On Hypnosis (Part 22/26)

Herbert Spiegel

Another well-known hypnotherapist is psychiatrist Herbert Spiegel. In the forefront of hypnosis research for decades, Spiegel taught a graduate course on the medical and therapeutic uses of hypnosis at Columbia University's College of Physicians and Surgeons. Originally trained as a psychoanalyst, Spiegel had become frustrated by the lengthy psychoanalytic process. He found that hypnosis could effect much speedier results.
According to Spiegel, hypnosis is a special state which we naturally slip into and out of throughout the day, and which the hypnotist merely utilizes:

All hypnosis is self-hypnosis. All that any "hypnosis" does is tap the natural capacity of an individual for focusing, for concentrating, for imagining, for visualizing, for blocking out distractions, for increasing awareness, for achieving greater control over the body's involuntary functions, for entering a different order of consciousness. The individual, in short, is not given anything new; he is simply helped to engage the means he already possesses in order to alter attention and perception and to influence his emotional and biological reactions.[1] 

The primary significant point of departure between Erickson and Spiegel is in the area of trance induction. Whereas Erickson was noted for his indirect techniques, Spiegel prefers a straightforward approach. This difference, though, is really not significant in terms of a fundamental view of hypnosis: both leading hypnotherapists agree that hypnosis is an "ability" or "talent" or "capacity" of the human mind to alter reality in ways that are beneficial and healing. Spiegel frequently talks about "self-mastery" and how "trance as an art form" can best aid us in this struggle.
The core of Spiegel's approach is well captured in a chapter from a book detailing his work entitled, "Mastering Symptoms."[2] Although both Erickson and Spiegel use a cognitive approach, there is an interesting difference in the type of cognitive process employed. Where Erickson would typically use a complex double binding statement to confuse or startle the patient, Spiegel will present a simple, comprehensible, linear line of thought. With overweight patients, for example, Spiegel carefully explains that

(1) overeating is poison for the body;

(2) they need their body to live;

therefore

(3) they should protect and respect their body by eating less.[3]

The overweight patient is then given the friendly advice "to reacquaint himself with his body so that when he meets it at his ideal weight, it will be like a reunion with an old friend."[4]
In contrast to Spiegel's rational approach, Erickson treated a 270-pound woman for her obesity by suggesting to her in trance: "Bearing in mind that you now weigh 270 pounds, I want you to overeat throughout the week enough to support 260 pounds."[5] The next week the patient was told to overeat sufficiently to support 255 pounds, and so forth. These suggestions are typical example of Erickson's use of the double bind whereby the patient was bound to overeat and bound to lose weight. Although Erickson was often indirect, he was not without a direct approach. To another overweight patient he suggested:

I really don't think you know how unpleasant your fatness is to you...so tonight when you go to bed, first get in the nude and stand in front of a full-length mirror and really see how much you dislike all that fat you have. And if you think hard enough and look through that layer of blubber that you've got wrapped around you, you will see a very pretty feminine figure, but it is buried rather deeply. And what do you think you ought to do to get that figure excavated?[6]

Superficial differences between Spiegel and Erickson in style of suggestion are typical of the types of differences that exist among all hypnotherapists . The main categories include direct versus indirect suggestion, and an overall approach that is authoritarian versus permissive-naturalistic. Most well-trained hypnotherapists would probably use all four factors, depending upon the patient. Some patients respond better to suggestions given in an authoritarian manner; others are more receptive to suggestions that hook into their ongoing, natural behaviors, and so on.
Types of suggestion and styles of approach are incidental to the underlying agreement that hypnosis is beneficial. Types of suggestion may vary be varied accord ing to superficial personality characteristics, but the underlying intent remains the same: all hypnotherapists attempt to engage and utilize a condition of dissociation.

Amnesia
Hypnosis knock s out memory and and the meaning of experience. You have amnesia, an experience without recall. In many cases, a partial or complete amnesia is suggested for any traumatic material that arises. Amnesia is considered useful because supposedly a person can undergo a traumatic but curative emotional experience on an unconscious level and not have to cope with it consciously. Trauma can be siphoned off while consciousness rests in its disconnected state of trance reverie. This goes hand-in-hand with the view that reliving or recalling a traumatic experience can be disintegrating, so amnesia is used as a kind of protective shield.
The integration of pain, however, absolutely requires full cortical consciousness. The reason experience is not integrated is because the message relay centers toward the cortex were blocked from transmitting the message to consciousness; instead shunting the message to other non-healing brain structures. The reason is that the message was too much to handle without totally disrupting cortical functioning.
In a way, amnesia is a form of double-barrelled hypnosis: the person is partially unconscious to begin with by virtue of being in a trance, after which a total unconsciousness for events is suggested by the hypnotherapist.

