From the clinical aspect, the experienced operator can observe the signs and symptoms characterizing the progress of an induction. As belief is compounded into conviction, there is, in good subjects, a steady progression toward more obvious relaxation and alertness to the operator's suggestions.
EYE CHANGES
First, during the initial stages of the induction, the responsive subject generally closes his eyes promptly upon command. If there is a momentary lid lag or delay in eye closure, this often indicates resistance, poor motivation, and possible failure. The next objective is to produce a catalepsy of the smallest muscles of the body—those of the eyelids. The eyelid muscles are the easiest to catalepse. All suggestions are directed toward this objective in the manner described earlier.
After lid catalepsy has been achieved, the operator can assume that the subject will follow all the remaining suggestions, because it has already been emphasized that the final result will depend on how well he cooperates. Later the individual is asked to count backward from 100 to zero; this is one of the elementary suggestions. One can remark, “I have no way of knowing whether or not you are going to count backward and, if you do not count in this fashion or do not follow these simple suggestions as they are given, then, of course, you will not enter into hypnosis. The responsibility, then, for not entering the hypnotic state is due to your failure to follow my suggestions in a specific manner.” Thus the onus for entering hypnosis is placed on the subject rather than on the operator.
Other signs indicative of increasing depth are the blinking and the involuntary drooping of the eyelids. The trembling of the eyelids after closure usually indicates further deepening, contrary to the belief of inexperienced operators. After the suggestions are made that the lids are getting heavier and heavier, one notices some blinking and tiring of the lids. The subject, as mentioned earlier, does not know that the lids tire because of the upward position in which the eyes are held. The operator utilizes this blinking, saying, “The blinking indicates that your lids are really getting heavy, getting heavier and heavier.” The next step is based on the operator's judgment, experience and intuition. When there is an increased amount of blinking and fatigue, it is suggested in the following manner that the subject can close the eyes: “At the count of 3, if you really wish to go into a deep, deep state of relaxation, all you have to do is just let your lids close and let them close tight, very tight. That's right, closing, closing, closed. You will close your eyes not because you have to, but because you want to do this. Now, let your eyeballs roll comfortably up into the back of your head for a few moments so that you are ‘looking’ at your own hair. That's right. I can see your eyeballs moving up beneath your lids.” The next suggestion is given in a casual manner: “If you really wish to go into a nice, deep, pleasant, soothing state of relaxation, it is really so easy. All you have to do is just close your eyes and let your eyeballs roll up into the back of your head.” This is much more effective than saying, “I want you to close your eyes promptly and exactly at the count of 3.” (This peremptory command mobilizes a critical attitude. So does, “No matter how hard you try, you cannot open your eyes.” Here you are challenging the subject; with the intonation of your voice or the intraverbal aspects of your communication, you arouse antagonism.)
One can evert the upper lid and, if the eyeballs are rolled upward, be sure that a considerable depth has been reached. If there is no lid reflex when the eyelashes are lightly touched by the tip of the finger, this is indicative of a good response—at least a medium stage of hypnosis has been reached. The production of lid catalepsy is described below.
Spiegel has evaluated over 4,000 cases by means of the Hypnotic Induction Profile (HIP).9 Grades 4 and 5 are identified as highly hypnotizable. They have a typical group of personality traits which can help to formulate appropriate treatment strategies. The features of the grade 5 syndrome are: (1) the high eye-roll sign; (2) the high intact HIP score; (3) readiness to trust relative suspension of critical judgment; (4) an ease of affiliation with new experiences; (5) a telescoped time sense; (6) an easy acceptance of logical incongruities; (7) an excellent memory and a capacity for intense concentration; (8) an overall tractibility; and (9) paradoxically, a rigid core of private beliefs. Some investigators point out that the demand characteristics influence how a person responds to a hypnotic induction,7 and another researcher, though agreeing that the HIP may possibly be a rapid method for screening, cautions that a more variegated procedure may be more effective in clinical situations.2 This depends on the total interpersonal relationship between the patient and clinician.
Wheeler and co-workers on the other hand, found no evidence for the hypothesized relationship between eye-roll and hypnotic susceptibility. He used two widely accepted and validated measures of susceptibility. Eye-roll might be related to trance as gauged by the HIP, but these investigators feel that experimenter bias and selective elimination of subjects must be considered before such a relationship can be accepted.
MOVEMENTS OF HEAD
If the head of the subject spontaneously rolls sideways or forward, the hypnotic depth is increasing. When this occurs, the operator should support the head, as a strained posture usually results in spasm, which can prevent the hypnosis from becoming deeper. Some individuals, however, do not seem to mind the abnormal position and sink deeper and deeper into relaxation. If the jaws relax limply, this, too, is significant of increasing depth.
