In this book, many cases that have recovered following hypnotherapy have been described for illustrative purposes. However, just as there are dramatic successes, there are equally dramatic failures. These can be divided into problems during induction and problems during hypnotherapy.
FAILURES DURING INDUCTION
Fortunately, in the hands of a sophisticated hypnotherapist, failure to attain some degree of hypnosis is rare. This is especially true if the onus and the responsibility for going into hypnosis are carefully explained to the patient beforehand. Nearly all individuals can be hypnotized to some degree if the permissive and motivational technics described in this book are utilized. In the rare cases of those who cannot be hypnotized, one should be sure that certain misconceptions have been clarified. Some of these are described below.
Fear of Submission
The egocentric type of individual who fears being subordinated by the hypnotherapist's suggestions can be difficult to hypnotize. In spite of careful explanations to the contrary, many apparently willing individuals harbor this fear. Within this group are persons who have dominant personalities or who have a need to maintain a “one-up” position. To obviate this fear, which is a common cause for failure, the operator can casually remark during the initial phases of the induction, “You need follow only those suggestions which are fully in accord with your needs and wishes.” It is really surprising how conducive to greater hypnotizability this statement is, if it is unobtrusively inserted during the verbalization technic. The following case is a good illustration:
A very successful insurance company executive, a chronic alcoholic, could not be hypnotized by several physician-therapists or by two lay hypnotists. During the author's initial discussion with him, it was obvious not only that he feared being relegated to a subservient role, but also that he was poorly motivated to relinquish the symptom. Because of his repeated failure to be hypnotized, he was emphatically assured before induction, “You will hypnotize yourself; I will only act as teacher. If you follow my instructions, and I cannot force you to follow these, you will develop a deep state of relaxation at your own pace and in your own particular fashion. You have actually hypnotized yourself to the point where, try as hard as you might, you cannot stop drinking. You are the one who developed the symptom, and you are the only one who can remove it.” He agreed that all these assertions were logical and that he would do his best to follow all suggestions.
Five inductions were attempted over a period of 2 weeks. At no time did he appear to enter hypnosis, regardless of the technic employed. Following each session he triumphantly stated, “Doctor, I didn't feel a thing. I did everything you said. Guess I'm a hopeless case. You sure tried your best.” Although it is easy to blame the patient, without doubt this individual was wholly unable to submit to another person's directions because of his inordinate need to maintain control. Furthermore, he was looking forward to defeating every therapist, and by such maneuvers he had a perfect alibi for maintaining the chronicity of his symptom.
Lack of Motivation
Those who have little or no desire to get well are poor subjects for hypnosis. It is almost impossible to induce hypnosis unless the patient is sufficiently motivated. Many patients, such as alcoholics, smokers, and overeaters, do not wish to yield their symptoms because they have a “pleasurable neurosis.” The following is a typical example:
An extremely obese woman, who had seen numerous physicians, stated that she would like to try hypnosis for weight reduction, and that she would follow a diet, take her medication, and faithfully follow all directions. During her first visit she was informed, “Of course you mean every word you say, but behind your ardent protestations that you wish to lose weight are deeply unrecognized desires to cling to your symptom. We shall see how well you do.” Hypnosis was attempted by a wide variety of technics during several intensive sessions. In all instances she stated, “I hear everything you say and I do follow all of your suggestions, but I just can't relax.” She decided to break off therapy. Perhaps it would have been better if the nature of her resistances had been discussed and worked through before attempting hypnotic induction.
The hypnotherapist must recognize that, even though such failures will be encountered, there are other patients who, even though poorly motivated, can be helped by the establishment of healthy objectives. In cases such as the one just described, emphasizing the value of hypnosis as a powerful therapeutic adjunct in relationship to the cosmetic and health factors is highly motivating. The therapist must mobilize the patient's faith that he will be helped.
During the actual induction, many reluctant and poorly motivated individuals, especially those with habit patterns, can be induced by such suggestions as, “If you really wish to control your bodily functions (such as your appetite) and coordinate your thinking with your bodily processes, all you have to do is to slowly raise your arm about an inch at a time. With each inch that you raise your arm, tell yourself, ‘I am going deeper and deeper with each movement of my arm upward. I will indeed go deeper and deeper relaxed. In this way I will obtain greater mastery over such functions as my appetite.’” These suggestions are given just before arm levitation is suggested, and they can be repeated several times while the subject's arm is slowly being lifted to the perpendicular position.
To avoid failure, motivating the subject each step of the way usually ensures success, especially if the individual's attention is focused on one suggestion after another. If the suggestions are not clear to the patient, failure in induction can be expected. The commonest one is during eye closure or arm levitation. The patient will remark, “I thought my eyes (or arm) would close (or be raised) by itself.”
