Psychotherapy

by Hugo Münsterberg

We should feel reluctance to group such inhibition together with sleep because it would be a sleep which at any moment can pass from one part of the brain to others and which certainly leaves at every moment most of the cell groups unaffected. We saw that attention does not at all focus on one narrow point, but that an abundance of impressions, of ideas and associations, of thoughts and emotions can enter the field of attention, if they all lead to one and the same motor attitude, and that only the one part is inhibited which involves the opposite action. Such a jumping sleep which at every moment selects a special part would be, of course, just the contrary of that which characterizes the sleep state of the fatigued brain. But exactly these characteristics of attention belong to hypnotism too. It is not true that the mind of the hypnotized is asleep and that perhaps only one or the other idea can be pushed into his mind. On the contrary, his mind is open to an abundance of ideas, just as in the normal state. If I tell him that this is a landscape in Switzerland, he sees at once the mountains and the lakes, and his mind provides all the details of his reminiscences, and his imagination furnishes plenty of additions. His whole mind is awake; the feelings and emotions and volitions, the memories and judgments and thoughts are rushing on, and only that is excluded which demands a contrary attitude. This selective process stands decidedly in the center of the hypnotic experience and makes it very doubtful whether we are psychophysically on the right track, if we make much of the slight similarity between hypnosis and sleep.

This has nothing to do with the fact that hypnosis is best brought about by suggesting the idea of sleep, that is, the belief that sleep will set in. This belief is indeed effective in removing all the ideas which are awake in the mind which would interfere with the willingness to submit to the suggestions of the hypnotizer. But the fact that belief in sleep and expectation of sleep bring with them the hypnotic state is not a proof that the hypnotic state itself is sleep. Even the mental experiences which can remain in sleep, the dreams, are characteristically different from the hypnotic experience. Thus the dreams show that unselective awakening of ideas which is to be expected from a general decrease of functioning. The hypnotic variation is characterized just by its selective narrowing of consciousness. For the same reason, hypnotism is strikingly different from such diseases of the mind as dementia. Certainly in dementia too, many associations are cut off, but it is not a selective inhibition, it is a haphazard destruction resulting from the degeneration in the brain.

The fundamental principle of the hypnotic state lies in its selective character. Inhibited and cut off are those states which are antagonistic to the beliefs in the suggested ideas, and as their antagonism consists in their connection with opposite actions, the whole is again a question of motor setting. No doubt, such new motor setting can precede the normal sleep too; thus the sleeper may be insensitive to any surrounding noises, but perhaps awake at the slightest call from a patient who is intrusted to his care. In that case, one special feature of hypnotism is superadded to sleep but the sleep itself is not hypnotic. Again sleep may go over into a state which shares many characteristic features with hypnotism, that is, somnambulism, and it may be said with a certain truth that hypnotism is artificial somnambulism. But somnambulism, while arising in sleep, is not at all a feature of sleep.

While sleep is characterized by a decrease of sensitiveness and of selective powers, the selective process of hypnotism rather reënforces sensitiveness and memory in every field which is covered by the suggestive influence. Stimuli may become noticeable which the normal man is unable to perceive, and long-forgotten experiences which seem inaccessible to the search of the waking mind may reproduce themselves and may vividly enter consciousness. Again we have there symptoms which rather characterize the state of over-attention than the state of sleep. We might add further that we know states with all the characteristics of hypnotism in which even the subjective idea of sleep is entirely absent, for instance, all those which are usually called states of fascination. A certain shining light or a glimpse of an uncanny eye may startle and upset the imagination of the subject and throw him into a state of abnormally increased suggestibility. It is well known that whole epidemics of such captivation have occurred and have resulted in hysterias of the masses in which the subjects become the slaves of their impulse, perhaps to imitate what they see or hear, or to realize ideas in which they believe without logical warrant. They surely are not asleep, are not even partially asleep. Every center of their brains would be ready to work, if the captivated attention were not forcing the mind in one direction and selectively suppressing every impulse to opposite actions. The developed hypnotism finally shades off into innumerable states of hypnoid character in which the sleeplike symptoms are entirely in the background.

Thus the increased suggestibility of the hypnotic state will result not from a partial sleeplike decrease of functioning but the decrease of function is a motor inhibition which results from over-attention. In the ordinary attention, our motor setting secures only an increase in clearness and vividness of the attended ideas, but in an abnormal over-attention the new motor setting produces a complete acceptance with all its consequences. Abnormal or heightened attention thus goes directly over into the belief and into the impulse without resistance. There is no hypnotism which does not contain from the first stage this definite relation to certain objects of attention, usually to a particular person. All the manipulations, passes, fixation, monotonous speaking, and so on narrow the contents of consciousness but hold the idea of the hypnotizing person steadily in the center of attention. The awakened expectation of sleep, the associated feeling of tiredness all help to cut off attention from the remainder of the world, but as no real sleep sets in, this cutting off from the remainder reënforces the focusing of attention on the one central idea of the hypnotizing personality. Every word and every movement of this personality become therefore absorbed with that over-attention which leads at once from a mere perceiving and grasping to a complete sinking into the suggested idea with the suppression of all opposites, and thus to a blind acceptance and belief. We saw before that such belief is indeed nothing else but a motor setting in which certain ways of action are prepared. We are to think in accordance with the belief in the suggested idea and the channels for discharge in the opposite direction are closed. Even the ordinary life shows us everywhere that the step from attention to belief is a short one. The effort to grasp the object clearly works as a suggestion to accept that which we are seeking as really existing, and that from which we are to abstract and which we are to rule out through our attention, we believe to be non-existent. The prestidigitator does his tricks in order to sidetrack our attention, but he succeeds in making us believe that we see or do not see whatever he wishes.