CHARACTER OF BREATHING
Shallow, diaphragmatic breathing usually is associated with lighter stages, while slow, deep, regular, abdominal breathing generally is characteristic of deeper stages of hypnotism. One can remark, “You will go deeper and deeper with each breath you take. Your breathing is getting lower, deeper, and more regular.” The second phase can be correlated with the rhythmicity of the breathing. To heighten the effect of this suggestion, the operator can breathe deeply in unison with the subject.
If the eyes have not closed, one should say, “Your lids are beginning to close and, as they close, they are closing tighter and tighter; getting very, very heavy; getting heavier and heavier” (ideosensory activity). The more ideomotor and ideosensory activities the individual is involved in, the more readily will he enter into hypnosis—another illustration of misdirection of attention.
LIMPNESS OF LIMBS
While hypnosis is being induced, an arm or a leg can be lifted to see how it falls. If the limb falls slowly, it indicates voluntary control and that not too great a depth has been reached. The test for depth is made by gently clasping the wrist of the patient between the forefinger and the thumb and slowly lifting the arm. If the arm is allowed to fall, and it falls with a thud to the side or the lap, this denotes optimal relaxation and at least a medium stage of hypnosis.
To achieve heaviness of the lower extremities, one remarks: “Your toes are getting very, very heavy. If you really wish to go deeper and deeper relaxed, you can feel a numb, heavy, woodenlike feeling moving up, up, up to your feet, and then to your legs, and then to your thighs. Just imagine, if you will, that you are sitting on your legs, crosslegged. Your legs, beginning with your toes and feet, are really getting heavier and heavier. Your legs are relaxing more and more from your toes, up, up, up to your feet, up, up, up to your legs, and up, up, up to your thighs. And you can, if you really wish to go deeper, tell yourself that your legs from your toes to your thighs are really relaxed!”
LID CATALEPSY
Inability to open the eyes may occur in either light or deep stages. It indicates that the subject can become deeply relaxed. To induce lid catalepsy, one can remark (when the lids are closed), “Your lids are locked tight, tighter and tighter.” At the very second that the eyeballs roll upward, one can remark emphatically, “Your lids are closed tight. Roll your eyeballs up into the back of your head.” This is the eyeball-set. The subject is unaware that it is difficult to open the lids with the eyeballs rolled upward. He attributes this to the operator's suggestions, and this is another instance of misdirection of attention. These nuances of induction technics are picked up only with experience.
This important maneuver can also be accomplished in this way: “At the count of 3, you will close your eyes, not because you have to, but because you want to close your eyes. Do you not? And after you close your eyes, if you really wish to go into a nice, deep, soothing state of relaxation, you will do so. You can now, if you wish, close your eyes tightly—1 … 2 … 3 …. Now, roll your eyeballs up into the back of your head. Very good. You're doing fine.” It is always a good idea to praise the patient's efforts because most subjects wonder if they are responding adequately to the suggestions.
At this point, the individual may attempt to open his eyes. If the suggestions have been given properly, he will not be able to open them. This difficulty is evidenced by the furrows on the brow. If there is any doubt, one says, “If you really wish to go deeper and deeper, just imagine that the harder you try to open your eyes, the less chance you have of opening the eyes.” Motivation is being established each step of the way to coax the patient to go deeper by telling him that, if he really wishes to benefit from future suggestions, he must follow the preliminary suggestions. In other words, one must motivate the subject or use “bait” each step of the way. By the use of such measures, the desire and the responsibility for achieving hypnosis are put on the patient.
ARM CATALEPSY
Arm catalepsy is manifested by the extension of the arm straight up, with the fingers outstretched. The entire arm appears to be drawn up as far as it can stretch. A cataleptic limb resists counterpressure involuntarily and is usually indicative of a medium to deep hypnosis.
The individual is asked to raise his arm slowly. He is told that, if he wishes to relax still more, with each motion of the arm upward, he is to think and to imagine that “with each motion of my arm upward, I am going deeper and deeper relaxed.” By means of this suggestion, the subject associates the idea of relaxation with the resultant ideomotor activity. The following remark is helpful: “With each motion that the arm moves upward, if you think, imagine, and feel that you are really going deeper and deeper relaxed, you will indeed go deeper and deeper relaxed.” This makes full use of ideosensory and ideomotor activities and invariably results in arm catalepsy.
