Hypnotism

152 Hypnotism (from Greek hypnos-sleep), the doctrine of artificially induced special sleep-like states, called hypnosis and used in medicine as one of the methods of psychotherapy. Instead of H., the term hypnology is sometimes used, which however is incorrect, since this word etymologically means the science of sleep, i.e., of the natural process of periodic inhibition of higher nervous activity, and not of a particular case of such inhibition caused by special techniques; for the latter, the generally accepted name H. should be considered more appropriate. A series of actions or methods by means of which a person is plunged into hypnosis or a hypnotic state is called hypnotizing; a subject in hypnosis is designated by the words 'hypnotized', 'hypnotic', 'sleeping a hypnotic sleep'; the term 'medium' is less used. The person who produces the sleep is traditionally called a hypnotist. History of hypnotism is lost in the ancient Egyptian temple medicine, in some practical methods of Indian ascetics (yogis), in the ceremonies of mystical healing undertaken by medieval monks, feudal lords, kings, in the astrological teachings of Paracelsus and van-Helmont, who taught that just as a magnet attracts iron at a distance, so in a person there is a force by means of which, under certain conditions, one can subject other people, inanimate objects, events to one's influence. In past centuries (XVI, XVII, XVIII), the appearance from time to time of individual persons famous for their ability to cure patients without using drugs-by the laying on of hands, stroking, etc.-caused a great sensation. Sometimes for this purpose magnets were used; in the 17th century Masons and Rosicrucians (Robert Fludd, Maxwell) widely used magnets, and at one time the trade in them was considered very profitable; it is known that a certain Lenoble kept a warehouse of magnets in Paris at the end of the 18th century and successfully treated patients with them, which was certified by the Academy of Sciences. But a special interest in this kind of therapy was aroused by the Austrian physician Anton Mesmer (1734-1815), after he noticed that therapeutic results could be achieved without magnets, by simple touching of the hands to the patient, and he came to the conclusion that magnets are only transmitters of a special 'fluid' emanating from the human body; after this Mesmer began to treat by making so-called 'passes', i.e., smooth rhythmic movements at some distance from the patient's body in the direction from head to feet. Having acquired a huge practice and being unable to satisfy all those in need of his help, Mesmer declared that he could 'magnetize' inanimate objects, after which the latter began to exhibit healing power. For the mass application of his method, which received the name 'mesmerism', or 'animal magnetism', Mesmer constructed his famous 'tanks' or 'tubs', the contents of which, consisting of iron filings, broken glass, etc., he previously 'magnetized' with passes; after this patients were placed around holding onto the iron rods protruding from the tanks, and soon some reported various sensations, others developed twitching and convulsions, others fell into hysterical seizures or came into a state of ecstasy, catalepsy; a certain percentage obtained relief from painful symptoms and even complete cure. However, a medical commission appointed by the French government (1774) spoke against the authenticity of the cures, explaining all the observed phenomena partly as invention, partly as the imagination of credulous people. In 1784, one of Mesmer's followers, Puysegur, discovered a deep sleep-like state, which he called somnambulism; since then he sought to induce exactly such a sleep for therapeutic purposes, after which therapeutic results were observed in many cases. At the beginning of the 19th century (1814), the Portuguese abbe Faria began to decisively reject the existence of a magnetic fluid and explained the effect of passes and in particular the onset of sleep as a product of imagination, thus considering them dependent not on the 'magnetizer', but on the subject being put to sleep. Having discarded all passes, Faria for the first time applied the repeated verbal command 'sleep', i.e., began to use direct suggestion. An essential stage in the history of the development of H. were the experiments of the Manchester surgeon James Braid (Braid), who specifically studied the method of putting to sleep, which consisted in the subject having to immovably look at some shiny object. In his main work 'Neurypnology, or the rationale of nervous sleep, considered in relation to animal magnetism' (L.