In hypnotherapy, amnesia is induced as a supposedly desirable way of getting the patient to unconsciously rid himself of trauma and therefore of his neurosis. The diabolic aspect of all this is that the reason one cannot get rid of the Pain is because it is unconscious. So long as it remains unconscious it will stay forever. The hypnotherapist believes that the patient can go through all sorts of experiences in the hypnotic session, have no memory of them whatsoever, and then leave transformed. But in fact w hen you induce amnesia what actually happens is that the patient leaves therapy not only not transformed but more repressed. hypnotherapy and Primal Therapy are particularly antithetical on the matter of amnesia {tt220}

In introducing a particular case report, Erickson clearly describes the hypnotherapeutic ideal: a distinctive split between intellect and emotion, mind and body, carefully controlled by the hypnotherapist.[7] 

You point out to a patient that it is perfectly possible to remember the intellectual facts of something but not the emotional content, and vice versa. You point out that once, when you felt down-hearted and blue, you couldn't for the life of you figure out why, but there must have been a reason in the back of your mind. You experienced the emotions but you didn't have intellectual content. In recovering a traumatic memory you can uncover deep emotions and not intellectual content. If you want to, you can remember the actual intellectual content; you need not remember whether you felt sad, mad, or glad. It will be just a memory, as if it happened to somebody else.

One of Erickson's students was in danger of flunking out of medical school because he "absolutely and irrationally" refused to attend dermatology class. Erickson tells the student, Bob, that there has to be some explanation for this, some past event he has forgotten. He asks him if he can use him as a hypnosis demonstration subject in class, and tells him to spend the next week trying to remember what he had forgotten. A week later, Bob says: "How on earth do you go about remembering something you forgot a long time ago? You don't even know where to look!...It's gone!"
After putting Bob in a trance in order to find such a memory, Erickson describes to him how a memory is like a jigsaw puzzle, which you can put together piece by piece; how you can put the puzzle together right side up or upside down; and how the picture side of the puzzle represents the "intellectual content" of the memory while the blank side represents the "emotional foundation." He then leaves Bob with the choice of how to assemble the puzzle of a repressed memory (which had some role in producing his inability to attend dermatology lectures) in a meaningful way. When Bob, in a trance, does not know how to do this on his own, Erickson says to him:

"Suppose you haul out from your unconscious just a few little pieces of that unpleasant memory." Bob thought a minute and then perspiration began to form on his forehead. I asked, "What is it Bob?" He said, "I'm feeling sick in a funny sort of way. I don't know what kind of a way." I said, "That's fine, so you're feeling sick in a funny sort of way; you don't know in what kind of a way. All right forget about it." With that Bob developed an amnesia for the material that was making him feel funny. I then continued, "Suppose you reach down into your repressions and bring up a few pieces of the picture." Bob did essentially that and said, "Well, there is water and there is something green. I suppose that is grass, but that green isn't grass." I said, "That is fine, now you shove that down. Now bring up some more pieces of emotion." Bob brought up some more emotion and then said, "I'm scared, I'm scared. I want to run," and he was really perspiring and trembling. I said, "Shove it down again. Let's bring up a few other picture pieces.

We see how Erickson uses the technique of dissociating intellect and emotion. As more associations rise to consciousness, Erickson helps Bob repress them "when the emotion became too threatening." Meanwhile, while briefly feeling these emotions, Bob sweats profusely. Erickson periodically brings him out of the trance, lets him rest, and hypnotizes him again. At one point he tells Bob to "put all the blank sides together again," which he does. Erickson writes:

You should have seen him trembling and perspiring. He was actually shivering, so periodically I gave him a suggestion to blank it out and rest: "Take another deep breath and look at that blank reverse side of the jigsaw puzzle with the amnesic traumatic experience." He said, "Whatever is on the other side of that is something awful--it's just awful." I then told him to forget the entire emotional side. We'd turn the jigsaw puzzle over and see it intellectually only, without emotions. He described, "Two little boys, about eight or nine years old, they looked like cousins -they're playing in a barn, they are wrestling. Oh! Oh! One is getting mad with the other. Now they are hitting at each other. Now they grabbed some forks, they start stabbing at each other. Oh! Oh! One of them stabbed the other in the leg. That one is running into the house to tell. The one that stabbed him is a little bit afraid. He runs along, too. The boy's father isn't mad; the mother isn't mad; they are calling the doctor. The boy's father makes him sit on a chair to wait. There is the doctor driving in. The doctor is going to stick something in the boy. Oh, my goodness, what a funny thing. Look at that boy's face. He is lying there.

His face is swelling up, his eyes are swelling shut, his skin is turning a funny color, his tongue is so thick, and the doctor is scared. He is getting something else. He's got -- it looks like a needle or a pump of some kind, and he is pumping something into the boy, and now that swelling in the boy's face is getting less, his tongue is getting smaller, he is opening his eyes, and everybody is breathing deeply. The father grabs the other boy and takes him down to the horse trough. The father sits on the horse trough, hauls the boy over his lap, and starts spanking him, and he is really spanking him hard. The boy is looking down in the horse trough and he sees that green slime on the water and he is crying. There is something awful bad about this, and I don't know what it is. There is something awful bad." 

