Popular Science Monthly/Volume 33/October 1888/Hypnotism: What it Is and What it Is Not
|HYPNOTISM: WHAT IT IS AND WHAT IT IS NOT.|
IT has so long been the custom of the world, and of scientific men, to look upon Mesmer as a charlatan, and upon mesmerism as a delusion, that it is surprising to many persons to find that men of ability and repute are now engaged in investigating the phenomena which are still known under the vague title of "animal magnetism." The fact is that the teachings of Mesmer contained a certain element of truth, although it was seriously obscured by self-deception and intentional fraud, and that this kernel of truth has already been so far isolated as to show that it is deserving of serious study.
In the pages that follow I propose to give a concise account of the present state of our knowledge about "animal magnetism," or, as it is more properly termed, hypnotism, and shall endeavor to present certain facts in their real light, which have long been misunderstood in consequence of the teachings of Charcot and his pupils. While it can not be said with certainty that there may not exist some kind of "magnetic fluid" as the cause of the phenomena I shall describe, it is certain that a large proportion of them can be much more satisfactorily explained in other ways. Moreover, there is not at present a single well-substantiated fact, so far as I am aware, which requires the supposition of a magnetic fluid, or other similar mysterious influence, as an explanation. There being, therefore, no actual evidence of the existence of any such force as "animal magnetism," the expression may justly be objected to as a misnomer, and we must seek to replace it by a more suitable term. The word "hypnotism," proposed by Braid, of Manchester, is a very good substitute, and has at least the merit of being noncommittal.
It is not easy to define hypnotism sharply. It is probably sufficiently accurate to say that it is a condition of induced sleep almost identical with ordinary sleep, in which the brain is highly and peculiarly receptive of impressions from the outer world. Ordinary sleep is often disturbed by dreams. These dreams, as every one knows, vary greatly in vividness and character. Not infrequently the objects dreamed of are of the most fantastic and unreal nature, but they are nevertheless accepted by the unconscious individual as realities, and indeed have the subjective psychological value of perceptions. The stimuli which give rise to dreams arise as a rule within the brain of the sleeper; they are spontaneous. Let us now suppose that the stimuli come from the outer world, instead of from the brain of the sleeper, and we have precisely what happens in hypnotism. These stimuli generally consist in words spoken by the hypnotizer to the sleeping subject, who hears and understands everything that is said to him as though it was said in a dream. In many instances the hypnotized person realizes the existence of every object or person called up to his mind by the words of the hypnotizer. He sees the dog, or the man, or the house, exactly as its presence is affirmed by the speaker. He can be made to taste imaginary fluids or hear imaginary voices at the will of the physician, and, as I have just said, all these impressions are as real to him as actual perceptions. His will is so weakened that he can generally be made to execute the most varied motions at the command of the person who has put him to sleep. He may try to resist commands, but the resistance is feeble, and he eventually obeys automatically. His dreams are formed and guided by an external agency, and his muscles are brought into activity and controlled by the same influence.
The ideas, acts, and sensations which can thus be insinuated, so to speak, into the brain of a person in the hypnotic state, through the agency of speech, or any other external influence, are technically called suggestions. Individuals vary greatly in the readiness with which they react to suggestions when hypnotized, and their suggestibility is said to be high or low as the case may be. In general, persons possessed of a lively imagination in the normal waking state, are highly susceptible to suggestion in the hypnotic condition. Thus the two essential elements of hypnotism are sleep and suggestion. The degree of sleep varies in different cases, from the lightest somnolence imaginable, to a condition of profound lethargy, from which the subject can only be awakened with difficulty.
Suggestibility is by no means peculiar to hypnotized persons. Almost every one is sensitive to suggestion to a certain extent when awake, for in every human being, no matter how skeptical he may consider himself, there exists a certain degree of credulity, and this credulity may be played upon and taken advantage of in a measure. Children can be made to believe the most preposterous statements if they are made with sufficient gravity. The majority of healthy children are, moreover, auto-suggestionists; that is, they create air-castles, in which they soon come to believe firmly as objective realities. Too often such auto-suggestions are regarded by parents and friends as deliberate lies. They are in reality simply the creations of phantasy, which have become established as truths in consequence of being unopposed and uncorrected by reason and experience. In the course of time the reasoning faculties are developed and hold the imagination in check. Nevertheless, even adults are met with in whom the imagination so readily gets the upper hand that they may be induced to believe the most impossible things. I recently saw a young woman of moderate intelligence and education who was so readily influenced by suggestion in the waking state that she was unable to move from the place where she stood on being suddenly and decidedly told that it was impossible for her to budge. She could be made to see people who were in reality not present, and on the other hand could be made blind to the presence of persons and objects actually in the room. After repeatedly affirming that she was absolutely insensible to pain, it became possible to pass a needle deeply into the skin without provoking any signs of discomfort.
