Freud - Complete Works (281 page)

Psychical (Or Mental) Treatment

1597

   Some of the phenomena of hypnosis
(for instance, alterations in muscular activity) possess a merely
scientific interest. But the most significant indication of
hypnosis, and the most important one from our point of view, lies
in the hypnotic subject’s attitude to his hypnotist. While
the subject behaves to the rest of the external world as though he
were asleep, that is, as though all his senses were diverted from
it, he is
awake
in his relation to the person who hypnotized
him; he hears and sees him alone, and him he understands and
answers. This phenomenon, which is described as
rapport
in
the case of hypnosis, finds a parallel in the way in which some
people sleep - for instance, a mother who is nursing her baby. It
is so striking that it may well lead us to an understanding of the
relation between the hypnotic subject and the hypnotist.

   But the fact that the
subject’s universe is, so to say, confined to the hypnotist
is not the whole story. There is the further fact of the
former’s
docility
in relation to the latter: he
becomes obedient and credulous - in the case of deep hypnosis, to
an almost unlimited extent. And the manner in which this obedience
and credulity are carried out reveals a characteristic of the
hypnotic state, namely that in the hypnotized subject the influence
of the mind over the body is extraordinarily increased. If the
hypnotist says ‘You can’t move your arm’, the arm
drops motionless; the subject obviously tries with all his strength
but is unable to move it. If the hypnotist says: ‘Your
arm’s moving of its own accord, you can’t stop
it’, the arm moves and the subject is seen making vain
efforts to keep it still. The idea which the hypnotist has given to
the subject by his words has produced in him precisely the
mental-physical behaviour corresponding to the idea’s
content. This implies on the one hand obedience but on the other an
increase in the physical influence of an idea. Words have once more
regained their magic.

Psychical (Or Mental) Treatment

1598

   The same thing happens in the
domain of sense perceptions. The hypnotist says: ‘You see a
snake; you’re smelling a rose; you’re listening to the
loveliest music’, and the hypnotic subject sees, smells and
hears what is required of him by the idea that he has been given.
How do we know that the subject really has these perceptions? It
might be thought that he is only pretending to have them. But after
all we have no reason for doubts on the point; for he behaves
exactly as though he had them, he expresses all the appropriate
emotions, and in some circumstances he can even describe his
imaginary perceptions and experiences after the hypnosis is at an
end. We then perceive that he has been seeing and hearing just as
we see and hear in dreams - he has been
‘hallucinating’. He was evidently so credulous in
relation to the hypnotist that he was
convinced
that there
must be a snake to be seen when the hypnotist told him so; and this
conviction had such a strong effect on his body that he really saw
the snake - a thing which, incidentally, can sometimes happen even
to people who have not been hypnotized.

   It may be remarked, by the way,
that, outside hypnosis and in real life, credulity such as the
subject has in relation to his hypnotist is shown only by a child
towards his beloved parents, and that an attitude of similar
subjection on the part of one person towards another has only one
parallel, though a complete one - namely in certain
love-relationships where there is extreme devotion. A combination
of exclusive attachment and credulous obedience is in general among
the characteristics of love.

Psychical (Or Mental) Treatment

1599

   Some further points may be
mentioned in connection with the state of hypnosis. The words
spoken by the hypnotist which have the magical results that I have
described are known as a ‘suggestion’ and it has become
customary to apply the term as well where there is merely an
intention to produce a similar effect. Not only do the hypnotic
subject’s movements and feelings obey suggestions, but all
his other mental activities; and he does not as a rule take any
action on his own initiative. Hypnotic obedience can be employed in
making a number of highly remarkable experiments, which afford a
deep insight into the workings of the mind and produce in the
observer an ineradicable conviction of the unsuspected power of the
mind over the body. Just as a hypnotized subject can be obliged to
see what is not there, so he can be forbidden to see what
is
there and is seeking to impress itself on his senses - some
particular person, for instance. (This is known as a
‘negative hallucination’.) The person in question then
finds it impossible to attract the subject’s attention by any
kind of stimulation; he is treated as though he were ‘thin
air’. Again, a suggestion may be made to the subject to carry
out some action a certain length of time after waking from hypnosis
(‘post-hypnotic suggestion’); the subject keeps to the
allotted time and performs the suggested action in the middle of
his waking state without being able to give any reason for it. If
he is asked why he has done what he has, he will either refer to an
obscure impulse which he was unable to resist, or he will invent
some half-satisfactory excuse without remembering the real
explanation - namely the suggestion he has been given.