I said, "Well let one corner of the back of it soak through, and then another corner, let the back of it soak through, soak trough, soak through." You should have seen poor Bob as he began uniting the ideational content with the affect. Shuddering, trembling, crying out, horrified, he said "I can't stand it."

I again told him to develop a complete amnesia. "Take a rest Bob. You have a little more work to do. Maybe if you rest five minutes, we'll have enough strength to do a little more of the work." 

Erickson flipflops the patient back and forth between feeling and not feeling; between recalling a repressed childhood trauma with intellectual detachment and feeling the emotions associated with it in bits and pieces. Erickson contends that the amnesic behavior is really under the patient's control because he is responding to suggestion. But according to Erickson's description, the experience sounds like a finely orchestrated one-man play for which he provides the controlling "strings" of suggestion. Now the patient recalls a few memories; now represses them. A bit more here, and then "shove it down again."

...I asked him to continue. He dropped the amnesia until he couldn't stand it any longer, and then another amnesia, a rest, and then again another recovery until finally he said, "That little boy that stabbed the other one is me. That's my cousin and that was the fork we used for cleaning out the barn, and the doctor comes and gives him an anti-tetanus shot. He gets an anaphylactic reaction with all that edema, and everybody expects him to die including me. Then the doctor gave him adrenalin and he recovered, and then my father took me down to the horse trough and spanked me. I couldn't even stand the way my cousin looked, and there was my father spanking me and that nasty green slime on the water in the trough -- that horrible green slime and that horrible color of my cousin's face. No wonder I couldn't study my dermatology." That was the end of that. No wonder he didn't like dermatology.

In the final outcome Bob has retrieved the entire traumatic memory but has no recall of it -- or of the six-hour session he has experienced in front of an entire classroom of people. In other words, whatever traumatic emotions were recovered in the trance state were then re-covered by the amnesia. Yet, if we are to believe Erickson's account, through hypnosis Bob's traumatic memory had been shorn of its power to affect him. The next day, he showed up for dermatology. "It was almost a week before Bob recalled that he was attending dermatology. He just simply took it so matter-offactly that he didn't realize he had missed previous lectures and clinics."
In analyzing this case, Erickson asserts that it's a mistake to try to recover an entire traumatic experience all at once. He goes on to say that therapists can utilize the way people often have, in everyday life, an "intellectual appreciation of their position but an emotional indifference." This "detachment" is what helps the subject develop amnesia, which, according to Erickson, is "just as effective as a repression," in that it permits the traumatic material to be "available for examination...in small portions in relation to emotional healing and the ideational content."
Of course, it is not an examination of one's history that is needed, but feeling and integrating the feeling into the body’s system versus repressing it . The emotional aspect of suffering must be released from the limbic storehouse and raised into consciousness. That can only be done bits at a time. But it is the amount of Pain one can feel that is the limiting factor, not the cognitive aspect.
The active inducement of amnesia by hypnotherapists suggests to me a distrust of consciousness. It implies that there is something about the patient's experience which consciousness cannot handle. The assumption seems to be that either the emotions are too threatening, or cognition is not equipped to give them accurate meaning. In the above case, Erickson actively worked to dissociate intellect from emotion. But dissociating feeling from intellect is what gives neurosis its start in the first place: the meaning of the child's trauma, "I can never be loved for who I am,", is lost. Because the real meaning is lost, a symbolic one is substituted. With Erickson's patient, the fear is projected onto the field of dermatology -- a far cry indeed from the original trauma of stabbing his cousin in the leg.
Recovering the meaning of a trauma is an inextricable part of removing repression because it is eventually the meaning "They hate me and don't want me around" that sums up years of childhood experience with the parent. Repression of a trauma cannot be removed by simultaneously suggesting a repression of the memory of that recovery! To do so only ensures the continuance of repression and neurosis.

At best, amnesia is a safety valve for the patient. It is a kind of self-protective mechanism that inhibits the onslaught of too much Pain at one time. The point is that amnesia is the patient's defense rather than the therapist's tool. It is part of the problem, not part of the solution. It is something to be respected when it occurs spontaneously within a patient, but it is not something to be encouraged or suggested. Suggestions for amnesia are really suggestions for continued neurosis which ultimately deepen rather than integrate the existing fissures in consciousness.


[1]Donald S. Connery, The Inner Source: Exploring Hypnosis with Dr. Herbert Spiegel (New York: Holt, Rinehart & Winston), 1982.
[2]Ibid.
[3]_Ibid., p. 225.
[4]Ibid., p. 225.
[5]The Lectures, Seminars, and Workshops of Milton H. Erickson (Vol. I), edited by E. Rossi, M. Ryan, & F. Sharp. New York: Irvington, 1983, p. ??
[6]Ibid., Vol. II, p. ??
[7]Milton H. Erickson and Ernest L. Rossi, Hypnotherapy: An Exploratory Casebook. (New York: Irvington, 1979), 348-352.