type, hypnotic or nonvalidated conviction, requires no checking against stored information because the suggestions are accepted with a literalness as if they are real.
The degree of “conscious” response depends on the manner and the number of beliefs necessary to establish conviction. Hence, if we hear something long enough and strongly enough, we can build up conviction, as in religious faith, or a faith in brand names built up by advertisers! It is no wonder that conviction can be put to work in hypnotherapy so admirably.
It is known that, in the presence of the appropriate mind-set, thoughts based on conviction can heal or kill. Conviction of illness can lead just as readily to hypochondriasis or to sickness. No more forceful example can be found than that of voodoo death. Cannon describes how sorcery and witchcraft kill young, healthy people in spite of all modern medical care.4 Conviction of death processed into the brain may invoke the sympatheticoadrenal system, which supersedes volitional control and leads to death!
Voodoo “possession” bears an important relationship to hypnosis. The role of the priest or hungan is quite similar to that of the hypnotist. However, group dynamics and psychology of the individual play a larger role in voodoo than in a hypnotic setting.14 Bowers has made similar observations.3 Goodfriend and Wolpert recently reviewed the literature on death from fright.7 They concluded that psychological stress can be a precipitant of sudden death where there is no obvious cause.
Whenever distortion of reality is slipped into awareness through hypnotically induced heterosuggestions, it takes precedence over reality-testing even in well-adjusted individuals. It is by such measures that conviction at hypnotic and often at nonhypnotic levels can occur without volitional participation. The reverse is undoubtedly the mechanism for paranoid trends. The aberrant behavior characterizing the psychoses and the psychoneuroses is due, in part, to distortion of reality by the patient's autosuggestions. The phenomena of hypnosis temporarily mimic, in almost pure culture, the manifestations of deranged thinking and behavior. This does not imply that hypnotic behavior is psychotic behavior, but rather that they are opposite sides of the same coin.
If we can comprehend the relationship of belief and conviction to hypnosis, we should be able to achieve better insight into the basic causations of irrational mental functioning. Posthypnotic suggestions afford a remarkable experimental tool for studying the ontogenesis of many different types of neurotic behavior. Just as hypnotically produced suggestions are difficult to resist if they are in keeping with the individual's desires or rationalizations, so are delusional tendencies well-nigh impossible to eradicate by appealing to volition.
The following material has been mentioned in other chapters; however, in this context it warrants repetition. One can produce physiologic effects only if the corresponding imaginative processes are used to invoke the necessary sensory data. The fundamental principle of the law of reverse effect here holds true, namely, that the imagination is more powerful than the will. In this regard, imagining a posthypnotically suggested sensation results in its being experienced, provided contradictory impulses are excluded. The positive gustatory hallucination of “eating a steak” results because the needed data are available in the cortex. However, human beings cannot imagine ideomotor and ideosensory responses that have not been previously experienced.
Ideomotor and ideosensory responses are the sine qua non for facilitation of hypnosis. These activities depend on past experiences, which endow the organism with automaticity and require little cortical discrimination. When conviction becomes reflexlike and when it is accepted at this level, the resultant conviction leads to uncritical acceptance of other suggestions.
Briefly, then, an induction procedure makes full use of cortical and subcortical mechanisms. The technic, regardless of the methodology, provides the validation necessary for acceptance of beliefs.
Hypnotic susceptibility also has a high content of thought-out conviction. For instance, if a person expects to be hypnotized by someone in a prestige position, his expectancy level is raised. Subjects who are analytical or who know a considerable amount about hypnosis are difficult to induce by any technic because the prestige factor so necessary for conviction is not present. Furthermore, the initiated anticipate the carefully contrived sensory illusions. Because they cannot exclude irrelevant thoughts, they cannot give their full and continuous attention to the operator. As a result, the necessary diminution of sensory reality never occurs.
