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A Field Investigation by Hypnosis
of Sound Loci Importance in Human Behavior

Milton H. Erickson

Estimated reading time: 50 minutes, 58 seconds.

Reprinted with permission from The American Journal of Clinical Hypnosis,
October, 1973, 16,147-164.

At the Colorado State Psychopathic Hospital in July, 1929, the author listened to an extensive and very detailed account of six days of seasickness suffered by a resident in psychiatry newly arrived from England. This account was the author’s first direct knowledge of the subjective aspects of seasickness reported upon by someone trained in medicine and competent to answer questions informatively.

The information received led the author into prolonged private thinking about various aspects of seasickness, possible seemingly unrelated significances, and possible methods of experimental investigation.

The following September that resident questioned the author about hypnosis. l Not only did the resident express interest in learning about hypnosis but volunteered to be a hypnotic subject for the reason that the experience itself might enhance didactic learnings.

This offer to be a hypnotic subject presented the author with a most desirable opportunity for an experiment which he had been in the process of formulating for several weeks but without any expectation of an opportunity to put it to test. Accordingly the offer was accepted, and the resident was informed that an interesting experiment had been under contemplation for some time which might entail some possible, but only transient, discomfort, but which would be decidedly convincing and informative. The resident agreed readily to accede to any plans the author might have in mind.

Arrangements were made in the latter part of September to undertake privately the venture the author had in mind in a conference room shortly after  the  evening  meal.  That evening the resident was seated in an ordinary chair, while the author took a seat on a low footstool about six feet away, directly in front of the resident, with the author’s head level at the subject’s chest level. No one else was present in the conference room, and the author spoke in a normal but persuasive tone of voice.

The reasons for the use of a foot-stool at a distance of six feet were the recognitions that when one is seasick aboard ship there is a desire to keep one’s distance from others, and that sounds on a ship come predominantly from below.

A trance was quite readily induced by using the hand-levitation technique, which resulted first in a rising of the right hand to the face with instruction that the moment  of contact would  be marked by a  deep breath, a closing of the eyes, a feeling of great comfort, and the development of a deep trance. After a brief period of contact with the face, the hand would slowly descend and come to rest upon the thigh. Thereupon the left hand would duplicate the performance of the right hand, rising slowly to the face, then lowering to the lap. Upon the left hand touching the face, the right hand would simultaneously levitate, reaching the face at just the same moment as the left came to rest upon the thigh. Then the right hand would slowly descend to the right thigh. Five minutes were allowed to pass with the subject enjoying the comfort and restfulness of a deep trance state, knowing that the next task would be the simultaneous levitation of both hands so slowly that almost two minutes would be required for hands-face contact and another two minutes for their descent to the thigh level. All suggestions were limited to, “Soon, very soon, your (right, left, both) hand(s) will begin to move upward from your thigh(s), perhaps sooner than you expect, lifting upward bit by bit, higher and higher, elbow(s) bending more and more, your eyes closing slowly, your hand(s) getting closer and closer to your face, soon touching it, now touching it, now the (right, left, both) hand(s) beginning to lower slowly, coming to rest on your thigh(s), gently, taking a deep breath and going into deep trance with your eyes remaining closed, becoming increasingly comfortable and enjoying the restfulness of a deep hypnotic trance and remaining in the trance until I tell you otherwise.”

As the trance induction began, the subject’s eyes slowly closed and were completely shut by the time the right hand was halfway to the face at the first levitation; they remained closed with no further suggestions given about the eyes. The room was quiet, there were no interruptions. The suggestions were all given in a leisurely fashion with no special emphasis, there being only a calm, gently persuasive tone of voice. The subject gave every visual evidence of being a readily responsive subject and of achieving a deep trance state rather rapidly, and that responsiveness made unnecessary a rigid abidance to the stated time intervals. The time of the trance induction was approximately one hour after the evening meal, when both the resident and the author were off duty. All went very well until the simultaneous levitation of both hands was initiated. At this time a new factor was introduced. There was no change in the suggestions or tone of voice, but the author changed his behavior by silently bending his body back and forth, from side to side, and up and down in a jerking fashion so that the locus of his voice changed constantly from one level to another and from one point to another in an arhythmic fashion. By the time the subject’s hands reached a point halfway to the face, a strained and uncomfortable facial expression appeared, and before the hands had actually reached the face, the subject awakened, greatly nauseated, and vomited on the floor. While still retching, the subject explained, “I must have eaten something that disagreed with me. I feel just as sick as I was when I was aboard ship. I’m miserable. I can almost see the waves. I better bathe and go to bed. Maybe we can do this hypnosis bit some other time.”

Most reluctantly consent was given for the author “to clean up the mess on the floor,” and the resident retired to the hospital living quarters “to bathe and go to bed and get rid of this nausea.” The next morning the resident inquired of others if they had experienced gastric distress. Since none, including the author, had, the resident concluded that it was something peculiar to himself.

The following Sunday afternoon, four days later, a “casual conversation” ensued during which there seemed to be no recollection of the previous experience of nausea even though some bananas were consumed. The conversation led gradually to desired comments by the resident. These were, “I had a fine walk this morning, played two sets of tennis, and feel topping. What say we have another go at the hypnosis bit?”

The offer was immediately accepted and a “proper room assuring privacy” was selected. The fact that it also offered a convenient sink did not seem to make any impression upon the resident or to arouse any memories.

Precisely the same procedure as before was employed, with the exception of certain additional suggestions phrased to meet the situation if results comparable to those from the first efforts to induce hypnosis appeared. These were, “At any time this afternoon after  your  right hand begins to rise toward your face, you will go into a deep, entirely comfortable trance immediately, and any  time after that, should I  rap on this desk beside which I  am  sitting,  you will go into a  deep, sound, comfortable trance. I will now illustrate the rapping (demonstrating) while your hand continues lifting toward your face. If you understand, nod your head in affirmation. If you do not understand, shake your head negatively and I will repeat the instructions.” An affirmative nod was made with no alteration in the continued levitation of the hand, which had already risen a full two inches at the beginning of the instructions.

