Orne, M. T. What must a satisfactory theory of hypnosis explain? International Journal of Psychiatry, 1967, 3, 206-211.

What Must a Satisfactory Theory of Hypnosis Explain?

Martin T. Orne, M.D., Ph.D.

Director, Unit for Experimental Psychiatry Institute of the Pennsylvania Hospital and Department of Psychiatry University of Pennsylvania

Any theory of hypnosis must explain the kinds of changes that can be brought about and the ease with which this is accomplished. Further, it would be desirable to understand some of the reasons for differences of hypnotizability in the general population. Unfortunately, no theory has successfully addressed itself to these problems.

DR. CHERTOK's brief but illuminating review focuses on theories which have tried to explain the hypnotic phenomenon. The importance of a theoretical rationale which would allow us to bring order into our empirical observations is clear. Yet much effort has been devoted to explaining observations which do not stand up under scrutiny. A careful evaluation of the parameters of hypnosis is essential to the understanding of this phenomenon which has such great theoretical and clinical significance. I am unable to present a meaningful theory which would have more to recommend it than the formulations brought together by Dr. Chertok; rather, I will try to call attention to some aspects of hypnosis which I feel are not adequately explained by the presently available formulations and which need to be taken into account in any systematic study.

Physical Signs of Hypnosis

Not only did Babinski and Charcot define hypnosis as a "bodily state objectively identifiable by physical signs which could be induced by stimuli from outside the organism," but, in one fashion or another, Mesmer, Braid, Moll and, in more recent years, contemporary investigators such as Erickson have felt that hypnosis could readily be recognized by objective physical signs. Unfortunately there has never been agreement among investigators on the nature of these signs. The crisis which was held to be so important by Mesmer is rarely, if ever, seen today. Subjects no longer pass from sleep to somnambulism when the tops of their heads are rubbed, as was the case in Charcot's time, nor do all contemporary investigators agree that catalepsy is the hallmark of hypnosis, as is stated by Erickson. Not only is it possible to eliminate all obvious physical signs of hypnosis, as Erickson has pointed out, but it is even possible to eliminate all subjective experiences which might allow the subject to recognize that he is hypnotized. In a rather ingenious experiment, Gill and Brenman 1 demonstrated that there are no signs or symptoms pathognomic to hypnosis. They told deeply hypnotized subjects to act awake and remain in

The substantive studies on which these comments are based were supported in part by The Air Force Office of Scientific Research, Grant No. AF-AFOSR-707-65, the Group Psychology Branch of the Office of Naval Research, Contract No. Nonr-3952(00), and the National Institute of Mental Health, Grant No. MH 03369-05.

1 M. M. Gill and Margaret Brenman, Hypnosis and related states: Psychoanalytic studies in regression. (New York: International Universities Press, 1959.)



deep hypnosis, then asked each whether he was hypnotized. Upon receiving an affirmative answer, they asked how he knew. If the subject stated that he felt drowsy and had a tingling sensation in his fingers, he was given the suggestion that at the count of three he would no longer feel drowsy, would have no tingling sensation, but would remain hypnotized. They again inquired if the subject was hypnotized and, if so, how he knew he was. The subject might report that he had a light feeling in his body; this was again removed. In this fashion, any and all subjective and objective physical signs of hypnosis could be removed, though deep hypnosis was maintained. As I have indicated elsewhere, 2 physical signs of hypnosis can best be understood as a function of the subject's preconceptions about what constitutes hypnosis, augmented by cues from the hypnotist and the situation.

It should not be surprising that, when told to go to sleep and to carry out certain actions while asleep, the subject will look as though he is walking in his sleep. He is merely conforming to the instructions. Many investigators, notably Bernheim 3 and, more recently, Wells, 4 have pointed out that all hypnotic phenomena can be achieved without any induction of sleep.

It is relevant in this context that, despite concerted efforts by numerous laboratories over many years, no physiological change which is associated only with hypnosis has ever been recognized. We have not even been able to find physiological changes which are invariably associated with hypnosis. The failure to find such physiological concomitants may, of course, merely reflect a relative state of naivete in psychophysiology. Thus, the differentiation of relatively clear-cut affects such as fear and anger by physiological means remains a controversial issue.

