THE hypnotic state varies in intensity in different individuals, or in the same individual at different times, from a slight drowsiness to almost complete coma. Many attempts have been made to classify these stages by the phenomena exhibited, but it should be understood that these are but arbitrary divisions.

Drowsiness, being almost wholly a subjective symptom, can hardly be considered hypnosis. Until catalepsy is produced the patient is not hypnotized. Inability to open the eyes is a catalepsy of the orbicularis muscle. After this, rigidity of legs or arms in awkward positions follows the suggestion of the operator. The patient may be perfectly conscious, indeed may really be amused at his helplessness. While many other phases may now appear, yet for purposes of definition, the cataleptic stage signifies a certain well-recognized condition.

With certain restrictions, which will be fully considered later when speaking of automatism, the succeeding manifestations appear as suggested. Somnambulism has come by general consent to mean a state in which hallucinations are accepted, of which the patient has no recollection on waking. When this stage is reached analgesia and anesthesia are easily effected, and the patient is sure to be en rapport with the operator. He is oblivious to all other persons until they are introduced to him.

It is therefore well to keep clearly in mind these two stages, catalepsy and somnambulism, as distinguishing mild and deep hypnosis.

It is usually unwise to carry the patient deeper than catalepsy at the first sitting, as there is something uncanny in feeling one’s self in the power of another. As a matter of fact, unless the person has considerable knowledge of the subject, most operators simply talk to him for the first visit, explaining what is to be expected. He may be asked to close his eyes and put himself in a passive state. He should be assured that suggestibility is well-nigh universal in healthy individuals, but that his cooperation is absolutely essential.

As soon as catalepsy has been secured one should say with some emphasis : ” No one shall ever be able to hypnotize you against your will, or except for your good, or no one but your physician.” This suggestion is very reassuring. This cataleptic stage is sufficient for giving many therapeutic suggestions, indeed when we treat of this, we shall see that a-hypnotic suggestions are made by many therapeutists, many claiming that the passive state is all that is required. It is surprising how easily analgesia to a pin-prick may be secured. Anesthesia or complete insensibility to contact is not secured short of somnambulism.

One would hardly like to depend on the analgesia for surgical purposes short of the somnambulic stage.

In treating a stricture of the tear duct in a child of twelve years, the probing was so painful that very little progress was made in several visits. Catalepsy with analgesia to the prick of a needle was easily secured. The writer then suggested that the probing would not be painful, at the same time massaging over the region of the duct. The child was perfectly conscious, and in response to the question said it did not hurt when the probe was forced thru a tough stricture, opening the duct to the nose. Nevertheless altho she maintained it did not hurt, there was evident considerable muscular reaction.

It will be remembered that Esdaile’s use of hypnotism was almost entirely as an analgesic in surgery. He devoted half an hour to the hypnosis as a routine measure, and there can be little doubt that somnambulism was secured.

Bramwell hypnotizes on several successive days before attempting any very painful operations. He has secured complete anesthesia in only about ten per cent. This uncertainty evidently lessens its value as a general anesthetic, but where it is effective it is devoid of danger, which cannot be said of chloroform and ether. Not only does the patient suffer no pain, but the reflexes are abolished. This is certainly objective proof of anesthesia.

Analgesia in surgery has been demonstrated over and over again before representative medical societies. At the Boston Homeopathic Medical Society a few years ago Prof. George H. Earl reported a dispensary confinement case, where it became necessary to use forceps with no ether at hand. The patient was hypnotized and the delivery was practically painless. This naturally leads us to inquire why normal childbirth cannot thus be made painless, and Bramwell quotes numerous instances of its successful employment.

I have seen no reference to its use preliminary to giving an anesthetic. It would seem that it might here be of greatest value, in reassuring the patient and controlling the after vomiting. The value of hypnotism in medicine will be considered under ” Suggestive Therapeutics.”

The hypnotic control of the pulse has been frequently secured by the author. As an example a recent experience may be mentioned. When the subject, a medical student, had reached the somnambulic stage another physician was asked to take his pulse, but not to mention the result. It was then suggested that in ten minutes the rate would be in-creased ten beats per minute. The patient was left quietly reclining in an easy chair, no suggestions of an exciting or emotional nature being made. A second count showed the exact increase suggested. It was then suggested that in ten minutes the rate would be ten beats less than at first. The same physician announced the result as seven less.

Doctor Sidis and others have shown by sphygmographic tracings a marked change in the character of the curve under hypnosis. More interesting perhaps are the results of pneumographic tracings. The increased sensitivity of the hypnotic state is graphically shown by the great variations from the normal tracing caused by stimuli of various kinds. Thus laboratory results confirm the observations that suggestibility is greatly increased. The therapeutic bearing of this fact will be discussed under ” Suggestive Therapeutics.”

The transition to the alert stage seems somewhat contradictory. This has always impressed the author when telling a subject who has been put into a sound sleep that he can open his eyes and still remain asleep.

