Braid’s Later Theories of Hypnotism

In his two books, Hypnotism: Its History, Practice & Theory (1903) and Hypnotism & Treatment by Suggestion (1909), Bramwell expands Braid’s later thoughts into a more generally suggestion-oriented interpretation of hypnotism, which in many respects pre-empts modern “non-state”, or cognitive-behavioural, research on hypnosis. There is a distinct shift in emphasis from the idea of a special physiological state of nervous sleep, to a range of (ideo-dynamic) psychological mechanisms and their social context, e.g., the role of expectation, habit, imagination, imitation, verbal suggestion, association, attention, etc., become increasingly central to Braid’s approach and the physiology of rigid catalepsy or nervous sleep becomes somewhat less significant.

However, neither Bramwell nor Braid concluded from this that the classical eye-fixation induction should be completely abandoned, because it may have psycho-physiological effects which are helpful, though non-essential. It is also likely that most subjects expect to experience some kind of recognisable induction ritual, and so the eye-fixation technique, or a similar style of working, may itself be a kind of physical suggestion which facilitates subsequent suggestion by satisfying the client’s expectations about hypnotism.

Hypnotism: Its History, Practice & Theory (1903)

Braid’s theories changed as his knowledge increased, and he held in all three distinct and widely differing ones. In the first, he explained hypnosis from an almost purely physical standpoint; in his second, he considered it to be a condition of involuntary monoideism and concentration of the attention. His third theory differed from both of these. In it he recognised that reason and volition were unimpaired, and that the attention could be simultaneously directed to more points than one. The condition, therefore, was not one of involuntary monoideism. Further, he recognised more and more clearly that the state was essentially a conscious one, and that the losses of memory which followed on awaking could always be restored in subsequent hypnoses. Finally, he described as “double consciousness” the condition which he had first termed “hypnotic”, then “monoideistic”. [Bramwell probably meant that Braid wished to reserve the terms “hypnotism” and “monoideism” for special states associated with the use of suggestion, but that he came to see neither as essential to suggestion therapy.] As already noted, few students of hypnotism are acquainted with any of Braid’s theories except the earliest; and his third and latest one, which he promised to put before the public in a more complete form, never saw the light in the manner he intended. [In The Physiology of Fascination (1855), for example, Braid had stated, ‘It is my intention shortly to publish a volume entitled “Psycho-Physiology: embracing Hypnotism, Monoideism, and Mesmerism.”’] My account is drawn from little-known pamphlets, unpublished MS., etc. [Bramwell had acquired most of Braid’s works, including several unpublished pieces.]

The following is a summary of Braid’s latest theories:-

Hypnosis could not be induced by physical means alone.
Hypnotic and so-called Mesmeric phenomena were subjective in origin, and both were excited by direct or by indirect suggestion.
Hypnosis was characterised by physical as well as by psychical changes.
The simultaneous appearance of several phenomena was recognised and much importance was attached to the intelligent action of a secondary consciousness.
Volition was unimpaired, moral sense increased, and suggested crime impossible.
Rapport was a purely artificial condition created by suggestion.
The importance of direct verbal suggestion was fully recognised, as also the mental influence of physical methods.
Suggestion was regarded as the device used for exciting the phenomena, and not considered as sufficient to explain them.
Important differences existed between hypnosis and normal sleep.
Hypnotic phenomena might be induced without the subject having passed through any condition resembling sleep.
The mentally healthy were the easiest, the hysterical the most difficult, to influence.

In this country, during Braid’s lifetime, his earlier views were largely adopted by certain well-known men of science, particularly Professors W.B. Carpenter and J. Hughes Bennett, but they appear to have known little or nothing of his latest theories. [Bramwell, 1903: 293-294]

Hypnotism & Treatment by Suggestion (1909)