-Edinburgh, 1843) Braid also rejected any magnetic waves, attributing main significance to the fatigue of the sense organs from monotonous irritation and concentration of attention on the thought of sleep that should come. Incidentally, Braid applied his method for the painless performance of some surgical operations; after him people began to speak of 'Braidism' (Braidismus), and he himself first introduced the term H. Decisive significance in the evolution of H. was the appearance of the book by Liebeault (Liebeault A., 'Du sommeil et des etats anal, gues consideres surtout au point de vue de 1 acticn du moral sur le physique', P., 1866). This research, which was the result of many years of successful therapeutic experiments, did not at the time receive the attention it deserved, until in 1884 Professor of the medical clinic of the University of Nancy Bernheim, having repeated Liebeault's experiments and convinced himself of their authenticity, began to continue the observations of his predecessor. The result of these researches was the extensive work of Bernheim (Russian ed.: Bernheim H, 'On hypnotic suggestion and its application to the treatment of diseases', pt. 1-2, Odessa, 1887-88), which laid the true foundation for the science of H. The views of Liebeault and Bernheim constitute the content of the doctrine of the so-called Nancy school. Meanwhile, almost simultaneously (from 1876) Charcot in Paris also investigated the phenomena of H., conducting experiments on patients suffering mostly from severe forms of hysteria; this difference in the material on which observations were made (Liebeault and Bernheim also experimented on healthy people) led Charcot and his collaborators to conclude that hypnotic sleep is a pathological phenomenon, namely an artificial neurosis of the hysterical type, occurring only in persons with a hysterical predisposition. The school of Charcot (Paris school) distinguished in hypnosis three obligatory phases: 1) cataleptic, 2) lethargic and 3) somnambulistic state. At the same time Charcot and especially his collaborator Richet taught that hypnotic sleep arises directly depending on changes in the peripheral nervous apparatuses through monotonous irritation of the latter by agents such as bright light, sudden sound of a gong or quiet monotonous sounds, passes. In contrast to this, the Nancy school asserted that hypnosis is not connected with the presence in the subject of a morbid predisposition, can be obtained in most healthy people and finally is the result not of elementary physiological irritations, but of a more complex activity of the cerebral cortex, connected with the psyche. With the passage of time (from 1888 and until the end of the century), experiments made in various countries (Heidenhain, Preyer, Czermak, Krafft-Ebing, Forel-in Germany, Austria and Switzerland; Delboef and Crocq-in Belgium; Pitte, Berillon, Grasset, Pierre Janet-in France; Wetterstrand-in Sweden; Morelli and Lombroso-in Italy; Tokarsky and Bekhterev-in Russia), finally established that the truth is entirely on the side of the Nancy school and that hypnosis is a particular case of suggestion, which in turn is the result of suggestibility, which is in various degrees a normal property of the neuropsychic apparatus of every healthy person. This position received its bright formulation in the words of Bernheim: 'There is no hypnosis, there is only suggestion.'-Description and interpretation of the phenomena of H. until recently took place almost exclusively in terms and concepts of psychology. Only in recent years, thanks to the achievements of the physiological school of Academician I. P. Pavlov, for the first time it became possible to apply to this area the laws of brain functioning ('work of the large hemispheres'), i.e., to introduce into the doctrine of H. the methods, concepts and terms of modern physiology. Basic phenomena of hypnosis. The hypnotized subject lies on a couch or sits in a chair, makes no voluntary movements, is completely passive and in all respects looks like a sleeping person. The subjective state of such a hypnotic, as this is revealed by questioning, really corresponds to sleep, the depth of which however in different cases represents different degrees: light drowsiness, half-sleep or drowsiness, superficial sleep, deep sleep. At one time it was proposed to distinguish a definite number of such hypnotic states corresponding to their depth (Bernheim proposed 9 phases, Liebeault-6, Forel-3), but subsequent observations showed that such fractional divisions are extremely artificial and that for practical purposes the division of Forel is most expedient.