In summary, the ability to achieve hypnosis is often based on a single “learned” response, and once it has been achieved it is easy to develop more complex responses. The induction of hypnosis results from conditions which preclude logical thinking. If an individual has the conviction that he has been hypnotized, then further beliefs wholly or partially unrelated to reality are accepted as convictions. Stated simply, acceptance of hypnosis allows acceptance of all that follows, provided that the beliefs do not mobilize critical attitudes. First, cortical awareness is required to establish the sensory meaningfulness of the stimuli leading to hypnosis. This, in turn, allows the summation of convictions to gain control over critical faculties. Now, with reality held in abeyance, information that cannot be checked can be directly implanted to produce appropriate responses.
RELATIONSHIP OF CONVICTION TO DEPTH OF HYPNOSIS
The various hypnotic depths, as has been mentioned, are at best only arbitrary delineations, and no two individuals respond in a similar fashion to identical suggestions because reality varies from person to person and even changes in the same person from time to time. This accounts for the variations in hypnotic response often noted in even well-conditioned subjects.
It was pointed out that, in some highly suggestible individuals, conviction often can be instilled without hypnosis. For these, the need for conviction of hypnosis is obviated. Hence, the concept of “trance” really has no basis in fact, because nearly all “trance” phenomena can be produced without the necessity for inducing a formalistic state of hypnosis!
LIGHT STAGE OF HYPNOSIS
The fundamental principle in achieving any degree of hypnotic depth is to get the subject to accept the validity of simple suggestions first, and then build up to more complex suggestions (see Chap. 15).
MEDIUM STAGE OF HYPNOSIS
After limb catalepsy is attained, further belief is established by the suggestion of deep relaxation. As the depth increases, subcortical centers take over, much as in sleep.
SOMNAMBULISM OR DEEP HYPNOSIS
Here conviction is complete and there is no need for reality testing. The operator's suggestions are received with a literalness because no modification or distortion of the incoming information occurs. Furthermore, the suggestions cannot be compared with previous data, so they are accepted as convictions even though they are at variance with reality. If it is not present, amnesia is produced by a command to forget.
Negative and positive sensory illusions or hallucinations are readily produced because the subject's beliefs grow with conviction! In short, the brain can screen impressions selectively from awareness, or inhibit and distort sensory impressions so as to produce visual, auditory and other sensory hallucinations. Often, as a result of these impressions, there is an increase in voluntary performance. Erickson studied over 750 somnambulists and concluded that they spontaneously apprehend the surrounding environment of realities differently than subjects at nonhypnotic levels.6 He also observes that one type of reality apprehension does not preclude the other type.
DEHYPNOTIZATION
When good subjects are dehypnotized they usually follow most posthypnotic suggestions, since they cannot recall how or why the commands were issued to them in the first place because of the associated amnesia. If they are able to remember, they can resist because the suggestion is no longer a deeply implanted conviction. If they obey the posthypnotic suggestions, subjects offer innumerable rationalizations for their actions.
Not to belabor the point, the nature of posthypnotic suggestions is similar to that of compulsive acts. Like compulsive behavior, which does not follow logical or reality thinking, a posthypnotic suggestion will be resisted only and after recall that the command was given during hypnosis. Here the reality of the situation is recognized, thus negating the effects of the command. For an explanation of other posthypnotic phenomena, such as hypermnesia, age regression, or revivification, the reader is referred to Chapter 2. Not all posthypnotic suggestions will necessarily be followed if the subject's convictions are at variance with the reality of the situation. Also, every individual has different convictions as to what is right and what is wrong. Likewise, some of the different convictions that subjects report when hypnotized, and some of the differences observed by experimenters, have been reviewed by several investigators.2,8,16
In conclusion, the phenomenology of hypnosis as well as the degree of hypnotizability depend more or less on how the brain has been “programmed” by previous beliefs and convictions. Thus induction of hypnosis is the induction of conviction.12