   The state of hypnosis is brought
to an end without any difficulty by the hypnotist’s authority
asserted in the words: ‘Wake up!’ After the deepest
hypnosis there is no recollection of anything that has been
experienced during it under the hypnotist’s influence. That
portion of the subject’s mental life remains cut off, as it
were, from the rest. Other subjects retain a dream-like memory, and
yet others remember everything but report that they have been under
an irresistible mental compulsion.

Psychical (Or Mental) Treatment

1600

   The scientific gain brought to
physicians and psychologists by a knowledge of the facts of
hypnotism can scarcely be exaggerated. But in order to gauge the
practical importance of the new discoveries we must put a physician
in place of the hypnotist and a patient in place of the hypnotic
subject. Hypnosis would then seem pre-ordained to fulfil all the
physician’s requirements, in so far as he seeks to act
towards the patient as a ‘mind-doctor’. Hypnosis endows
the physician with an authority such as was probably never
possessed by the priest or the miracle man, since it concentrates
the subject’s whole interest upon the figure of the
physician; it does away with the autocratic power of the
patient’s mind which, as we have seen, interferes so
capriciously with the influence of the mind over the body; it
automatically produces an increase of the mind’s control over
the body, such as is normally to be observed only as an effect of
the most powerful emotions; and, owing to the possibility of
arranging that the instructions given to the patient during
hypnosis shall only become manifest subsequently, in his normal
state - owing, that is, to post-hypnotic suggestion -, hypnosis
enables the physician to use the great power he wields during
hypnosis in order to bring about changes in the patient in his
waking condition. A simple pattern of procedure would thus seem to
emerge for the purposes of mental treatment: the physician puts the
patient into a state of hypnosis, he suggests to him (according to
the particular circumstances) that he is not ill and that after
waking he will not be aware of his symptoms. The physician then
wakes the patient up and may feel confident that the suggestion has
done its duty against the illness. And if a single application of
this procedure were not sufficient, it could be repeated as many
times as necessary.

   There is only one consideration
that might discourage the physician and the patient from making use
of such a promising therapeutic method: the possibility that the
advantages of hypnotism might be balanced by some damage - if, for
instance, it left behind it a permanent disorder or weakness in the
subject’s mind. But enough experience has already been gained
to set aside such doubts: single hypnotic treatments are completely
harmless and even if they are frequently repeated they are on the
whole without bad effects. Only one point is to be noticed: if
circumstances demand a persistent use of hypnotism, the patient
falls into a habit of hypnosis and dependence on the physician
which cannot be among the purposes of the therapeutic
procedure.

Psychical (Or Mental) Treatment

1601

   Thus hypnotic treatment really
implies a great extension of medical power and consequently an
advance in therapy. Every sufferer may be advised to entrust
himself to it, so long as it is carried out by an experienced and
trustworthy physician. Hypnosis should, however, be used in a
manner different from what is usual to-day. As a rule this method
of treatment is only embarked upon after every other method has
failed and when the patient is already despondent and dejected. He
has then to leave his own doctor, who cannot or does not employ
hypnotism, and turn to a strange doctor, who as a rule does not or
cannot employ anything else. Both practices are disadvantageous to
the patient. The family doctor should himself be familiar with
hypnotic procedure and he should make use of it from the first, as
soon as he judges the illness and the patient appropriate for it.
Wherever hypnotism can be employed it should be on a par with other
therapeutic procedures and should not be regarded as a last resort
or even as a descent from science to quackery. But hypnotism can be
employed not only in all nervous conditions and in disorders due to
the ‘imagination’, as well as for breaking morbid
habits (such as alcoholism, morphine addiction, or sexual
aberrations), but also in many organic diseases, even of an
inflammatory nature, in which, though the underlying disorder
persists, there is a prospect of relieving the symptoms (such as
pains or impediments to movement) which are troubling the patient.
The selection of cases for hypnotic treatment must depend entirely
on the judgement of the physician.