The following are distinguished: 1) light sleepiness, when the subject can still open the eyes by an effort of will, 2) light sleep, or hypotaxy ('fascination' or 'charm' of French authors), when the hypnotized person hears all words addressed to him by the hypnotist but cannot make any movement and subsequently remembers clearly everything that happened to him during the session, and 3) deep sleep, or somnambulism, characterized by extreme passivity, usually by a significant increase in suggestibility and by the absence of any memories of the fact of hypnotization and of the suggestions made, i.e., by amnesia upon awakening. Amnesia is what distinguishes somnambulism from all other, more superficial degrees of hypnosis. Hypnosis differs from natural physiological sleep in that it occurs not as a result of fatigue of the organism, but as a direct or indirect suggestion from another person, and in that the sleeping person remains dependent on the person who put him to sleep and carries out most of the suggestions and commands coming from the latter. This relationship between the hypnotized person and the hypnotist is denoted by the technical term 'rapport', which means contact or connection. The hypnotized person does not carry out suggestions or commands from other persons; however, if this is followed by a suggestion from the person who induced the hypnosis, the rapport can be transferred to other people, and in this case all commands of the latter will be carried out as long as the corresponding suggestions of the hypnotist remain in force. Suggestions or commands of the latter are designated as suggestions. Suggestions are carried out by the subject not only while the hypnotic state lasts, but some of them, under appropriate conditions, can be carried out upon awakening. Suggestions of the latter kind, on the possibility of which the therapeutic application of hypnosis is based, are called post-hypnotic suggestions, in contrast to the first, which are called hypnotic. The suggestions carried out by the hypnotized person may concern the functions of 1) motor, 2) sensory, 3) sensory (functions of analyzers), 4) some functions of the autonomic nervous system, and 5) higher nervous activity, or psyche. As a general rule, the motor functions of the hypnotized person lose their voluntary character, i.e., personal initiative is destroyed or significantly weakened; thanks to this, any position given to the limbs and body of the hypnotized person is maintained by him for a longer or shorter period. The resulting waxy flexibility (flexibilitas cerea), accompanied by hypertonia of the entire muscular system, reaches its highest, most effective expression in the so-called cataleptic bridge, when the hypnotized person can be placed with heels and back of the head on two chairs, and weight piled on the middle part of the body, which is unsupported, while the body of the sleeping person remains rigid and stretched like a board. Similarly, any suggested movements (e.g., rotation of the arms around each other, etc.) can continue for an indefinite time until a new suggestion to stop such 'automatic' acts follows. Such movements in the hypnotized person do not cause fatigue for a long time, which usually sets in quickly in the corresponding cases in a waking person. Such motor phenomena are already observed at the second degree of hypnotic sleep—at hypotaxy.—At this same stage, a certain decrease in sensitivity to touch, prick, temperature can also be caused by appropriate suggestion. The resulting anesthesia and analgesia allow for deep pricks into the skin, piercing its fold through, making incisions. Such anesthesia is most pronounced in states of somnambulism, when the suggestibility of the subject is particularly heightened.—Changes in sensory functions, i.e., the work of analyzers, are sometimes already observed at the stage of hypotaxy, however only to a small degree, whereas at the stage of somnambulism hallucinatory phenomena (images of people, animals, landscapes, entire events and scenes) can be suggested, as well as so-called negative hallucinations, when the hypnotized person, for example, shows no awareness of the presence in the room of certain objects, people, etc., regarding which he was given a corresponding suggestion.