In this manner a posthypnotic suggestion was inserted into the procedure without altering the process itself. Its meaningfulness would be dependent only upon the development of a need for its use. Such a possibility had occurred previously when the resident aroused from the trance upon the development of physical distress. Should there be a repetition of the arousal it could thus be corrected at once.

The author continued, ”You will continue in a deep trance a sufficient period of time to meet your didactic and  experiential needs, whereupon  I shall awaken you with the understanding that any hypnosis thereafter will be in accord only with your own wishes and in accord with matters not necessarily related to today’s work. When you awaken, you will have a total amnesia for all that has happened since the very first efforts to induce a trance were made. However you will be given a full account of everything and in a manner that will meet your wishes fully. When you feel certain that you understand these suggestions, your right hand will begin to descend to your thigh after it reaches your face. If you do not understand the instructions fully, your right hand will remain in contact with your face, and the instructions will be repeated.”

However, the subject’s hand continued to levitate. When the resident had reached the point of levitating both hands, the author began his erratic body movements. By the time the subject’s hands were less than halfway to the face, there occurred the same results that had occurred the previous Tuesday evening.

Upon awakening, the resident dashed to the sink and vomited; while still retching, he gasped, ”What’s happening?” The author immediately rapped sharply three times on the desk, and a trance state became visibly present, with an immediate disappearance of signs of physical stress.

To explain the situation that then existed, it must be recognized that the posthypnotic cue of rapping on the desk had resulted in the development of a third trance state. Since it was a new trance, there was no physical distress or nausea. The nausea and vomiting belonged only to the first two trances. Use was made of this third trance by giving the resident a mouthwash followed by a drink of cold water to remove any sense of  physical  discomfort  or  remaining  taste of  the   mouthwash. The instructions were simply, “Use this mouthwash, please. Now drink this glass of ice water, please.” No attention was given to the sink, and in accepting the glass of water, the resident had turned his back toward the sink, and was allowed to continue standing there. The author then took a seat at the desk, ignoring the footstool, which no longer served any purpose. Thus, with the resident standing with his back to the sink, not sitting in a chair with a peripheral view of the sink, and the author seated at the desk with the resident looking at him with only a peripheral view of the footstool, a new immediate reality situation was effected, different from those of either of the first two trances.

At this point it must be noted that the first two trance states were terminated by the development of a state of nausea apparently caused by the arhythmic alteration of the loci of the author’s verbalizations.

The movements required to alter the loci were not visible to the resident because of eye closure during the trance state. At the arousal of the resident from the second trance state the author discontinued those movements, thus giving the resident no clue for an understanding. The utterance of the bewildered inquiry of ”What’s happening?” at the termination of the second trance indicated a posthypnotic amnesia for the circumstances of the first two trances and, as it transpired, for non-trance events back to the time just preceding the first trance.

The investigation was continued by the author instructing the resident, “When you arouse from the trance, you may ask any question that might come to your mind. Be curious about anything you wish, and be willing to accept any bewilderment that may occur. I assure you that I will answer all questions and explain everything fully. Is that satisfactory to you? If it is, just nod your head affirmatively.” The resident’s head nodded slowly.” All right, awaken now!”

The resident slowly aroused, taking about a minute, looked around bewilderedly and asked, ”What … why how did I get here?”

”Yes, you are here in the laboratory and this is the way it happened. We were reading today’s Sunday comic papers and there they are on  the desk, and that led to a mention of that new catatonic schizophrenic patient you were assigned last Friday, and that led us to the laboratory here.”

“I can see that this is the laboratory and I can see last Sunday’s comic papers there, but the last patient I was assigned was that very depressed woman, and she came in today.” [That patient had arrived the preceding Tuesday.]

“Now listen carefully and behave in exact accord with what I say, doing no more than I specifically ask. Agreed?”

“If you wish, but I don’t understand what….

“Just do what I    ask   and    you will understand  most agreeably, so hop to it quickly. Don’t make any comments. Take a look at what’s in the sink, keep your mouth shut, don’t speak, read the date on that newspaper, keep silent, pick up the telephone there and ask the operator what day it is, quickly now.”

With a most puzzled look the resident did as told, then sat down weakly in a chair and said, “She said it’s Sunday. Are you and Jack up to your usual??  [Jack was a  colleague with whom  the  author often enjoyed collaborating in practical jokes.]”

The author stated, “I have certain legitimate purposes in which I am interested and which, I assure you, will be fully approved  by  you. You can judge them as I present them, and if they are nonoffensive and not objectional, you will do them. Okay?”

“I do not understand, but if you say so, I will do as you ask.”

“Now write on  that  sheet  of  paper  three  separate  sentences giving the day of the week, the kind of patient that was most recently assigned to you, and your knowledge of why you are in  this room.  Then sign your name to those statements and leave the paper on the desk in a readable position with a paperweight holding it in place.”

The resident, very puzzled, obeyed, writing:

  1. Today is
  2. The last patient assigned to me was a female, manic-depressive, in a depressed
  3. I do not know why I am here in this

The resident was asked to read aloud what had been written and to state if it were correctly stated. The statements were affirmed and the signature was acknowledged verbally.

“Now, Doctor, both you and I know that you wrote those statements and that  you have read them  aloud with full conscious  conviction that they are true. Right?”

“Quite so!”

“We both  know  about unconscious  slips of tongue  and  pen-slips that reveal what the unconscious mind knows. So now you may rewrite those statements, doing so quickly, writing them with unconscious knowledge.”

“I do not understand.”

”Your unconscious mind does, so hop to it.”

The first sentence was written, “Today is Sunday.”

