Summary and Statement of Problems

The present review of the literature on hypnotherapy shows that the therapeutic applications of hypnosis, as well as the theories advanced to explain the phenomenon, have reflected, on the whole, the changing concepts of psychology, physiology, and psychopathology. Despite significant advances both in the clinical application of hypnosis and in its theory, most standard psychiatric text-books present hypnotherapy as an approach which is limited to the suppression of symptoms "by command or entreaty."

We have seen that although such suppression of symptoms by direct suggestion is one of the methods of hypnotherapy several other techniques are possible. Hypnosis may be used as "prolonged sleep;" it may also serve as a medium whereby direct suggestion can be aimed at underlying attitudes rather than at symptoms; traumatic experiences may be revived and "abreacted" in hypnosis; the specialized techniques of hypnosis may be fully exploited to achieve therapeutic leverage, and finally hypnosis may be combined with psychoanalysis in an effort to bring about "insight" in the patient as well as symptom-relief.

We would like to outline some of the problems which we believe must be tackled if hypnotherapy is to develop its potentialities to the full.

Hypnotizability needs to be studied more extensively and with utilization of the best insights of modern psychiatry. Up-to-date figures on the influence on hypnotizability of age, sex, intelligence, psychiatric status, character type and other factors are urgently needed to gain some idea of who is hypnotizable, and of the range in which hypnotherapy may be applicable. Research should be undertaken in the development of techniques to enhance hypnotizability and to widen the range of the hypnotizable. Both psychological and physiological factors (like hypnotic drugs) must be considered. The problem of hypnotizability is intimately connected with that of the nature of hypnosis. A really adequate knowledge of who is hypnotizable should offer clues to the nature of the hypnotic state. A fixed preconceived notion of the nature of the hypnotic state could be a stumbling block here, inasmuch as some of the factors which are held in common by those who are hypnotizable may not be considered in our ordinary psychiatric studies and psychological tests.

Some understanding of the nature of the hypnotic state may be gained from prolonged study of cure by hypnoanalysis where the aim is not only therapeutic but also an attempt to analyze the hypnotic state.

Studies like those proposed by Kubie (294)—in which psychophysiological states, resembling hypnosis but without the transference phenomena of hypnosis, are produced should add much to out under standing of the nature of hypnosis. It is probably premature to lay so without having seen the data, but we feel that the danger exists in such studies of the experimenter overlooking himself as hypnotist even though he ostensibly does nothing but hook up the apparatus. The problem is similar to that of presumed autohypnosis in primitives, where the hypnotist may really be the fantasied tribal god or some analogous figure.

Out of a suggestion by Schilder (295) comes a problem which seems to us worthy of serious consideration. Schilder believes that there is no necessary relationship between the depth of hypnosis, as the concept is ordinarily understood, and the depth of hypnosis in the sense of the extent to which the individual's personality is really involved in the hypnotic state. He says that one individual in the somnambulist stage may be essentially little involved in the hypnotic state where another individual in a light stage of hypnosis may be deeply involved. Both of these types of depth of hypnosis require much clarification and definition. The traditional stages and depths of hypnosis are static concepts which will require much modification if they are to define the fluid and dynamic state which hypnosis appears to be.

The problem of the depth of hypnosis in the sense of degree to which the personality is involved is closely related to the therapeutic potentialities of hypnosis in a particular individual. We have already seen that there is no necessary correlation between the depth of hypnosis in the traditional sense and its effectiveness as a therapeutic agent in a particular case. Tests for the depth of hypnosis in this new sense may give us far more information about the prognosis with hypnotherapy in a particular case than do the traditional tests. It may be far more useful, for example, to discover if an individual can understand a dream significantly better in the hypnotic than in the waking state, than to see if catalepsy can be successfully suggested.

Many of the problems with which those who are studying "brief psychotherapy" are dealing seem to us to have bearing on hypnotherapy, since hypnotherapy can really be considered one of the techniques of brief psychotherapy. It seems to us that the concept of a hierarchy of psychiatric disturbance in the sense of the degree to which the core of the personality is involved is a useful one. It is difficult to define the concept accurately, but grossly we refer to the difference between a symptom peripheral to the mainstream of the personality and a disturbance of the basic character structure. Perhaps psychiatrists and especially psychoanalysts are not sufficiently flexible in their choice of the variety of psychotherapy for a particular case. In hypnotherapy, for example, hypnoanalysis could be reserved for cases which had either not ponded to direct suggestion therapy or which manifestly require more thoroughgoing treatment.

The psychoneuroses of soldiers, a problem looming ever larger on the horizon, seems to offer a special challenge to brief psychotherapy. In many eases, the acute disturbance seems superimposed on a basically adequate adjustment and it would seem reasonable that in such cases techniques of brief psychotherapy, including hypnotherapy, could be successfully employed.

In the traumatic neuroses, in particular, repression as a defense mechanism seems to play an especially important role. All observers agree that the defense which is most characteristically penetrated by hypnosis is repression. Group discussion in the course of research on hypnotherapy at the Menninger Clinic has crystallized the hypothesis that defense mechanisms other than repression may be attacked by hypnosis. We have seen some preliminary evidence that the mechanism of "isolation" may be affected by the hypnotic state. Patients in hypnosis often recall events the details of which they were perfectly familiar with in the waking state but which they now report with much more vivid affect, as though under the influence of the hypnotic state, content and affect had been reunited.

Both intensive and extensive research is necessary in order to explore the potentialities of hypnosis as a therapeutic agent. Such research, conducted within the framework of a scientific psychopathology, and carried through by a close collaboration between those trained in orthodox techniques of psychotherapy and those exploring untried methods, may result in an important addition to the available tools of clinical psychiatry.