Induction of Hypnosis by Physical Means

While a number of techniques have been advocated for the induction of hypnosis by physical means, all of these depend upon the subject's knowledge and expectation that he will be hypnotized. The best that can be said for physical methods is that they may augment verbal suggestion and expectation. Even here systematic studies of physical adjuncts to the induction of hypnosis have been remarkedly disappointing. If one controls for the subject's increased expectation of being hypnotized, which is a natural consequence of a fairly dramatic and impressive procedure, no further augmentation by physical procedures can be demonstrated. Certainly there is no evidence that hypnosis can be induced by any physical means without positive expectation on the part of the subject. Until such evidence is available, it appears fruitless to speculate about the effect of physical procedures on hypnotizability.

The parallel between sensory deprivation and hypnosis has been drawn by Gill and Brenman 5 and emphasized by Dr. Chertok. However, recent work 6 has shown that many of the sensory deprivation effects can best be understood as interactions between

2 M. T. Orne, The nature of hypnosis: Artifact and essence, J. abnorm. soc. Psychol., 1959, 58, 277-299.

3 H. Bernheim, Suggestive therapeutics: A treatise on the nature and uses of hypnosis. (New York: G. P. Putnam's Sons, 1889.)

4 W. R. Wells, Experiments in waking hypnosis for instructional purposes, J. abnorm. soc. Psychol., 1924, 18, 389-404.

5 Op. cit.

6 C. W. Jackson, Jr. and E. L. Kelly, Influence of suggestion and subjects' prior knowledge in research on sensory deprivation, Science, 1962, 132, No. 3499, 211-212; also M. T. Orne and K. E. Scheibe, The contribution of nondeprivation factors in the production of sensory deprivation effects: The psychology of the "panic button," J. abnorm. soc. Psychol., 1964. 68, 3-12.



subjects' expectations and the experimental treatment rather than as functions of the physical conditions as such. The importance of subjects' expectations, both in bringing about the hypnotic effect and in sensory deprivation effects, is usually overlooked and must be taken into account in developing any meaningful theory.

Hypnosis and Transference

Irrational feelings toward the hypnotist can readily be demonstrated in patients' fantasies. The hypnotic relationship tends to resemble parent-child interactions, and the use of hypnosis in treatment may lead to striking alterations in the patient's attitude toward his therapist. Clinical observations such as these have been the basis for theoretical formulations which have equated transference and hypnosis. While these data would be explained by such a formulation, any theory of hypnosis must also take into account the phenomenon as it occurs in other settings. The investigation of hypnosis is facilitated by the ease with which it may be induced in normal individuals in an experimental setting. In a research setting, hypnosis may be used to demonstrate a broad range of psychopathological events in normal individuals. A meaningful comparison of data from the therapeutic context to the purely laboratory setting is made possible.

To the extent that we are dealing with the transference phenomenon, one would expect it to be maximized in the clinical contesxt. Yet the hypnotizability of normal individuals in experimental settings is higher than that of any pathological group, including hysterics in a therapeutic setting. (Hysterics represent the most hypnotizable group among individuals with overt psychopathology but are considerably less hypnotizable than normal volunteers.) 7

Examining the laboratory data, one is impressed with the ease with which hypnotizability can be measured. A number of workers have devised scales and, in recent years, the careful work of Hilgard's 8 group has amply documented the remarkable stability of the phenomenon in any given group. Thus the test-retest reliability of hypnotic tests approaches that of intelligence tests. Most relevant, however, is that it makes little difference whether the hypnotist is a young, insecure research assistant or a senior authority figure; nor does the sex of the hypnotist matter. Normative data obtained in different laboratories are remarkably similar. Further, any subject's score on a particular hypnotizability scale will tend to be stable over succeeding sessions, even though the status and sex of the hypnotist may vary. Even in a clinical setting, the status of the therapist is remarkably unimportant. Thus Gill and Brenman observed that their residents were as effective in inducing hypnosis as was a senior analyst. Implicit in a transference theory of hypnosis is the emphasis on the importance of the status and prestige of the hypnotist. Hypnotizability, however, can best be described as a subject attribute, whereas one would expect transference to be related more to the interaction between patient and therapist.

