Copyright 2001 Scientific American, Inc.

The Truth and

the Hype of

BY MICHAEL R. NASH
Photographs by Kyoko Hamada

Though often denigrated as fakery or wishful

thinking, hypnosis has been shown to be
a real phenomenon with a variety of therapeutic
uses—especially in controlling pain

SCIENTIFIC AMERICAN 47
Copyright 2001 Scientific American, Inc.
“Y OU ARE GETTING SLEEPY. V E R R R Y
A waistcoated man swings his pocket scientists still don’t know why. Neverthe-
SLEEPY . . .”
R. Hilgard and are still used today to de-
watch back and forth before the face of a less, hypnosis is finding medical uses in termine the extent to which a subject re-
young woman seated in a Victorian-era controlling chronic pain, in countering sponds to hypnosis. One version of the
parlor. She fixes her gaze on the watch, anxiety and even— in combination with Stanford scales, for instance, consists of
tracking its pendular motion with her conventional operating-room proce- a series of 12 activities— such as holding
eyes. Moments later she is slumped in her dures— in helping patients to recover one’s arm outstretched or sniffing the
chair, eyes closed, answering the hypno- more quickly from outpatient surgery. contents of a bottle— that test the depth
tist’s questions in a zombielike monotone. Only in the past 40 years have scien- of the hypnotic state. In the first instance,
Everyone has seen a depiction of hyp- tists been equipped with instruments and individuals are told that they are holding
nosis similar to this one in movies and on methods for discerning the facts of hyp- a very heavy ball, and they are scored as
television. Indeed, say the word “hypno- nosis from exaggerated claims. But the “passing” that suggestion if their arm
sis,” and many people immediately think study of hypnotic phenomena is now sags under the imagined weight. In the
of pocket watches. But it is now much squarely in the domain of normal cogni- second case, subjects are told that they
more common for hypnotists simply to tive science, with papers on hypnosis pub- have no sense of smell, and then a vial of
ask a subject to stare at a small, station- lished in some of the most selective scien- ammonia is waved under their nose. If
ary object— such as a colored thumbtack tific and medical journals. Of course, they have no reaction, they are deemed
on the wall— during the “induction pat- spectacles such as “stage hypnosis” for very responsive to hypnosis; if they gri-
ter,” which usually consists of soothing entertainment purposes have not disap- mace and recoil, they are not.
words about relaxation and suggestions peared. But the new findings reveal how, Scoring on the Stanford scales ranges
to concentrate. when used properly, the power of hypnot- from 0, for individuals who do not re-
But is hypnosis a real phenomenon? If ic suggestion can alter cognitive processes spond to any of the hypnotic suggestions,
so, what is it useful for? Over the past few as diverse as memory and pain perception. to 12, for those who pass all of them.
years, researchers have found that hyp- Most people score in the middle range
notized individuals actively respond to Wheat from the Chaff (between 5 and 7); 95 percent of the pop-
suggestions even though they sometimes TO STUDY any phenomenon properly, ulation receives a score of at least 1.
perceive the dramatic changes in thought researchers must first have a way to mea-
and behavior they experience as happen- sure it. In the case of hypnosis, that yard- What Hypnosis Is
ing “by themselves.” During hypnosis, it stick is the Stanford Hypnotic Suscepti- BASED ON STUDIES using the Stan-
is as though the brain temporarily sus- bility Scales. The Stanford scales, as they ford scales, researchers with very differ-
pends its attempts to authenticate incom- are often called, were devised in the late ent theoretical perspectives now agree on
ing sensory information. Some people are 1950s by Stanford University psycholo- several fundamental principles of hypno-
more hypnotizable than others, although gists André M. Weitzenhoffer and Ernest sis. The first is that a person’s ability to
respond to hypnosis is remarkably stable
MICHAEL R. NASH is associate professor of psychology at the University of Tennessee at during adulthood. In perhaps the most
THE AUTHOR