Resistances to Induction
The handling of resistances to induction has been discussed in Chapter 13. In general, those manifested during the induction procedure are utilized to defy the hypnotherapist. Many patients equate hypnotizability with imbecility; others are too analytic or know too much about the “misdirection of attention” that is involved in hypnotic induction. Still others, like the one just described, have an “I'll-bet-you-can't-hypnotize-me” attitude. Such individuals fear someone who they think is omnipotent. The explanation that no one hypnotizes another individual can eliminate this resistance. One can remark, “You are the only one who can hypnotize yourself; I really have very little to do with it. If you follow the simple suggestions, and I have no way of knowing whether or not you follow these, then you will follow the more complicated suggestions. However, if you break one link in the chain, then the entire sequence of suggestions will be interrupted. For instance, if I suggest that you count to yourself and you do not, since I have no way of knowing this, I cannot do very much about that, can I?” Such measures enlist the active cooperation and participation of the patient.
Other patients panic when they feel themselves entering into a hypnotic state:
A very well-known screen actor consulted me for his homosexuality. As he felt himself sinking deeper and deeper into the hypnotic state, he began to shake, perspire, and show other symptoms of inner turmoil. When asked why he was acting in this fashion, he stated that he had a mutual masturbatory fantasy which involved me. By such measures the patient was attempting to seduce me and yet at the same time he was attempting to comply. Since he had ambivalent feelings with reference to the acceptance or the rejection of my suggestions, he experienced panic when he felt that he was about to be hypnotized. Naturally, these feelings were worked through before further induction was attempted.
Other patients' resistances can be handled by asking them to discuss their feelings. It is generally a good idea to interrupt the hypnotic induction if the patient is not following the suggestions. For example, if the patient does not raise his arm when it is suggested, one can remark, “If you wish to continue, it's up to you. Your arm will not move up by itself. If you want to go into a deep, deep relaxed state, you will raise your arm at your own pace, and in your own particular fashion. Remember, you are in charge.” If the arm does not rise, the hypnotic induction should be terminated. The therapist must not evince the slightest show of anger or blame the patient. Rather, it is much better to state, “Perhaps I did not make myself entirely clear in our preliminary discussion. You did very well, and next time I am certain that you will do much better.”
Often, arrogant and skeptical patients cannot be hypnotized by the conventional approach. A disguised technic or giving a placebo under the guise of its facilitating hypnosis often increases the susceptibility of refractory subjects.
FAILURES DURING HYPNOTHERAPY
Disraeli once stated that there are three types of lies: little lies, big lies, and statistics. There are no accurate data available, comprising long-term follow-up studies, to evaluate the failure rate in selective cases treated by hypnosis. These probably do not exceed those treated by other psychotherapeutic methods. However, most of the cases of failure, as herein described, are in the therapy of symptoms of a bizarre nature which have exhausted other therapeutic approaches. Therefore, it is not surprising that a relatively high incidence of failure will occur during hypnotherapy.
These failures are due to (1) difficulties in the patient; (2) difficulties in the hypnotherapeutic management; and (3) difficulties in the therapist management. All these, singly or in combination, are usually responsible for failures in patients, even if they readily can be hypnotized. One should, therefore, continually bear in mind the dictum, “One is not treated by hypnosis, but rather, in hypnosis.”
Difficulties in the Patient
To avoid such failures in this group, patients should be carefully screened and selected.
A 42-year-old man was referred for hypnotherapy because he had a profound dislike for his facial appearance. Since childhood, he had been called “Hawky” because of his sharp, aquiline features, particularly his nose. In reality, he was a nice-looking, well-groomed individual of excellent body build. He had had three marriages, the first to a prostitute, the second to a burlesque dancer, and the third to a woman who had become pregnant by another man before he married her. His third wife, because of his “ugliness,” insisted that she had the right to have sexual relations with another man. Otherwise, she threatened to divorce him. He never had been able to relate to women and had poor social relationships. He had no understanding of his deep-seated masochistic needs, evidenced by his neurotic attachments (all three of his wives browbeat him and were below his social and intellectual status). He stated that he had been in “therapy” for several years. Now he asked, “Can't you just hypnotize me into thinking that I am good-looking?”
It was obvious that he attributed all his troubles with women to his appearance, never realizing that he had a deep-seated personality problem. He was informed that it would be impossible to produce an amnesia by hypnosis for the feelings associated with his facial features. He mentioned that he was going to have plastic surgery for correction of his narrow nose. It was emphasized that this should be postponed until he understood the real needs for his emotional difficulties. Despite this advice, he insisted on being hypnotized. Naturally, this was refused. He went to another hypnotist-physician, who failed to help him for the obvious reasons given above. Fortunately, also, he could not get a plastic surgeon to operate on him.
If hypnotherapy is utilized as an adjunct in the framework of a psychotherapeutic approach based upon a good doctor-patient relationship, failures will be less frequent.