At first sight, these cases appear like impostures, because they are opposed to common experience, but careful examination shows that there are cases of the kind in which simulation can be pretty effectually excluded. Still, it must be admitted that simulation can readily be overlooked, and that the number of cases in which suggestibility in the waking state is so highly developed must be very small. I am inclined to look upon these higher grades of suggestibility in the waking state as pathological.
These facts have led Prof. Bernheim, of Nancy, to define hypnotism as a peculiar psychical state, characterized by increased suggestibility. In proposing this definition, Bernheim perhaps gives too little importance to the sleep which in the vast majority of cases is essential to the production of a high degree of sensibility to suggestion. At the same time there appears to be no serious reason why the term hypnotism should not be so far extended in meaning as to include those exceptional cases in which the phenomena characteristic of the hypnotic state can be produced without first inducing sleep.
The history of hypnotism is anything but flattering to the penetration and generosity of the various scientific men who during the past century have from time to time passed judgment upon the claims of its advocates, and affords a striking illustration of how the progress of knowledge may be hindered by excessive skepticism.
I can not review even the more important features of the history of "animal magnetism," interesting as it is, except in the briefest manner. The life of Mesmer is full of instruction and romance, and is well worth a careful reading; although one can not help concluding that he misdirected and prostituted his intelligence to his greed of money and love of notoriety, and that he was, upon the whole, a man of very questionable character. As is well known, the central hypothesis of Mesmer's theory is the existence of a subtile universal fluid, which he called "animal magnetism," in the belief that its action was in some manner analogous to that of the magnet.
In 1841 Braid, of Manchester, showed that the majority of the phenomena which Mesmer had sought to explain by means of "animal magnetism" could be just as well if not better explained without the hypothesis of a magnetic fluid. He demonstrated, in other words, that we have no reason whatever to believe in the existence of a magnetic fluid as a cause of hypnotic phenomena, and this was certainly a most important step in our progress. Braid showed that it was possible to throw persons into a condition of trance or sleep without the use of any so-called magnetic passes, and without contact of any kind. In order to induce this sleep, he simply required his patient to look fixedly at a brilliant object placed before his eyes, at the same time that he concentrated his thoughts upon the idea of going to sleep. After a variable period, generally two or three minutes, the eyes closed suddenly, the head fell to one side, and the patient was asleep. Braid found that the intensity of this sleep varied considerably in different cases, and that he could sometimes give rise to hallucinations, emotions, paralyses, etc., by simply giving the subject verbal suggestions; that is, by affirming the presence of these various conditions. The various phases of sleep induced by Braid resembled one another so much that he had no doubt they were essentially manifestations of one and the same condition. This condition he palled "nervous sleep," or hypnotism.
We may justly say that Braid was the first to study the phenomena of hypnotism in a scientific spirit, and to show that they were in no way miraculous or mysterious. Still, his observations were very incomplete, for he failed to appreciate the nature of suggestion and the subtle rôle it plays in the manifestations of hypnotism. In consequence of this. Braid eventually confused hypnotism and phrenology in such a way as to lead him greatly into error concerning the former, and it is probable that, at the end of his life, he was much further from the truth than many years before.
After the appearance of Braid's work, the subject remained in statu quo for a number of years. In England, Braid was looked upon with suspicion, and had scarcely any adherents, while in France a number of scientific men became interested in his work, and contributed many observations upon hypnotism.
These observations in general confirmed those of Braid, and it was not until 1866 that Liébault, of Nancy, came to the front with new facts and original views of hypnotism. We can not follow Liébault into his somewhat vague theories of the cause of hypnotism and its various states. It is enough to say that he maintained that the different physical conditions included under this term are determined chiefly through some form of mental action, and afford striking illustrations of the influence of the mind upon the body. This view of Liébault's is of great significance, for it is the point of departure of the supporters of the Nancy school of hypnotism, who hold that an enormous number of hypnotic manifestations can only be explained through suggestion. Liébault was an extremely conscientious and able observer. He had the courage of his convictions, and, scorned by his colleagues, lived in retirement, practicing among the poorer classes, and devoting his life to the study of the problems of hypnotism. The originality of Liébault's book, and the stimulus it gave to investigation, entitle it to be considered the most important work upon hypnotism which has appeared since the time of Braid.
