THE HYPNOTIST, dangling a swinging pocket watch before the subject’s eyes, slowly intones: “You’re getting sleepy … You’re getting sleepy …” The subject’s head abruptly slumps downward. He is in a deep, sleeplike trance, oblivious to everything but the hypnotist’s soft voice. Powerless to resist the hypnotist’s influence, the subject obeys every command, including an instruction to act out an upsetting childhood scene. On “awakening” from the trance half an hour later, he has no memory of what happened.

In fact, this familiar description, captured in countless movies, embodies a host of misconceptions. Few if any modern hypnotists use the celebrated swinging watch introduced by Scottish eye surgeon James Braid in the mid-19th century. Although most hypnotists attempt to calm subjects during the “induction,” such relaxation is not necessary; people have even been hypnotized while pedaling vigorously on a stationary bicycle. Electroencephalographic (EEG) studies confirm that during hypnosis subjects are not in a sleeplike state but are awake—though sometimes a bit drowsy. Moreover, they can freely resist the hypnotist’s suggestions and are far from mindless automatons. Finally, research by psychologist Nicholas Spanos of Carleton University in Ontario shows that a failure to remember what transpired during the hypnosis session, or so-called posthypnotic amnesia, is not an intrinsic element of hypnosis and typically occurs only when subjects are told to expect it to occur.

The Consciousness Question
The iconic scene we described at the article’s outset also raises a deeper question: Is hypnosis a distinct state of consciousness? Most people seem to think so; in a recent unpublished survey, psychologist Joseph Green of Ohio State University at Lima and his colleagues found that 77 percent of college students agreed that hypnosis is a distinctly altered state of consciousness. This issue is of more than academic importance. If hypnosis differs in kind rather than in degree from ordinary consciousness, it could imply that hypnotized people can take actions that are impossible to perform in the waking state. It could also lend credibility to claims that hypnosis is a unique means of reducing pain or of effecting dramatic psychological and medical cures.

Despite the ubiquitous Hollywood depiction of hypnosis as a trance, investigators have had an extremely difficult time pinpointing any specific “markers”—indicators—of hypnosis that distinguish it from other states. The legendary American psychiatrist Milton Erickson claimed that hypnosis is marked by several unique features, including posthypnotic amnesia and “literalism”—a tendency to take questions literally, such as responding “Yes” to the question “Can you tell me what time it is?” We have already seen that posthypnotic amnesia is not an inherent accompaniment of hypnosis, so Erickson was wrong on that score. Moreover, research by Green, Binghamton University psychologist Steven Jay Lynn and their colleagues shows that most highly hypnotizable subjects do not display literalism while hypnotized; moreover, participants asked to simulate hypnosis demonstrate even higher rates of literalism than highly hypnotizable subjects do.

Other experts, such as the late University of Pennsylvania psychiatrist Martin Orne, have argued that only hypnotized participants experience “trance logic”—the ability to entertain two mutually inconsistent ideas at the same time. For example, a hypnotist might suggest to a subject that he is deaf and then ask him, “Can you hear me now?” He may respond “No,” thereby manifesting trance logic. Nevertheless, research by the late Theodore X. Barber, then at the Medfield Foundation, and his colleagues showed that participants asked to simulate hypnosis displayed trance logic just as often as hypnotized people did, suggesting that trance logic is largely a function of people’s expectations rather than an intrinsic component of the hypnotic state itself.

Brain Changes
Still other investigators have sought to uncover distinct physiological markers of hypnosis. Under hypnosis, EEGs, especially those of highly suggestible participants, sometimes display a shift toward heightened activity in the theta band (four to seven cycles per second). In addition, hypnotized participants frequently exhibit increased activity in their brain’s anterior cingulate cortex (ACC).

Yet neither finding is surprising. Theta activity is typically associated with states of quiet concentration, which frequently accompany hypnosis. The ACC is linked to the perception of contradictions, which many hypnotized participants experience as they imagine things—such as childhood experiences in the present—that seem to conflict with reality. Further, psychologists have reported similar brain changes among awake subjects. For example, the ACC becomes activated during the famous Stroop task, which requires subjects to name the colors of ink (such as “green”) in which competing color words (such as “blue”) are printed. Thus, these brain changes are not unique to hypnosis.

Fueling the perception of hypnosis as a distinct trancelike state is the widespread assumption that it leads to marked increases in suggestibility, even complete compliance to the therapist’s suggestions. Nowhere is this zombielike stereotype portrayed more vividly than in stage hypnosis shows, in which people are seemingly induced to bark like dogs, sing karaoke and engage in other comical behaviors in full view of hundreds of amused audience members.

Yet research shows that hypnosis exerts only a minor impact on suggestibility. On standardized scales of hypnotic suggestibility, which ask participants to comply with a dozen suggestions (that one’s arm is raising on its own power, for example), the increase in suggestibility following a hypnotic induction is typically on the order of 10 percent or less. Moreover, research demonstrates that a formal hypnotic induction is not needed to produce many of the seemingly spectacular effects of hypnosis, such as reduction of extreme pain or various physical feats, popular in stage hypnosis acts, such as suspending a participant horizontally between the backs of two chairs. One can generate most, if not all, of these effects merely by providing highly suggestible people with sufficient incentives to perform them. Stage hypnotists are well aware of this little secret. Before beginning their shtick, they prescreen audience members for high suggestibility by providing those people with a string of suggestions. They then handpick their participants from among the minority who comply.

We agree with Lynn and psychologist Irving Kirsch of the University of Hull in England, who wrote in 1995 that “having failed to find reliable markers of trance after 50 years of careful research, most researchers have concluded that this hypothesis [that hypnosis is a unique state of consciousness] has outlived its usefulness.” Increasingly, evidence is suggesting that the effects of hypnosis result largely from people’s expectations about what hypnosis entails rather than from the hypnotic state itself. Still, it is always possible that future studies could overturn or at least qualify this conclusion. In particular, research on potential physiological markers of hypnosis may elucidate how hypnosis differs from other states of consciousness. Although hypnosis poses fascinating mysteries that will keep scientists busy for decades, it seems clear that it has far more in common with everyday wakefulness than with the watch-induced trance of Hollywood crime thrillers.

Note: This article was originally printed with the title, "Altered States".