When hypnosis is indiscriminately employed, without careful patient selection, it is only logical to assume that a high incidence of failures will occur. Therefore, the therapist, on the basis of his judgment and clinical acumen, should understand the motivations behind the desire for hypnotherapy when it is requested. It is these motivations that can be the determining factor as to whether or not failure will ensue. All too often, patients are looking for the magical removal of symptoms and expect to be cured “in the third act.” Failures are inevitable if patients are unwilling to recognize their unrealistic demands. The patient who is trying to “climb into the therapist's lap” is destined to be a failure.
A 44-year-old alcoholic woman requested that hypnosis be tried for the alleviation of drinking. She revealed that she was frigid with her husband but sexually responsive to another man with whom she had many clandestine meetings. She evinced considerable guilt over her extramarital relationships as therapy progressed, but refused to recognize the deep-seated need to suffer and atone, evidenced by her continual need to degrade herself in drunken debauches.
Though readily hypnotizable, she made little progress—she wished to maintain her relationship with her lover but could not face the realities of divorce. She had hoped that hypnosis would effectively suppress her drinking. It was pointed out that she could not have her cake and eat it, too; that if she wished to continue in therapy, she would have to decide whether or not she could make an adjustment to her husband, leave him, or “beat her head against a stone wall” by remaining in her present situation. She broke off therapy soon after, but returned at a later date—sadder but wiser—and began making an attempt to adjust to her husband.
Difficulties Due to Hypnotherapy
Many individuals expect the impossible from hypnosis; namely, rapid relief from long-standing problems. Often they have had years of psychotherapy and yet, when they consult the hypnotherapist, they expect to be cured in several sessions. By far the commonest cause of failure with hypnotherapy is the termination of treatment because the progress is not as rapid as the patient had assumed it would be. It is also surprising how many physicians think that hypnosis is a rapid method. Although many cases involving severe disorders can be improved even in a few visits, the bulk of chronically disturbed patients require many visits and intensive therapy. Even so, this is more rapid than some of the more orthodox approaches.
The most difficult patient is the one who adopts a hopeless resignation about eventual recovery. It is here that the physician must give the subject greater self-confidence and inculcate a more optimistic outlook. Patients who do not develop the necessary mind-set, which is a prerequisite for the acceptance of posthypnotic suggestions, are destined to fail. Their prejudices, biases, and other negativistic attitudes militate against the full acceptance of hypnotherapy. Additional difficulties during hypnotherapy are due to the communication problem. Some therapists “talk down” to their patients; others may “talk over their heads.” Still others show their indifference at nonverbal levels—they lack empathy and do not establish an effective rapport.
Many failures occur in hypnotherapy because the needs for the symptom are not made clear to the patient; this is a potent cause for failure. Psychoneurotics cling to their symptoms, as this provides them with a value system which often may act as a defense. It is, obvious, as well, that not all individuals can recover, as the very nature of their illness precludes recovery.
Many failures result when hypnosis is utilized indiscriminately, without definitive goals. The author remembers a writer who came in with a prepared list of suggestions, all of which involved concentration, creativity, enhancement of his ability, and following through on assignments. This patient expected hypnosis to remove his poor motivations. He had consulted several lay hypnotists without success. Such cases only point up the need to understand the nature of the complaints as they relate to the total character structure.
The following case of failure in hypnosis was tragic:
An exceptionally obese 48-year-old man was referred for weight loss. He had recently suffered a coronary attack. This individual was a successful, hard-driving businessman who was always looking for “angles.” When the author stated his fee, the patient made a counterproposal that he would pay $10 for each pound that was lost. The patient thought that he was going to get the best of the bargain, but, much to his surprise, he lost 40 pounds in 2 months; thus he owed much more than he would have if he had come in at the regular fee. As a result, he broke off treatment and died several months later of another heart attack. A thorough evaluation of this man's incorporative needs was suggested during treatment but was refused. The characterologic difficulties should have been worked through before any type of therapy was instituted.
Another alcoholic woman made “a flight into health.” She, too, had been in analysis and had been referred by her psychoanalyst for hypnotherapy. After four sessions she stopped drinking for 3 months, but then considered herself cured and refused to return either to the analyst or to myself. It was obvious that she used the referral as a means of escaping from the analysis, and the temporary improvement to avoid further therapy. Naturally, as expected, she resumed her drinking and she became very hostile for a slight pretext, namely, that I didn't talk to her long enough on the telephone when she called at 4 a.m. to announce that she had started drinking again. Her drinking was a defense against her intense anger toward an impotent, weak, and passive-feminine husband, who had her “caught in a trap.” The defensive nature of her actions was pointed out.
To obviate difficulties due to hypnotherapy, it is important to outline therapeutic goals. Hypnosis can be directed either to a symptomatic approach or to a characterologic rehabilitation. Individuals who can be treated by symptom removal are those who have poor emotional resources, inadequate time, and poor motivation. For instance, hypnosis can be used for symptomatic relief of smoking in the patient who has a carcinoma of the lungs, or in the one who has a bronchiectasis, without working through the need for the symptom. On the other hand, relief of the symptoms of insomnia or alcoholism may be successful from one standpoint but still may be considered a failure because the individual is wholly unable to adjust to his life situation for other reasons.