—Some changes in the functions of the autonomic nervous system, insofar as these depend on cortical processes (changes analogous to those that are sometimes the result of strong emotions—fear, ecstatic state, etc.), are sometimes already observed at the stage of hypotaxy, and as experience shows, can extend far beyond the time limits of hypnotic sleep, thus representing realized post-hypnotic suggestions. Thus, for example, changes in lactation, digestion, blood circulation (changes in vasomotor innervation), in the secretion of glands, in menstruation, etc., can be induced, and in rare cases (the possibility of which is beyond doubt) it has been possible to obtain skin erythemas, blisters resembling burns, i.e., the most severe manifestations of disturbance of vasomotor function. Biologically stable 'unconditioned reflexes' (tendon, skin, pupillary) undergo almost no noticeable disturbances. Changes in higher nervous activity, or psyche, i.e., in psychological terminology, associative processes, memory, judgments, etc., can also present various pictures that formerly seemed extremely mysterious but have now received an exhaustive explanation with the help of the basic facts and concepts of the physiology of the brain (see below). Particularly incomprehensible have always been the so-called changes in personality, when the hypnotized person, for example, seems to be transported into past periods of his life, plastically reproduces his childhood, i.e., behaves like a child, or else exhibits the behavior of a person of the opposite sex, some historical figure, etc. Despite the possibility of significant weakening of critical ability in some hypnotized persons, it is now recognized that one should not overestimate the depth of such personality transformations, because despite the sharp and sometimes extremely strange changes in the entire behavior of hypnotized persons (e.g., walking on all fours, barking like a dog, etc.), these changes have the character of a semi-conscious 'game' and leave the essential nature of the human personality untouched. In accordance with this, the question of the forensic significance of hypnosis, in the sense of the danger of abuse of influence on a person and of suggesting to him any criminal acts that he would not have committed if he had not received the corresponding suggestion, is also resolved. The question boils down to whether the hypnotized person is a passive automaton in the hands of the hypnotist or whether he retains the ability to resist suggestions that are unacceptable to him in an ethical, aesthetic, or other sense. All experiments made in this direction (even in the case of a positive result, i.e., the hypnotized person carrying out the suggested imaginary crime with the help of a cardboard dagger or an unloaded revolver) could not fully resolve this question, since there always remains the possibility that the hypnotized person was aware of the comedy being played out, i.e., knew that his act would not have any serious consequences. However, experiments conducted by various authors (Forel, Delboeuf, etc.) lead one to think that a certain decrease in resistance to suggestions unacceptable to the subject does sometimes occur, especially in cases where there is some degree of instability of moral and social habits. In any case, the role of hypnotism in criminology is rather limited, if one takes into account that during all the time of the scientific study of hypnosis, i.e., for more than half a century, not a single unquestionable case of a crime committed under the influence of hypnosis has been recorded in legal practice. Experience shows that even relatively harmless suggestions (but for some reason unpleasant to a given hypnotized person, such as actions that make him look ridiculous) are usually not carried out. A special place in the literature on hypnosis was occupied by the question of criminal actions on hypnotized subjects by hypnotists—first of all, criminal suggestions to engage in sexual relations with the latter. And here everything just said about unacceptable suggestions in general remains valid. There is no doubt that in the presence of normal psycho-social and moral inhibitions, such a suggestion will not be carried out; usually in such cases, spontaneous termination of hypnosis or a violent attack of hysterical type immediately occurs. Of course, one cannot deny that in some subjects, easily sexually excitable, the entire setting of the hypnotic session (recumbent position, sometimes slightly darkened room, passes, touches, as well as some blunting of personal activity and sense of responsibility for one's actions, especially when the hypnotized person has a firm belief in the impossibility of resisting 'hypnotic force') can result in such sudden submission that subsequently may be remembered by the subject as actual violence on the part of the person who performed the hypnosis.

