Suggestion and Hypnotizability
The preceding material has been leading to the practical applications of hypnosis. Before this matter can be considered, an understanding of the relationship of suggestion and hypnotizability will be required. Pertinent in this regard is a paragraph from an article written by Heron of the University of Minnesota, entitled “Principles of Hypnosis,” published in the Southern Medical Journal. In this he says, in essence, that everyone, whether as a layman or as a professional man, spends a good portion of his waking time endeavoring to control certain segments of the behavior of other persons. For example, physicians and dentists are concerned with those aspects of the behavior of their patients that have to do with their health. Do their patients look upon them in a friendly manner? Do they accept surgery when advised? Do they follow directions on the prescriptions that are written? Do they take more rest and sleep when they need it?
There are only a few ways in which control of behavior can be attained: by mechanical means, by the use of drugs, by the use of rewards, by the use of punishment, by the use of reason and, very importantly, by the use of suggestion. It is suggestion that is basic in hypnosis.
Many attempts have been made to define hypnosis, both in terms of phenomena involved and in terms of possible causal mechanisms, but no definition has yet satisfactorily answered all the questions raised by the subject matter. Bernheim advanced the concept that suggestion is the basic factor in producing and in utilizing hypnosis. Suggestions need not be of a verbal nature only. They can occur at any sensory level. These include, of course, the olfactory, the gustatory, the auditory, the tactile, the visual, and many others.
Suggestion and hypnotizability are very highly correlated. In hypnosis, repetition is an important factor, as it is in many things, especially in learning. Initially, suggestion and repetition can be considered of basic importance. If asked for a capsule definition of hypnosis, one might say: suggestion and repetition. Everything else that the student learns will be modification, amplification, variation, and explanation of these two basic ingredients.
To these may be added monoedism, concentration on one idea to the exclusion of all others, as suggested by Braid, or in other words the elimination of all external stimuli except those needed to initiate the desired behavior. To this we may add expectant desire, imagination, visualization, and the prestige of the operator. All these play an important part in the initial induction of hypnosis. Any one or any combination of these factors may be involved in producing the hypnotic state.
Bernheim pointed out that there is really no marked difference between normal acts carried out in the hypnotic state and those carried out in the normal, waking state. The term “normal state” might give the impression that hypnosis is an abnormal state. Actually, it is a continuum from the ordinary state of wakefulness.
Furthermore, all the phenomena of the trance state can be demonstrated in at least a minor form in the waking state. If this is accepted, then hypnosis can be considered as the control of behavior (speaking of behavior in terms of thought and action) through suggestion. It is sometimes necessary to influence patients for their own welfare, and suggestion does this very well. The suggestions can include a variety of activity, such as the behavior or suggestions involved in a mother’s singing her baby to sleep: the monotonous, mellifluous, repetitious sound of the lullaby, producing a soporific effect on the child.
Repetitions of direct statements in advertising—Buy Bonds, Buy Bonds; Drink Sparkling Pop, Drink Sparkling Pop—are effective in producing the desired behavior by virtue of their repetition. In regard to one soft drink, this method of advertising has been so effective that it is one of the most widely consumed beverages in the world, not excepting water.
Propaganda advanced by government agencies and others to influence behavior falls within this category. Dentists and physicians occasionally use placebos. They give them to their patients and say, “Take this and it will make you well,” and the patient does take the placebo and it does make him well. But is it the innocuous medication that has accomplished this? No, it is the suggestive therapy that has been previously mentioned.
At this point it would be well to advance some common definition of the word “suggestion.” Webster defines suggestion as the presentation of an idea, impulse, or belief to the mind. However, a psychologically effective suggestion must not only be presented; it must also be accepted uncritically—not uncritically in the sense of being without any evaluation of any kind, but uncritically in the sense that it is reacted to favorably, and leads to initiation of appropriate behavior. To be effective, the suggestion must be acted upon by the subject or patient, even if there are no logical grounds for his acceptance of the suggestion. Thus this definition of suggestion can be reached: Suggestion is an idea that one accepts uncritically and favorably, resulting in the initiation of appropriate behavior.