REFERENCES
1. Arnold, M.B.: Brain function in hypnosis. Int. J. Clin. Exp. Hypn., 7:109, 1959.
2. Barber, T.X.: Hypnosis: A Scientific Approach. New York, Von Nostrand, Reinhold, 1969.
3. Bowers, M.K.: Hypnotic aspects of Haitian voodoo. Int. J. Clin. Exp. Hypn., 13:157, 1965.
4. Cannon, W.B.: “Voodoo” death. Psychosom. Med., 19:182, 1957.
5. Chertok, L.: Psychophysiological mechanisms of hypnosis. New York, Springer-Verlag, 1969.
6. Erickson, M.H.: Further experimental investigation of hypnosis: hypnotic and non-hypnotic realities. Am. J. Clin. Exp. Hypn., 10:87, 1967.
7. Goodfriend, M., and Wolpert, E.A.: Death from fright: report of a case and literature review. Psychosom. Med., 38:348, 1976.
8. Hilgard, E.R.: Hypnotic Susceptibility. New York, Harcourt Brace Jovanovich, 1965.
9. Kelley, E.C.: Education is communication. ETC: Rev. Gen. Semantics, 12:248, 1955.
10. Kline, M.V.: Clinical and Experimental Hypnosis in Contemporary Behavioral Sciences. Introductory Lectures in Medical Hypnosis. New York, Institute for Research in Hypnosis, 1958, p. 1.
11. Kroger, W.S.: Techniques of hypnosis. J.A.M.A., 172:675, 1960.
12. Lacey, H.: Beyond Hypnosis. Whittier, Cal., Independent Publishing Company, 1952.
13. Penfield, W.: Some mechanisms of consciousness discovered during electrical stimulation of the brain. Proc. Nat. Acad. Sci., 44:51, 1958.
14. Ravenscroft, K.: Voodoo possession: a natural experiment in hypnosis. Int. J. Clin. Exp. Hypn., 13:157, 1965.
15. Rowland, V.: Conditioning and brain waves. Sci. Am., 201:89, 1959.
16. Shor, R.E., and Orne, M.T.: The nature of Hypnosis. Selected Basic Reading. New York, Rinehart & Winston, 1965.
17. West, L.J.: Psychophysiology of hypnosis. J.A.M.A., 172:672, 1960.
ADDITIONAL READINGS
Anokhin, P.K.: Electroencephalographic analysis of corticosubcortical relations in positive and negative conditioned reactions. Ann. N. Y. Acad. Sci., 92:899, 1961.
Arnold, M.B.: Emotion and Personality. New York, Columbia University Press, 1960.
Bailey, P., and von Bonin, G.: The Isocortex of Man. Urbana, Ill., University of Illinois Press, 1951.
Barber, T.X.: Physiological effects of “hypnosis.” Psychol. Bull., 58:390, 1961.
Brazier, M.A.B.: Brain and Behavior. Proceedings of the First Conference of the Brain Research Institute, University of California, Los Angeles. Washington, D.C. American Institute of Biological Sciences, 1961.
Crasilneck, H.B., and Hall, J.A.: Physiological changes associated with hypnosis: a review of the literature since 1948. Int. J. Clin. Exp. Hypn., 7:9, 1959.
Diamant, J., et al.: An electroencephalographic study of the waking state and hypnosis with particular reference to subclinical manifestations of sleep activity. Int. J. Clin. Exp. Hypn., 8:199, 1960.
Gorton, B.E.: Physiological aspects of hypnosis. In Schneck, J.M. (ed.): Hypnosis in Modern Medicine. Springfield, Ill., Charles C Thomas, 1953.
__________: The physiology of hypnosis. In The Annual Review of Hypnosis Literature. New York, The Society for Clinical and Experimental Hypnosis, 1953.
Simon, A. (ed.), et al.: The Physiology of Emotions. Springfield, Ill., Charles C Thomas, 1961.