That the motor setting alone determines those changes and that a real sleeplike inability of the centers does not set in, can also be demonstrated by the results of later hypnotizations. I ask my hypnotized subject not to perceive the friend in the room; he is indeed unable to see him or to hear him. Yet his visual and acoustic centers are not impaired, the defect is only selective, inasmuch as he sees me, the hypnotizer, and not the friend. But even this selection inhibits only the attitude and not the sensorial excitement. If I hypnotize him again to-morrow and suggest to him now to remember all that the friend did and said during yesterday's meeting, he is able to report correctly the sense impressions which he got, which were inhibited only as long as they contradicted the suggestion, but now rush to consciousness as soon as the suggestion is reversed. As a matter of course, he must therefore have received impressions through eye and ear in his hypnotic sleep of yesterday from all that happened, only he was not aware of it because the channels of the accepting attitude were blocked.

As soon as the over-attention has produced the acceptance of the belief, all further effects are automatic and necessary. If I tell the hypnotized person that he cannot speak and he absorbs this proposition, with that completeness in which he accepts it as a fact, not speaking itself unavoidably results. The motor ideas with which the speech movement has to start are cut off and the subject yields passively to the fate that he cannot intonate his voice. Thus a special influence on the will is in no way involved. If the idea is accepted, and that means, if the preparatory setting for the action has been completed, the ideas of opposite activity must remain ineffective; the suggested idea must discharge itself in action without resistance. As a matter of course the new line of action will then surround itself with its own associations and will thus give to the subject the impression that he is acting from his own motives. As soon as the psychophysical principles are understood, there is indeed no difficulty in going from the simplest experience to those spectacular ones where we may suggest to the profoundly hypnotized person that he is a little child or that he is George Washington. In the one case, he will speak and cry and play and write as in his present imagination a child would behave; in the other case, he will pose in an attitude which he may have seen in a picture of Washington. There is nothing mysterious and his utterances are completely dependent upon his own ideas, which may be very different from the real wisdom of a Washington and the real unwisdom of a child. I may suggest to him to be the Czar, by that he will not become able to speak Russian. In the same way I may suggest changes of the surroundings; he may take my room for the river upon which he paddles his canoe, or for the orchard in which he picks apples from my bookshelves.

Finally there is no new principle involved, if the action which is prepared by any belief has to set in after the awaking from hypnotic sleep, the so-called post-hypnotic suggestion. As a matter of course, just these have an eminent value for psychotherapy. I may suggest to-day that the subject will overcome to-morrow his desire for the morphine injection, or that he will feel to-night the restfulness which will overcome his insomnia. But if the suggestion of an idea means belief, and if belief means a preparation for action, we have indeed no new factor before us if the action for which we prepare the subject is from the start related to a definite time. If we do not link it with the consciousness of a special time or of a special occasion which will occur later, the suggestion soon fades away. That my library is an orchard is forgotten perhaps within ten minutes, if I have not come back to it in the conversation. But if I say that after awaking as soon as I shall knock on my desk three times, you will be in the orchard again, the psychophysical apparatus is prepared, a new setting has set in, the three knocks will bring about the complete transformation. In short the difficulties disappear as soon as we are consistent in interpreting all suggestive influences as changes in the motor setting and as the result of the antagonistic character of all of our motor paths.

We say the difficulties disappear. Of course, that is meant in a relative sense only. It means essentially that we are able to bring the complex state of hypnotism down to the similar state of attention and motor adjustment, but of course we must not forget that we are far from a satisfactory explanation of the process in attention itself. We know that the opening of motor channels in one direction somewhat closes the channels for discharge in the opposite direction, but what mechanism does that work is still very obscure. Whichever principle of hypothetical explanation we might prefer, it certainly leads to difficulties in view of the extreme complexity of attention in states of suggestion and hypnotism. We might think of a mechanism which through the medium of the finest blood-vessels should produce a localized anæmia in those centers which lead to the antagonistic action. Or we might fancy that by extremely subtle machinery the resistance is increased in those tissues which lie between the various neurons, or we might even think of toxic and antitoxic processes in the cerebral regions; and any day may open entirely new ways of explanation. We may add that even if the mechanism of attention were completely explained, we are also still far from understanding the physiological changes which go on in the sphere of the blood-vessels or of the glands and the internal organs. We understand easily that the idea of the subject that he cannot move his arm keeps the arm stiff; but that his idea to blush really dilates the blood-vessels of his cheek is much less open to our causal understanding; still less that in very exceptional cases perhaps a part of the skin becomes inflamed, if we make believe that we touch it with a glowing iron. And yet here too we see that we move in the same direction and that we have to explain these exceptional and bewildering results by comparing them with the simpler and simpler forms, that the process of attention contains all the germs for the whole development.

In claiming that hypnotism depends upon the over-attention to the hypnotizing person, we admit that the increased suggestibility belongs entirely to suggestions which come from without. Only that which at least takes its starting point from the words or the movements of the hypnotizer finds over-sensitive suggestibility. Ideas which arise merely from the associations of the subject himself have no especially favorable chance for acceptance. But surely we also know states in which the suggestibility for certain of one's own ideas is abnormally increased. Great individual differences exist in that respect in normal life. There are normal hypochondriacs who believe that they feel the symptoms of widely different diseases under the influence of their own ideas, and others who are torturing themselves with fears on account of unjustified beliefs. But the abnormal increase of suggestibility parallel to that of hypnotism for suggestions from without exists for suggestions from within, mainly in nervous diseases, especially in neurasthenic, hysteric, and psychasthenic states. Within certain limits, we might almost say that this increase of suggestibility for autosuggestion is the fundamental characteristic of these diseases, just as increase of suggestibility for heterosuggestions characterizes hypnotism.