Hypnosis refers to just about any situation where we respond to verbal suggestions in a particular special way. This involves a mentally very flexible condition where our imagination and fantasy are more free and more vivid. A series of instructions, called an induction, is the most common way to do this. Just about any situation where we relax and allow ourselves to become absorbed in something can lead to the appropriate conditions for hypnosis. These conditions also sometimes occur without relaxation, such as immediately following confusion or distraction. Most hypnotic inductions involve a highly cooperative process, rather than hypnosis being something that is "done to" someone.

Science and the Arts of Hypnosis

Hypnosis today is often considered from two different perspectives : the sciences used to study how it works, and the arts used to make use of it for specific purposes. These are such very different perspectives for two main reasons. First, there is the schism between the academic and the clinical subcultures that is found in many fields of psychology. Second, there is the particularly wide gap between hypnosis practice and academic psychology because of the periods when hypnosis was considered completely disreputable. This helped to polarize even further those who helped the arts using hypnosis to survive and those who would study hypnosis scientifically.

In science, there is the basic idea of being able to create psychological conditions where people respond to verbal suggestions in a seemingly unusual way. This is what researchers study, and what forms the foundation for the practice of hypnosis as an adjunctive treatment in medicine. In order to study hypnosis in this manner, we define it as precisely as possible, and in most cases we utilize simple tests and suggestions. It is primarily from this perspective that the current document has been written.

The second perspective is the historical creation of the arts of hypnotic influence. This means making use of response to verbal suggestion in order to influence attitudes and behaviors more dramatically or over a longer period of time. This might be a healing art, a performing art, or a form of self-help. When we use hypnosis as a healing art, it is a form of psychotherapy and adheres to the same basic principles and ethical considerations as other forms of therapy. As a performing art, hypnosis has very little in common with psychotherapy aside from the occasional elimination of superficial symptoms by suggestion.

Skill at hypnosis does not automatically confer healing powers or medical qualifications on anyone. If someone is not qualified to treat something without hypnosis, then they are not qualified to treat it with hypnosis either.

For more information on the arts of hypnotic influence, especially hypnotherapy as practiced by non-psychologists, I recommend starting with Roy Hunter's excellent FAQ on the alt.hypnosis newsgroup, maintained at Roy's home page at http://www.hunter.holowww.com. In order to learn more about psychotherapy in general, I highly recommend either of two starting places : Dr. John Grohol's award winning Mental Health page, or Mental Health Net.

1.1 Defining Hypnosis

Since there is no single well accepted theory of hypnosis, the trick is to make the definition as theory neutral as possible, descriptive and not implicitly explanatory. Yet even the description is sometimes controversial. One thing that has become known for certain is that hypnosis is only interesting from a phenomenal perspective.

The subjective experience of hypnotized people is what is special about hypnosis, not any identifiable objective measurements. If there are any objective behavioral correlates of hypnotic experience, they are either so subtle as to escape detection, or so idiosyncratic that we can't draw general conclusions from them.

Prominent researcher E.R. Hilgard provided the following in his 1965 review of the scientific data on hypnosis up to that point (Hilgard, 1965) :

"Without attempting a formal definition of hypnosis, the field appears to be well enough specified by the increased suggestibility of subjects following induction procedures stressing relaxation, free play of imagination, and the withdrawal of reality supports through closed eyes, narrowing of attention, and concentration on the hypnotist. That some of the same phenomena will occur outside of hypnosis is expected, and this fact does not invalidate hypnosis as a research topic."

Specifying exactly what "increased suggestibility" means has been extremely difficult. What this means in practical terms is that the hypnotized person experiences certain classical hypnotic phenomena, particularly in response to verbal suggestion. Years ago, one of the hypnosis researchers (Weitzenhoffer) dubbed this the "classic suggestion effect." The thing that sets these hypnotic phenomena apart from simple compliance with a suggestion is that they are experienced as being somehow effortless or involuntary. This is what sets hypnotic suggestibility (sometimes called primary suggestibility) apart from other kinds of compliance. The sensation of responding in an involuntary way is the most notable difference between hypnosis and other conditions. (Zamansky and Ruehle, 1995).