In sharp contrast to the views held by Liébault and his pupils (Nancy school) stand those of Charcot and his school (school of Salpêtrière or Paris school). Charcot began the study of hypnotism in 1878, and his observations were almost exclusively made upon hysterical patients. His method of inducing sleep is similar to that of Braid. The patient gazes intently upon a brilliant object, and after a variable period falls suddenly asleep. Charcot regards hypnotism as an abnormal nervous state—a neurosis, in fact, of which there are three phases, each possessing certain well defined characteristics. . The patient may be brought from one of these stages into another at will, by means of certain skillfully performed manœuvres. The three states are known as lethargy, catalepsy, and somnambulism.
The lethargic state may be obtained either by fixation of a brilliant object, or by pressing upon the closed eyelids. The condition is characterized by the presence of deep sleep, muscular relaxation, loss of sensation, partial or complete, abeyance of the intellectual functions, and the absence of all reaction to suggestion. A curious hyperexcitable condition of the nerves and muscles (neuro-muscular hyperexcitability) is, however, present, which causes any muscle to contract when its corresponding nerve is excited by friction or slight pressure. Thus, pressure upon the facial nerve (the great motor nerve of the face) causes distortion of the features on the same side of the face.
The second stage is that of catalepsy. It is only necessary to raise the eyelids in order to transform the lethargic condition into that of catalepsy. If only one eyelid be raised, the corresponding side of the body becomes cataleptic, while the other side continues lethargic. The peculiar hyperexcitability of the nerves and muscles is absent in this stage, and the patient remains for some time in any position into which he may be put. In this stage suggestions may act through the sensibility of the muscles as a medium. Thus, if the hands are joined as in prayer, the face grows very grave, and the patient may kneel as if to pray. Catalepsy may be converted into lethargy by simply closing the patient's eyelids.
The third stage of Charcot's hypnotic series is somnambulism. Somnambulism can be primarily induced by fixation, or may be developed out of the lethargic or cataleptic stages by light friction on the top of the subject's head. The sensitiveness of the subject to suggestions is very greatly increased. The neuro-muscular hyperexcitability is not present, and contractions can not be produced by excitation of the nerves or muscles. Light breathing upon the skin, however, gives rise to a special form of contraction which, it is said, can only be counteracted by similarly stimulating antagonistic groups of muscles. These three phases Charcot has been pleased to group under the title of the "grand hypnose," for what reason it is difficult to say, unless, indeed, it is because the description originated in Paris.
Thus it happens that, at the present day, the Paris school and the school of Liébault are the principal exponents of hypnotism. Upon many of the most essential questions these two schools stand in opposition. According to Charcot, hypnotism is a pathological condition observed chiefly in hysterical patients, which can be divided into the three sharply defined phases just spoken of. According to Bernheim, who is at present the chief representative of the Nancy school, the hypnotic state is not a neurosis, but a condition closely allied to ordinary sleep, which can be brought about in a very large proportion of perfectly healthy persons. The peculiar physical conditions described by Charcot as invariable concomitants of hypnotism, Bernheim considers the result of suggestion, and the three typical states he regards as the artificial effects of similar influences.
From a careful examination of a large number of hypnotized persons, I am forced to the conclusion that these views of Bernheim's are correct, and that the school of the Salpêtrière is in serious error. Before reviewing the facts which have led me to this conclusion, let us inquire a little more carefully into the nature of the hypnotic phenomena manifested by healthy individuals. This will greatly facilitate an understanding of the principal objections to Charcot's views.
First, as to the proper method of inducing the hypnosis or artificial sleep. This is very simple, and it is always well to assure the subject that you do not intend to make use of any supernatural means, and that there is no magnetism of any kind about your procedure. Where persons are very skeptical of your ability to put them to sleep, it is a good plan to hypnotize a few patients in their presence, as an evidence of what you are able to do. Having thus obtained the subject's confidence, the physician asks him to look him intently in the eye, and to think of nothing but of going to sleep. The subject should be seated in a comfortable position, preferably with his back to the light. The recumbent position is not usually necessary. While the patient's eyes are still fixed, as just described, upon the operator's eyes, the latter says, in a monotonous but distinct tone: "Your eyelids are getting heavy, very heavy. Your eyes are red and moist. You are getting sleepy, very sleepy, very sleepy, Now you are nearly asleep. Your eyelids are shut; you can not open them, because you are asleep, fast asleep. Try as hard as you will, you can not open them. You can not wake up," etc. While these words are being uttered, the lids begin to drop and the eyes really look sleepy, and, if the subject is a good one, the pupils can generally be seen to dilate and contract alternately.
