Hypnosis

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Professor Charcot was well-known for showing, during his lessons at the Salpêtrière hospital, "hysterical" woman patients – here, his favorite patient, "Blanche" (Marie) Wittman, supported by Joseph Babiński. The neurologist endorsed hypnotism for the treatment of hysteria.

Hypnosis is a natural psychological process in which critical thinking faculties of the mind are bypassed and a type of selective thinking and perception is established. Although some individuals experience an increase in suggestibility and subjective feelings of an altered state of consciousness, this is not true for everyone. In fact, some supposed hypnotic indicators and subjective changes can be achieved without relaxation or a lengthy induction by means of simple suggestion or waking hypnosis, a fact that increases the controversy and misunderstandings surrounding hypnosis and the hypnotic state.

Etymology

The words hypnosis and hypnotism both derive from the term neuro-hypnotism (nervous sleep), all of which were coined by Étienne Félix d'Henin de Cuvillers in the 1820s. The term hypnosis is derived from the ancient Greek ὑπνος hypnos, "sleep", and the suffix -ωσις -osis, or from ὑπνόω hypnoō, "put to sleep" (stem of aorist hypnōs-) and the suffix -is. These words were popularized in English by the Scottish surgeon James Braid (to whom they are sometimes wrongly attributed) around 1841. Braid based his practice on that developed by Franz Mesmer and his followers (which was called "Mesmerism" or "animal magnetism"), but differed in his theory as to how the procedure worked.

Definition

A person in a state of hypnosis has focused attention, and has increased suggestibility.

The hypnotized individual appears to heed only the communications of the hypnotist and typically responds in an uncritical, automatic fashion while ignoring all aspects of the environment other than those pointed out by the hypnotist. In a hypnotic state an individual tends to see, feel, smell, and otherwise perceive in accordance with the hypnotist's suggestions, even though these suggestions may be in apparent contradiction to the actual stimuli present in the environment. The effects of hypnosis are not limited to sensory change; even the subject's memory and awareness of self may be altered by suggestion, and the effects of the suggestions may be extended (post-hypnotically) into the subject's subsequent waking activity.

A definition of hypnosis, derived from academic psychology, was provided in 2005, when the Society for Psychological Hypnosis, Division 30 of the American Psychological Association (APA), published the following formal definition:

Hypnosis typically involves an introduction to the procedure during which the subject is told that suggestions for imaginative experiences will be presented. The hypnotic induction is an extended initial suggestion for using one's imagination, and may contain further elaborations of the introduction. A hypnotic procedure is used to encourage and evaluate responses to suggestions. When using hypnosis, one person (the subject) is guided by another (the hypnotist) to respond to suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought or behavior. Persons can also learn self-hypnosis, which is the act of administering hypnotic procedures on one's own. If the subject responds to hypnotic suggestions, it is generally inferred that hypnosis has been induced. Many believe that hypnotic responses and experiences are characteristic of a hypnotic state. While some think that it is not necessary to use the word "hypnosis" as part of the hypnotic induction, others view it as essential.

History

Hypnosis has a long history from ancient times to the present. People have been entering into hypnotic-type trances for thousands of years. In many cultures and religions, it was regarded as a form of meditation. The earliest record of a description of a hypnotic state can be found in the writings of Avicenna, a Persian physician who wrote about "trance" in 1027. Its current uses have been scientifically studied by a host of both practitioners and researchers.

Sleep temples

Hypnotism as a tool for health seems to have originated with the Hindus of India who often took their sick to sleep temples to be cured by hypnotic suggestion. This technique was also used in Egypt and Greece. The Law of Manu, which was the ancient Sanskrit book on the Science of the Indian people, categorized different states of hypnosis discerning different levels of gradation: the "Sleep-Waking" state, the "Dream-Sleep" state, and the "Ecstasy-Sleep" state. Hypnotic-like inductions were used to place the individual in a sleep-like state, although it is now accepted that hypnosis is different from sleep.