The resident noticed this, looked amazed and puzzled, but rapidly wrote the next two sentences without seeming to be aware of what was occurring. They read: “The last patient was assigned to me on Friday and was a male catatonic schizophrenic. We came to this room for hypnosis.” As the signature was appended, the resident exclaimed, “Sunday? Tuesday?” Then, after reading both sets of statements and reading the date on the Sunday newspaper, the resident remarked, “And this is next Sunday’s newspaper, but not today’s date? I am thoroughly confused. What has hypnosis got to do with being seasick in Colorado?”

The resident was systematically reminded of (a) the seasickness discussed in July, (b) the discussion of hypnosis having begun early in September, (c) the volunteering to be a subject the previous week, (d) the depressed female patient assigned on the previous Tuesday, (e) the events of that Tuesday evening, (f) the male schizophrenic patient assigned on Friday, and (g) ”Now it is Sunday afternoon, you had a fine walk and played tennis this morning, then earlier this afternoon we chatted, ate some bananas, and then we came here to the laboratory to try  hypnosis a second time.”

“A second time? I don’t know what you mean! But that wasn’t here! It was tonight … I mean, I got sick on the floor of the conference room but that sink there … please let me compose myself. I’m all mixed up.”

The resident was told, “Take all the time you want and recover every memory you need for a complete understanding of this situation.”

Shortly the statement was made, ”Well, I think I have everything sorted and put together quite rightly except for some seasickness. Just what happened to make me experience being on deck on a ship crossing the Atlantic and being seasick here in Colorado? Twice, too! I really must apologize for that mess you so kindly cleaned up for me. It’s embarrassing. I better look to that sink right now. I know you have some kind of explanation for me, so while I do the bit with the sink, please hop to that.” There followed then a detailed discussion of the thinking the author had done following the account of the six-day period of seasickness. The items considered to be of importance and upon which this investigation was based were:

  1. One of the basic considerations in the learning of sounds is the identification of the loci of their origin, which includes loci as above, below, in front, in back, to the right, and to the left, as well as every other possible plane which may incorporate combinations of these directional

The immediate reality environment on board ship differs in many ways from the immediate reality on land. It requires many and often unrecognized alterations of response to all sensory stimuli.

  1. However smooth the ocean may be there is a constant irregular rocking of the ship, necessitating the experiencing of a constant relative shifting of the loci of sound as well as alterations, many unrecognized, of responses to sensory
  2. Seasickness not only causes physical and emotional distress but in addition alters in some degree established patterns of behavior and causes a sense of loneliness and even an aversion for any contact with others.

The final conclusion reached was that in these two instances in inducing a trance in  the  resident  the  slight  irregular  alteration  of  the loci of sound appeared to have the effect of a conditioned or conditioning stimulus sufficiently strong to revive the previously experienced seasickness.

Further hypnotic work was done later with the resident, primarily in relation to self-experience and instruction, but only after the author had promised no further investigative work related in any way to the ocean trip. Finally, permission was given for trance induction by simultaneous verbal suggestions and the body movements previously employed from the beginning of the induction, but with the resident’s eyes open. This procedure handicapped trance induction, the rationalization being offered by the resident that the body movements resulted in either a sense of amusement or an intellectual challenge to predict the next movements. Thus, whether because of amusement, intellectual interest, or whatever else may have been the actual mental set, the resident’s response to the verbal suggestions was diverted or prevented.

This led finally to the resident consenting to trance inductions by the same technique employed in the investigation study. It was also agreed that the tests be made while the resident, eyes closed, facing away from the author, was sitting in a chair and the author was sitting on a footstool, the trance inductions being made in a series. In some of the inductions hand-levitation suggestions only would be used; in some there would be a combination of levitation suggestions and body movements, with the resident kept unaware of the specific methodology employed until the series ended.

The inductions totaled nine, done over a period of nearly a month, no more than one trance induction in one day and at intervals of at least two days. On the fourth and seventh trance inductions the resident interrupted   the   procedure   because of “liverish feelings.” A similar interruption occurred during the ninth induction, when the resident again developed ‘1iverish feelings” which were emphatically asserted as caused by a combination of body movements and verbal suggestions. The previous “liverish feelings” of the fourth and seventh inductions were also declared to have been unquestionably caused in the same way. This was a correct statement. The other inductions led only to uncomplicated trances. The resident refused to permit any further trance inductions in which body movements were used.

When this same procedure was attempted with other naive subjects whose only motivation was a desire to cooperate in hypnotic experimentation, the curiosity aroused by the request that they keep their eyes closed and face away from the author constituted an obstacle to hypnotic response, despite the fact that subsequently they were found able to develop trance states. Even after this they objected to turning their backs to the author for trance induction, since their original curiosity would immediately come to the foreground.

SECOND ACCOUNT

 The opportunity for another similar study occurred in 1942. However, it was a very brief, one-time effort permitting the achievement of similar results but no opportunity for adequate discussion.

The occasion was a chance meeting at a social gathering. The man was a university professor with a special interest in any unusual forms of human behavior. The author learned that Dr. X, whose professional interests were related to psychology and human behavior in general, had traveled on board ship many times but invariably had suffered from seasickness no matter how smooth the ocean was. Later in the conversation with him, while discussing various forms of behavioral manifestations in psychoses, the topic of hypnosis arose, since Dr. X knew the author by reputation. He inquired about some of the author’s publications which he had read and then asked if it might be possible then and there to induce in him some hypnotic phenomena that could be explained only in terms of the effects of hypnosis and not be subject to interpretation in some other way. After considerable thoughtful study this challenging request was accepted.

During the early part of the conversation with Dr. X seasickness had been a minor topic. This had reminded the author of the experience with the psychiatric resident, but fortunately no mention had been made to that matter. The conversation had first centered on Dr. X’s professional field, then turned to the author’s professional experience, and finally to the topic of hypnosis. The author assured Dr. X that his wishes could be met, and retirement was made to another room to insure privacy and no intrusion by the other guests present.