If two fingers of one hand slightly separated be held before the patient's eyes, he rolls his eyes down, following the fingers as they are moved down until the eyelids actually close. When the eyes close the subject is almost asleep, and a few judicious words affirming that he is asleep complete the hypnotizing.
In order to obtain good results it is necessary to watch the subject very carefully. Every sign of submission to the hypnotic influence should be immediately turned to account. Thus, if the eyes are seen to close suddenly, the subject should be at once told that he is asleep and can not wake up. If, instead, the operator adheres to a rigid formula, he may affirm the presence of sleep too soon, and the subject loses confidence, and the trial fails. The great secret of success is to watch closely, and suit the words to the symptoms of sleep as they develop. The importance and the difficulty of doing this well can only be appreciated after trial.
The rationale of this mode of hypnotizing is very simple. It consists essentially in an imitation of the processes of ordinary sleep by means of verbal suggestion. The attention is fixed by making the subject look into the physician's eyes, which thus answer the same purpose as Braid's glass knob. The heaviness of the eyelids, the dryness and subsequent moistness of the conjunctiva, and the gradual approach of somnolence, are natural episodes which usher in ordinary sleep. These we actually bring into existence by acting on the imagination through speech. It is a case of verbal suggestion in the waking state. The skill of the hypnotizer consists in making the subject believe he is going to sleep; that is all. It is not necessary that he should possess any peculiarities of temperament and voice, as has been supposed. Strokes and passes are useless, except in so far as they heighten suggestion. In short, everything lies in the subject and not in the hypnotizer. Nobody can be hypnotized against his will.
The persons who prove most refractory are so because they either consciously or unconsciously resist the operator's influence. They are not passive. Persons who are very much preoccupied with a certain idea are difficult to influence; hence hypochondriacal and hysterical patients make poor subjects^ largely on account of their introspection and egoism. Many people think that it is a sign of weak will to yield readily to hypnotism, and that it is a sign of strong character to resist. Both views are equally erroneous. I have frequently seen persons of strong, determined character fall asleep at the first trial. On the other hand, hysterical patients with very little will-power are generally highly refractory. Men are as readily hypnotized as women. Imaginative persons, and those who sleep very soundly, are generally easily hypnotized.
It has been repeatedly stated that frequent hypnotization is dangerous. It is questionable whether hypnotism has ever proved really dangerous, even when it is induced as it is at the Salpêtrière. With Braid's method, it often happens that a severe headache or general nervous irritability is produced, and hysterical or epileptic paroxysms are occasionally brought on in persons subject to them. It is important to understand that these evil results are not due to the hypnosis; they are the result of the long fixation, Liébault, Bernheim, and Forel have hypnotized many thousand persons in the manner I have described—that is, by suggestion—and have never witnessed an unpleasant or harmful after-effect.
It is impossible to give an exhaustive description of the hypnotic manifestations here. The most that can be done is to mention briefly the principal classes of phenomena with which one meets; and, having done this, some of the more remarkable ones can be studied by themselves.
Liébault divides hypnotic sleep into six grades. The division is arbitrary and theoretical, and the grades can not be sharply separated from one another, for there are all imaginable transitions. Nevertheless the classification is useful, and I shall give it here as the best means with which I am acquainted of introducing the characteristics of hypnotism.
Under the first degree Liébault includes those cases in which the somnolence is so slight that it is questionable whether it can really be called sleep. There is a sense of drowsiness, often very pronounced, and the eyelids feel heavy, but this influence may only continue while the operator is speaking. As soon as his influence is withdrawn the subject wakens.
In the second degree the subject's eyes are closed. He hears everything that is said to him or that occurs about him, but does not awake spontaneously for some time. As the magnetizers say, he is in the "hypotaxic" or charmed condition.
This degree of hypnotism is characterized by the existence of what is called suggestive catalepsy. If, as soon as the subject is asleep, one of its arms be lifted, it will remain, in a certain number of cases, just where it is put. It is rigid, and resists any attempt to change its position; that is, it is cataleptic. The phenomenon is called suggestive catalepsy, because it is the result of suggestion and is not spontaneous. The arm is lifted into a certain position; it remains, because the act of putting it there—the suggestion—insinuates into the mind the idea of keeping it there. The psychical process which determines this phenomenon is purely automatic. The will does not come into play.
It often happens that patients whose sleep is no deeper than that just described imagine, upon waking, that they have not been asleep, because they remember what has been said to them; or they think that their somnolence has been due to their desire to be obliging. If they are again hypnotized, the catalepsy can be made to reappear, although the subject may have previously avowed his intention of preventing it.