Knoxville and is editor in chief of the International Journal of Clinical and Experimental Hypno- compelling illustration of this tenet, a
sis. He received his Ph.D. from Ohio University in 1983 and completed his clinical internship at study showed that when retested, Hil-
the Yale University School of Medicine the same year. He has published two books, one on the gard’s original subjects had roughly the
research foundations of hypnosis and the other on psychoanalysis, both co-authored with Eri- same scores on the Stanford scales as they
ka Fromm of the University of Chicago. He is the author of more than 60 publications in scien- did 10, 15 or 25 years earlier. Studies
tific journals on the topics of human memory, dissociative pathology, sex abuse, psychother- have shown that an individual’s Stanford
apy and hypnosis. Nash has received numerous awards for his scientific and clinical writing. score remains as consistent over time as

48 SCIENTIFIC AMERICAN JULY 2001

Copyright 2001 Scientific American, Inc.
his or her IQ score— if not more so. In ad-
dition, evidence indicates that hypnotic
responsiveness may have a hereditary
component: identical twins are more
likely than same-sex fraternal twins to
have similar Stanford scores.
A person’s responsiveness to hypnosis
also remains fairly consistent regardless
of the characteristics of the hypnotist: the
practitioner’s gender, age and experience
have little or no effect on a subject’s abil-
ity to be hypnotized. Similarly, the success
of hypnosis does not depend on whether
a subject is highly motivated or especial-
ly willing. A very responsive subject will
become hypnotized under a variety of ex-
perimental conditions and therapeutic
settings, whereas a less susceptible person
will not, despite his or her sincere efforts.
(Negative attitudes and expectations can,
however, interfere with hypnosis.)
Several studies have also shown that
hypnotizability is unrelated to personal-
ity characteristics such as gullibility, hys-
teria, psychopathology, trust, aggressive-
ness, submissiveness, imagination or so-
cial compliance. The trait has, however,
been linked tantalizingly with an individ-
ual’s ability to become absorbed in activi-
ties such as reading, listening to music or
daydreaming. IT DOESN’T TAKE MUCH to induce hypnosis: staring fixedly at a spot on the wall and listening to
Under hypnosis, subjects do not be- the soothing voice of a hypnotist will do the trick for most people.
have as passive automatons but instead
are active problem solvers who incorpo- occasionally in day-to-day life and more the fact that many people who are hyp-
rate their moral and cultural ideas into dramatically in certain psychiatric and notizable can be led to experience com-
their behavior while remaining exquisite- neurological disorders. pellingly realistic auditory and visual hal-
ly responsive to the expectations ex- Using hypnosis, scientists have tem- lucinations. But an elegant study using
pressed by the experimenter. Neverthe- porarily created hallucinations, compul- positron emission tomography (PET),
less, the subject does not experience hyp- sions, certain types of memory loss, false which indirectly measures metabolism,
notically suggested behavior as something memories, and delusions in the laborato- has shown that different regions of the
that is actively achieved. To the contrary, ry so that these phenomena can be stud- brain are activated when a subject is
it is typically deemed as effortless— as ied in a controlled environment. asked to imagine a sound than when he
something that just happens. People who or she is hallucinating under hypnosis.
have been hypnotized often say things like What Hypnosis Isn’t In 1998 Henry Szechtman of McMas-
“My hand became heavy and moved A S S C I E N T I S T S D I S C O V E R more about ter University in Ontario and his co-work-
down by itself” or “Suddenly I found my- hypnosis, they are also uncovering evi- ers used PET to image the brain activity of
self feeling no pain.” dence that counters some of the skepti- hypnotized subjects who were invited to
Many researchers now believe that cism about the technique. One such ob- imagine a scenario and who then experi-
these types of disconnections are at the jection is that hypnosis is simply a matter enced a hallucination. The researchers
heart of hypnosis. In response to sugges- of having an especially vivid imagination. noted that an auditory hallucination and
tion, subjects make movements without In fact, this does not seem to be the case. the act of imagining a sound are both self-
conscious intent, fail to detect exceeding- Many imaginative people are not good generated and that, like real hearing, a
ly painful stimulation or temporarily for- hypnotic subjects, and no relation be- hallucination is experienced as coming
get a familiar fact. Of course, these kinds tween the two abilities has surfaced. from an external source. By monitoring
of things also happen outside hypnosis— The imagination charge stems from regional blood flow in areas activated dur-