In this adjoining room the author positioned Dr. X and himself in the same manner as had been done with the resident  in  psychiatry. Then it was explained that, to achieve specific results explainable  only as attributable to hypnosis, two items of conscious  cooperation  would be required-namely, closing and keeping shut his eyes, and listening continuously, intensely, and attentively to everything the author said even if irrelevant, redundant, or apparently serving no recognizable purpose. Dr. X was informed that this would insure participation by his “unconscious mind” and cautioned that such intent listening might occasion some fatigue and even some transient discomfort, but that he need not be concerned or distressed by any such developments.

Then the author, seated on a low hassock, speaking in a monotonous tone of voice, and bobbing up and down, back and forth, and from side to side, thereby constantly changing the locus of his voice in an irregular fashion, proceeded to give a general discussion of hypnosis. No suggestions were given. All utterances were descriptive of general hypnotic phenomena, with the statement included that the unconscious mind could and would understand meanings not perceptible to the conscious mind and that the unconscious mind could act and would act upon instruction in accord with its own understandings entirely independently of the conscious mind. This statement was reiterated several times, being interwoven with the general remarks about hypnosis.

After about seven minutes of such discussion Dr.  X’s face showed the typical placid, immobile faces of the hypnotic trance, but within another two minutes the placid hypnotic faces disappeared, and a  look  of conscious distress appeared, Dr. X opened his eyes, began gagging, hurriedly secured his handkerchief, and  placed it  to his  mouth, rushing to the lavatory as he did so.

Upon his return from the lavatory he remarked, “I just don’t know what happened to me. I was listening attentively to what you were saying when a sudden wave of nausea hit me. If I were on board ship, I’d know what was going on, but here I can’t understand. The feeling disappeared as rapidly as it appeared. I have no nausea or discomfort now. It was gone by the time I got into the lavatory. It just disappeared as rapidly as it had appeared.”

“Perhaps you developed a trance state in which a state of nausea was engendered which, in turn, aroused you from the  hypnotic trance. If  such is  indeed  the  case,  you  will  unconsciously  place  your  left hand behind your head with the fingertips touching your right ear.”

Without noting what he was doing with his left hand, Dr. X explained very earnestly that he had not developed a hypnotic trance, but had only listened to the author’s exposition of hypnosis.

“Then why is your left hand behind your head with your fingers touching your right ear?” Upon noting this, Dr.  X dropped   his   left hand to his lap and replied simply and with a tone of wonderment, “I must have done that unconsciously.”

As Dr. X spoke, the author moved from the hassock to a standing position still in front of Dr. X but very definitely to his right.

“Yes, I think you did it unconsciously to signify that you did develop a hypnotic trance,” speaking in a manner to keep Dr. X’s attention fully upon the author. “I assure you that I merely listened attentively, but I did not go into a trance.” “Then why is your left hand again behind your head with your fingertips on your right ear again?” Dr. X turned his face away from the author, glanced first at his left thigh, then at his uplifted elbow, and then slowly lowered his left hand to his left thigh, seeming not to understand the situation.

“Yes, Dr. X, [as he again turned his face toward the author] your left hand by its position indicated and indicates [slowly Dr. X’s left hand began to rise toward the back of his head] that a state of hypnosis was induced in you.”

“But wouldn’t I know it? I certainly don’t know it, and you are just assuming that I was hypnotized.”

“No, that is not the case. It is simply that you do not know consciously something that you do know unconsciously. Now listen carefully. Do not make any movement until I tell you what to do. Now move slightly the fingers of your left hand and tell me what you feel with them.”

The expression of amazement that appeared on his face as he became consciously aware that his left hand was again behind his head and that his fingers were touching his right ear, indicated that he knew that his unconscious mind did know something that he did not know consciously.

Thereupon the author gave Dr. X an explanation comparable to that which had been given to the English psychiatrist. As this explanation was given, the author had carefully chosen a chair to the right of  Dr.

The explanation was given in a casual, conversational tone of voice. Repeatedly, as the author spoke, Dr. X’s left hand would levitate to the back of his head. Each time, as his fingertips touched his right ear, he would self-consciously lower his left hand to his lap, only to position it in

the same way again. The author continued his explanatory remarks. His final comment was, “It  is  evident  that in some way you induced a trance by some kind of technique by which you did something or said something to me that I    don’t know about that makes me keep on doing this [again self-consciously lowering his left hand to his lap] without knowing that I  am doing it. Will I keep on doing it? Good heavens! I’ve done it again!” He was assured that as soon as he was fully convinced of the character of his behavior, it would cease.

At this point of time other matters compelled his departure, and as he put on his hat, his left hand again levitated rapidly to the back of his head, and when his fingertips touched his right ear, he ejaculated, “I’ll be damned! I am being stubborn about being convinced.”

THIRD ACCOUNT

In mid-March, 1968, the author was visited in Phoenix, Arizona, by Dr. Thomas P. Hackett, now teaching psychiatry and hypnosis at Harvard Medical School. The occasion for this visit was Dr. Hackett’s interest in the author’s hypnotic technique in the treatment of the chronic pain suffered by a patient Dr. Hackett had referred to the author.

However, the author had another chronic pain patient whom he intended to use in initiating a discussion with Dr. Hackett on the use of hypnosis for pain control, especially intractable pain. This patient, Frank, then in his late sixties, had six years previously undergone a right-sided hemipelvectomy. This radical surgery had resulted from a sarcoma of the thigh which had originally been misdiagnosed. When he developed phantom-limb pain, his surgeon, Frank declared, had advised him that he was “old enough and rich enough to live on dope the rest of your life.” The phantom-limb pain had been extensively described as an  experiencing of a feeling of his toes being severely twisted, his foot being bent double, and his leg being pulled far back behind him and being severely twisted. These feelings occurred irregularly in convulsive episodes and might last from two to three minutes and number from three to 10 times in 24 hours. They often awakened him from sleep. Invariably they were marked by flooding perspiration, particularly of the face, sometimes a fall to the floor even when seated in a chair. Constantly present was a severe aching pain which often became additionally a throbbing pain, sometimes lasting many hours. During the episodic attacks or the periods of severe throbbing pain, there were frequent involuntary outcries which the patient learned finally to subdue usually to a low-pitched moaning. His story was confirmed in all details in separate interviews with his wife.