Before considering a few of the psychologic principles connected with suggestion, it would be desirable to demonstrate one physiologic phenomenon that gives a rationale for accepting a number of the psychologic phenomena. This is the Kohnstamm Phenomenon.
DOCTOR A (demonstrating)
Doctor K has agreed to help us. Doctor, will you please stand up, facing parallel to the wall and about a foot away from it? Feet together, heels together, toes together, shoulders back, chest out, stomach in, at the position of attention. With your left hand, press it against the wall as if you were going to push a hole in the wall. Push hard so that you can feel the tension building up in your arms, your upper arm, your shoulder muscles. In twenty seconds, at the count of three, take a giant step away from the wall. (Lapse of twenty seconds.) One—two—three. (Subject steps away from wall and his left arm rises of its own accord.) There is a perseveration of muscular activity in the arm which caused that to happen. Did you voluntarily help the arm go up?
DOCTOR K (subject)
DOCTOR A (demonstrating)
Thank you very much, Doctor K.
DOCTOR A (demonstrating)
The foregoing demonstrated an entirely physiological response. This may furnish a rationale for accepting the fact that such things do happen psychogenically.
Many of the devices used to help patients psychologically involve the same mechanism, except that it occurs on a psychologic basis. This leads directly into the first psychologic principle, the law of concentrated attention.
THE LAW OF CONCENTRATED ATTENTION
This principle states that when spontaneous attention is concentrated on an idea, the idea tends to realize itself. When the idea involves muscular or other motor activity, it is known as ideomotor activity. When the sense organs are involved, as in feeling, temperature change, and so on, we speak of ideosensory activity. If a person holds his arm out to the side, stiffly and rigidly, with his eyes closed, and thinks to himself that there is a rope tied to his wrist, upon which someone is pulling harder and harder to force it in front of him, the arm will gradually move toward the front without any conscious effort. The arm moves, and it is on a psychologic basis, without any voluntary activity. That is ideomotor activity. When sensations are involved, such as those related to temperature change and anesthesia, the process is known as ideosensory activity. These activities combine to form a neuropsychophysiologic reorientation and reintegration within the person, with the resultant sensory and/or motor changes described.
The second important psychologic principle involved in suggestion is Coué’s “law of reversed effort,” which is sometimes known as his law of reversed effect. It says this: When the will and the imagination come into conflict, the imagination always wins. When one thinks that he would like to do something but feels he cannot, then the more he tries the more difficult it becomes. If a person were asked to walk along a twelve-foot plank placed on the floor, he would have no difficulty in doing so. But if the plank were placed on two chairs about twenty or twenty-four inches from the floor, he might have some difficulty traversing the plank from one end to the other. Then if the plank were placed across a courtyard at the twelfth story between two office buildings, what motivation would he need to have to induce him to cross that plank? What happens to him? He gets up there and notices the distance from the ground. Then he thinks to himself, “I might fall,” and then, “I might not get across.” The harder he tries to traverse that plank, the more difficult it becomes for him. This principle will be used over and over in hypnotic induction procedures.
THE LAW OF DOMINANT EFFECT
The third principle is the law of dominant effect. Here we learn that attaching an emotion to a suggestion makes it more effective. Furthermore, a stronger emotion tends to repress or eliminate a weaker one. For example, if two students are studying and one does not feel like studying any more, he may suggest to his friend, “Let’s go to a movie.” He may follow this with the reminder, “You remember the last time you studied hard before an exam you flunked?” The chances are that his friend will then put his books aside and say, “Well, let’s go.”
Suggestibility has been described as the degree with which one readily accepts suggestions. This must be distinguished from gullibility, which involves the use of deceit. Erickson has described suggestibility further as a capacity, or indication of one’s capacity, to respond to ideas, which is normal. Suggestibility is a function of normal behavior. All of us who are normal are suggestible. If that were not so, we would spend all our time analyzing the suggestions made to us: “What does he mean by that?” and we would have no time left for normal, ordinary responses.