That something of the kind occurs to the subject is often evident from the slight hesitation which he shows. I have frequently said to a patient, ” Your sleep is not quite like ordinary sleep because you can open your eyes. You can hear me speak to you, can you not ? His reply will often show considerable effort and the word ” yes ” may be whispered. This has been observed so often that one should be suspicious that he is being deceived if the subject should respond in a loud voice at first.

Hallucinations will now be accepted. These may be either positive or negative. That is, the subject may be told that he is looking at a beautiful landscape; this would be a positive hallucination. Or he may be told that the chair which stood in front of him has vanished, that there is no one present in the room; these are negative hallucinations.

This brings us to the subject of rapport. Before any suggestion of the kind is made the patient appears perfectly oblivious to the presence of all save the operator, and appears not to hear when the operator speaks to others than himself.

This rapport seems to be a phenomenon of hypnosis entirely independent of the suggestion. The operator can, however, introduce an observer either under his true name or fictitiously.

The deductive nature of the hypnotic state is universally recognized. For example, the subject is told that he is John L. Sullivan, and he immediately assumes his idea of the pugilist.

On one occasion in a public hall the writer saw a washerwoman taken on the stage and told that she was Susan B. Anthony, and informed that she was to address the audience on ” Women’s Suffrage.” In the normal state probably no amount of persuasion would have induced the woman to say a word in public, and yet she bowed to the audience and made a very good speech. She believed herself to be the person named, and given this premise, deduced a logical sequence.

Suggestions should be made direct, emphatic, and oft repeated. Sidis has shown this to be in strong contrast to the normal state, in which suggestions are effective in proportion to their indirectness. For example, if you want your friend to whistle a tune, he would probably refuse your command, but if he be somewhat preoccupied, you pretend yourself the same, but carelessly whistle the tune, and the chances are that your friend will change his tune and whistle yours.

In like manner the mental processes differ. The conscious self reasons inductively. He builds up a conclusion by putting together separated and unrelated experiences. For example, Newton watching the apple fall conceives that there is a mutual attraction between the earth and the apple, then between the earth and the sun, and concludes with a theory of universal gravitation.

It is claimed that the threshold of sensation is raised by hypnosis, that sight and hearing are more acute. This has not been personally demonstrated.

Post-hypnotic amnesia usually occurs without suggestion, but it can be either increased or diminished, by telling the patient that he will either remember or forget the events that transpire during his sleep.

Post-hypnotic suggestion is a very striking phenomenon. You suggest complete amnesia on waking. Then tell the patient that when you take out your pocket-handkerchief he will immediately get up and leave the room. When he wakes it is well to have one of the observers determine that amnesia is complete.

No matter what the subject may be doing, when you inadvertently give the signal he responds like a machine, and is entirely ignorant of the cause of his action. On a subsequent hypnosis, however, he would be able to tell you all about it.

This is the most effective way of reviving subconscious memories. Long forgotten happenings of childhood can be brought out. This has been utilized in discovering the causes of hallucinations and psychoses. So many experiments in the post-hypnotic appreciation of time have been made by many different observers, that we are forced to conclude that the power greatly transcends that of the normal waking consciousness. A very simple way to test this is to suggest that the post-hypnotic suggestion shall be carried out at a certain time, instead of at some stated signal. My own experiments in this line have not been very extensive, but sufficient to convince me of the truth of the claim.

In one instance it was suggested that half an hour after waking, the subject, who was one of a company of professional friends, should become aware that his right shoe was hurting him; that it would feel like a stone or nail in his shoe, and that the discomfort would become so great that he would be compelled to take off his shoe and rub his foot.

After he waked, he remained seated with his back to the dock, and the half-dozen people present were listening to something which I was reading aloud. In exactly twenty-seven minutes, he was seen to look at his foot and move it uneasily in the shoe. The right leg was then raised and thrown across the other and the shoe moved with the hand. In about a minute he interrupted my reading by remarking aloud, ” I never knew that shoe to hurt me before.” Paying no attention to the remark, I continued reading, when he interrupted again by saying, ” I wonder what it is.” With some impatience I said, ” I wish you would not interrupt me.” ” I haven’t heard a word you have read,” was the reply.

Some one suggested, ” Perhaps you have a nail in your shoe.” ” I don’t wear nailed shoes,” was the impatient reply. At this there was such a general laugh that he said : ” Ah, I know, it is a suggestion, you want me to take my shoe off. Well, I won’t do it.”

He lighted a fresh cigar and smoked very vigorously for a few minutes, but while the company roared with laughter he took off his shoe and rubbed his foot. On being questioned afterward he said that he could have resisted, but he realized that he should be uncomfortable till he did it, and therefore obeyed.

This absolute obedience has been termed automatism, which is a subject demanding careful consideration, because of its important bearing on the possibility of criminal suggestions. It was formerly believed that once the subject succumbed to the operator he became his slave, absolutely unable to refuse any command. This belief is quite universal in the lay mind, and, I am sorry to say, is quite generally shared by the medical profession.