Treatment of this patient had been limited to pain control and the correction of his drug addiction which had developed within three weeks post surgically. Various drugs had been prescribed by his surgeon, but it was soon decided that Demerol administered intramuscularly by his wife in amounts ranging from 50 mg. to 100 mg. no oftener than every two hours would probably be the best method of medication.

Frank always carried extra prescriptions with him. His addiction was not a typical addiction. Rather it was a drug dependency. He might take 100 mg. 12 to 16 times in 24 hours for several days in succession, and this period might be followed by several days during which he might take no more than four 50 mg. injections during the night, having been awakened by convulsive episodes. There was no set pattern in his drug dependency. He had an intense fear of ‘1ooking or acting like a dope addict-I’ve seen them all around the world. I am a man, not a freak, I don’t want to be torn to pieces by pain and drugs, but I can’t last much longer, so do something, anything your conscience allows.”

He had tried every possible psychological measure for his pain “from witch doctors, occultism, Zen-Buddhism, stage hypnosis, exotic mysticism, to hypnosis by a competent physician.” He was finally instructed by a staff physician at Stanford University Medical Hospital to seek aid “from an experienced internist.”

He consulted Dr. T. E. A. von Dedenroth of Tucson, where he was spending the winter. Dr. von Dedenroth, after much effort to induce a trance, referred Frank optimistically to the author.

At the first interview Frank repeatedly apologized for being “a lousy, impossible subject, but I can’t help being bossy, stubborn, constantly watchful, and disputatious.”

No open or direct hypnosis could be used, since the patient declared himself to be “too disputatious to let anybody take charge of my mind. Any help you give me for my pain and my drug addition you’ll have to sneak in when I ain’t looking. I’ve been top-dog so long I can’t stop even when it’s for my own good. You can knock me out with drugs, anaesthetics, or a baseball bat, but that’s no good, I want to enjoy life, but this pain and the drug are interfering. I’ve read everything I could lay my hands on about phantom limb pain, and drugs are not the answer. They dull the pain and dull your mind, and that ain’t living. After Stanford University Medical Hospital recommended hypnosis, I read up on scientific hypnosis and found that it can permit major operations even though it is a use of psychology. But Dr. von Dedenroth found out that I’m a nut, too hardheaded and too disputatious by nature to be hypnotized. Anyway, he did his best, and I tried my best, too. But he described you as having a hypnotic technique so sneaky that you could keep dry in a heavy rain, and the way he said that, I believed him. So you’ve got my permission to do anything you can get by with. So you’ve got a miserable nut on your hands and the light is green, so it’s all yours.”

While the patient was explaining the situation as he saw it, the conclusion was rapidly reached that the only possible hypnotic approach to him would have to be an interspersal technique (Erickson, 1966) by way of a “casual” conversation.

He was found to be a most charming conversationalist and seemed to know how to make a conversationalist out of anybody he met. He was most sociable and gregarious and, like Will Rogers, had apparently never met anybody he didn’t like, including scoundrels. He gave practically no personal information, aside from that of his hemipelvectomy, pain and drug dependency, except that which he disclosed incidentally. Very little of a           personal character about him was learned, and this was primarily general in nature. He was a high school drop-out, self-educated by extensive reading covering the fields of art, literature, philosophy, drama, biography, history, science, industry, and business. He owned seven business corporations, two of which were identified as salmon canning and as the importation of many diverse items ranging from rare art objects to the basic needs of industry in general. He had progressed from extreme poverty in his youth to his present status as a multimillionaire. He had endowed orphanages, hospitals, libraries, and museums, had traveled extensively throughout the northern hemisphere, and knew about hunting and fishing in many countries, but he never related any personal experiences. He enjoyed gambling and made repeated trips to Las Vegas, Nevada, but always set the total of his gains or losses at the total of either $3,000 or $5,000 for each trip. Whether winning or losing, when the predetermined figure was reached, he abruptly terminated his visit. He was always intensely interested in the personal lives of others, which made possible the author’s hypnotic approach. Another item of absolute importance for this report was his neurotic, fetishistic honesty in relation to anything he said or did, the reason for which the author carefully did not seek to learn, thereby winning the patient’s trust, since that patient’s frequent references to this attitude seemed to be a testing of the author’s willingness to restrict himself to the stated problem of pain and drug use.

Two three-hour sessions were held with the patient before any attempt to use an interspersal technique of hypnotic induction. By the close of the third three-hour session the patient could drift in and out  of a    trance state without necessarily closing his  eyes. It must be added that he developed a full capacity for an amnesia for all  matters related to hypnotic procedures and always obeyed any instructions given him readily and unquestioningly, and retained benefits achieved until some uncontrollable condition developed such as illness. He would not accept instruction to foresee such possibilities. While he retained a full conscious memory of the nonhypnotic content of therapeutic sessions, he either chose or was actually unable to be aware of long, unaccountable lapses of time occasioned by prolonged trance states to permit adequate instructions in pain control.

This aspect of his personal behavior was used to devise an investigational approach which might possibly yield results comparable to those reported in the two preceding accounts, while at the same time serving the purpose of demonstrating a technique of indirect hypnotic induction suitable for resistant patients with chronic pain or other problems. The results were quite serendipitous in that, while serving the primary purpose of an indirect trance-induction technique, an unexpected repressed memory was uncovered. Nevertheless, a confirmation of the two preceding accounts resulted in a completely unexpected fashion.

Several times on later occasions the patient observed with what seemed to the author a most probing tone of voice, “I don’t know what you are doing, but my problems are decreasing.” An evasive reply was made each time, ”Maybe I won’t have to do anything.” After the first three sessions there was no further discussion of the use of hypnosis for his benefit, but this did not preclude discussion of hypnosis as a phenomenon or in relation to other patients. This, as well as discussion of an almost endless variety of other topics, gave the author ample opportunity to use an interspersal technique for reinforcements or reinstatements of pain control.