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Copyright 2001 Scientific American, Inc.
ing both hearing and auditory hallucina-
tion but not during simple imagining, the
investigators sought to determine where
in the brain a hallucinated sound is mis-
takenly “tagged” as authentic and origi-
nating in the outside world.
Szechtman and his colleagues imaged
the brain activity of eight very hypnotiz-
able subjects who had been prescreened
for their ability to hallucinate under hyp-
nosis. During the session, the subjects
were under hypnosis and lay in the PET
scanner with their eyes covered. Their brain
activity was monitored under four condi-
tions: at rest; while hearing an audiotape
of a voice saying, “The man did not speak
often, but when he did, it was worth hear-
ing what he had to say”; while imagining
hearing the voice again; and during the
auditory hallucination they experienced
after being told that the tape was playing
once more, although it was not.
The tests showed that a region of the
brain called the right anterior cingulate
cortex was just as active while the volun-
teers were hallucinating as it was while
they were actually hearing the stimulus.
In contrast, that brain area was not active
while the subjects were imagining that
they heard the stimulus. Somehow hyp-
nosis had tricked this area of the brain into PEOPLE UNDER HYPNOSIS, though deeply relaxed, can carry out the instructions
registering the hallucinated voice as real. of their hypnotist. This woman is being told that her arm is becoming as heavy as lead.
Another objection raised by critics of Highly hypnotizable subjects will lower their arms under the imagined weight.
hypnosis concerns its ability to blunt pain.
Skeptics have argued that this effect re- out to determine which brain structures pany pain— such as increased heart rate—
sults from either simple relaxation or a are involved in pain relief during hypno- are relatively unaffected by hypnotic sug-
placebo response. But a number of ex- sis. They attempted to locate the brain gestions of analgesia.
periments have ruled out these explana- structures associated with the suffering But couldn’t people merely be faking
tions. In a classic 1969 report, Thomas H. component of pain, as distinct from its that they had been hypnotized? Two key
McGlashan and his colleagues at the Uni- sensory aspects. Using PET, the scientists studies have put such suspicions to rest.
versity of Pennsylvania found that for found that hypnosis reduced the activity In a cunning 1971 experiment dubbed
poorly hypnotizable people, hypnosis was of the anterior cingulate cortex— an area The Disappearing Hypnotist, Frederick
as effective in reducing pain as a sugar pill known to be involved in pain— but did Evans and Martin T. Orne of the Univer-
that the subjects had been told was a pow- not affect the activity of the somatosen- sity of Pennsylvania compared the reac-
erful painkiller. But highly hypnotizable sory cortex, where the sensations of pain tions of two groups of subjects: one made
subjects benefited three times more from are processed. up of people they knew to be truly hyp-
hypnosis than from the placebo. In an- Despite these findings, however, the notizable and another of individuals they
other study, in 1976, Hilgard and Stan- mechanisms underlying hypnotic pain re- told to pretend to be hypnotized. An ex-
ford colleague Éva I. Bányai observed that lief are still poorly understood. The mod- perimenter who did not know which
subjects who were vigorously riding sta- el favored by most researchers is that the group was which conducted a routine
tionary bicycles were just as responsive to analgesic effect of hypnosis occurs in hypnotic procedure that was suddenly in-
hypnotic suggestions as when they were higher brain centers than those involved terrupted by a bogus power failure. When
hypnotized in a relaxing setting. in registering the painful sensation. This the experimenter left the room to investi-
In 1997 Pierre Rainville of the Uni- would account for the fact that most au- gate the situation, the pretending subjects
versity of Montreal and his colleagues set tonomic responses that routinely accom- immediately stopped faking: they opened

