INTRODUCTION

Hypnotherapy is often referred to as an induced state of relaxation in which the mind is more receptive to suggestion. In the main, hypnotherapy is the deliberate use of the trance state to effect change in both conscious and unconscious states of mind. The individual and not the therapist is considered to be in control of the trance state (Rankin-Box & Williamson 2006). Although Heap and Aravind (2002) have suggested that hypnosis is an interaction between two people, it would seem that the self-induced trance state is a common daily occurrence in all people and it is not necessary for a hypnotic trance to be induced by, or dependent upon, a second party for it to occur. In this respect, self-hypnosis can be perceived as a normal state of mind.

Trance is commonly described as an altered state of consciousness. This natural state may occur several times each day (commonly referred to as day dreaming), however the neurophysiological rationale or mechanism for this is still not clearly understood. Similarly, semantic debates persist about accepted definitions of the terms hypnosis or trance. This would appear to be influenced by the way in which hypnosis and the application of the trance state is interpreted or used. Thus the social significance attributed to the function and use of the trance state can vary across cultures and sub-sects in society.

The specific induction of the trance state has formed part of many cultural practices over the centuries such as India, China, North America, Africa and Egypt (Conachy 1994). For instance, Bourguignon (1968, 1973) reported that from a sample of 488 societies, 90% had at least one socially accepted method of altering states of consciousness and trance was used in one way or another for the improvement of the individual and the community.

There are also intriguing differences in the way different social groups describe trance states. For instance, rituals involving a high degree of repetitive chanting or actions may induce trance states. Since ritual appears to be an intrinsic part of human life, it is common for people with highly ritualized lives or behaviours to be able to induce trance without specific conscious awareness until after an action has been completed, e.g. making the bed or driving to and from work when always using the same route. In such instances, trance does not block consciousness or alertness but reduces the need for the brain’s neurocognitive processes to constantly monitor our actions. In contrast to this, daily existence without any ritual behaviour at all can be perceived as stressful and tiring, since a high degree of alertness is constantly required, e.g. working in a hostile environment or living with uncertainty.

Repetitive daily rituals cross all cultures and examples of highly ritualistic practice can be observed with shamanic healing, prayer, meditation, spiritual rituals, rhythmic dance, or other forms of repetitive practice. Each of these can induce the trance state.

The use of ‘suggestion’ in visualization, should be used cautiously to induce trance since a suggestion may not always invoke a therapeutic response, for instance, strong imagery of hot summer days in a garden full of flowers might stimulate an allergic response such as hay fever or sneezing. Suggestion, refers to the presentation of an idea to a client and the extent to which the client accepts the idea (suggestibility) is influenced by motivation and expectation. There is again, no definitive research to adequately explain this phenomenon. While suggestion remains largely psychological, it is possible using hypnotherapy, to anaesthetize parts of the body and influence the autonomic nervous system commonly considered not to be under voluntary control (Rankin-Box 2006, Whorewell et al 1992).

Anthropologically, the labels ascribed to trance induction seem to vary according to the social value placed on the significance of trance states. For some social groups, ritual trance forms a central aspect of particular ceremonies or rites of passage for its members and plays a vital part in maintaining the social cohesion of the group. It would seem that the induction of trance has been used for many centuries and across many cultures and societies. Thus the history of hypnosis should perhaps be explored in conjunction with anthropological research.

Repetitive and ritualistic actions or thoughts then, appear to predispose a state of trance. Such repetition need not occur sequentially or over a short period of time in order to invoke this state of mind. For example, individuals engaging in repetitive routines such as working on conveyor belts, or participating in rituals associated with prayer, ceremonies, healing or shamanistic practice may induce trance states. This is often remarked upon in Western society by individuals driving home from work and being unable to recall large parts of the journey home, despite having driven safely.

HISTORY

It is apparent that the origins of the use of ‘trance’ (more commonly termed ‘hypnosis’) are lost in the mists of time. Claims that the history of hypnosis originates with Franz Mesmer are misleading, since they proffer an ethnocentric approach to the use of trance within Western society and neglect the role trance has played in emergent Western civilization and other cultures.

Nevertheless, Mesmer is attributed as raising awareness of trance in Western society by the development of Mesmerism in the mid-1700s. His claim that health imbalances were affected by ‘animal magnetism in the body’ were perceived as revolutionary at the time and this was latterly perceived as the first medically orientated model using trance (and the use of magnets to restore magnetic balance in the body) to affect physical and psychological change. In line with other ethnographic and anthropological studies, Mesmer employed highly stylistic and theatrical rituals to induce trance his medical qualifications lent credibility and greater acceptance to his theories. However, in 1784, his work was largely discredited by the Franklin Inquiry.