Within two months the patient declared he needed no further help. Since he was indeed “a most disputatious character,” it was not considered advisable to explain to him the possibility that some adverse event might cause him to lose his new-found ability to control his pain. However, he did agree to return if “anything else” should happen.

Nine months later here turned following a severe attack of Hong Kong influenza and the near death of his adored wife from the same illness, his pain and drug dependency having recurred, as was expected  should  a stress situation develop. He stated, “I do not know how in hell you talk me out of pain and Demerol, but you sure do, and that damn flu has put me right back to where I was when I first came, maybe worse.”

No real effort was made to help him in the first three two-hour sessions. This discouraged him, and he ceased to be wary and over watchful. He unhappily said that he would “try another couple of sessions, and when they peter out, I’ll take your advice about some other drug than this damn Demerol.”

At the close of the next session he aroused from a deep trance without awareness of the fact  that  he  had  been  in  a  trance,  since  the  author was continuing the casual conversation at the beginning of the session. Suddenly he became startled, looked at his watch, recognized that three hours had passed, then exclaimed, ”You son-of-a-bitch, you sneaked past me again when I wasn’t looking,” and then recited from Kipling’s “The Ballad of East  and West,”  beginning  with “Oh,  East  is  East,  and  West is West” finishing with “though they come from the ends of the earth,” adding, “Okay, Milton, I’ll see you as many times  more  as  you  need  to tie  things  down snug and  tight.” Reply was made, ”Right, you do your business your way, and I will do mine my way.”

There was a second recurrence over a year later following surgery for an enlarged prostate gland and a resulting secondary infection which required three months hospitalization in his home state. During this period of time he repeatedly received transient help from the author by way of long-distance telephone calls, but this was not fully satisfactory, never lasted more than a week, and could be negatively affected by necessary medical procedures. When he was released from the hospital, he promptly came to Phoenix for a satisfactory reestablishment of his pain relief and freedom from drug dependency.

However, it should be noted that he never did lose his phantom-limb pain completely. Rather, there would be transient minor recurrences, at which time he “would simmer down, get my head straightened around, and get it under control again.” These recurrences he stated, “were nothing like the real thing, but bad enough to worry me. I just have to take a little time out, knowing that I can do without them.” Any illness or excessive fatigue could bring on such minor recurrences, but they never constituted a real threat to his peace of mind. (This type of experience is typical in the author’s experience with other phantom-limb pain patients, and provision is always so made, since perfection is not a human attribute).

There were two other items of interest of great value in the handling of Frank’s problems. The first was, “I swore an inviolate oath when I was 16 to be absolutely honest in all my dealings, and thank God I’ve kept that oath!” No effort was made to ascertain the reason for this oath, but the age of 16 indicated a possibility of some juvenile indiscretion, and his frequent direct or indirect references to truth and honesty, often in poetic quotations, kept the author alert for possible significances. None was learned.

The second item was Frank’s hesitation about accepting an invitation to attend the author’s class at Phoenix College, where instruction on hypnosis was being offered to physicians, dentists, and psychologists. He had replied, “Oh, I know you won’t say anything to embarrass me. So well, why not go? I might as well. Maybe I might learn something about the way you are handling me!”

No effort had been made to reassure him about the visit to Phoenix College. Additionally the author had observed on many occasions what he considered to be a fetishistic, neurotic striving on Frank’s part to be utterly correct in everything he discussed. However, no effort had been made to extract possibly withheld information. In every possible way the author made clear without explicitly saying so that the problems of pain and drug dependence were all that were considered to be in the purview of the author.

In presenting him to the students at Phoenix College no mention was made of his drug dependency-to Frank’s obvious relief, since his facial expression of alert wariness disappeared when it became apparent that no such mention would be made. As a result of such restraint and in many other ways Frank had developed an absolute trust in the author. He also developed an open-eyed trance state during the author’s lecture at the college, which was most convincing for the students. Some of them made their own tests to be sure of their observations. Frank also, on his own initiative, made a second visit to the class and again developed a trance state which was circumspectly tested by the students.

To meet Dr. Hackett’s needs both men were asked separately to meet the author in his office at 9:00 A.M. When they arrived, no explanations were made. They were simply introduced to each other and asked to sit down, which they did promptly but with bewildered expressions on their faces.

Addressing the patient, the author said, “Frank, I want you to close your eyes and to keep them closed until I tell you otherwise. Is that all right?”

He answered, “If you say so, all right. You never do anything without having a damn good reason. It ought to be interesting to find out what you’re up to. So here goes,” and with that remark Frank closed his eyes. The author was fully aware that Frank would develop a trance state immediately, since he had been so conditioned in the course of his therapy. Turning to Dr. Hackett the author said slowly, very slowly, in an even tone of voice, repeating the same jerking movements of back and forth, up and down and from side to side described in the two previous accounts, “And Dr. Hackett will observe and listen carefully and silently while I instruct you. He will not understand, but your unconscious mind will understand as I speak. You will recall, Frank, a not too terrible thing, but it will be some specific instance long forgotten by you in which you were dishonest or violated the law in some way, an occasion of which you were ashamed at the time and which is now coming back into your mind, and you will recall it fully. It was an occasion for which there was no real reason and for which you were so ashamed that you forgot it. Now slowly open your eyes and tell us the whole story.”

Frank, with a most astonished expression on his face, opened his eyes, saying, “Well, I’ll be damned. How in hell you ever dredged that up I’ll never know. And I don’t want to know! I forgot it once and I’m going to forget it again. I haven’t thought about it for at least 15 years, and I   still don’t want to remember it. I forgot about it as fast as I could, but now that you have pulled it up, I might as well tell you about that damn peccadillo. Then I am going to forget it again.”