However, it should not be forgotten that the setting of a session described above, in connection with erotic fantasies, can (and has on more than one occasion) provided grounds for obviously false accusations of immoral criminal actions; in view of this possibility, some authors recommend that in doubtful cases (e.g., when hypnotizing hysterics of a certain type), sleep should be induced only in the presence of witnesses. Susceptibility to hypnosis is undoubtedly not the same in different individuals, although Oscar Voigt once asserted that every healthy person, provided the experimenter is sufficiently persistent, can achieve all degrees of hypnotic sleep, including somnambulistic states. However, the statistics of the most experienced physicians who use hypnotism show that there exists a certain, though small, percentage of individuals who are not susceptible to hypnosis in any degree. Age has some influence insofar as young subjects are generally more suggestible and therefore more easily hypnotized than people of mature and especially advanced age. Opinions regarding sex differ greatly, but the traditionally recognized greater degree of susceptibility in women is not confirmed by observations. Persons suffering from pronounced psychoses and, as a result, having lost their normal relationship to external stimuli, especially to social factors, are thus found to be little susceptible to hypnosis. So-called psychoneurotics, and among them especially hysterics (suffering from attention disorders, mood instability, fears, extreme egocentrism, negativism), psychopaths, and other 'borderline' cases exhibit either an extremely high degree of suggestibility and susceptibility to hypnosis (however, in most cases, selective suggestibility, i.e., limited to the given physician) or complete insusceptibility. A completely healthy, fully adequate person in all respects typically yields to the second degree of hypnosis—hypotaxia—and only in rare cases exhibits somnambulism with subsequent amnesia. In general, the greatest importance should be attached to the circumstance of how powerful a stimulus the hypnotist is for a given individual, capable of inducing blind obedience, conscious or unconscious renunciation of personal initiative. Continuing the analysis of the hypnotic state in terms and concepts of psychology, it can be said that subjects who tend to react quickly and strongly to a stimulus defined by the word 'authority' (Platonov) are more easily hypnotized. According to the assumption of some researchers (Trotter), submissibility, and therefore suggestibility, from which hypnosis depends, is a derivative of the 'herd instinct' (submission to the leader); according to the opinion of others (MacDougall), a certain degree of submissibility is a basic property of the nervous-psychic apparatus of animals and humans; according to the opinion of still others (Freud, Ferenczi), a significant role in hypnotic submission is played by the infantile-sexual attitude, which was characteristic of the given hypnotist in relation to one of the parents and which is now repeated in relation to the hypnotist; the latter, of course, can only occur in the case where the hypnotist possesses certain traits reminiscent of the 'infantile situation,' i.e., when he appears in the role of either a strict father, whose words always evoked obedience, or in the role of a mother who sought the child's obedience by other, gentler means. Ultimately, one must come to the conclusion that just as a person's suggestibility, and in particular his susceptibility to hypnosis, depends in each given case on such variable and accidental factors that cannot be subjected to a bare statistical accounting under such headings as age, sex, profession, class, intellectual development, strength of will, etc. In particular, the last-mentioned factor (strength of will), contrary to common opinion, has no decisive significance, since, for example, subjects with little activity may nevertheless not react through blind obedience and even resist hypnosis; whereas an active and persistent person is capable of consciously submitting to the demands of an authoritative physician, especially when he voluntarily places himself under the control of a person from whom he expects help, for his own interests, for example therapeutic ones. Methods of hypnotizing, i.e., the technique of inducing sleep, include a whole range of variants, the action of which will become clearer after considering the essence of hypnosis and the mechanism of its onset. For persons who tend to fall asleep naturally very quickly, a simple reminder of sleep is sufficient, i.e., verbal suggestion with the enumeration and description of the phenomena that should follow, such as heaviness of the eyelids, closing of the eyes, fatigue, drowsiness, etc., so that these phenomena occur almost immediately and as a result some degree of hypnosis is obtained. In other cases, some auxiliary procedures that have taken a firm place in hypnotic practice are used: 1) passes introduced by Mesmer, 2) suggestion to look at a shining object, 3) fixation of the subject to be hypnotized, i.e., staring into the eyes, 4) light pressure by hand on the hypnotist's forehead and eyeballs. It is highly advisable to use the so-called fractional method of Oscar Voigt, which consists in that sleep is not induced all at once, but in several stages, interrupted by awakening and questioning the subject about his experiences during such short sessions. Here, the reports of