Both the concept of hypnosis and the practice of hypnosis have been controversial throughout its two hundred year modern history. Since the very beginning of this period, many practitioners of hypnosis as an art form have had great regard for it, and then later come to the conclusion that it consists of "nothing more than" imagination. Little, if anything, that we can do with hypnosis is actually unique to hypnosis. A hypnotic induction is not essential to demonstrate hypnotic phenomena. Modern research has largely confirmed that hypnosis is not a unique physiological state, and that imagination is indeed a central element. At the same time, though, we have come to an increasing regard for the depth and subtlety of human imagination under all conditions !

One of the most promising advances in the theoretical perspective on hypnosis has been the communications analysis approach. This was pioneered by the followers of Milton Erickson and other innovative hypnosis experts who saw hypnosis as a dynamic cooperative process involving intimate human communication as well as imagination, rather than (or in addition to) a problematic state of consciousness.

1.2 What else is "like hypnosis ?"

There are basically three varieties of things that are commonly called hypnosis or compared to hypnosis :

1. Formal hypnosis, which includes relaxation and the use of suggestion,
2. Self hypnosis ("suggestions" are provided mentally and silently, or provided on a previously made tape)
3. Alert hypnosis (there is no relaxation component)

Common examples of how these processes are used include :

• Hypnotherapy : Psychotherapy which emphasizes the use of hypnosis.
• Medical hypnosis : Used as an adjunct to medical treatment to reduce pain or other symptoms.
• Stage hypnosis : Emphasizing confusion, distraction, and social pressure to gain quick, dramatic compliance for entertainment purposes.
• Self-Help : Using taped inductions, prepared scripts, or self-talk to attempt personal changes with the help of suggestion.

Things that have little or nothing directly to do with hypnosis include :

• sleep
• barbiturate-induced stupor
• gullibility or moral weakness
• mental illness
• "brainwashing"

The important elements in things we call hypnosis are, roughly in order of decreasing importance :

• slightly enhanced primary suggestibility for verbal language (words are effortlessly converted to actions and perceptions, we sense our response as involuntary)
• engagement of imagination and fantasy (absorption in a dramatic role, seeming "as real as real", suspension of critical judgment)
• vivid imagery and intense emotion
• cooperative interpersonal communication, response to social cues (there is a guide, and we trust them)
• relaxation and enjoyable stillness

One of the ways to help make a complex definition more clear is to provide examples of things that don't fit. Some of the things that are not hypnosis but appear to share some similarities include :