In order to avoid these difficulties, it is best to enable the individual to function without the need for frustrations and tensions. Hypnotherapy can also be directed toward facing life problems, rather than retreating into childlike or regressive behavior. Such an approach facilitates a good work and relaxation record, unimpaired sexuality, and ability to adapt to life stresses. Some patients have to be taught how to accept a subordinate role without “boiling up inside.” Others must understand that they can assume leadership, and still others must realize their limitations. In general, hypnotherapy will eliminate encountered difficulties, if the therapy is directed toward the establishment of confidence, self-assertiveness, and greater tolerance.
The use of autohypnosis usually enables the patient to use self-exploration to work out his problems more effectively. However, autohypnosis is seldom successful if the patient is not motivated to participate in the working-through processes.
Difficulties in hypnotherapy are noted in the individual whose emotional resources are inadequate to cope with his problems. Often it is permissible for the therapist to assume the role of a paternal figure and deliberately foster dependency. This is especially helpful for those who have had a recent bereavement. In others, who wish to cling to their symptoms, one can utilize symptom substitution, as described in other situations, to avoid therapeutic failure. In the case of the stutterer, for instance, anxiety was averted by teaching him to transfer his blocking to the twitching of one of his fingers. There are other individuals who never can completely recover. For these, partial improvement based on limited goals is not a failure. In the case of the passive-dependent alcoholic, who can be controlled for short periods and who makes only a partial adjustment, some modicum of success is achieved.
Other individuals rationalize their reasons for seeking hypnotherapy, and this results in failure. In one instance, a psychopathic male prostitute attempted to save his unhappy marriage through being hypnotized. At first he presented himself with symptoms of insomnia and nervousness. During the anamnesis the real reasons for seeking hypnosis were revealed. He was advised to seek marital counseling.
Another individual wished to learn autohypnosis, ostensibly to be able to concentrate on his work as a physicist. In reality, he felt wholly inadequate around women, and he had hoped that hypnosis would give him more self-reliance. He stated that he had been in psychotherapy for several years, but had heard that autohypnosis enabled individuals to overcome all sorts of psychological problems. A thorough personality evaluation was advised, together with a discussion of his various difficulties. It is important for the therapist to recognize that overcoming inadequacies and lack of confidence requires learning how to handle the reasons derived in therapy. This takes a considerable amount of time.
Difficulties occur when passive individuals, such as certain types of homosexuals, submit to hypnotherapy only to derive masochistic gratification from the all-powerful figure of the therapist. Unless these neurotic motivations are understood, improvement will be retarded. A case in point is a homosexual male schoolteacher who was unable to carry out his sexual needs for fear of apprehension. As the result of his frustration, he utilized the hypnotic situation to yield to and to fight against authority at one and the same time. Failure was averted when it was pointed out how he was fulfilling his passive needs and also reenacting the same conflict he had had with other surrogate figures. He ultimately made a satisfactory recovery.
To summarize, lack of motivation and inability to face life's problems are the commonest reasons for difficulties in hypnotherapy. Those who have no desire to make an adequate adjustment to their situations, because they develop anxiety reactions, fall into this group. Those who have poor inner resources and are unable to tolerate frustration and anxiety usually do not have sufficient strength to receive help from any type of hypnotherapy. Another common difficulty is the secondary gain value of the symptom to the psychoneurotic individual. All these difficulties have been discussed in this book.
Difficulties in the Therapist
In general, hypnotherapy should utilize the individual's own capacities to work out his problems. If the therapist assumes an authoritarian role, the patient will never become completely free from authority, nor will his character structure be changed. Therefore, throughout this volume, the use of autohypnosis and sensory-imagery conditioning has been stressed repeatedly. Every patient is informed that it is his problem, that he has “sales-talked himself into it, and, likewise, he can just as readily sales-talk himself out of his complaints.” It is really remarkable how such a gross oversimplification can be highly motivating to the skeptical and resistant patient.
Often the therapist may set standards that are too high for the patient to fulfill; this only causes further depression and anxiety. By such an approach the therapist does not give the patient enough motivation to seek further assistance; this only mobilizes hostility and usually results in discontinuance of the therapy. Moreover, such a parental or authoritative approach never allows the individual to grow up and develop an acceptance of himself. He will remain dependent upon the therapist, requiring repeated reinforcement and support. If all these mechanisms are not understood, strong dependency always will be maintained.
It is surprising how minor factors may produce difficulties due to the therapist. The author recollects an interesting patient who had complained of menopausal symptoms of several years' duration. It is his custom after the third or fourth visit to call his patients by their first names. When this was done in her case, the patient broke off therapy, even though she was making good progress.