Catalepsy is characterized by an increased tonicity of all the muscles of the arm from the fingertips down to the wrist and from the elbow to the shoulder. The whole body can be made cataleptic. The muscles are balanced against each other, and certain muscles become very rigid without the subject's knowledge. The fingers remain for long intervals in any position in which they are placed. There is an associated waxy flexibility—flexibilitas cerea.
FOLLOWING POSTHYPNOTIC SUGGESTIONS
A good test for medium hypnosis involves telling the subject that, after being dehypnotized, he cannot count the even numbers from 1 to 10. Some subjects will remember that the suggestion was given and can still count, but without omitting the alternate numbers. This indicates that no more than a light stage has been reached. Ways to induce the patient to follow posthypnotic suggestions are given in Chapter 2.
DEVELOPMENT OF GLOVE ANESTHESIA
Although an objective finding associated with the medium stages, glove anesthesia is often characteristic of deep hypnosis. The entire hand can be made insensitive in a circumscribed area from the fingertips to the wrist. This area of the hand will be numb, woodenlike, and “anesthetic.” It will feel just as completely “numb” as if an anesthetic had been injected. As proof, a large-bore needle can be placed through the skin without a facial flinch or grimace on the part of the patient. The technic for its production also is described in the obstetric section in Chapter 33.
FOLLOWING POSITIVE AND NEGATIVE HALLUCINATIONS
When patients accept the validity of hallucinatory suggestions, it indicates that a profound hypnotic depth has been achieved. A negative hallucination, as described in Chapter 2, is produced by making suggestions that an object that is present cannot be perceived (through any of the senses). A positive hallucination is produced when a suggestion is made that something is there that is not present.
SOMNAMBULISM
In somnambulism, patients can walk, talk, and engage in all types of activities with their eyes open, while in a deep stage of hypnosis. Due to the spontaneous amnesia, patients seldom recall what occurred during somnambulism. Anesthesia, hyperesthesia, and dissociation are readily induced.
Somnambulism is one of the deepest stages of hypnosis, easily recognized by the immobility of the features, the staring eyes, the widened palpebral fissures, the flattened nasolabial folds, the masklike countenance, and the dreamy look. There is also an economy of motion or a time lag between the giving of a suggestion and the following of it. The speech is slow and slurred, and there is loss of the startle reflex. The individual is in a state of fixed attention, and there is also a concomitant absorption in his own physiologic processes.
Somnambulism occurs at the nonhypnotic level, too, as in the sleepwalker, or in the individual who spontaneously develops a fuguelike state, without having undergone a formalized hypnotic procedure. During somnambulism, the subject generally responds automatically to nearly all suggestions.
A large body of research indicates that the degree of hypnotizability remains relatively constant and that the various depths cannot be altered by different behavioral-situational factors.14 Gur could not obtain deep degrees of hypnosis using operant conditioning.3 He believes that hypnotizability is largely determined by factors other than situational variables.
Even though all children are not deeply hypnotizable, they are more so than adults.5 This predisposition may, in part, be genetic. Morgan tested 140 pairs of twins and found a significant correlation to support a genetic component.6 He also found that parent hypnotizability was also present, and posited that the child's hypnotizability was environmentally influenced, either through social learning or identification.
REFERENCES
1. Diamond, M.J.: Modification of hypnotizability: a review. Psychol. Bull., 81:180, 1974.
2. Eliseo, T.S.: The hypnotic induction profile and hypnotic susceptibility. Int. J. Clin. Exp. Hypn., 22:320, 1974.
P.57
3. Gur, R.C.: An attention-controlled operant procedure for enhancing hypnotic susceptibility. J. Abnorm. Psychol., 83:644, 1974.
4. Hilgard, E.R.: Hypnotic Susceptibility. New York, Harcourt, Brace & World, 1965.
5. London, P., and Cooper, L.M.: Norms of hypnotic susceptibility in children. Dev. Psychol., 1:113, 1969.
6. Morgan, A.H.: The heritability of hypnotic susceptibility in twins. J. Abnorm. Psychol., 82:55, 1973.
7. Orne, M.T.: On the social psychology of the psychological experiment with particular reference to demand characteristics and their implications. Am. Psychol., 17:776, 1962.
8. Spiegel, H.: An eye-roll test for hypnotization. Am. J. Clin. Exp. Hypn., 15:25, 1972.
9. _________ The grade 5 syndrome: the highly hypnotizable person. Int. J. Clin. Exp. Hypn., 22:303, 1974.
10. Wheeler, L., et al.: Eye-role and hypnotic susceptibility. Int. J. Clin. Exp. Hypn., 22:327, 1974.