• Meditation : Meditation often shares some characteristics with our psychological state under hypnosis. Descriptions of our spontaneous experience under some kinds of meditation are similar to those under some conditions of hypnosis. Some people infer from this that the "trance" seen in hypnosis and that seen under meditation is the same. The observation is an interesting one, but there is currently no good way to confirm or disprove this notion, without actually turning meditation into hypnosis by testing for response to suggestions. Meditation does not necessarily involve specific responsiveness to verbal suggestion, or an enhanced sensitivity to social cues. It may or may not involve fantasy. These are important elements in hypnosis, particularly from a process perspective. Sensitivity to social cues is a cornerstone of the communications analysis view of hypnosis, and is absent during meditation. A meaningful definition of hypnosis that emphasizes how we use it will not include meditation as an example, and vice versa.
• Guided imagery : While it appears very similar, and often overlaps, hypnosis is not "just" guided imagery. There are additional important elements to hypnosis that are not generally found in guided imagery. We can certainly engage in guided imagery during hypnosis. But not all hypnosis involves guided imagery, and guided imagery does not necessarily result in hypnosis. More importantly, the skill for imagery is not the same as the skill for entering and using hypnosis. Vivid imagery is an important element in hypnosis, but it is not sufficient. There are other elements needed for hypnosis, including but not limited to hypnosis-relevant attitudes (Glisky, Tataryn, and Kihlstrom, 1995). There is evidence that guided imagery under hypnosis has subtly different effects on the body than guided imagery under relaxation alone. Also, there is so far no strong correlation between abilities at imagery and abilities at hypnosis. Vividness and motor imagery are only weakly correlated with hypnotizability, although the ability to become absorbed in imagery is slightly better correlated with hypnotizability. Ultradian cycles for imagery and hypnotic susceptibility vary at different rates (Wallace & Kokoszka, 1995). Overall, imagery is an important component in hypnosis, but guided imagery is not in any sense synonymous with hypnosis, the underlying ability to do hypnosis and the underlying ability to do imagery are two different things. To illustrate in practical terms that imagery is not the primary factor, it has been observed that verbal hypnotic suggestion takes effect even when we concentrate on imagery that is contrary to the suggestion ! (Zamansky and Ruehle, 1995)
• Self-hypnosis : The main reason why modern practitioners like to say that "all hypnosis is self-hypnosis," is that they feel it is necessary to emphasize that the hypnotized person is the one in control in both cases, and should be the focus of attention in hypnosis study. This is entirely true. Like meditation, however, self-hypnosis is not dependent upon responsiveness to verbal suggestion or responding to subtle social cues, so it really is a different process in some important ways. The key experience of involuntariness or effortlessness in hypnotic responding is shared by hypnosis and self-hypnosis, so they clearly share a similar kind of psychological state in general. However, one involves dynamic responses to ideas, and the other dynamic responses to words. There is no external guide during self-hypnosis. There are differences in the ease with which we can be hypnotized by another person and with which we can hypnotize ourselves. There is some evidence that automated response to words is an important element in hypnosis. For a number of reasons, it is necessary to make a distinction in spite of the similarity of hypnosis and self-hypnosis.
• Self-regulation, or "alert hypnosis" : This includes autogenics, biofeedback, and other methods used to influence autonomic body processes or increase primary suggestibility that do not involve a formal hypnotic induction. These are often distinct from hypnosis because they do not involve responding to social cues, but rather to cues provided by instrumentation. In addition, there is often no essential verbal component, and no necessity for relaxation. Some would call these methods kinds of "alert hypnosis," and in cases where the remaining elements are present, this is probably as reasonable as the distinction of self-hypnosis for cases where only the interpersonal element is missing.
• Subliminal self-help tapes : Let's assume for the sake of discussion that there exists a "subliminal" technology that actually works. This means that a message is encoded which we can reliably perceive but not be aware that we are receiving it. The message would become what is known as "implicit," meaning that it can affect our behavior though we do not recognize it as a memory of anything in particular. Hypnosis can also create or make use of implicit memory, however that doesn't mean that anything that affects implicit memory is hypnosis. As far as is known, subliminal suggestion would have none of the important elements that distinguish hypnosis ! Why do we even for a moment think that this would work in some way similarly to hypnotic suggestion ? I discuss this in detail in another section.
• Neurolinguistic Programming (NLP) : Neurolinguistic Programming (NLP) is partially derived from careful observation of the patterns in what happens during hypnosis. It is therefore, at least in part, an extension of the communications analysis view of hypnosis. NLP borrows its basic concepts largely from cognitive psychology, which views behavior as guided by schemata or strategies. NLP practitioners use a variety of methods to attempt to determine what strategies people use for various activities, and then to modify those strategies or utilize them for other purposes. Some of the techniques used in NLP also resemble "alert hypnosis," because they use language patterns also used in hypnotic induction to elicit cooperation, build trust, and increase the effectiveness of suggestions. In practical terms, very little of NLP involves hypnosis.
• The Placebo Effect : The placebo effect is the most common name for various bodily responses to expectations, especially with regard to medical healing effects. Placebos are commonly used with control groups in medical experiments, because a certain amount of positive results can be expected in some people because of expectations of a positive result. Attitudes, beliefs, and expectations are known to play a very important role in our behavior under hypnosis, just as they play an important role at other times, and suggestion is a factor in placebo response. The role of expectations in hypnosis is particularly interesting because of the dramatic effect on our imagination. One of the most fascinating examples is in the elaborate role enactment known as "age regression," where the content is often directly related to expectations set prior to hypnosis. Hypnotic suggestion cannot entirely be described as placebo effect, however, as there are a number of distinct differences. Some of these differences can be demonstrated experimentally. This is why we can meaningfully compare hypnosis experimental groups with placebo control groups. Response to hypnotic suggestion is much more closely related to the semantic content of the suggestion than the more general effects of placebo, that is, it is far more specific. The correlation between placebo responders and hypnotizability is good but nearly strong enough to conclude that they are the same attribute. The placebo effect has some overlap with hypnosis, but is not the same thing as hypnotic suggestion. (Evans, 1977; Evans 1981; McGlashan, Evans & Orne, 1969; Orne, 1974)