Magnetism

Paracelsus (1493-1541) was the first physician to utilize magnets in his work. Many people claimed to be healed after he passed magnets (or lodestones) over their body. Around 1771, a Viennese Jesuit named Maximilian Hell (1720-1792) was using magnets to heal by applying steel plates to the naked body. One of Father Hell's students was a young medical doctor from Vienna named Franz Anton Mesmer (1734-1815).

Western scientists first became involved in hypnosis around 1770, when Mesmer started investigating an effect he called "animal magnetism" or "mesmerism." Mesmer found that, after opening a patient's vein and letting the patient bleed for a while, by passing magnets over the wound it would stop bleeding. Mesmer held the opinion that hypnosis was a sort of mystical force that flows from the hypnotist to the person being hypnotized, but his theory was dismissed by critics who asserted that there is no magical element to hypnotism.

In the early nineteenth century, an Indo-Portuguese priest, Abbé Faria (1756-1819), revived public attention to animal magnetism by introducing oriental hypnosis to Paris. Unlike Mesmer, Faria claimed that it 'generated from within the mind’ by the power of expectancy and cooperation of the patient.

Early medical research

The evolution of Mesmer's ideas and practices led James Braid (1795-1860) to coin the term and develop the procedure known as hypnosis in 1842. Popularly titled the "Father of Modern Hypnotism," Braid rejected Mesmer's idea of magnetism inducing hypnosis, and ascribed the creation of the 'mesmeric trance' to a physiological process—the prolonged attention on a bright moving object or similar object of fixation. He postulated that "protracted ocular fixation" fatigued certain parts of the brain and caused the trance, "nervous sleep." In 1843, he published his Neurypnology: or the Rationale of Nervous Sleep, calling the procedure "neuro-hypnosis." Believing sleep was involved, he used terms such as "hypnosis" and "hypnotist" for the first time. Later, realizing that "hypnosis" was not sleep, he later tried to change the name to monoideaism but it was too late as the term "hypnosis" had stuck.

A report in 1842 described an amputation performed on a hypnotized participant without pain. The report was widely dismissed and there was strong resistance in the medical profession to hypnotism, but other successful reports followed. For example, James Esdaile (1805-1859) reported on 345 major operations performed using mesmeric sleep as the sole anesthetic in British India. However, the development of chemical anesthetics soon saw the replacement of hypnotism in this role.

The deaths of Braid and Esdaile curbed interest in hypnotism. Experimentation was revived into the 1880s, mainly in continental Europe where new translations of Braid's work were circulated.

Early psychological studies

For several decades Braid's work became more influential abroad than in his own country. The French neurologist Jean-Martin Charcot (1825-1893) endorsed hypnotism for the treatment of hysteria. La méthode numérique ("The numerical method") led to a number of systematic experimental examinations of hypnosis in France, Germany, and Switzerland. The process of post-hypnotic suggestion was first described in this period. Extraordinary improvements in sensory acuity and memory were reported under hypnosis.

France became the focal point for the study of Braid's ideas after the eminent neurologist Étienne Eugène Azam translated Braid's last manuscript (On Hypnotism, 1860) into French and presented Braid's research to the French Academy of Sciences. At the request of Azam, Paul Broca, and others, the French Academy of Science, which had investigated Mesmerism in 1784, examined Braid's writings shortly after his death. Azam's enthusiasm for hypnotism influenced Ambroise-Auguste Liébeault, a country doctor. Hippolyte Bernheim discovered Liébeault's enormously popular group hypnotherapy clinic in Nancy (known as the "Nancy School"), and subsequently became an influential hypnotist.

The study of hypnotism subsequently revolved around the fierce debate between Bernheim and Jean-Martin Charcot. Charcot argued that hypnotism was an abnormal state of nervous functioning found only in certain hysterical women. He claimed that it manifested in a series of physical reactions that could be divided into distinct stages. Bernheim argued that anyone could be hypnotized, that it was an extension of normal psychological functioning, and that its effects were due to suggestion.