   The time has now come, however,
to dissipate the notion that with the expedient of hypnosis a
period of easy miracle-working has dawned for the physician. A
number of circumstances must be taken into account which are
calculated to lower our expectations from hypnotic therapy
considerably, and to reduce to their proper proportions the hopes
that may have been raised in patients. First and foremost, one of
the basic assumptions turns out to be untenable: namely, that
hypnosis makes it possible to deprive patients of the interfering
autocratic element in their mental behaviour. In fact they retain
it, and manifest it even in their attitude to the attempt to
hypnotize them. It was stated above that some eighty per cent of
people can be hypnotized; but that high figure is only reached by
including among the positive cases any that show the slightest sign
of being influenced. Really deep hypnoses, with complete
tractability, such as are chosen as examples in describing the
state, are actually rare or at all events not as frequent as one
would wish from the therapeutic point of view. The impression made
by this fact can, however, in turn be modified when it is borne in
mind that depth of hypnosis and tractability to suggestions do not
go
pari passu
; so that one often sees good suggestive
results where there is no more than a slight hypnotic
insensibility. But even if we consider hypnotic tractability
independently, as being the more essential feature of the
condition, it has to be admitted that different people show their
idiosyncrasies by only letting themselves be influenced up to a
certain degree of tractability, at which point they come to a halt.
Thus different people show a very varying degree of suitability for
hypnotic treatment. If it were possible to find a means by which
all these various grades of the hypnotic state could be intensified
to the point of complete hypnosis, the idiosyncrasies of patients
would once more have been eliminated and the ideal of mental
treatment would have been attained. But this advance has not yet
been made; it still depends far more on the patient than on the
physician with what degree of tractability a suggestion will be
received - it depends once more, that is, upon the patient’s
choice.

Psychical (Or Mental) Treatment

1602

   And there is another, still more
important consideration. In describing the very remarkable results
of suggestion, people are only too ready to forget that here, as in
all mental operations, relative size and strength must be taken
into account. If we put a healthy person into deep hypnosis and
then tell him to take a bite out of a potato under the impression
that it is a pear, or if we tell him that he is meeting one of his
acquaintances and must greet him as such, he is likely to prove
completely tractable, because the hypnotized subject has no serious
reason for resisting the suggestion. But in the case of other
instructions - if, for instance, we ask a naturally modest girl to
uncover herself or if we ask an honest man to steal some valuable
object - we may already find the subject putting up a resistance,
which may even go to the length of his refusing to obey the
suggestion. This teaches us that even in the best hypnosis
suggestion does not exercise unlimited power but only power of a
definite strength. The hypnotic subject will make small sacrifices,
but, just as though he were awake, he hesitates before making great
ones. If, then, we are dealing with a patient, and urge him by
suggestion to give up his illness, we perceive that this means a
great sacrifice to him and not a small one. Here the power of
suggestion is contending against the force which created the
symptom, and maintains them, and experience shows that that force
is of quite a different order of strength from hypnotic influences.
The same patient who is perfectly tractable in putting himself into
any dream-situation one may suggest to him (if it is not actually
objectionable) may remain completely recalcitrant towards a
suggestion which denies the reality of, let us say, an imaginary
paralysis. There is the further fact, moreover, that precisely
neurotic patients are for the most part bad hypnotic subjects, so
that the struggle against the powerful forces by which the illness
is rooted in the patient’s mind has to be waged not by a
complete hypnotic influence but only by a fragment of it.