The commonest difficulty stemming from the therapist is his own countertransference feelings or the way he feels about the patient and hypnotherapy. If he feels some personal antagonism to the patient, he should not treat him. Or if he feels insecure with the method, he will, on the basis of subliminal cues, transmit his own insecurities to the patient. Such therapists will, as a result, see nothing but dangers, because hypnotherapy is, in reality, dangerous for them! Therefore, those therapists who think that hypnotherapy is fraught with dangers are undoubtedly transmitting their personal convictions.
In this chapter, the author has attempted to present briefly some of the reasons for failures with hypnotherapy. Usually, successful cases are stressed for teaching purposes. The hesitancy to present failures or unsuccessful cases is understandable, but these are equally valuable for instruction. Admission of failure is a sign of intellectual and emotional maturity. The author used to conduct a weekly class for postgraduate students which might well be called “My mistakes of the week clinic.”
Hypnotherapy, while an ancient science, is still struggling against great handicaps because of irrational prejudice. The author has his share of failures and relapses following hypnotherapy. However, he generally attempts to analyze the reasons for them. He also is well aware that the placebo effect of any type of psychotherapy is over 60 per cent, and that many get better irrespective of the therapy.
There are also spontaneous remissions. It is the author's hope that this chapter will contribute to a better understanding of the role that hypnosis plays in psychotherapy. Also, it should be pointed out that one can over emphasize failures with hypnotherapy as well as sensationalize cures; neither should be told to patients. An increasing knowledge of its successful applications and the reasons for its failures eventually will accord this modality a secure position in medical practice and therapy.
In conclusion, it can be stated that the same measures may be utilized to avoid failures in hypnotherapy as in any other psychotherapeutic procedure. First, the nature of the patient's values as well as his motivation for recovery should be explored; next, the need for his symptoms in terms of their secondary gain value. Such information can usually be obtained in the one or more evaluation sessions before hypnotherapy is instituted or even attempted. To avoid failures, hypnosis should be used, in most instances, with reeducation, supportive and psychodynamic psychotherapy, behavior modification, group therapy, and other eclectic procedures, including drugs.
Authors: Kroger, William S.
Title: Clinical & Experimental Hypnosis: In Medicine, Dentistry, and Psychology, 2nd Edition
Copyright ©2008 Lippincott Williams & Wilkins
> Back of Book > Appendix
Appendix
An Interview with William S. Kroger, M.D. by Michael D. Yapko, PhD.
This interview was first published in the Milton H. Erickson Foundation Newsletter in the Winter, 1987, edition (Vol. 7, No. 3, pp. 1-4). It is reprinted here with the kind permission of The Milton H. Erickson Foundation. The Foundation's address is: 3606 North 24th Street, Phoenix, AZ. 85016. The Foundation website address is: www.erickson-foundation.org.
This interview was subsequently published in the American Journal of Clinical Hypnosis in the January, 1996, issue (Vol. 38, No.3, pp.164-171). It is reprinted here with the kind permission of the American Society of Clinical Hypnosis. The Society's address is: 140 N. Bloomingdale Road, Bloomingdale, IL. 60108-1017. The Society's website address is: info@asch.net.
INTRODUCTION
William S. Kroger, M.D., died this past December at the age of 89. Dr. Kroger was one of the most highly distinguished, elder statesmen in the field of clinical hypnosis. Born in 1906, Dr. Kroger's fascination with hypnosis developed at a young age, and endured throughout his long, extraordinary career. Not only did Dr. Kroger write the book that was long considered THE book on hypnosis, Clinical and Experimental Hypnosis in Medicine. Dentistry, and Psychology, but he authored and coauthored many other important works, including Hypnosis and Behavioral Modification, and Psychosomatic Gynecology and scores of scientific articles. Dr. Kroger's precedent setting visual recording in the 1950's of a thyroid surgical procedures done with hypnosis as the only anesthetic remains a landmark event in helping propel the young and then questionable field of hypnosis onto its current level of acceptability. Anyone who professionally practices hypnosis owes a great deal to William Kroger, whose pioneering efforts paved the way for the field to grow to its current proportions. Dr. Kroger was interviewed early in 1987 at the annual meeting of the American Society of Clinical Hypnosis. This interview was originally published in the The Milton H. Erickson Foundation Newsletter.
MY—First, let's talk about Bill Kroger. Can you provide some biographical information, such as when you were born, where you were born, and where you got your training?
