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The Power of Suggestion and the Placebo Effect
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Hypnosis is a means by which a person may be led to accept suggestions which may lead to some desirable outcome, whether physical or psychological. We sometimes say that it is a method of offering suggestions to the unconscious mind of a person requiring treatment or assistance. Unfortunately, the term unconscious mind carries with it a whole baggage of philosophical and psychological assumptions most of which do not concern us outside of the sphere of theoretical speculation. Suffice to say that the general public has some notion as to what is meant by the term â‚Źunconscious mindâ‚Ź and are happy to interpret this on their own terms. Suggestion is the essence of hypnosis. The most popular, and obstructive, misconception surrounding hypnosis is that the most important element is something called a trance, which is supposedly some magical, metaphysical state somewhat akin to general anesthesia! There cannot be a hypnotherapist in the land who hasn't been told at some time or another that he or she has failed to put the client under. You didn't put me under; I could hear everything you said, I can remember everything " one hears this said time and time again, even when one has taken some pains to explain that the purpose of hypnotic induction is not to render the subject unconscious or to put them to sleep. By trance we simply mean a shift in the quality of consciousness, from fully alert, rational consciousness to a quiet, passive condition in which the rational / critical faculties are lulled into a quiescent state. The trance state is induced by suggestion and the purpose of it is to impart suggestion. As said, suggestion is the essence of hypnosis. Suggestion and the Placebo Effect. Suggestibility is a highly complex and elusive quality. It is so intimately bound up with our interpretation of the world in which we live that it tends to be overlooked or taken for granted. Moreover, it tends to operate at a level somewhat below our normal levels of critical and rational awareness. Consequently, we are often far more suggestible than we think we are and are usually quite unaware of the extent to which suggestions of one sort or another influence our everyday lives. One way in which suggestibility may be measured is through the placebo effect. In a recent study from the University of Hull, Kirsch et al conducted a meta-analysis on data submitted to the United States FDA and arrived at the conclusion that there was virtually no statistically significant difference between the effectiveness of SSRI antidepressants and placebos except at the deepest and most severe level of depression. These findings were misinterpreted by sections of the mass media as evidence of the ineffectiveness of SSRI antidepressants. In my opinion, however, what these findings show is the effectiveness of suggestion, both direct and indirect, in the context of the administration of placebos. Suggestion clearly works. However, one curious feature of much of the scientific literature on the placebo effect is a certain reluctance to attribute its effectiveness to the power of suggestion.
One problem with most definitions [of the placebo effect] is their implication that the placebo effect is non-specific. Kirsch, however, pointed out that, whereas the ingredients of a placebo preparation may be totally non-specific, the effects of placebos can be very specific. The specificity of the placebo effect depends on the information given to the patient (ie, the expectation). For example, placebos can have opposite effects on heart rate or on blood pressure depending on whether they are given as tranquillizers or as stimulants. Thus, precise definition of placebo effectâ‚Ź is difficult. Still to this day, extensive examination leaves scientists and philosophers to conclude that the placebo concept as presently used cannot be defined in a logically consistent way and leads to contradictions. Confliction explanations " expectation, faith, classic conditioning, anxiety relief, symbolic processes, patient-doctor relationship, self-perceptions " vie for acceptance. The placebo effect has attributes of a neo-mesmeric energy. The contradictions referred to above disappear when it is realized that suggestion does not always take the form of an imperative proposition. Suggestion can be indirect. For example, effective suggestion can depend upon the associations related to the actual appearance of a placebo. If a doctor were to attempt to administer a placebo in the form of a jelly baby or a sausage roll the patient's suspicions would be alerted and the suggestions as to the effectiveness of the placebo would be undermined. On the other hand, the appearance of a shiny white pill would reinforce the suggestion of the efficacy of the placebo. To ignore the role of suggestion in placebo is to ignore the elephant in the room. Hypnosis and suggestion. The effect of hypnosis and hypnotherapy is similar to the placebo effect in that the efficacy of both is dependent upon direct and indirect suggestion. There are, however, two very significant differences. The effective administration of a placebo requires an element of deception. Hypnosis and hypnotherapy do not. The recipient of a placebo believes that he or she is taking some sort of effective medicine rather than, say, a bread-pill. But the suggestions administered in hypnotherapy are fully understood by both the therapist and the patient. The person undergoing hypnotherapy for smoking cessation will be told that he or she no longer smokes. The person having hypnotherapy for weight loss will be told that they will avoid certain foods in future. This is not to deny that both direct and indirect suggestion could be used to deceive a patient but I cannot think of a therapeutic context in which such deception would be essential to the improvement and well-being of the patient concerned.
The other significant difference is that, in hypnotherapy, suggestions are used to bring about a change in the quality of consciousness of the person undergoing treatment. What I am referring to here is the hypnotic trance, the phenomenon which causes more confusion and misunderstanding of hypnosis and hypnotherapy than almost any other. Therapists, and even leading experts in the field, disagree as to the nature and significance of trance. My own view is that the term trance can be applied to any healthy (i.e., non psychotic, non drug-induced etc) state of consciousness other than fully alert, wakeful consciousness.
Daydreaming, drowsiness " states in which one's state of consciousness is lower than it is during normal waking consciousness " all these are states in which the individual is rendered far more susceptible to suggestion than during fully alert, waking consciousness. Generally speaking, the deeper the trance, the greater the susceptibility to suggestion, though there are exceptions to this rule. Scientific interest in suggestion and suggestibility goes back many years. In 1959, Weitzenhoffer and Hilgard devised the famous Stanford Scale of Suggestibility, a series of suggestibility tests to measure and quantify the receptivity of a given subject. But scientific research into suggestibility has never really gone beyond this and it is not hard to understand why. Suggestibility is what makes us truly human. It is the reason why we are moved by sunsets and mountains, why we are awed by Beethoven and moved to tears by Puccini. We could define great art as that which appeals to our innate suggestibility.
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