Pierre Janet (1859–1947), Charcot's student, was appointed director of the psychological laboratory at the Salpêtrière in 1889, later he became a lecturer in psychology at the Sorbonne and then chair of experimental and comparative psychology at the Collège de France. Janet reconciled elements of Charcot's views with those of Bernheim and his followers, developing his own sophisticated hypnotic psychotherapy based upon the concept of psychological dissociation. Janet described dissociation as the splitting of mental aspects under hypnosis (or hysteria) so skills and memory could be made inaccessible or recovered. His work provoked interest in the subconscious and laid the framework for reintegration therapy for dissociated personalities.

Émile Coué (1857–1926) practiced the "hypnosis" of Liébeault and Bernheim's Nancy School. However, he abandoned their approach altogether and developed a new approach (c.1901) based on Braid-style direct hypnotic suggestion and ego-strengthening. Coué's method did not emphasize "sleep" or deep relaxation, but instead focused upon autosuggestion involving a specific series of suggestion tests. Coué's method became a renowned self-help and psychotherapy technique, which contrasted with psychoanalysis and prefigured self-hypnosis and cognitive therapy.

Sigmund Freud (1856–1939), the founder of psychoanalysis, studied hypnotism at the Paris School and briefly visited the Nancy School. At first, Freud was an enthusiastic proponent of hypnotherapy. He "initially hypnotised patients and pressed on their foreheads to help them concentrate while attempting to recover (supposedly) repressed memories", and he soon began to emphasize hypnotic regression and ab reaction (catharsis) as therapeutic methods. He published an influential series of case studies with his colleague Joseph Breuer entitled Studies on Hysteria (1895), which became the founding text of the subsequent tradition known as "hypno-analysis" or "regression hypnotherapy."

However, Freud gradually abandoned hypnotism in favor of psychoanalysis, emphasizing free association and interpretation of the unconscious. Struggling with the great expense of time that psychoanalysis required, Freud later suggested that it might be combined with hypnotic suggestion to hasten the outcome of treatment, but that this would probably weaken the outcome: "It is very probable, too, that the application of our therapy to numbers will compel us to alloy the pure gold of analysis plentifully with the copper of direct [hypnotic] suggestion."

Theories of Hypnosis

Some theories of hypnosis attempt to describe hypnotic phenomena in terms of brain activity while others concentrate more on the phenomenological experience. There is a fundamental distinction between "state" and "non-state" theories of hypnosis. State theorists believe that an altered state of consciousness is a core part of hypnosis, whereas non-state theorists believe that more mundane psychological processes such as focused attention and expectation are sufficient to explain hypnotic phenomena. The precise definition of what constitutes an altered state of consciousness is a matter of some debate.

The American Psychological Association remains neutral in the argument between 'state' and 'non-state' theorists. However, this controversy may be decreasing as modern brain-imaging techniques offer hope for an increased understanding of the nature of hypnosis, and as the value of both perspectives is increasingly recognized.

Alpha- and Theta-state theories

Through data collected by Electroencephalography (EEGs), four major brain-wave patterns—frequency of electrical impulses firing from the brain—have been identified. The Beta state (alert/working) is defined as 14–32 cycles per second (CPS), the Alpha state (relaxed/reflecting) as the 7–14 CPS, the Theta state (drowsy) as 4–7 CPS, and the Delta state (sleeping/dreaming/deep sleep) as approximately 3–5 CPS.

One physiological definition of hypnosis states that the brainwave level necessary to work on issues such as stopping smoking, weight management, reduction of phobias, sports improvement, etc., is the alpha state. The alpha state is commonly associated with closing one's eyes, relaxation, and daydreaming.

