Hypnosis and suggestion can then be used, in Hilgard's terms, to restructure communication between cognition and response. He's not sure how, but in some way hypnosis results in the erection of two separate communication barriers. One barrier (running vertically in the diagram) splits cognition into two disconnected compartments and similarly splits voluntary and involuntary responses to pain.
Now what we have – at least diagrammatically – is a brain split in half. On the left side all channels of communication in the overt hypnotic reality of no pain are open and consistent; the subject registers no felt pain consciously, expresses no felt pain bodily, and communicates no felt pain verbally. On the right side we have an additional barrier (running horizontally) between cognition and communication so that the felt pain is not communicated unless a technique such as automatic writing or talking is introduced into the hypnotic situation. So in the covert hypnotic reality of felt pain, the subject registers pain unconsciously and expresses it involuntarily through vital sign indicators, but cannot or does not communicate it. Hilgard believes this model explains how a person can feel neither pain nor suffering at the conscious level within hypnosis, yet still register the physiological signs of pain unconsciously.
Pain and Awareness
As yet, there is no scientific definition of pain. It can be described and its components listed, but investigators have been "unable to come up with a definition that (catches) the single 'essence' of pain, beyond the common sense notion that we are dealing with what hurts." It seems we have made little progress since Aristotle's day, when he himself omitted the sense of pain from his list of man's five senses. It was not until the nineteenth century that the sensory component of pain was recognized as a physiological and psychological reality. Before that, pain was linked to its maiden-opposite of pleasure, and both were viewed as "passions of the soul" rather than as provinces of science.
The "hidden observer" has enormous implications for psychology. It means that while we have the capacity for concealing, repressing, denying, and dissociating from pain, we are not actually getting rid of it. We may be able to remove it from awareness, but it still exists in the lower levels of consciousness. This is the crux of neurosis: while we may split off from Primal Pain, it remains within us, exerting a real force and producing all manner of symptoms. Now we have corroboration that out of mind is not out of body. Hypnotic pain control techniques can temporarily relieve us of physical pain, just as our absorption in a certain task or spectacle may allow us to forget about physical pain for a time, but sooner or later we again become aware of it. Similarly, to repress emotional pain does not eliminate it nor alleviate the symptoms it produces.
Today it is recognized that pain contains both a sensory component and a suffering component. The presence of one does not necessarily mean the presence of the other. We can be in physical pain without feeling badly emotionally, and we can feel badly emotionally without being in any sensory pain. For most of us, however, the two go hand-in-hand: being physically ill is emotionally upsetting and being emotionally upset is physically painful.
The distinction between the sensory and suffering components of pain has many significant medical and psychotherapeutic ramifications. This was demonstrated several years ago, when an experimental operation was performed on a group of patients who were suffering from intractable pain. The operation involved a pre-frontal lobotomy, which means that a group of connecting fibers between lower and higher (cortical) brain centers were severed. After the operation the patients reported that they could still feel the sensation of pain but that it did not bother them. In other words, the suffering component of the pain was alleviated surgically while the sensory component remained.
This is also the situation in neurosis.–– A neurotic may feel neither pain nor suffering, depending upon the degree of defense, or "gating" of pain between levels of consciousness. The neurotic's face may show a good deal of misery while he remains unaware of feeling miserable; his body may be stiff with tension, yet he doesn't know why. He can talk about his deprived childhood with complete detachment. No feeling of suffering or distress reaches his awareness.
Thus, in all three conditions – neurosis, hypnosis, and lobotomy – awareness and recall on the cognitive level are effectively disconnected from the emotional components of what is remembered.
There is obvious value in using hypnosis to remove the suffering component from organic pain when it cannot be alleviated in any other way. No one benefits from unbearable pain related to terminal cancer, constant back pain caused by a genetic spinal problem, or from constant residual pain after a serious car accident.