Before discussing hypnotic theories, I wish to draw attention to the cases and experiments just cited. In some, the condition termed hypnosis was present. This varied from slight drowsiness or lethargy to apparently profound sleep, followed by amnesia on waking, i.e., the subjects were unable to recall the events of the so-called hypnosis. At first, both Braid and Liébault regarded this as artificially induced sleep, and believed that it must be evoked before patients would respond to suggestions, either curative or experimental. The condition, however, might be more accurately described as “imitation sleep”. The deeply hypnotised subject believed he had been asleep, because he could not afterwards recollect what had happened. Various facts, however, show great dissimilarity between imitation and natural sleep [i.e., between so-called “hypnotic sleep” and natural sleep]. When the subject is re-hypnotised and questioned, he can relate all that took place in the previous hypnosis with the exception of any special sensations inhibited by suggestion. Thus, my patients who had undergone painless hypnotic operations could afterwards describe them, and knew what had been said and done by those around them. They were only unable to recall pain, as that sensation had never reached consciousness. Further, in the so-called lethargic state [the deepest stage of hypnosis according to the Salpêtrière school] the subjects, who lie apparently asleep, hear and respond to the operator’s suggestions, even if these are whispered so softly that they could not have heard them in the normal condition. […] In every instance, where I questioned so-called hypnotic somnambules as to their mental condition in previous hypnoses, I found that they knew where they had been and what they had been doing or thinking about. They felt that they were the same persons in the so-called hypnotic state as in the waking one, and were conscious that their reason and volition were unimpaired. [It was not, therefore, an autonomous “unconscious”, “subconscious”, or “dissociated” mind, but their normal conscious mind, that was listening to the hypnotic suggestions and responding.]

Further, subjects in whom hypnosis had been evoked would afterwards pass into the suggestible condition characteristic of it, at any signal to which they had been taught to respond, and without going through any intermediate state even superficially resembling sleep. […]

In some of the cases nothing even superficially resembling sleep was induced: the patients simply rested in an armchair while suggestions were made. Yet, in many instances, the curative results were as striking as those obtained after the induction of so-called hypnosis.

In both groups increased suggestibility had been developed, and a control of the organism obtained far beyond the will-power of ordinary life. Examples of this are found in the influence of suggestion upon menstruation, perspiration, the secretion of milk, the action of the bowels, etc. [That is, despite the absence of anything remotely resembling a sleep-like “trance”, suggestions given in the waking state were found effective and capable of influencing bodily function usually classed as “involuntary”, by means of ideo-dynamic reflex action.] (Bramwell, 1909: 133-135)

Braid’s method. – Braid took a bright object, generally his lancet case, held it in his right hand about a foot away from the patient’s eyes, and at such a distance above the forehead that it could not be seen without straining. The patient was told to look steadily at it and to think of nothing else. The operator then extended and separated the fore and middle fingers of the right hand, and carried them from the object towards the patient’s eyes. The lids generally closed involuntarily; if this did not happen the process was repeated, and rarely failed.

Later, as Braid found that fixed gazing was frequently followed by slight conjunctivitis, he changed his methods: prolonged staring was abandoned, and the patient instructed to close his eyes at an early stage of the proceedings. Hypnosis was induced as easily as before and without unpleasant symptoms. If the body and mind were at rest, Braid found he could hypnotise as readily in the dark as in the light, and he also succeeded with the blind; these facts induced him to abandon his physical theory [of eye-fixation leading to nervous fatigue] and to conclude that the influence was exerted through the mind. He observed that repeated hypnoses increased susceptibility; this arose from habit, association of ideas and imagination. In such cases, if the patients believed something was being done which ought to produce hypnosis, the state appeared. On the other hand, the most expert hypnotist would exert his influence in vain if the patient did not know what was expected and, at the same time, voluntarily yield to the demands of the operator. Later, Braid asserted that direct verbal suggestion was the best method for inducing hypnosis and its phenomena; physical methods were simply indirect suggestions, their influence depending upon the mental states they excited. [Braid had already emphasised that physical manipulation of the body posture and facial expression were likely to evoke corresponding ideas and feelings in the mind of the subject; rather than having a direct physical effect, eye-fixation might suggest the idea of focused attention and sleepiness by mental association.] (Bramwell, 1909: 159-160)

Before describing my later methods, I wish again to draw attention to several points in connection with the so-called hypnotic state. As we have seen, the subject may have his eyes open, and act like a normal individual who is awake. In the lethargic condition, when he appears to be asleep, he still hears all that is said around him. Further, all the phenomena of so-called hypnosis can be induced in the waking state, without the patient having preliminarily passed through any condition resembling sleep. It is to Braid’s earlier work that we owe the theory that it was necessary to induce hypnosis before beginning treatment by suggestion. At first he regarded the condition as an artificial sleep, but pointed out later that only one in ten of those he cured passed into a state even superficially resembling [normal] sleep. He proposed, therefore, to abolish his entire terminology, as it misled the public, and made them believe they could not be cured by suggestion unless they had first been put to sleep. With the majority of Braid’s patients there was not even an apparent loss of consciousness – they simply became slightly drowsy, and afterwards remembered all that had happened – while, with others, hypnotic phenomena were induced, without any previous stage in any way resembling sleep. Further, in those cases where sleep had apparently been present, it could be proved that the condition was really a conscious one, as the recollection of all that had occurred could be evoked by suggestion.