“I was sitting in a boat facing the Golden Gate Bridge. The bass were biting like hell. As fast as you dropped your hook into the water, you had a bass snagged. Big ones, too! When I had the limit of 15, 1 was taking my rod apart to put it in its case, when my friends said, ‘Don’t do that, Frank. You will never again see a run of bass like this. Keep on hooking them until the run stops. We’ll pay the fines if we get caught.”‘ Well, it wasn’t the offer to pay the fines that made me yield like a weak son-of-a-bitch. I just plain wanted to catch bass that were willing and eager to be caught. I just put my rod back together and pulled in another 24 bass before the run ended. Best fishing I ever did, damn it. But I can’t say I’m proud of it.

I just felt as guilty as hell.

”We weren’t caught, but I made damn sure that every fish was properly cleaned and dressed and I personally saw to it that they were delivered to an orphanage. I hope the kids enjoyed those damn fish. I didn’t.”

Frank was dismissed without any explanation being given to him. His parting comment was, “It beats the hell out of me how you dug that personal history out of me, and I sure don’t know why. You’ve only been interested in my pain and the Demerol before, but I suppose you’ve got your reasons. You always do. And if you want anything more, you’ll dig it out in your own style when I ain’t looking, so what the hell? Maybe you’ve got some idea about publishing it. Well I’m going back to the hotel and get busy forgetting about those damn bass. Makes me sick just to think about them. That’s why 1 never went fishing again.”

Nearly a year later, during a social visit, out of context, Frank remarked, “Telling you about those 39 bass took away some of my guilt. When I got back to the hotel, I started looking through that book of your collected papers to get some clue as to how you dug up that peccadillo, but I just got as confused as that Boston doctor looked when I left your office that morning and I don’t feel that I have to forget again. I still can’t figure out how you dredged it up because I had forgotten it.” He did not seem to be really asking for an explanation. No further reference was ever made to that account or to Dr. Hackett, which was most contradictory to the insatiable hunger for information he had always shown in all other situations.

After Frank’s departure a brief discussion was offered to Dr. Hackett of the two preceding accounts together with a brief discussion of the processes of learning how to define the focal point of origin of sounds and the usual disregard of such learnings in studies of human behavior. The pertinence of the above account to Dr. Hackett’s needs lay only in demonstrating to him convincingly that adequate use of hypnosis is not dependent upon patter, verbiage, what the operator knows, understands, expects, hopes for, wants to do, or the offering of instruction in accord with the operator’s understandings, hopes and desires. On the contrary the proper use of hypnosis lies in the development of a situation favorable to responses reflecting the subject’s own learnings, understandings, capabilities, and experiences. This can then give the operator the opportunity to determine the proper approach for responsive behavior by the subject. These considerations have been increasingly recognized by the author during the past 20 years as basic requisites in the development of hypnotic techniques and of psychotherapy. Subject behavior should reflect only the subject himself and not the teachings, hopes, beliefs, or expectations of the operator.

DISCUSSION

In any evaluation of these investigations, emphasis must be placed upon the special motivation of each of the three subjects. The first subject was a young English psychiatrist very much interested in learning what psychiatry was like as practiced in the United States. The second subject had a lifelong ‘interest in the many aspects and kinds of human behavior. Both he and the resident had an intense intellectual interest in learning. The author merely offered them a special opportunity to learn something of particular interest to them.

The situation with the third subject was entirely different. He had undergone an emergency hemipelvectomy because of a malignant tumor on his right thigh followed by four years of phantom limb pain and narcotic dependency. His therapy related only to those two problems, and he had twice mistakenly assumed that no unforeseen or totally unexpected occurrences might occasion a return of his symptoms. Hence his motivation was based on emotional as well as physical distress. The freedom from pain after four years of physical anguish and relief of his fear of a continuance of drug dependency resulted in an emotional basis that dominated all relationships with the author.

Also to be recognized is that both times after a trance had been induced and the author had introduced a minor arhythmic alteration of the locus of his voice, the first two subjects had awakened spontaneously with manifested physical distress. Presumably the distress resulted from the randomly altered loci of the author’s verbalizations, and it must also be noted that spontaneous amnesias became apparent for the immediately preceding events. However, the amnesia for the first trance of the resident was sufficient to include events of the four days preceding the second trance, even though the memory of the physical distress that had terminated that trance had been retained and proper conscious functioning had remained unimpaired. The amnesia for the resident’s second trance became immediately apparent upon arousal from the trance state by the physical distress that had been developed during it, but this amnesia was terminated by the posthypnotic cue which caused the development of a third trance. The amnesia of this third trance state was systematically demonstrated and corrected, at least to a major degree, since no effort was made to discover completely what other items might have been included in that amnesia.

In the first two accounts the random alteration in the loci or origin of the author’s voice revivified previous states of physical distress. No thought was given at the time of investigation to the accompanying unpleasant unhappy emotions. In the third account there resulted the recovery of a repressed memory marked by very unhappy emotions, although the associated physical activities were otherwise pleasant. Thus the elements common to all three accounts were the movements transmitted from the ocean, unpleasant emotions, hypnosis, and the irregularly randomly altered loci of the origin of the author’s voice.

The first account resulted from the author’s association of ideas while reflecting upon the description given him of dizziness during a period of seasickness. The memory of childhood activities with his playmates had come to mind. These activities, so common among schoolchildren, were: (a) squatting down, hugging the knees tightly, and then suddenly springing upright with the fervent hope, if not of actually fainting, of experiencing various changes in subjective feelings, which sometimes included dizziness and (b) of whirling around rapidly in order to enjoy all of the intriguing subjective sensations of dizziness and general physical discomfort, which tended to vary in accord  with  the  position  in  which the head was held. A refinement of this latter activity  was accomplished  by the author’s affixing a crossbar to one end  of a  rope,  tying the  other end to the hayfork track in the barn, twisting the rope to the greatest possible extent and then “riding  it  down” to  insure  the  greatest  number of subjective experiences. One of  the  most  intriguing  discoveries  was that sometimes the direction from  which  a  voice  was  heard  seemed  to be wrong even though the  voice  was recognized.  When the expedient of a whistle was employed by the participants instead of the recognizable voices, there were more frequent difficulties in recognizing the direction from which the whistling came.