In the third degree the phenomena just described are present, but the sleep is deeper than before. The sensibility to pain is nearly or quite abolished, and can generally be entirely abolished by verbal suggestion. The physician says authoritatively, "Your hand is dead and can no longer feel anything," and he may then puncture the skin with a needle, and the subject shows no sign of pain. Automatic movements of various kinds can be produced in this stage. The arms may be made to rotate about one another, and the subject may be dared to stop them, but he can not. He hears and remembers everything that is said to him.
All these phenomena are present in the fourth degree, but, in addition, there is loss of relationship with the outer world. The sleep is so deep that the subject only hears what the hypnotizer says. He is in relation with the hypnotizer and no one else, but may be switched off, so to speak, into relationship with any one else at pleasure.
The fifth and sixth degrees are distinguished by forgetfulness of what has happened, or amnesia, upon waking, and constitute somnambulism. In the fifth degree the amnesia is not complete. The patient still vaguely remembers what has been told him, or may have a confused recollection of what has occurred during a certain period of his sleep, while he may have completely forgotten everything else.
Persons who exhibit this degree of sleep are extremely sensitive to suggestion. They may be made cataleptic and absolutely insensible to pain. They can be made to execute the most varied automatic movements, and to experience hallucinations and illusions of the senses. A solution of quinine is drunk with every show of satisfaction if the operator merely states with sufficient emphasis that it is a delicious cup of chocolate.
The fifth degree of hypnotism is known as light somnambulism. In deep somnambulism (sixth degree) the subject has no memory whatever of what has passed during the sleep. There is absolute amnesia. Nevertheless he can hear and obey suggestions with great readiness. There are cases of deep somnambulism, however, in which there is scarcely any suggestibility, and in which all the senses appear to be in temporary abeyance.
The above description of the various grades of hypnotism is far from satisfactory, for every person preserves in some degree his own individual peculiarities and impresses them upon the hypnotic state, and this gives rise to an almost infinite number of varieties which overlap one another in every imaginable way.
The proportion of somnambulists to the total number of persons who can be hypnotized is large, being about nineteen per cent in adults. Sex seems to be an unimportant factor, contrary to what was formerly supposed, for the preponderance in favor of women is only about one per cent. The proportion of somnambulists among children is much higher, being about twenty-six per cent in children from one to seven years of age. More than half the children between the eighth and fourteenth year are somnambulists.
I have heretofore only spoken of the phenomena which are present during the actual sleeping state of the hypnotized subject. In addition to these, there is a class of manifestations which make their appearance after the subject has awakened. These post-hypnotic phenomena, as they are called, are the result of suggestion, and can only be produced in somnambulists. The manifestations themselves only differ from those of somnambulism in that they persist, or only take effect, after the subject awakes. Thus, we can suggest post-hypnotic acts, illusions of the various senses, and hallucinations. For example, a good somnambulist is hypnotized and told that on awaking he will commit a certain act, that he must commit it, and can not offer any resistance to his desire to commit it. Accordingly, when he awakes he executes the suggestion which has been insinuated into his mind, either literally or with some slight modification, and, not having any recollection of what has been told him, believes that his act is spontaneous. These cases afford the best illustration I know of the relativity of our freedom of will, and of the truth of Spinoza's saying, that our consciousness of free-will is but ignorance of the causes of our acts. If the act which has been suggested is one which might readily be committed spontaneously, the subject makes no comment upon it. If, however, he has been told to do something ridiculous, he is usually a little ashamed of his act, and looks silly and embarrassed; or, if asked why he did such a foolish thing, he invents a justification of some kind, and these excuses are often exceedingly amusing.
It is possible, moreover, to give rise to post-hypnotic illusions and hallucinations of the various senses. Hallucinations of sight are perhaps more readily provoked than any other kind. A person may be made to see a rose, a bright light, a cat, or a devil. In short, in some persons almost every imaginable visual hallucination may be provoked. Binet and Féré have tried to demonstrate the peripheral character of visual hallucinations, by showing that such hallucinations are doubled when the patient looks through a prism. If, for example, a person has an hallucination of a rose, he sees two roses on looking through a prism. Bernheim has shown conclusively that this discovery of Binet and Féré is the result of an imperfection in their manner of experimenting, and that in reality a prism produces no effect whatever on the hallucination. In experimenting on hysterical patients, however, it is very easy to be deceived with reference to this point, for when the prism is placed before their eyes they see at once that everything looked at through it appears double, and conclude, with hysterical shrewdness, that the hallucination ought to be doubled likewise. In other words, they either consciously or unconsciously apply their newly derived knowledge of the effect of a prism to the hallucination.