Despite this, variations of Mesmer’s approach to trance initiation continued to evolve. In the late 1700s, Marquis de Puysegur described a state of ‘artificial somnambulism’ (being asleep while awake). The Abbey de Faria referred to ‘lucid sleep’. Braid referred to this as ‘nervous sleep’ and termed trance induction as ‘Hypnotism’.

During the Second World War, Simmel developed a technique called ‘hypnoanalyses for treating neurosis’ (Tamin 1988). However, the word ‘hypnotism’ gained acceptance in Western medical circles and today hypnosis, recognized as a legitimate medical practice, continues to be acknowledged. More recently, Erikson has referred to hypnosis as ‘an inner state of absorption’ (Erikson & Rossi 1980). This appears as a special state described as hypnoidal or hypnotic and trance appears to be the most widely accepted term.

Erikson’s approach initiated theorists of the trance ‘state’ and included Hilgard, Spiegel and Shatok. They argued that trance occurs after the therapist uses induction and deepening methods to guide an individual into a deep relaxation known as altered state of consciousness (ASC). Here, subjects enter a light, medium or deep trance and become responsive to suggestion as they enter deeper trance. Erickson believed that clients required an individual rather than a generic approach. However, he did believe that people already held the necessary resources to overcome their problem and hypnotic states were natural phenomena which occurred during a normal waking day. This theory currently persists and a number of these techniques form the basis of Neuro Linguistic Programming (NLP).

More recent developments in this field are described by Rankin-Box (2001, 2006), Erikson and Rossi (1980) and Spiegel and Spiegel (1978).

Although hypnosis continues to be used as a form of stage entertainment, such trance induction is induced by the individual, not the hypnotist. Thus it is not possible to induce trance against an individual’s will. An individual must be willing to enter the trance state and stage hypnotists use self-induced trance to startling effect. In the UK, the Hypnotism Act of 1952 was introduced to protect the public against ‘dangerous’ practices when hypnosis is used for entertainment.

In 1955, the British Medical Association commenced a second inquiry into hypnosis and suggested it should be taught to psychiatrists at medical schools (British Medical Association 1955). Clinical hypnosis is now taught in medical training programmes in the USA, France and Germany. It was finally offered as a special study option for undergraduates in Medicine at the University of Oxford Medical School in 2002.

There is continuing debate as to whether hypnosis is a ‘special’ state or not and there is continuing debate concerning sociocognitive vs state explanations of hypnosis. State View (SV) theorists argue that there is a special state called the hypnotic trance. This state is marked by increased suggestibility, current imagery including past memories and reality distortions such as false memories. There is also a belief that future research will discover a physiological rationale for the hypnotic state. Supporters of the SV approach to hypnosis include Erickson and Spiegel. Hilgard also developed the ‘Stanford Scales of Hypnotic Susceptibility, Forms A, B and C’. These scales are one of the measures currently used to objectively measure how susceptible an individual may be to hypnosis (Woody & Sadler 2005).

As early as 1960, Wyke proposed a Reality Testing Theory, also referred to as a physiological theory. Here, the process of formal hypnosis is described as involving the gradual detachment from external sensory perception (this can include closing eyes, remaining still, relaxation and focusing upon internal sensations). This form of ritualistic behaviour can create a partial suspension of reality and increases suggestibility. This could also imply a greater physiological process occurs during hypnosis than previously considered. Reducing sensory input is influenced by the reticular activating system in the central part of the brain stem and it is claimed that this may enhance patient suggestibility (Wyke 1960).

Hilgard’s Neo-dissociation Theory of Hypnosis argues that individuals are constantly assessing and prioritizing events going on around us at any one time. This model suggests that the hypnotic trance modifies this arrangement so that systems become dissociated from each other and thus allowing greater critical analysis, e.g. by enhancing the ability to re-prioritize smoking from a significant daily activity and relegate it both consciously and sub-consciously to a lesser behavioural role. This argument has links with the work of Kallio and Revonsuo (2005) who suggest that the effectiveness of hypnotic analgesia might be explained as re-prioritizing perceptions of pain. Thus one can be aware of pain but develop an ability to block the neural receptors in order to reduce the sensation of pain.

The point at which an individual may be said to be ‘in trance’ has not yet been clearly determined. This may be due to competing theories concerning how trance is achieved and exactly what is happening during hypnosis. Future neurophysiological research may identify a physiological marker capable of defining the state constituting trance and distinguishing between the hypnotized and non-hypnotized states (Heap & Aravind 2002). However, trance appears to be a regular physiological activity of daily life. It is not necessarily dependent upon specific (external) trance induction. It would seem that the debate about which factors initiate trance and the extent to which this state can influence medical care and procedures will continue for some time yet.