52 SCIENTIFIC AMERICAN JULY 2001

Copyright 2001 Scientific American, Inc.
their eyes, looked around the room and in generally meet the criteria for truthful- of effort we expended: if the event is
all respects dropped the pretense. The real ness, whereas those of simulators do not. tagged as having involved a good deal of
hypnotic subjects, however, slowly and mental effort on our part, we tend to in-
with some difficulty terminated hypnosis Hypnosis and Memory terpret it as something we imagined. If it
by themselves. PERHAPS NOWHERE has hypnosis en- is tagged as having involved relatively lit-
Fakers also tend to overplay their role. gendered more controversy than over the tle mental effort, we tend to interpret it as
When subjects are given suggestions to issue of “recovered” memory. Cognitive something that actually happened to us.
forget certain aspects of the hypnosis ses- science has established that people are fair- Given that the calling card of hypnosis is
sion, their claims not to remember are ly adept at discerning whether an event ac- precisely the feeling of effortlessness, we
sometimes suspiciously pervasive and ab- tually occurred or whether they only can see why hypnotized people can so eas-
solute, for instance, or they report odd ex- imagined it. But under some circum- ily mistake an imagined past event for
periences that are rarely, if ever, recount- stances, we falter. We can come to believe something that happened long ago.
ed by real subjects. Taru Kinnunen, (or can be led to believe) that something Hence, something that is merely imagined
Harold S. Zamansky and their co-work- happened to us when, in fact, it did not. can become ingrained as an episode in
ers at Northeastern University have ex- One of the key cues humans appear to use our life story.
posed fakers using traditional lie-detector in making the distinction between reality A host of studies verify this effect.
tests. They have found that when real and imagination is the experience of ef- Readily hypnotized subjects, for instance,
hypnotic subjects answer questions under fort. Apparently, at the time of encoding a can routinely be led to produce detailed
hypnosis, their physiological reactions memory, a “tag” cues us as to the amount and dramatic accounts of their first few

WHAT DO YOU KNOW ABOUT HYPNOSIS?

IF YOU THINK ... THE REALITY IS ...
It’s all a matter of having a good imagination. Ability to imagine vividly is unrelated to hypnotizability.

Relaxation is an important feature of hypnosis. It’s not. Hypnosis has been induced during vigorous exercise.

It’s mostly just compliance. Many highly motivated subjects fail to experience hypnosis.

It’s a matter of willful faking. Physiological responses indicate that hypnotized subjects are not lying.

It is dangerous. Standard hypnotic procedures are no more distressing than lectures.

It has something to do with a sleeplike state. It does not. Hypnotized subjects are fully awake.

Responding to hypnosis is like responding to a placebo. Placebo responsiveness and hypnotizability are not correlated.

People with certain types of personalities are likely to be hypnotizable. There are no substantial correlates with personality measures.

People who are hypnotized lose control of themselves. Subjects are perfectly capable of saying no or terminating hypnosis.

Hypnosis can enable people to “relive” the past. Age-regressed adults behave like adults playacting as children.

A person’s responsiveness to hypnosis depends on the technique Neither is important under laboratory conditions. It is the subject’s
used and who administers it. capacity that is important.

Hypnosis may actually muddle the distinction between memory

When hypnotized, people can remember more accurately. and fantasy and may artificially inflate confidence.

Hypnotized people can be led to do acts that conflict with their values. Hypnotized subjects fully adhere to their usual moral standards.

Hypnotized people do not remember what happened during the session. Posthypnotic amnesia does not occur spontaneously.

Performance following hypnotic suggestions for increased muscle

Hypnosis can enable people to perform otherwise impossible feats strength, learning and sensory acuity does not exceed what can be
of strength, endurance, learning and sensory acuity. accomplished by motivated subjects outside hypnosis.

