On one, I want you to do one thing: Look up. On two, do two things: Slowly close your eyes and take a deep breath. On three, do three things: Breathe out, relax your eyes, and let your body float. Imagine you are floating in a bath, a lake, a hot tub, or just floating in space. Each breath is getting deeper and easier.
The patient is 80 years old. She is lying under the bright lights of an operating room at Harvard University’s Beth Israel Deaconess Medical Center, where radiologist Elvira Lang is about to thread a catheter through her arteries. The tiny tube will work its way to one of the woman’s kidneys, where it will block the organ’s blood supply. A surgeon is scheduled to remove the kidney the next day. Embolizing the kidney will help keep the operation simple, safe, and tidy. But the woman is running a fever, and her kidney may be infected. Because she ate earlier in the day, she can’t be given a sedative. What should have been a routine procedure has become an ordeal.
“This is your safe and pleasant place to be,” one of Lang’s associates reads from a laminated card. “You can use it in a sense to play a trick on the doctors. Your body has to be here, but you don’t.”
Lang is one of a growing number of hospital physicians who use hypnosis in addition to anesthesia. With David Spiegel, a professor of psychiatry at Stanford University School of Medicine, she has conducted extensive studies of hypnosis in the operating room, often with dramatic results. By adding hypnosis she can make an operation shorter, less painful, and less dependent on drugs. The hardest part of the procedure is getting other doctors to accept it.
Over the years a number of rigorously controlled studies have proved that hypnosis reduces pain, controls blood pressure, and can even make warts go away. But because very few studies have attempted to find out how it works, most scientists are skeptical of its power. Critics suggest hypnosis is no different from the placebo effect. They both use the power of suggestion to get the mind to control the body; neither is a substitute for medicine.
That skepticism has driven Spiegel and other researchers to take a hard look at what happens in the brain during hypnosis. Trance, they have found, opens a window onto the nature of the imagination. Through it we are beginning to glimpse how the mind distinguishes daydreams from reality.
Spiegel is a second-generation hypnotist. His father, Herbert Spiegel, is a psychiatrist who first used hypnosis as a battlefield surgeon in World War II. In 1943 he even used the technique on himself when he was struck by a mortar from a German tank in Mateur, Tunisia. A steel shell fragment protruded from his ankle, but he managed to tune out the pain.
Hypnotized subjects could resist intense pain for a full minute longer than those who weren’t hypnotized.
Soon after returning home, the elder Spiegel was hired as a professor of combat psychiatry at the School of Military Psychiatry at Mason General Hospital in Brentwood, New York. There he used hypnosis to treat hundreds of returning veterans, becoming ever more convinced of its effectiveness. At the same time, the first clinical studies of hypnosis began to appear. In 1961 psychiatrist Ralph August published a study of 850 women who gave birth under hypnosis. Only 4 percent—34 women—required painkillers. Other studies found that hypnotized subjects could resist intense pain for a full minute longer than those who weren’t hypnotized, and for 30 seconds longer than those who had been given a placebo painkiller.
By the 1960s Herbert Spiegel was teaching clinical hypnosis at Columbia University, and his son was among his students. David Spiegel went on to attend medical school at Harvard and to specialize in psychiatry and clinical hypnosis as his father had. In 1978 the two Spiegels coauthored what became the standard textbook in the field: Trance and Treatment: Clinical Uses of Hypnosis.
Now 62, David Spiegel is tall and a bit disheveled, with his father’s oval face. He listens with the stoic patience of a man who has faced many disbelievers. “Hypnosis has been controversial since the beginning,” he says. “The thing is, it just won’t go away. There’s so much about the phenomenon that’s interesting.” Among researchers in the field, Spiegel says, there are two schools of thought and a growing chasm between them. One school claims that hypnosis fundamentally alters a subject’s state of mind; the other believes that there is nothing radical about it, that all the strange experiences and odd behaviors typically associated with hypnosis can be observed in people who are not actually in a hypnotic trance. Spiegel belongs to the first school, and over the years he has had a running debate with two scientists on the other side: Irving Kirsch, a psychologist at the University of Hull in England, and Stephen Kosslyn, a professor of psychology at Harvard.
Kirsch doesn’t deny that hypnosis can be effective. When he was still practicing clinically, he often used the technique. “With hypnosis you do put people in altered states,” he says. “But you don’t need a trance to do it.” He likes to illustrate the point with a talisman of the hypnotic trade: a pocket watch hanging on a chain. Put your elbow on a table, he says, hold the chain between your thumb and forefinger, and let the weight swing freely. Now, keeping your hand as steady as possible, imagine that the pendulum is moving back and forth parallel to your chest. “Just focus on it moving in that direction, side to side,” he says. “Ignore everything else and imagine it going side to side at its own rhythm.” Once it’s swaying that way (and it inevitably will), imagine it swinging another way—clockwise, say, or toward you and away—just to prove to yourself that it’s not a coincidence. Once again, the weight will obey your mind. This little trick works on even the most skeptical and unhypnotizable of people. You don’t have to enter a trance for your subconscious and your body—in this case, the tiny muscles in your fingers—to respond to suggestion. “I could have hypnotized you and done the same thing, but it wouldn’t have been a result of the hypnosis,” Kirsch says. “It would have been a result of your focusing on moving it in a particular direction.”
Spiegel disagrees. He admits that suggestion alone is a powerful tool but believes that hypnosis magnifies its effects. One of his best-known studies found that when subjects were hypnotized and given suggestions, their brain-wave patterns changed. In another of Spiegel’s studies, people under hypnosis were told their forearms were numb, then given light electrical shocks to the wrists. They didn’t flinch or respond in any way, and their brain waves resembled those of people who experienced a much weaker shock.
To Kirsch, this still wasn’t enough to prove the power of trance, but Stephen Kosslyn was beginning to wonder. Kosslyn is an exceedingly polite man with a gray beard and perpetually raised eyebrows. The hypnosis literature is rife with examples of subjects aping what they believe is hypnotic behavior, he says. This “demand effect” is exactly what makes placebos so effective. As for the brain-wave study, other events in the lab—such as interaction with the investigators—could have caused the shift in the subjects’ state of mind. “Is it just playacting?” Kosslyn wondered when he first saw Spiegel’s data. “Or is there something really going on in the brain?”
To find out, Spiegel and Kosslyn collaborated on a study that focused on a part of the brain that is well understood: the fusiform circuit. Part of the occipital lobe, the circuit has been found to process the perception of color. Neuroscientists zeroed in on it by placing subjects in a positron-emission tomography (PET) scanner to measure blood flow in the brain while having them look at cards with color rectangles. Spiegel and Kosslyn wanted to see if subjects could set off the same circuit by visualizing color while they were under hypnosis.
The first step was to find the right study subjects. Only a small fraction of the population—known as highs in hypnosis circles—can enter a deep trance, just as only a few people cannot be hypnotized at all. The rest of us fall on a spectrum in between. Spiegel and Kosslyn selected eight people from a pool of 125 possible subjects; then Kosslyn’s team ran the experiment at Massachusetts General Hospital in Boston. As in previous studies, subjects were put inside a PET scanner and shown a slide with color rectangles, and their brain activity was mapped. Then they were shown a black-and-white slide and told to imagine its having a color. Both tasks were repeated while under hypnosis.