The numerous techniques for removing the awareness of pain and the everyday distractions that achieve the same thing show us the dramatic abilities of consciousness to alter its own perceptions. And we certainly need hypnosis to achieve this. In everyday life, we are very adept at keeping ourselves distracted from what is going on inside. A busy, even hectic lifestyle is probably the main defense today. Phone calls, letters, business deals, discussions, movies, television, are all part of the hypnotic process. It seems that half the people watching TV are indeed mesmerized – as if half the population is in a coma after six p.m. One lets in the message, particularly the commercial message, without any critical capacity, whatsoever. One is simply the passive recipient. The next day, as if in a posthypnotic suggestive state, one goes to the store and buys Crest and Kellogg’s Corn Flakes, just as one has been programmed to do.
Hypnotic pain techniques demonstrate how far cognition can go in structuring a false reality. But how is this possible? By what physiological mechanism is it achieved?
The Endorphin System
I have already discussed the plasticity of the third level of consciousness and its role in susceptibility to hypnosis. There are additional, more specific neurological factors which help make dissociation possible. One is the left brain-right brain dichotomy referred to by Hilgard to illustrate his "hidden observer" discovery. Another is the system of "gating" which exists between levels of consciousness to inhibit or facilitate the flow of information. Still another is the body's capacity to produce morphine-like substances called endorphins. And the neuroinhibitor, serotonin. These chemicals block the message of pain from crossing the cleft between nerve cells, the synapse, in effect gating the message from reaching higher brain centers.
The neuroinhibitors function as the biochemicals of repression and its twin, dissociation. They are produced to quell both physical and emotional pain. Although the body does not differentiate between the two types of pain in qualitative terms, it does respond differentially in quantitative terms. As I pointed out in Prisoners of Pain:
The Swedish pharmacologist Lars Terenius has discovered that patients suffering from emotional Pain produce more endorphins than those suffering from physical pain. Emotional Pain is real and often physically more intense than "physical pain." Those with emotional or psychological Pain in Terenius' studies had less tolerance to physical pain. Their bodies were hyperactive, producing more Pain suppressants.
When the amount of pain assaulting the system can no longer be integrated, endorphins are mobilized to repress the experience and the memory of the event. These endorphins can be many hundreds of times more powerful than commercially produced morphine. They keep events out of full consciousness by interfering in the connection between feeling and the realization of feeling, between injury and reaction to it, between sensation and cognition. Nonetheless the trauma remains in the system, full and intact.
Through the production of endorphins, the person may be able to dissociate from the pain of his hand submerged in icy water, but the icy water nonetheless causes his vasomotor system to contract in pain. Similarly a child may be able to dissociate from the Pain of losing his mother, but that Pain is still causing his system to siphon off its impact in some way – be it through acting-out behavior, compulsive eating, chronic depression, or whatever. The child may simply "numb-out." He is no longer emotionally reactive. He's inert, immobile, and emotionally "dead". He no longer suffers the horrendous pain of losing his mother. He goes on with life in a very "dead" fashion. Nonetheless, there is always some physical manifestation of the presence of pain in the system, regardless of what one is consciously experiencing.
See Hilgard, p. 48, Figure 15, right diagram.
Hilgard, Hypnosis in the Relief of Pain, p. 29
The same effects can be achieved with marijuana, morphine, and other drugs that suppress the suffering aspect of pain more than the actual sensation of pain. Aspirin, on the other hand, does just the opposite: it reduces localized sensory pain but does not reduce anxiety or suffering. Localized sensory pain has a specific physical location in the body; anxiety, by contrast, is a non-specific and diffused state of being.
For a brief discussion of "gating," see "The Gated Mind" in my book Prisoners of Pain (New York: Doubleday, 1980) pp. 111-114. For a more technical discussion see "The Gating of Pain" in Primal Man (New York: Thomas Crowell Co., 1975 ), pp. 126-134.
Arthur Janov, Prisoners of Pain, p. 85.