This assertion is supported by the following facts: If an hallucination be called forth by suggestion in a hysterical patient, in a room which is sufficiently dark to make the objects it contains nearly or quite invisible, the hallucination is not doubled in looking through a prism for the first time, for the subject is unconscious of the fact that the glass through which he is looking has the property of doubling the image of a real object. Repeat the experiment in a light room, and the patient will state that she sees the hallucination double. If the subject of the trial be an unsophisticated child, and not an hysterical woman, the hallucination is in every instance single.
The duration of post-hypnotic hallucinations varies considerably in different cases, but is usually not greater than a few minutes. Instances are, however, recorded where they have lasted hours, and even days. It must be remembered that post-hypnotic hallucinations can only be induced in a moderate proportion of somnambulists.
I can not omit a few words about the state of the circulation and respiration during hypnotic sleep. Braid noticed that, when a subject was hypnotized, the pulse was at first slowed, but afterward accelerated, and he attributed this acceleration to the occurrence of cataleptic rigidity of the muscles. He also observed that the respiration was increased in frequency, and sometimes became difficult. Later observers have made numerous experiments, some of them very carefully conducted, in order to settle these points, and their results in general support Braid's conclusions. These investigators, however, employed Braid's method of hypnotizing, and this fact vitiates their results, because the continued fixation on the glass knob requires a good deal of physical effort, tires the eyes, and gives rise to a certain amount of emotion, particularly in subjects who have not been previously hypnotized. In consequence, there is a physiological increase in the rapidity of the pulse and respiration, not unlike that which some persons experience when being examined by a physician, and which are therefore to be regarded as the effects of emotion and fatigue, rather than of hypnotism. This view receives confirmation from the fact that subjects who are hypnotized by the suggestion-method of Liébault and Bernheim seldom exhibit any alterations in the rhythm and rapidity of the circulation and respiration. I say seldom, because it does sometimes happen that a nervous person experiences an acceleration of these functions when hypnotized for the first time, even when the suggestion-method is employed.
There are also rare cases of somnambulism in which it is possible to modify the pulse-rate by means of suggestion. Thus, Beaunis reports a case in which the pulse registered ninety-eight beats per minute during the sleep and was reduced to ninety-two per minute by a suggestion of decrease. Then the heart, having recovered from the effects of suggestion, returned to its previous rate of pulsation, and a suggestion of increase resulted in an acceleration to one hundred and nineteen beats per minute.
There are exceptional cases of somnambulism in which it is possible to produce the most astonishing effects upon the circulation of the blood at the surface of the skin by suggestion. Nosebleeds have actually been produced in this way, and in several cases real blisters were caused. In one of these cases eight postage-stamps were applied to the shoulder during hypnotic sleep, and the suggestion was given that a blister was being applied. The subject was allowed to sleep all day, and on the following morning the stamps were removed. The skin under the stamps was found to be thick, wrinkled, and yellowish white, over an area of from four to five centimetres in diameter, and around this space there was a zone of intense redness. By four o'clock of the same day, four or five small blisters had appeared, and fifteen days later evidences of inflammation were still present. This case was observed by Bernheim himself, and there are others of like nature reported by equally competent observers.
I have tried to show bow essential a rôle suggestion plays in determining the various phenomena of hypnotism. Let us employ the facts we have gathered as the basis of an examination into the views which have emanated from the Salpêtrière.
As already stated, the experiments of Charcot have been made chiefly upon persons suffering from hysteria, and it is well known that those who suffer from this disease are more prone to every form of deception and simulation than any other known class of beings. Hence we may safely say that it was unfortunate to choose such persons for the subjects of a physiological investigation, particularly as most of the hypnotic phenomena are of a subjective and not of an objective character.
The number of persons in whom the "grand hypnose" already spoken of has been induced at the Salpêtrière is very small, being thirteen in ten years, according to Binet and Féré. These subjects have been regularly hypnotized and experimented upon for a long period of time, and the process has become second nature to them. They have been prepared, and phenomena which they exhibit are in most instances the result of many years of a peculiar kind of culture. They do many remarkable things at the operator's will; but these ought not to be considered as characteristic hypnotic manifestations. It is much more correct to look upon them as hypnotic tricks, if I may use the expression. A patient is hypnotized and goes into the so-called state of lethargy. A bright light is held before the eyes, the eyes are opened by the operator, and the patient is cataleptic; but no one can pretend to say that the catalepsy thus induced is characteristic of hypnotism. The subject has become cataleptic through a sensorial suggestion—the bright light—simply because she has learned to do it, probably by seeing other patients similarly affected or by hearing the operator speak of the effects he expects to get. Take a healthy person and hypnotize him. When he is sound asleep, open his eyes with a bright light before them and observe whether he becomes cataleptic or not. Either he simply wakes up, or his lids close again and he relapses into sleep. It is possible that in very rare instances spontaneous catalepsy may make its appearance, but it is always difficult to surely exclude the influence of suggestion by word, gesture, or imitation. Even in hysterical patients the cataleptic state may be dissolved or prevented by the use of suggestion.