To these memories were added recollections of the author’s ‘1istening in all directions” when engaged in mischievous pranks or the evasion of responsibilities. It may be that the “dizziness” experiments led to his childhood conception of ‘1istening in all directions. ”

As the author reviewed these memories and compared them with the similar experiences and learnings of his children and their playmates, he speculated about the possibility of the rolling movements of the ship affecting unnoticeably the psychiatric resident’s perception of sound in the same way as had the play activities of his childhood and those of his children and their playmates. Further mulling over these thoughts led to the realization that, unless necessary for an understanding, little attention is given to a precise recognition of minor changes in the locus of origin of sounds. Certainly this would be true in the matter of seasickness. Further speculation led to the question of how a preliminary investigation might be made by using hypnosis to create a situation in which there could be systematic but random minor alterations in the locus of sound origin not likely to be recognized. Three such individual opportunities became possible and were investigated, with positive results that minor random alterations in the loci of sound origin could be an integral but unrecognized part of a larger experience.

Additional studies with the first subject disclosed that similar results could be obtained after an understanding of the original investigation only after elaborate precautions to render the subject unaware of the changes of loci of sounds. Any precaution to prevent awareness precluded similar results. No satisfactory experiments with other subjects could be set up because of intellectual interest or curiosity about experimental procedure.

It must also be noted that both times after a trance had been effectively induced and the author had, in an unnoticeable way, introduced something that presumably led to unpleasant developments for the subject, there had occurred a spontaneous awakening by the subject characterized by an amnesia for trance events. Parenthetically, mention may be made at this point of the pertinence of these findings to the question, if there is one, of the antisocial use of hypnosis. Also, one might think about contentions that there is no such thing as hypnosis and that anything achieved by the use of hypnosis can also be accomplished by the subject in the waking state. All of the significant results obtained by the author’s investigation developed out of a trance, without any recognizable suggestion of any sort being given. These were spontaneous nausea and vomiting, spontaneous awakening, and a comprehensive amnesia. All that was suggested was merely hand levitation and eye closure.

Efforts were made to replicate this investigation subsequently with those few trained subjects who customarily developed a trance state with the eyes remaining open and who had a history of seasickness. Such subjects would either fail to develop a trance or would arouse while in the trance. There would be only bewilderment at the author’s physical behavior. Having them sit with their back toward the author, in addition to adding a new element to the situation, resulted in no trance and the expressed feeling that “the whole thing seems silly.” Insistence upon remaining with back toward the author not only added a  new element but required repeated instruction  “to be relaxed  and  comfortable  and to   remain   so  continuously,”   thereby   negating   possible unpleasant spontaneous developments.

One additional fact needs to be mentioned. This is that further trances could be induced in the resident only after emphatic reassurances that nothing unpleasant would happen. Even then prolonged effort was required, but thereafter trance induction was easily achieved.

Another item of suggestive importance is that three experienced subjects had failed to respond when they were used as subjects, because of amusement engendered by the author’s body movements, or because of the intellectual challenge the movements presented in the prediction of the direction of the next body movement, or because of bewilderment or curiosity or some other unknown reason when asked to face away from the author when trance induction was attempted. When they were told the possibility of nausea developing as a consequence of the author’s body movements during trance induction, they adopted an attitude of introspection and shortly reported an inner sense of discomfort, which they assessed as similar to the first and second accounts. However, none was willing to continue beyond the first recognition of inner somatic discomfort.

The second account was a hopeful effort to determine if there were a possibility of achieving results that might possibly validate the findings of the first account. However, the author was not too hopeful, since the professor’s seasickness was less severe than had been that of the psychiatric resident. Also, he had not been at sea for over a year and he was 23 years older than the resident. Fortunately he was sufficiently interested in hypnosis to be fully cooperative as well as uncritical of the author’s specious explanation that he could be more fully attentive if he kept his eyes closed so that he would not be visually distracted while the author was speaking.

The third account differed from the first two. Its primary purpose was to meet Dr. Hackett’s needs by demonstrating that hypnotic results could be induced effectively in a chronic pain patient by means of a most indirect technique. The author’s previous work with Frank made a trance an easy certainty. The hope was that stimuli not recognizable to the hypnotic subject and not even recognizable to Dr. Hackett until explained could result in some responses that could be used informatively for Dr. Hackett.

The secondary consideration was in relation to the author’s belief that  the  patient  was  exaggeratedly  and  neurotically  honest  and  that this obsessive-compulsive honesty quite possibly could be based  upon some actual incident, possibly some juvenile delinquency during which ‘1istening in all  directions”  was  quite  likely  to  have  occurred.  Hence the technique was worded to elicit some  such  memory “long forgotten” and “not too terrible” in the eyes of a man of wide experience in his late sixties and with an extensive history of philanthropy. The patient was protected by defining the possible incident as “not too terrible.” The random, irregular changing of the locus of the author’s voice was added to the indirect technique for two reasons. The first was that a specific meaningful incident might be elicited, but this was actually a mere hope not based on any factual knowledge. A second reason was that it might possibly affect the trance state in some informative way. In brief there might be something to gain but nothing to lose, and failure could be corrected by another type of approach. The results were delightfully specific, informative, and confirmatory of the first two accounts, even though they were shown in an unexpected way and served to confirm the author’s suspicions of “a neurotic honesty” in the third subject.

SUMMARY

Three unexpected occurrences, one in 1929, one in 1942, and the third in 1968, gave the author an opportunity to further a particular type of field investigation. This was initiated as a result of the train of thought engendered by the first event. As the author had listened to the psychiatric resident’s account of seasickness marked by nausea, vomiting, and dizziness, he had recalled some of his childhood experiments and those of his playmates and some of the results of the experiences of his children and their playmates. The question arose about the role of the significance of minor changes in the loci of origin of sounds. This led to a field investigation in three separate instances, each involving only one person.