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 SCIENTIFIC AMERICAN Gets Hypnotized
Our staff sees what it’s like to “go under”
Here at SCIENTIFIC AMERICAN we pride ourselves on our skepticism be poor subjects, and others who deemed themselves tough
toward pseudoscience and on our hard-nosed insistence on solid cases were surprised to find their two outstretched arms coming
research. So when we invited Michael R. Nash of the University of together by themselves or their mouth clamped shut so that
Tennessee at Knoxville to write the accompanying article on the they couldn’t say their name.
scientific basis of hypnosis, we warned him that we’d put him We all had a sense of “watching” ourselves and were
through the wringer— which we did. But while editing the article, sometimes amused. “I knew what my name was, but I couldn’t
we began to wonder: Isn’t this something we should experience think how to move my mouth,” recalled one staff member.
ourselves? How many of us would be hypnotizable? Another said his fingers “felt stuck” during the finger-lock
We invited Nash and research psychologist Grant Benham to exercise. “At first they pulled apart easily enough, but then they
New York so we could see what hypnosis was like firsthand. Six seemed to sort of latch up. It was interesting to see that it was
editorial staffers— three men and three women, none of whom so difficult.”
had been hypnotized before— were willing to give it a try. What Only one of us experienced item number 12 on the Stanford
we found surprised us. scale—posthypnotic amnesia. In this exercise, the hypnotist tells
Nash and Benham set up two quiet offices for our initiation the subject not to remember what occurred during the session.
into hypnosis. Each researcher hypnotized three people “Every time I’d try to remember,” said the staff member who had this
individually, spending about an hour with each subject. They sensation, “the only thing that came back to me was that I shouldn’t
took us through the Stanford Hypnotic Susceptibility Scales, remember. But when Dr. Benham said it was okay to remember, it all
which rate an individual’s responsiveness from 0 to 12. came flooding back.”
One of the most surprising things about our hypnotic In general, the experience was much less eerie than we had
experience was its very banality. To induce hypnosis, Nash and expected. The feeling was akin to falling into a light doze after
Benham merely asked us to stare at a yellow Post-It note on the you’ve awakened in the morning but while you’re still in bed. All of
wall and spoke to us in a calm voice about how relaxed we were us found that we felt less hypnotized during some parts of the
becoming and how our eyes were growing tired. “Your whole body session than during others, as if we had come near the “surface”
feels heavy— heavier and heavier,” they read from the Stanford for a few moments and then slipped under again.
script. “You are beginning to feel drowsy— drowsy and sleepy. All in all, we concluded that seeing is believing when it comes
More and more drowsy and sleepy while your eyelids become to hypnosis. Or maybe we should say hearing is believing: I’m the
heavier and heavier, more and more tired and heavy.” That one who heard— and swatted— the imaginary fly.
soothing patter went on for roughly 15 minutes, after which all — Carol Ezzell, staff writer and a 7 on the Stanford scales
but one of us had closed his or her eyes
without being directly told to do so.
The Stanford scales consist of 12
different activities ranging from trying to
pull apart one’s interlocked fingers and
feeling one’s elevated arm lower
involuntarily to hallucinating that one hears
a buzzing fly. Of the six of us, one scored an
8, one a 7, one a 6, two a 4 and one a 3.
(A score of 0 to 4 is considered “low”
hypnotizable; 5 to 7 is “medium”
hypnotizable; 8 to 12 is “high” hypnotizable.)
None of us accurately predicted how
susceptible we would be: some who thought
themselves very suggestible turned out to

PEOPLE ARE AWARE of what they do during

hypnosis, although their actions feel
involuntary. Some of us laughed at our
inability to say our names or open our eyes
under hypnotic suggestion.