hypnotists are taken into account and serve as a kind of starting point for further stages of hypnotizing. Based on the fact that many persons lying on the operating table exhibit signs resembling a hypnotic state even before the beginning of anesthesia, some hypnotists try to go the reverse way, i.e., give the hypnotist minimal doses of chloroform or ether along with the suggestion that a deep sleep should now occur. This method, so-called narcosis-hypnosis, is used by some German specialists (Friedländer). Bringing a person out of the hypnotic state (dehypnotization, awakening) is carried out as follows: the hypnotist is told (suggested) that upon the occurrence of a certain signal, for example, upon counting to 3-5, he will open his eyes, all drowsiness and heaviness will disappear, and he will be in the same waking state as before the session. To avoid self-suggested subsequent sensations, in persons who approach hypnosis with prejudice, it is useful to always make a special suggestion about the complete harmlessness of the hypnotic state. Sometimes awakening does not occur immediately, which is not of essential importance; in rare cases, hypnosis directly passes into natural sleep, and then rapport disappears; therefore, in such cases, usual methods for stopping natural sleep are used to awaken the subject. Left to himself, the sleeping hypnotist, after some time, returns to a normal state on his own. Some persons, mostly suffering from hysterical reactions, learn to bring themselves into a hypnotic state (autohypnosis), using the same methods as when hypnotizing another person (looking at a bright spot, enumerating signs of sleep, bringing oneself to a calm state, etc.). Theory of Hypnosis. Thanks to the works of I. P. Pavlov, it can already be considered finally established that the doctrine of the Nancy school is correct, according to which natural sleep and hypnosis are phenomena of the same order, differing only quantitatively. Natural sleep is internal inhibition, spreading more or less uniformly over all areas of the cerebral hemispheres, as well as over some underlying areas (subcortical ganglia), as a result of which not only higher nervous activity (psychic processes) but also some physiological processes in the organism are functionally weakened. To understand the hypnotic state and, in particular, the phenomena of rapport, it is necessary to distinguish not only the degree of inhibition of brain functions, but also the spread and distribution of such inhibition over the surface of the brain. Something quite analogous to rapport, i.e., the fact of an unbroken connection with certain elements of the surrounding reality, is sometimes characteristic of natural sleep; the usual example given in such cases is the deep sleep of a mother sitting by the cradle of a sick child and not reacting to the strongest irritations, such as noises on the street, voices in the house, etc., but immediately awakening at the slightest sigh or movement of the child; this also includes the sleep of a person who has fallen asleep on duty and wakes up only at irritations related to his service and is completely insensitive to others, even if intense, indifferent moments. Obviously, here the inhibition did not extend to certain areas or any separate area of the cortex, which continued to remain in a state of excitation and bears the figurative name 'guard post.' These data make understandable a special type of inhibition of the cerebral cortex, in which partial sleep occurs, bearing the name hypnosis.

This entire process can be schematically represented as follows: a special stimulus—the person of the hypnotist (understood, of course, not so much in its objective content as dynamically, with all its properties, including authority, scholarly knowledge, reputation for possessing 'great power,' etc.)—causes in the hypnotist's brain a focus of excitation (dominant—the term of Prof. Uktomsky) so strong that the rest of the cortex comes into a state of inhibition, in other words—it sleeps, with the exception of those few parts of it that perceive stimuli coming from the hypnotist. The latter (i.e., the stimuli), remaining isolated (since they do not encounter any opposing stimuli of opposite sign that could hinder their further propagation), begin to manifest their effects on various aspects of the body corresponding to the content of the suggestions: on its motor, sensory, sensory, vegetative, and psychic spheres. Thus, the muscular excitation corresponding to the suggested automatic act (e.g., rotating one arm around the other) remains isolated, since the opposite innervation (cessation of movement), which in the waking state would inevitably manifest itself by stopping such an inappropriate act, does not occur for the simple reason that all processes in the cortex are switched off (a phenomenon which in the language of psychology is called weakening of associations, absence of criticism, etc.). The mechanism presented makes understandable the facts of unhesitating fulfillment of many of the most bizarre suggestions. With the inhibition of the cerebral cortex over its entire area, with the exception of the areas serving for the perception of the word and the actions of the hypnotist, there disappears any fundamental difference between such elementary hypnotic phenomena as the inability to stop the meaningless movement of the hands, and a much more complex phenomenon, for example, a hallucinatory-like experience of one's own childhood, in the absence of any memories