MM. Binet and Féré, Prof. Charcot's assistants, imagine that they have eliminated the effects of suggestion because they make their experiments in their so-called cataleptic and lethargic stages. They say, "These (stages) are unconscious stages of the ' grand hypnose/ stages in which the condition of the senses and intelligence renders the subject a perfect stranger to what is going on around him." Nothing could better illustrate the imperfection of their method of research, for, as we have seen, some knowledge of what is going on is retained in all but the most exceptional cases.
The number of non-hysterical persons hypnotized by Liébault, Bernheim, and Forel is very great. Yet not one of these observers has ever been able to obtain the results of the Paris school except through the use of suggestion.
The use of a bright light or the simple opening of the lids to produce catalepsy, and the friction of the head to produce somnambulism, have been found absolutely unnecessary by these observers, no matter whether the patient has been hypnotized by Braid's method or by the suggestive method. As we have already seen, all that is necessary to produce catalepsy is to lift the arm or affirm the existence of rigidity. If the sleep be profound enough, the automatic movements which usually occur in somnambulism can be provoked by simple suggestion, and, if the sleep he not sufficiently deep, no amount of friction of the head unaided by suggestion will produce somnambulism.
We may safely conclude, therefore, that in reality the "grades of the hypnotic series" do not exist as such. There is no sharp line of demarkation between the so-called lethargic, cataleptic, and somnambulistic stages. The existence of catalepsy and somnambulism is dependent entirely upon the degree of sleep and the nature of the suggestion. I do not mean to say that the Charcot school have described what they have not seen, but it seems probable that they have misinterpreted what they have observed, and have not taken into account the influence of suggestion in producing the conditions which they hold to be spontaneous. That they have succeeded by repeated hypnotization and either intentional or unintentional suggestion in reproducing a condition in their subject close akin to a neurosis I am fully convinced; but I hold that a state obtained in this way should not be taken as a basis for a description of hypnotism.
If the thirteen cases of the "grand hypnose" at the Salpêtrière were the only examples known of the effects of hypnotism, there might be some justification for looking upon them as typical examples; but to do this in the face of many thousand cases of hypnotism induced in non-hysterical persons and presenting uniform characteristics of a widely different nature, seems to be a one-sided position to say the least. I have no desire to detract from the just reputation of one who has done so much to advance the science of medicine, but I believe that in reference to the subject of hypnotism Charcot has committed a serious error in regarding a neurosis which is unquestionably an artificial derivative of hypnotism as the type of hypnotism itself, and it seems probable that this error is largely due to a failure to appreciate the subtle role of suggestion.
We have now reviewed the more important facts at present known about hypnotism. Into the question of cerebral physiology I can not enter here, for I desire to confine myself to facts, and we can not go far into that realm unless we give ourselves up to speculation and abandon the surer footing of facts entirely; nor can I stop to speak of the interesting phenomena of spontaneous double consciousness, of retroactive hallucinations, and of spontaneous somnambulism. Full descriptions of these and of many other interesting conditions can be found in the more recent treatises upon hypnotism.
The medico-legal aspects of hypnotism have recently been very carefully studied, and only a short time since a special treatise appeared upon the subject. The forensic questions suggested by hypnotism are certainly of great interest, but I can not help thinking that their actual importance has been considerably exaggerated. The problem is such a novel one and suggests so many curious possibilities that it is not strange that some persons should have had their mental equilibrium a little disturbed from speculating about it.