54 SCIENTIFIC AMERICAN JULY 2001

Copyright 2001 Scientific American, Inc.
 SOMATOSENSORY CORTEX

months of life even though those events HYPNOSIS MIGHT ALLEVIATE pain by decreasing
did not in fact occur and even though the activity of brain areas involved in the
adults simply do not have the capacity to experience of suffering. Positron emission
remember early infancy. Similarly, when tomography (PET) scans of horizontal (top) and MINIMALLY
given suggestions to regress to childhood, vertical (bottom) brain sections were taken UNPLEASANT
highly hypnotizable subjects behave in a while the hands of hypnotized volunteers were
roughly childlike manner, are often quite dunked into painfully hot water. The activity of PAINFULLY
emotional and may later insist that they the somatosensory cortex, which processes HOT
were genuinely reliving childhood. But physical stimuli, did not differ whether a
research confirms that these responses subject was given the hypnotic suggestion that
are in no way authentically childlike— the sensation would be painfully hot (left) or
not in speech, behavior, emotion, percep- that it would be minimally unpleasant (right). In
tion, vocabulary or thought patterns. contrast, a part of the brain known to be
These performances are no more childlike involved in the suffering aspect of pain, the
than those of adults playacting as chil- anterior cingulate cortex, was much less active
dren. In short, nothing about hypnosis en- when subjects were told that the pain would be ANTERIOR CINGULATE CORTEX
ables a subject to transcend the funda- minimally unpleasant (bottom).
mental nature and limitations of human
memory. It does not allow someone to ex- is in the best position to decide with the treatment of other conditions. Listed in
hume memories that are decades old or to patient whether hypnosis is indicated and, rough order of tractability by hypnosis,
retrace or undo human development. if it is, how it might be incorporated into these include a subgroup of asthmas; some
the individual’s treatment. dermatological disorders, including warts;
What It’s Good For Hypnosis can boost the effectiveness irritable bowel syndrome; hemophilia;
SO WHAT ARE the medical benefits of of psychotherapy for some conditions. and nausea associated with chemothera-
hypnosis? A 1996 National Institutes of Another meta-analysis that examined the py. The mechanism by which hypnosis al-
Health technology assessment panel outcomes of people in 18 separate studies leviates these disorders is unknown, and
judged hypnosis to be an effective inter- found that patients who received cogni- claims that hypnosis increases immune
vention for alleviating pain from cancer tive behavioral therapy plus hypnosis for function in any clinically important way
and other chronic conditions. Volumi- disorders such as obesity, insomnia, anx- are at this time unsubstantiated.
nous clinical studies also indicate that iety and hypertension showed greater im- More than 30 years ago Hilgard pre-
hypnosis can reduce the acute pain expe- provement than 70 percent of the patients dicted that as knowledge about hypnosis
rienced by patients undergoing burn- who received psychotherapy alone. After becomes more widespread in the scien-
wound debridement, children enduring publication of these findings, a task force tific community, a process of “domesti-
bone marrow aspirations and women in of the American Psychological Associa- cation” will take place: researchers will
labor. A meta-analysis published in a re- tion validated hypnosis as an adjunct pro- use the technique more and more often as
cent special issue of the International cedure for the treatment of obesity. But a routine tool to study other topics of in-
Journal of Clinical and Experimental the jury is still out on other disorders with terest, such as hallucination, pain and
Hypnosis, for example, found that hyp- a behavioral component. Drug addiction memory. He forecast that, thus ground-
notic suggestions relieved the pain of 75 and alcoholism do not respond well to ed in science, the clinical use of hypnosis
percent of 933 subjects participating in 27 hypnosis, and the evidence for hypnosis would simply become a matter of course
different experiments. The pain-relieving as an aid in quitting smoking is equivocal. for some patients with selected problems.
PIERRE RAINVILLE ET AL., SCIENCE, VOL. 277, AUGUST 15, 1997

effect of hypnosis is often substantial, and That said, there is strong, but not yet Although we are not quite there today,
in a few cases the degree of relief match- definitive, evidence that hypnosis can be hypnosis has nonetheless come a long
es or exceeds that provided by morphine. an effective component in the broader way from the swinging pocket watch.
But the Society for Clinical and Ex-
perimental Hypnosis says that hypnosis MORE TO E XPLORE
cannot, and should not, stand alone as the Hypnosis for the Seriously Curious. Kenneth Bowers. W. W. Norton, 1983.
sole medical or psychological intervention Contemporary Hypnosis Research. Erika Fromm and Michael R. Nash. Guilford Press, 1992.
for any disorder. The reason is that any- For an introduction to the history of hypnosis and its modern-day uses, visit the Web site
one who can read a script with some de- of the Institute for the Study of Healthcare Organizations and Transactions at
gree of expression can learn how to hyp- www.institute-shot.com/hypnosis_and_health.htm
notize someone. An individual with a For information on hypnosis research and clinical applications, visit the International
medical or psychological problem should Journal of Clinical and Experimental Hypnosis at www.sunsite.utk.edu/IJCEH
first consult a qualified health care pro- Video of an actual hypnosis session can be viewed at
vider for a diagnosis. Such a practitioner www.sciam.com/2001/0701issue/0701nashbox1.html

www.sciam.com SCIENTIFIC AMERICAN 55

Copyright 2001 Scientific American, Inc.