A centuries-old technique that calls up images of a wild-eyed Svengali dangling a gold watch and whispering "Sleep . . . sleep," hypnosis is enjoying a renaissance among those seeking a non-drug treatment for problems ranging from smoking to the pain and nausea of cancer patients undergoing chemotherapy.
Contemporary hypnotists -- likely to be physicians, psychologists or other clinicians -- work with the patient to achieve a restful state that can be fruitful for resisting pain, changing habits or confronting painful memories.
"Very currently, there is some strong interest in hypnosis," says William F. Hoffman Jr., executive vice president of the American Society of Clinical Hypnosis in the Chicago suburb of Des Plaines, Ill. The society's 3,500 members include doctors, psychologists, podiatrists, dentists, social workers and nursing specialists. Mr. Hoffman and others report that the centuries-old technique is the subject of renewed interest among health professionals because of the current emphases on non-drug remedies, patient self-care and the relationship between mind and body.
Doctors and psychologists say only those formally trained in medicine and psychology should be able to use the technique, a point disputed by so-called "hypnotherapists" -- hypnotists for hire who lack academic credentials.
Hypnosis is used to help treat a host of medical problems. Its uses include modifying behavior for those who wish to stop smoking or want to end binge eating; controlling the pain of surgery or dental work for subjects who cannot or choose not to use pain-killing drugs; controlling pain and nausea for cancer patients on chemotherapy; helping people come to terms with depression, anxiety and phobias; dealing -- in conjunction with therapy -- with post-traumatic stress disorder; and treating certain autonomic disorders, such as heart dysrhythmia.
There is nothing magical about hypnosis, according to experts, and although the hypnotized are usually relaxed, it is a state that has little to do with drowsiness.
"When we concentrate, in order to facilitate concentration, we usually go into a spontaneous trance," says Dr. Herbert Spiegel, a faculty member at the College of Physicians and Surgeons at Columbia University in New York and an internationally recognized expert on hypnosis. "When you go to a play or movie and you like it so much you lose awareness of the world around you -- that's spontaneous hypnosis. It's an everyday experience."
Dr. Spiegel says that hypnosis is "a way of mobilizing your inner energy and becoming more aware of your own motivation and inner resources."
In the stereotypical model, the hypnotist puts the subject into a trance. In the modern medical model, the therapist helps the patient achieve a relaxed state of "non-critical suggestibility," says Dr. Fred Serafini, a Hartford physician who is president of the New England Association of Clinical Hypnosis. "All hypnosis is self-hypnosis," says Dr. Serafini. He and others usually teach patients how to achieve this state on their own.
As for technique, most therapists seem to use relaxation techniques and gentle conversation, although the swinging watch and spinning spiral (called Archimedes' spiral) are not unheard of as ways to "induce" hypnosis.
"I prefer not to do that because of the theatrical associations," says Dominic R. Marino, a psychologist from East Hartford, Conn.
Most of those interviewed for this story seemed to prefer a verbal technique. In a recent session, Mr. Marino asked a subject familiar with meditation techniques to close his eyes and relax different parts of the body step-by-step and to methodically calm down by monitoring each breath. A simple behavior-modification session at Mr. Marino's office takes from 20 to 30 minutes. (Mr. Marino makes an audio tape of the session that patients can replay later.) Other hypnotists will lead patients on pleasant, relaxing daydreams or ask them to focus their eyes on an object.
There is some disagreement about whether everyone can be hypnotized. There are some ways to test for susceptibility. Eye mobility -- the ability to look up while closing the eyes, for example -- is a "biological marker" of susceptibility, Dr. Spiegel says. Most seem to agree that almost anyone can be hypnotized if the motivation and interest are strong.
Dr. Louis Dubin, a dentist and psychologist at Temple University in Philadelphia, says three factors are important: motivation, a good relationship between the patient and the clinician; and dispelling of myths about hypnosis. He says that patients fear they will become "zombies" under hypnosis.
"They're fully aware of what's going on at all times," Dr. Dubin says. "They do not do antisocial behavior." In short, hypnotized folks won't go on a killing spree or take their clothes off unless these are things they would ordinarily do.
If pain control is the goal, therapists ask hypnotized patients to let certain parts of their body go numb. Suggestions ("cigarettes are deadly") might be given to those wishing to break habits. But for more complex psychological problems, the "trance" is a state in which therapy -- which might include remembering events and feelings -- takes place. Dr. Arturo Morales, a West Hartford, Conn., psychiatrist, notes that those who suffer from multiple personalities are adept at hypnosis -- their amnesia or flashbacks or multiple personalities are self-hypnotic phenomena. Dr. Morales says he can help these patients regain disturbing memories of child abuse or other traumatic events so they can develop a story about the memory or get angry about it.