WK—Three great things happened in April, 1906: The San Francisco earthquake, and the birth and death of Dr. William S. Kroger. I was born dead at Mercy Hospital, and revived by the famous Dr. De Lee, who was the father of modern obstetrics. My mother was the original behavior modifier: She said to me, “Dr. De Lee saved your life-you've got to be like Dr. De Lee.” And so I had to fashion myself on the pattern of Dr. De Lee. I slowly and systematically was (shaped) into being an obstetrician/gynecologist. I Went to Evanston High School, class of ′24. I went to Northwestern University in Chicago, a brand new school, but a great school. In 1931, I was functioning as an intern/extern at the Evanston Hospital under the great Dr. Danfurth, who was president of the American Gynecological Society, and Dr. Christopher, whose book on minor surgery was a classic. I had also become very much enamored of psycho-analysis in 1926, when I met Lionel Budson in medical school after he had just come back from being psychoanalyzed by Freud. He had astudy club, which I attended with many prominent psychiatrists and psychoanalysts of the day. This was the beginning of the Chicago Psychoanalytic Institute. I applied for candidacy, but they didn't allow me because I wasn't practicing as a psychiatrist. But, I did take many of the courses and I had an analysis under Rudolph Hurst at the Institute, and I also worked under Franz Alexander. I was very much involved with psychoanalytic theories and principles, so much so that I wrote my first book, called Psychosomatic Gynecology. It is an anthology of everything germane to the female. It starts with the womb and ends with the tomb. It's the first book on hypnosis and hypnoanalysis—it takes endocrinology and neurobiology and puts them in a general systems approach and [considers] every condition including premenstrual tension, and anorexia nervosa. Now, mind you, this was between 1941 and 1951. It was a classic, and it made my reputation. It was [especially] important for hypnosis because I was asked to lecture at schools and medical meetings of repute (after its publication).
MY—Which of your works would you consider to be the most significant?
WK—Psychosomatic Gynecology was the most significant work I ever did because I took everything and looked at it from a multidisciplinary approach. The endocrinological, the neurological systems … in fact, our chapter on neuroendocrinology is as fine as anything that could be written today, and it was written over 45 years ago! We even had a chapter on the limbic system, which is just beginning to be talked about now. We had immunological aspects of cancer in that book, even personality profiles … we had a tightly written book, approximately 500 pages, and I'm quite proud of it. It's not out of print, it can still be gotten.
MY—Your interest in hypnosis obviously started very early on.
WK—My interest in hypnosis started in 1919. My father had a fur store in Evanston, Illinois. To stimulate business, a professional hypnotist was hired to hypnotize a woman as a publicity stunt in order to create interest in the Main Street Businessmen's Association. This I can see as if it was yesterday. The girl's name was Florina, and she was dressed in purple flowing gowns and veils. And the hypnotist, with the piercing eyes, approached her and said, “Fiorina, sleep!” He stared in her eyes, and she fell backwards and then they put her in a coffin and buried her in the ground. I was a curious little cuss, and so I went by and paid a nickel to see this sleeping beauty in the ground. She lay there in a vault for two days, and I thought, “Gee, that's fantastic!” On the third day, they dug her up. “Fiorina, wake up!” She opened her eyes, she blinked, she stood up—it was the same things you'd see on stage today.
So, I went around to the kids in the neighborhood and I looked into their eyes and said, “Sleep!” And, to my amazement. half of them fell over! I did the usual things, like put pins in their arms. I thought, “Jeez, I could be a doctor some day—this would be great for anesthesia.” So, I didn't realize that hypnosis was anything more than a stage tool until I got to Northwestern University. At Northwestern University I met the late Dr. J.D. Morgan, whose book you may be familiar with on abnormal psychology. We had several lectures on hypnosis, and I thought, “My God, this is a scientific tool!” Dr. Morgan and I soon became good friends. I opened up an office near him and he used to drop by or send me patients, and was a great admirer of my work. I was the only doctor then who was using hypnosis in the Chicago area. 1 was laughed at, ridiculed, vilified, and abused. I was made to walk seven steps behind everybody else, like I was a leper. I was even persecuted as an exhibit by the Illinois State Medical Society. They were just against hypnosis—the (very) word.
MY—Why do you say “persecute?”
WK—They made life miserable for me … barred me from this and from that …
MY—Really? The pressure was that bad?
WK—Sure, they threatened me! Oh, the difficulties I went through (to use hypnosis). You don't know how difficult it really was!
MY—What an incredible uphill battle!
WK—Very much so. I was fighting a crowd.
MY—Your convictions were strong. It didn't intimidate you?
WK—[No, because I knew I was right!] When I worked in a drug store, if you'd walk in and I'd say to you, “This is good medicine, you take it and you'll get better,” you came out ahead. The patients clearly did better than if I'd say, “I don't know if the medicine is any good, but try it anyway.” So, I asked myself, what is the X factor that makes a drug work? It must be suggestion. Later on, I found out Emile Coue was a pharmacist. He coined his famous phrase, “Day by day in every way you're getting better and better” by noticing the effects on his patients from the way he'd interact with them, both his nonverbal and verbal communication. Communication is of profound significance in getting individuals better.