In conclusion I wish to make a few remarks about the value of hypnotism in the cure of disease. This is a subject upon which the greatest difference of opinion at present exists among professional men, but there can be no question that the majority maintain an attitude of the most rigid skepticism. That it is very difficult at present to form an exact estimate of the therapeutic value of hypnotism is certain, but I can not help believing, after careful observation of a considerable number of cases in which it was tried, that the virtues of hypnotic suggestion are real and great. To be sure, the class of maladies in which benefit can be expected is limited. There is no evidence at present that organic states of disease can be in any way modified by hypnotism, and it is not probable that there ever will be. But there is evidence, and evidence of the best kind, that a large number of functional diseases have been benefited and even permanently cured. Liébault, Bernheim, and Forel have succeeded in curing, or at least in improving, such conditions as headache, functional disturbances of the bladder, St. Vitus's dance, writer's cramp, migraine, neuralgia, sleeplessness, constipation, diarrhœa, and certain manifestations of hysteria. Still, I do not wish to imply that hypnotic suggestion is of use in all forms of functional disease. In a large number of trials of the influence of hypnotism upon the insane, Forel found that the insanities supposed to be unaccompanied by anatomical changes in the brain were as little benefited as those which are known to be the result of actual brain-disease.
The majority of the insane are difficult or impossible to hypnotize. Yet, with, it is possible to influence a small proportion of cases, and to even temporarily abolish hallucinations; but in general the results are unsatisfactory. In a series of experiments made to determine the effect of suggestion upon the fixed delusions of the form of insanity popularly known as monomania, it was found that ^q delusions could occasionally be driven away for an instant during sleep—that is, the patient could be made to renounce them; but in every instance they were present to their fullest extent as soon as the hypnotic influence wore off.
Chronic alcoholism is one of the conditions in which the most gratifying effects have been obtained by therapeutic suggestion. In several instances the habit of drinking was permanently broken, and all desire for alcohol destroyed by means of energetic suggestions against its use. The habitual use of morphine, chloral, and cocaine has been similarly overcome. The constant surveillance of such patients, afforded by an asylum, is of course an important auxiliary feature in determining such cures. One must not speak with too great certainty as to the permanency of these cures, for the cases have not been under observation long enough to preclude the possibility of relapse.
In a few cases, certain bad habits in children have been broken through suggestion, and I am confident that hypnotism has an important application here.
The frequency and duration of the hypnotic sittings, as employed for the cure of disease, vary with the character of the ailments. In chronic alcoholic disease, for example, the patient should be hypnotized every day for at least half an hour, and it is generally many weeks before much benefit can be obtained. On the other hand, attacks of neuralgia or migraine may sometimes be cured at a single sitting, I recently saw a case of spontaneous somnambulism in a young girl cured in this way. The patient was in the habit of walking in her sleep, and had been under treatment by physicians for a long time, but none of them had succeeded in doing anything to improve her condition. Finally, she was brought to Prof. Forel, was hypnotized and treated with energetic suggestion, directed against her sleep-walking. Six months have elapsed, and the somnambulism has not once reappeared. The exact indications for the use of hypnotism have not yet been determined, but it seems probable that functional nervous disorders will be one of the classes of cases in which it will always be most successfully used.
In order to get the best results in any individual case it is important to make all the suggestions in the somnambulistic state, in which there is amnesia upon waking. Otherwise it is impossible to obtain such complete control over the patient's mind.
Such, then, are the uses of hypnotism as we at present know them. Unfortunately, there are abuses also. I have said that, when properly employed, hypnotism is absolutely harmless. When, however, a nervous or hysterical woman is repeatedly hypnotized for half an hour at a time, for the purpose of exhibiting her powers to an inquisitive public, the case is different, and I believe that the patient is harmed physically, mentally, and morally. Unfortunately, traveling "magnetiseurs" are not the only persons who give such exhibitions. I was recently present at a public demonstration of hypnotism in Paris, given by a well-known French physician under the name of a scientific lecture, which was nothing more than a vulgar unscientific catering to the curiosity of an equally vulgar and unscientific public. If a law similar to that of Belgium, prohibiting such abuses of hypnotism, were immediately carried into effect in other civilized countries, I believe there would be a timely prevention of much mischief. As it is, the matter will probably be overlooked until enough harm has been done to convince thoughtful persons that some decided measure is necessary to prevent injury at the hands of ignorant or unprincipled persons.
- The French use the word suggestion to express this idea, and although the English suggestion, as commonly employed, does not perfectly correspond with its use as employed by French authors, it answers the purpose better than any other word.
- The word somnambulism is commonly used to designate sleep-walking. As used in hypnotism, it has the more extensive meaning of forgetfulness after waking from hypnotic sleep. Very often, however, this amnesia is associated with such highly developed automatic movements that the person is able to walk about.
- Although I have never seen the effects of suggestion carried to this point, I have several times seen distinct localized erythema created through repeated and energetic suggestion.
- I recently had an opportunity of studying the cases of the "grand hypnose" at the Salpêtrière, and my belief in the correctness of Bernheim's views was fully confirmed.