and considerations relating to other periods of life. Much more elementary, but essentially identical, mechanisms underlie the so-called hypnotism of animals. As early as the time of Athanasius Kirchner (17th century), it was known that a chicken could be brought into a state of catalepsy if quickly placed on a table or floor, drawing a line with chalk in front of its beak. Subsequently it was found that the chalk mark plays no role here, and what is important is the sudden change in the position of the body, unusual for this type of animal and causing a reflex state of immobility, or akinesia. Such inhibition of motor functions of the cortex is in principle no different from hypnotic catalepsy in humans, except that in the latter this mechanism develops in a more complex way—as a reaction to word-stimuli (to the suggestion of falling asleep, rest, complete submission). Numerous investigations on birds, guinea pigs, snakes, crayfish, frogs, etc., were conducted in this direction by Preyer, Verworn, Danilevsky, Mangold, and others. Hypnotism in therapy should be considered as a symptomatic means that sometimes provides significant services. In cases where the use of anesthesia is impossible in surgery, hypnotic analgesia can be used, but, of course, only after finally confirming the appropriate suggestibility of the subject, which would allow the operation to be performed under hypnosis. Observations by Platonov, Pod'yapol'sky, and others lead one to believe that this method of anesthesia could be used somewhat more frequently than has been done up to now. Favorable results have also been described in obstetric and gynecological practice. Nevertheless, H. in these areas of medicine will never have great importance, since it requires for its application extremely high degrees of suggestibility necessary to eliminate fear and anxiety in anticipation of pain, and the indicated degrees are encountered far from frequently. A special area of application of H. has always been neuropathology, and in it the department of functional diseases (neuroses, psychoneuroses), as well as cases of isolated nervous symptoms in one or another system of organs (organ neuroses); however, the diseases themselves do not yield to treatment, but for the most part only individual distressing symptoms: headaches, neuralgic pains, etc., disorders of vegetative functions, such as various sensations in the area of the heart, gastrointestinal tract, urogenital sphere, as well as disturbances of motor functions in these areas. The indicated phenomena in general fluctuate within wide limits under the influence of so-called emotional experiences (affects). The effect of H. completely coincides with the limits of changes called affective. In psychoses, the significance of H. is negligible; in very suggestible subjects suffering from cyclothymia, under especially favorable circumstances (special rapport with a particular physician), some minimal symptomatic effect is possible. Reports of successful treatment of epilepsy (Wetterstrand, Forel, Pod'yapol'sky, O. Voigt, etc.) are far from convincing due to the undiagnosed nature of a whole series of cases and the short duration of observation. The beneficial effect of hypnosis in hysterical reactions and the successful alleviation by this method of certain features of the so-called hysterical character are based entirely on rapport, understood as broadly as possible, i.e., on the subordination of the patient's personality to a given physician and on efforts to cultivate in oneself a set of new, more valuable psycho-social skills. Here it is not the method itself that is important, but the personal influence. The neurosis of obsessive states (psychasthenia) in its severe constitutional forms is relatively little amenable to treatment with H.; in milder cases, improvement can be achieved by raising the general tone of the personality, suggesting to the patient greater confidence in his abilities, calmness, self-control, etc. Hypnotic sleep by itself, without accompanying special suggestions, is a therapeutic means in the treatment of many distressing states of nervous-psychic tension and fatigue with general anxiety, insomnia, and other symptoms; some authors (O. Voigt, Schultz and the first-Wetterstrand) extended such hypnotic rest to many hours and even days. A large and important area of application of H. is represented by drug addictions. But if it must be said with full definiteness about severe and long-standing cases of morphinism, cocaineism, alcoholism that only a closed medical institution can give results, then milder cases (especially of alcoholism) often respond well to outpatient hypnotic treatment. However, it should be emphasized here that it is not so much the method itself that has an effect, but re-education under the guidance of a given psychotherapist. A somewhat special method is the mass treatment of alcoholics with hypnosis (and suggestion while awake). This contingent of patients is distinguished by great susceptibility to hypnosis. Suggestibility in a collective as a rule increases. With systematic and long-term treatment, a large percentage of alcoholics recover; however, a necessary condition is the repetition of such courses (3-4 courses of 20-30 sessions) with breaks; simultaneously with hypnosis, other methods of psychotherapy ('rational,' 'work') are applied here, since the best results are given by combined treatment. For a comparative evaluation of H. and other methods of psychotherapy—see Psychotherapy.