MY—You became very interested in organizing other professionals with an appreciation for the clinical uses of hypnosis.
WK—Yes, I did. I was one of the cofounders of the Society for Clinical and Experimental Hypnosis, and later helped form the American Society of Clinical Hypnosis-about six or seven years later. My wife and I put on the greatest hypnosis meeting of its time, as a matter of fact. We put on a hypnosis meeting for the SCEH, and we had the largest turnout of any meeting everthere were over one thousand people there. We started with only $40.00 in the treasury.
MY—Can you talk about your relationship with Milton Erickson?
WK—I met Milton Erickson in the late 1930's when we attended the American Psychological Conference at Northwestern. We had been “pen pals” until then, and when he came to my office I showed him some very interesting cases I had. So, Erickson and I were pen pals and [then] became friends for many years. Later, we taught together. It seems now I' m the only guy who doesn't say much about him, and yet I was probably closer to him than anybody.
MY—Are there some things that you'd like to be able to say about him?
WK—Well, I would say he was the original behavior modifier. He was a master of the double bind. I would say that the hypnosis didn't play such an important role [in his work], but the way he structured a situation was ingenious. He'd force the patient into a recovery, and that was his forte. I think he had a good feel for people and, of course, he had a demeanor that inspired confidence. He spoke with assurance. For example, if he was working with a pain problem, he might say, “Look, do you think you could have less discomfort?”, or “Would you be willing to keep less discomfort?”, or “Would you like to have less discomfort than you're willing to keep?”, or he'd say, “Don't you think you're overdoing it? Now, I think it's time for a change.” Words can kill and words can cure! He was the great master of words. That's how he did it. It wasn't so much the hypnosis as I see it. We taught many seminars together.
MY—What's your impression of all the focus on Erickson?
WK—Well, I think a lot of it is merited. Erickson contributed a lot, but his stuff will-have to be put in the proper perspective. Its significance has perhaps been carried a little bit too far. Erickson might come out of his grave and ask, “Is this me?” Erickson was a very modest man.
He was never looking for self-aggrandizement. I attribute his techniques to a profound knowledge of human nature, a solid eclectic psychology on the nature of everyday living. He could take a patient into his heart. That was his secret, the patient could feel his empathy. It wasn't so much what he did, but it was that feeling the patient had in knowing that he cared. And then, of course, he could structure the therapy well.
MY—There is so much word by word analysis of his techniques.
WK—Those are after the fact, though. Erickson was a gifted therapist, an honest man, and a dedicated scientist … Erickson used to sit and talk to me about many things, and he was very receptive when I'd talk to him about brain-computer analysis.
MY—How do you describe the process of hypnosis?
WK—No other living system can do [what humans can]. Ideas have representations and names. You can't say to a dog, “Go to the toilet.” He doesn't understand toilet. But a human canand that makes humans unique, because they can manipulate symbolic communication. The cortex is uniquely different in a human than in any other living system. And it's the cortex that you get out of the way (in terms of its criticalness) that allows you to introduce a feeling of belief. So, what is hypnosis? It's the induction of conviction. People may say “hypnosis is this” or “hypnosis is that,” but it's a very simple thing that's [been made] enormously complex.
MY—What would you most want readers to know about what you've been doing? There are so many things you did that were dramatic; I think one of the most dramatic was the film on the thyroid surgery. It amazed me.
WK—Yes, that was an important film. It was an historical moment. First one in the world, and we pulled it off! (The medical director] was sitting downstairs in his office, getting a blow by blow description of how the surgery was going. He was hoping it would fail [because hypnosis was involved]! (That tells you something about how things were.) I was an angry young man, you sec, because I had to fight against the crowd. I had to fight and it left a scar on me, and 1 recognize it. Individuals who have never gone through things like that can't really understand it. You see, today hypnosis has some respectability. But in those days, people said, “Walk seven steps behind me, you're a leper!” They didn't want to associate with me. They said, “You're a hypnotist” (as if that was the worst thing you could be).
MY—It must be very gratifying for you to see, because of your efforts, how far this field has advanced.
WK—Well, naturally, I'm pleased … to think that the fruit of my efforts, not only by me, but by others, too, that my work not only in hypnosis, but on psychosomatic medicine, sex, and other subjects, have crossed this line of fire and gained acceptance and recognition. If you've lived long enough to see your work come to fruition, that is indeed gratifying because you've spent your whole life on it and you've taken your knocks.
MY—Call it the fruits of your labor, but it's obvious that as you walk around here at the (1987) ASCH convention that everyone knows your name and work.
WK—Yes, but there are very few people who know of my work in other fields. Very few people know I was a pioneer in sex; very few people know of my work in biomedical engineering.
MY—Now in the age of specialization, if people are into therapy and hypnosis, they often don't know what's going on in another field.
WK—You're right. We need to move into areas like general systems theory, adapter control processes, feedback control, serial mechanisms, and brain-computer analogies. That's where today's discoveries in computer technology have to go to compete in tomorrow's market. Hypnosis has become static.