Braid’s later observations passed unnoticed, and, until recent times, nearly all operators proceeded on his earlier lines. They suggested artificial sleep, lethargy or drowsiness, and then began treatment. They did not recognise that the artificial or, more correctly speaking, imitation sleep was only one of the phenomena of increased suggestibility, due to suggestion. Given increased suggestibility, any of the phenomena of hypnosis might be evoked as readily as imitation sleep, and the patient cured just as easily when that state had been omitted.

For many years, [the founder of the Nancy School] Liébault’s methods were similar to Braid’s earlier ones, and he always tried to induce what he called sommeil provoqué [“artificial sleep”]. Gradually the views of the Nancy School were modified till they resembled Braid’s later theories. Now, Bernheim [the leader of the Nancy School] states that there is nothing in hypnotism but the name. All is “suggestion”, and patients can be cured without the induction of artificial sleep. Bernheim’s statement requires some modification: all the phenomena we have been accustomed to call hypnotic are undoubtedly the result of suggestion; but the suggestions must be accepted by the patient before the phenomena can be evoked.

The essence of the whole condition, then, is an increased suggestibility; the production of a preliminary imitation sleep is not necessary, and is simply a waste of time. In some instances, I tried to induce so-called hypnosis [i.e., “artificial sleep”] a hundred times before I succeeded. Now, with the method I shall presently describe, I commence curative treatment at once, and obtain quicker results.

Lest my readers may be confused by my asserting, on the one hand, that the hypnotic state – i.e., a condition of sleep – does not really exist, and, on the other, by my talking of inducing hypnosis, I will summarise my views. Every stage of the so-called hypnotic condition is a conscious one. In some instances the subjects have their eyes open and are obviously wide awake, in others their eyes are closed and they appear to be asleep; but, even in the most profound condition, the sleep is only apparent, not real, as the subjects retain consciousness, volition and intelligence. The condition described as the hypnotic is essentially one of increased suggestibility. The artificial or imitation sleep, suggested by the operator, is only one amongst the many phenomena which can be evoked by suggestion. In what is described as the deepest stage – i.e., hypnotic somnambulism, followed by amnesia – when the state is terminated, the patients believe they have been asleep, because they do not remember what has happened. This is equally true, whether they have been apparently asleep, or seemingly awake with their eyes open in the “alert” stage. The lost memories of both stages can always be recalled in subsequent hypnosis. Further, it is probable that the amnesia is an artificial one due to the suggestions of the operator. When I use the word hypnosis – and it is almost impossible to avoid doing so until this fresh conception of the condition is accepted – I only mean that I have tried to induce increased suggestibility [as opposed to a sleep-like state] by methods which I shall presently describe. The condition – i.e., increased suggestibility – is sometimes preceded by drowsiness, but this is often absent, and the patients are voluntarily thinking of some restful monotonous subject during the whole process. Sometimes the patients’ minds are filled with the melancholy thoughts of neurasthenia, or obsessional fears; at others their attention is fixed on their hysterical convulsions or other uncontrollable muscular movements; but, despite this, increased suggestibility is frequently induced. Here there has been neither imitation sleep nor restful monotonous thought, but, nevertheless, brilliant therapeutic results are often obtained in such cases.

I will now describe my present methods. In many respects they resemble those I have used for years; the difference between them, more apparent than real, being due to what I believe to be a clearer conception of the so-called hypnotic state. […]

The first suggestions refer to the conditions which I wish to create while the patient is in the armchair. I tell him that each time he comes he will find it easier to rest, to turn his attention away from me and to concentrate it upon something restful [after simply closing his eyes normally]. I have previously explained that I do not wish him to go to sleep, but that, if he can get into the drowsy condition which precedes sleep, the suggestions are likely to be responded to more quickly. (Bramwell, 1909: 162-168)