Individuals who appear most motivated to follow the instructions of one who is subsequently going to hypnotize them are not necessarily the best responders. Further, in a laboratory setting, subjects who are able to enter into hypnosis are not necessarily more inclined to perform better on such tasks as squeezing a dynamometer or memorizing nonsense syllables than relatively unhypnotizable individuals.9 Punctu-

7 Gill and Brenman, op. cit

8 E. R. Hilgard, Hypnotic susceptibility. (New York: Harcourt, Brace & World, 1965.)

9 P. London and M. Fuhrer, Hypnosis, motivation and performance, J. Pers., 1961, 29, 321-333; also F. J. Evans and M. T. Orne, Motivation, perform-



ality, often taken as a measure of therapeutic rapport, tends to be an attribute of poor rather than of good subjects. While such findings cannot negate a transference theory of hypnosis, they would certainly not be predicted by it.

Recognizing that the tendency to enter into hypnosis is remarkably stable in a given situation, and will remain relatively stable even in situations that vary considerably, one would expect that personality correlates could readily be demonstrated. However, the search for psychological correlates of hypnotizability has been almost as disappointing as the absence of psychophysiological concomitants mentioned earlier. The literature includes many isolated studies in which such correlates have been demonstrated but the relationships tend to be unstable and usually fail to replicate in different samples, even within the same laboratory. 10 It is not possible to predict hypnotizability reliably by the usual kinds of psychological tests, whereas even poor work samples of hypnotizability are excellent predictors. To the extent that hypnotizability is conceived of as a kind of "transference readiness," one would expect that it could be predicted best by experienced clinicians interviewing subjects. In a major project, Dr. Josephine Hilgard and her co-workers,11 using clinical interviews, tried to predict hypnotizability. In contrast to the situation in which clinical predictions are usually made, it was possible for them to obtain rapid feedback.

The clinician would predict hypnotizability; the subject then went to an independent investigator who assessed his hypnotizability and made the score available to the clinical group, so that it might continually improve its predictive skills. While these studies have led to interesting hypotheses, the predictive power of the interviews -- despite the unique opportunity for improving predictive indices -- has been disappointing compared with a work sample by relatively inexperienced investigators.

The clinical data alluded to earlier remain to be explained. The fact is that patients do tend to develop intense feelings about their therapists more rapidly, and perhaps slightly differently, when hypnosis is used. Furthermore, the symptomatic relief which may follow an appropriate hypnotic suggestion often closely resembles a transference cure. The patient who has been hypnotized and shown that striking subjective experiences can be brought about by suggestions from the therapist naturally feels more confident that the therapist can help him bring about therapeutic progress. The patient's experience with hypnosis can enable him to regard it as an effective technique in bringing about change, much in the way he may regard the use of effective drugs or surgery. Such an experience will tend to facilitate the rekindling of archaic feelings characteristic of the parent-child relationship and may well make the patient feel that the therapist is a special kind of person with special powers. Thus the change in the transference relationship could be caused by, rather than form the basis of, the hypnotic experience. It should be emphasized that the manner in which hypnosis is used may maximize or minimize such changes; further, interpretations (particularly of dreams) can have a similar effect on a patient by demonstrating that his therapist

Footnote 9 cont.

ance, and hypnosis, Int. J. clin. exp. Hypnosis, 1965, 13, 103-116.

10 E. R. Hilgard and Lillian W. Lauer, Lack of correlation between the California Psychological Inventory and hypnotic susceptibility, J. consult. Psychol., 1962, 26, 331-335; also R. E. Shor, M. T. Orne, and D. N. O'Connell, Psychological correlates of plateau hypnotizability in a special volunteer sample, J. Pers. soc. Psychol., 1966, 3, 80-95.

11 Josephine R. Hilgard, Personality and hypnotizability: Inferences from case studies. In E. R. Hilgard, Hypnotic susceptibility, op. cit., pp. 343-374.



is able to understand him in a special way.

Perhaps of equal importance is the change in the therapist's behavior toward the patient when hypnosis is induced. In observing films of hypnotist-subject interaction, one is eventually struck by significant changes in the hypnotist's behavior. These changes, often overlooked because one tends to focus on the subject, are evident when the same film strips are studied long enough; one loses interest in the subject's behavior and observes the hypnotist. Typically the hypnotist becomes exquisitely responsive to subtle cues from the subject. While the tendency is to conceive of hypnosis as a relationship in which the subject is controlled, observation shows that the hypnotist's behavior is directly contingent upon the subject's response; the more effective the hypnotist, the more appropriate his adaptation to the subject's response. The therapist tends to be closer to the patient, more ready to treat him as a child than is common in the usual therapeutic relationship, and more willing to communicate directly to the patient some of the changes which may be necessary for improvement. The alterations in the therapist's behavior toward the patient when hypnosis is used may be the major factor in bringing about significant changes in the transference relationship; they may help to explain why hypnotherapeutic intervention has had considerable therapeutic effectiveness in individuals who appear to be very difficult, if not impossible, to hypnotize. I have suggested elsewhere 12 that this may explain why depth of hypnosis does not correlate with the response to therapeutic suggestions.