MY—How so?
WK—There's a reification of the same ideas. For example, most people refer to it as a “trance.” It's not a “trance.” To me, that term is like fingernails on a chalkboard! That's the most ridiculous term for it. It's simply a state of increased awareness. If you're more aware, whatever you hear is going to sink in better. If it sinks in better, you get better responses, whether it's hitting a golf ball or having an erection. As Bernheim once said, “There is no hypnosis, only suggestion.” That's how I conceptualize it. I conceptualize it in terms of biochemical engineering concepts as a method of transmitting a message in a minimal noise environment. If the signal-to-noise ratio is reduced, the message is clearer.
MY—What do you see ahead for the field of hypnosis?
WK—I'm going to continue to emphasize the cybernetic principles of feedback systems relative to theories of hypnosis, as well as some of the very important neuropsychophysiological aspects by making the computer analogies. The brain functions like a computer; I'm not saying the brain is a computer—I'm only saying I think we can better understand the brain's chemical qualities and neurophysiological mechanisms in terms of electronic principles and feedback mechanisms.
MY—Your view contrasts the interpersonal views which emphasize language, language patterns, and patterns of influential communication. You obviously don't think they are the best focus for understanding hypnotic phenomena.
WK—Well, language is a signal. It is important what you're saying. Earlier I said that if you communicate that you expect a person to get better, then you can expect him to actually get better. Now, an induction technique is an interesting study on feedback control. I might say, “You are looking into my eyes, your eyelids are getting heavy,” if I am doing an eye fixation technique. And if your eyelids do get heavier, they're not necessarily getting heavy because of what I'm saying. Rather, they're getting heavy because of the fact that I've also positioned you with your head back and now you're gazing up at the ceiling. But you may impute to me a magical omnipotence. You may say, “My God, my eyelids did get heavy! This guy'sgot power!” If someone accepts ideas A, B, C, and D, then he'll likely also accept X, Y and Z. All the time, you say, “Yes, that's why that happened.” And all the time, it had nothing to do with what you're saying, rather it had to do with his beliefs. You're restructuring people's beliefs.
MY—It's interesting that so many people were initially attracted to the simplicity of hypnosis, and yet now it has become so much more complicated.
WK—They make it complicated. I have been studying hypnosis for more than sixty years and it's not complicated at all. It's a very simple process of everyday life. Hypnosis is merely a process of getting a message through without redundancy.
MY—As you've said, minimizing the noise, and maximizing the signal.
WK—Minimizing the signal-to-noise ratio. As I said from the minute we sat down, hypnosis is nothing more or less than the transmission of a message in a minimum noise environment. That's all! Why do we have to have all these other damn meanings to it? They obfuscate everything!
MY—Your use of information processing models holds a great deal of potential for further development of the field. Thanks for taking the time to do this interview, Bill.
Postscript
At the time I conducted this 1987 interview with Dr. Kroger, I had already attended quite a few of his workshops on hypnosis. I admired his gutsiness and willingness to confront difficult issues head on and his ability to make complex things simpler. After a period of more than two years of intermittent correspondence following this interview, I arranged to spend a full day with Dr. Kroger in his home in Palm Springs, California, in December, 1989. There was no specific agenda for this day, other than my desire to learn more from this man who knew so much.
Dr. Kroger pushed me, cajoled me, and challenged me to better understand anatomy and physiology, neurological functions, chaos theory and cybernetics. But above all, he repeatedly emphasized to me the need to “take the patient into your heart.” He never doubted the healing value of warmth and empathy.
Dr. Kroger described himself to me as “an old family doctor,” We discussed cases where he had spent up to six hours with a patient, not typical of today's practices. He was an old family doctor in the best sense—he had started out as a GP in the early 30's and “studied it all, because there were no real specialists in those days.” Dr. Kroger wasn't bragging. He just told me how it was.
As you could no doubt tell, Dr. Kroger valued simplicity. He said to me, “We make simple things complicated. Do we really need hundreds of different psychotherapies?” True to form, he chastised me affectionately whenever I made use of abstract theoretical constructs or ambiguous language. That day, he called himself a “great collator of ideas,” but I think that description is far too modest. He also called himself a “doubter”, one who needed to have things proven to his satisfaction before he could accept them. Toward that end, he was a researcher as well as a clinician (Did you know he did some of the pioneering studies on the efficacy of certain medications, such as Valium and Elavil?). During that last visit I had with Dr. Kroger, he performed an induction with me that was simple yet elegant. Throughout, he reminded me of my ability to learn and challenged me to use that ability in new and different ways. And, he made me feel that he “took the patient into his heart.”
There were many who knew Dr. Kroger far better than I, but I admired William Kroger. I am saddened that the world of clinical hypnosis has lost one of its most important architects and builders.