Bramwell has made most exhaustive experiments on this line, which have, I believe, conclusively shown that quite the reverse is true. He has adopted the very rational method of questioning the patient under hypnosis concerning his motives for action and refusing to act.

In the first place, it should be understood that good subjects frequently refuse suggestions from mere caprice. Numerous instances of this are on record. I do not refer to criminal suggestions, but actions which are absolutely harmless. Bramwell mentions the case of a young girl who had many times carried out post-hypnotic suggestions. On this occasion he directed that on waking she should go to the sideboard and pour for herself a glass of water. Much to his surprise, the suggestion was not carried out. She was rehypnotized and asked why she had refused to obey. She said that she did not feel sufficiently acquainted with him to take such a liberty.

In my patient the impulse to take off the shoe would undoubtedly have been overcome had there been ladies present.

At a college society meeting I suggested to one of the company whom I had hypnotized that at a certain signal, after waking, he should go to the punch-bowl and take a drink out of the ladle. He took up the ladle full of punch, raised it as if to drink, then hesitated for several seconds, finally poured it into a glass and drank from it. No comment was made, but it was evident that the impropriety of the act prevented its execution.

The classic experiment of telling a subject that a lump of sugar is arsenic and that he is to poison his friend has been assumed to prove criminal suggestion. It will usually be carried out. The patient will also stab his friend with an imaginary dagger. But further questioning reveals the fact that the subject appreciates the distinction between these experiments and the real things.

Bramwell tells of an instance of a caretaker who had shown his pluck by shooting at some genuine burglars. He was afterwards hypnotized and was made to believe that some friends in an adjoining room were breaking and entering. The ball-cartridges had been secretly replaced by blanks, but he supposed the revolver still loaded. Instead of carrying out the suggestion, he very carefully laid the revolver away.

Popular literature furnishes innumerable instances of belief in this fallacy. Nearly all hypnotists of the present generation have believed it till experience has demonstrated the contrary. Bernheim formerly held this view quite strongly, but latterly admits that not more than four or five percent of his patients will accept criminal suggestion. Is it unreasonable to suppose that this percentage is normally criminally inclined?

As far as I am able to judge, the great majority agree with Bramwell, who says : ” I have never seen a suggestion accepted in hypnosis which would have been refused in the normal state. I have frequently noticed increased refinement in hypnosis, subjects have refused suggestions which they would have accepted in the normal condition.”

This may depend on the early education of the subconscious, the development of a finer sensibility than the later volitional years had been able to live up to. Probably all of us have had the experience of attempting to silence the voice of conscience by reasoning with ourselves that the coveted sin wasn’t so bad after all. If one has succeeded in convincing himself in this way, the laying bare of his subconscious nobler nature may reveal a higher type of manhood.

” The question as to whether hypnotism can be successfully employed for criminal purposes must be determined in each individual case by the character of persons engaged in the experiment.” ” If the subject be a criminal character he might follow the suggestions of a criminal hypnotist and actually perpetrate a crime.” I In such a case a resort to hypnotism for criminal purposes would be unnecessary, except to abolish fear of detection. The effect upon the will of continued hypnosis is not proved to be detrimental.

If we accept the statement of Moll, that intelligent people and those with strong wills are more easily hypnotizable than the reverse, it would seem that this very strength of will is required to perfectly control one’s inhibitory faculties, that extraneous thoughts — other ideas than those suggested — shall be held in abeyance. The proof of this statement is the fact that the good operator, whom it is tacitly assumed must be of strong will, may also be a very good subject.

Hypnotic experiments should be conducted with great care, to guard against erroneous conclusions.

This point is well illustrated by the history of the development of the science.

One should constantly be on his guard lest he be deceived by the subject pretending influences which are not real. Until one has become somewhat expert, he should never employ a paid subject. It is advisable to experiment with a small company of friends, assuming the rôle both of subject and operator. The educational value of being hypnotized has not been properly recognized. In this way you have a practical knowledge of the phenomena which you witness in your subject.

Auto-suggestions and preconceived ideas are very important factors in producing unexpected results. The subject is vividly alert not only to the things you say but to your unuttered thoughts. It is not intended by this to claim telepathy, but we all unconsciously disclose our thoughts by gestures and inflections. This is illustrated by the ” willing game.” In this a person is brought into a room blindfolded, it having been arranged that he should find some article. One or two of the company who know what is desired take the ” operator” by the hand, and all of the company concentrate their attention on the thing selected. With the attention thus fixed the ” guides ” unconsciously contract or relax their hand muscles, and really direct the operator to the desired spot.

This is known as “muscle reading,” and often gives surprising results, but it does not prove telepathy.

It has been claimed that a hallucination of a coin can be doubled by a prism. With a real object a prism gives diplopia, and a patient who knows this property of a prism would by the deductive process perceive a double hallucination. It is possible to secure the hallucination of two coins without a prism, so we need not invoke the principle of false orientation of a hallucinatory image.