The Puzzle of Hypnosis

We have avoided defining hypnosis. It is such a well-known phenomenon that the omission is likely to go unnoticed. Yet what are the aspects of hypnosis which demand explanation? The fact that patients or experimental subjects readily follow instructions is not new, nor does it require any special state to explain it. In fact, we have been able to show that subjects who have agreed to participate in an experiment will carry out the most bizarre instructions without being hypnotized. 13 While it is possible that the induction of hypnosis leads to greater behavioral compliance by the subject, this has not been demonstrated. 14 It was pointed out earlier that hypnosis is not accompanied by any particular physical sign. The hypnotized individual has the capability of responding to cues from the hypnotist by altering his subjective experience. If these cues demand an alteration which distorts perception or memory, it is still possible for him to respond to them by altering his apparent perception of the real world. What is impressive about the hypnotized subject's behavior is that he appears capable of ignoring reality, responding instead to a reality constructed in part by the hypnotist's words. In addition, he may have amnesia for the experience and may manifest the effects of hypnosis at a much later time in response to predetermined cues. Again, what impresses one about the posthypnotic suggestion is not so much that the subject carries out the behavior, but that he does not appear cognizant of the reason for doing so.

Hypnosis is even more puzzling; the dramatic effects of the condition must be juxtaposed with the ease with which it is induced in suitable subjects, even by rela-

12 M. T. Orne, Hypnosis, motivation and compliance, Amer. J. Psychiat., 1966, 122, 721-726.

13 M. T. Orne, On the social psychology of the psychological experiment: With particular reference to demand characteristics and their implications, Amer. Psychologist, 1962, 17, 776-783.

14 M. T. Orne, Psychological factors maximizing resistance to stress: With special reference to hypnosis, in The quest for self-control, Samuel Z. Klausner, ed. (New York: The Free Press, 1965.)



tively untrained hypnotists. If induction required a long time, a great deal of technical skill, some powerful drug, many hours of isolation, or a similar major intervention, it would be far less puzzling. Any theory of hypnosis must explain the kinds of changes that can be brought about and the ease with which this is accomplished. Further, it would be desirable to understand some of the reasons for differences of hypnotizability in the general population. Unfortunately, no theory has successfully addressed itself to these problems.

Many attempts have been made to explain the hypnotic phenomenon. Usually these have tried to account for aspects such as increased compliance on the part of the hypnotized individual or his ability to transcend his normal volitional capacity, which do not appear to be necessary characteristics of hypnosis.15 On the other hand, they have failed to explain other characteristics which seem to be essential. Until parameters of the phenomenon are thoroughly understood and its essential characteristics can be separated from its artifacts, a meaningful theory will be difficult, if not impossible, to develop. Instead, we have at hand the less exciting but essential task of controlling for bias and artifact in observation, subtle cues often outside of the awareness of the experimenter to which the subject nonetheless responds, and similar problems. More modest theories sticking closely to empirical observation will be needed to guide research, and these may ultimately lead to more satisfying, comprehensive formulations. Such a task will be tedious and time-consuming, but in attempting to explain the peculiar kind of dyadic interaction which we call hypnosis, we will inevitably learn a great deal about the closely related interaction which we call psychotherapy. In any case, until such time as this is accomplished, a comprehensive theory of hypnosis seems premature.

15 M. T. Orne, e.g. Hypnosis, motivation and compliance, op. cit.; Psychological factors maximizing resistance to stress: With special reference to hypnosis, op, cit.; and The nature of hypnosis: Artifact and essence, op. cit.

The preceding paper is a reproduction of the following article (Orne, M. T. What must a satisfactory theory of hypnosis explain? International Journal of Psychiatry, 1967, 3, 206-211.). It is reproduced here with the kind permission of Jason Aronson -- An imprint of Rowman & Littlefield Publishers, Inc.