Another physiological definition states that the theta state is required for therapeutic change. The theta state is associated with hypnosis for surgery, hypnoanesthesia (the use of hypnosis to numb sensation of pain), and hypnoanalgesia (the use of hypnosis to decrease sensitivity to pain), which occur more readily in the theta and delta states. Anesthetics, sedatives and hypnotics disrupt neuronal synchrony, thought to underlie theta waves, in both humans and animals, as well as in simple neuronal circuits (see: http://www.stanford.edu/group/maciverlab/Theta.html). It should be noted that hypnoanalgesia of the skin is a common test for somnambulism. Arm and body catalepsy are one of a few tests done to determine readiness for these surgical applications. ^{[citation needed]}

However, it is important to reflect upon the fact that both arm and body catalepsy can be induced in normal non-hypnotized subjects. Indeed, arm catalepsy is a standard stage-hypnotist's test of susceptibility. Moreover, normal, non-hypnotized subjects can be found in any of these states of cortical arousal without also displaying any of the behavior, traits or the enhanced suggestibility associated with being hypnotized. Reading, watching movies, and meditating may be also forms of hypnosis.^{[citation needed]}

Social constructionism / Role-playing theory

This theory suggests that individuals are playing a role and allowing the hypnotist to create a reality for them. This relationship depends on how much rapport has been established between the hypnotist and the subject (see Hawthorne effect, Pygmalion effect, and the Placebo effect).

Generally, during the hypnotic process people become more receptive to suggestion, causing changes in the way they feel, think, and behave. Some psychologists such as Robert Baker claim that what we call hypnosis is actually a form of learned social behavior, a complex hybrid of social compliance, relaxation, and suggestibility that can account for many esoteric behavioral manifestations. Psychologists, such as Sarbin and Spanos, have suggested that strong social expectations are played out by subjects, who believe they are in a state of hypnosis, behaving in a way that they imagine a hypnotized person would behave.

Nicholas Spanos states “hypnotic procedures influence behavior indirectly by altering subjects’ motivations, expectations and interpretations” and hypothesized that the behaviors associated with hypnosis are acted out knowingly by the person. He alleged that there are two reasons that cause people to misconstrue their state of consciousness as hypnosis. One of the reasons being that people believe that their behavior is caused by an external source instead of the self. The second is related to the way hypnotic rituals are performed. The hypnotist says certain things which are first interpreted as voluntary and then later on in the procedure as involuntary. An example being “relax the muscles in your legs” and then later “your legs feel limp and heavy.”

Spanos’ findings were not to prove that the hypnotic state did not exist at all but to prove that the behaviors exhibited by those individuals are due to “highly motivated” individuals.

Much experimental work has demonstrated that the experiences of hypnotized subjects can be dramatically shaped by expectations and social nuances. This view is often misunderstood: it does not discount the claim that hypnotized individuals are truly experiencing suggested effects, just that the mechanism by which this has taken place has in part been socially constructed and is not necessarily reliant on the idea of an altered state of consciousness. It is

Dissociation and neodissociation theories

Pierre Janet originally developed the idea of dissociation of consciousness, as a result of his work with hysterical patients. He believed that hypnosis was an example of dissociation: areas of an individual's behavioral control are split off from ordinary awareness. In this case, hypnosis would remove some control from the conscious mind and the individual will respond with autonomic, reflexive behavior. Weitzenhoffer describes hypnosis via this theory as "dissociation of awareness from the majority of sensory and even strictly neural events taking place."

Neuropsychological theory of hypnosis

Neuropsychological theories of hypnosis attempt to explain hypnotic phenomenon in terms of alterations in brain activity. Gruzelier, based on large amounts of EEG research, proposed that hypnosis is characterized by a shift in brain activity from anterior (front) to posterior (back).

Hypnosis as a conditioned process leading to sleep

Ivan Pavlov believed that hypnosis was a "partial sleep." He observed that the various degrees of hypnosis did not significantly differ physiologically from the waking state and hypnosis depended on insignificant changes of environmental stimuli. Pavlov also suggested that lower brain stem mechanisms were involved in hypnotic conditioning.

Some modern well-known hypnotherapists subscribe to this theory, since in hypnosis, the subject typically appears to be asleep because of eye closure that is typically part of the induction procedure. However, there is quite a bit of literature on blood pressure, reflexes, physiochemical and EEG studies which indicates that hypnosis more closely resembles complete wakefulness.^{[citation needed]}

Hyper–suggestibility theory

Currently a more popular theory, it states the subject focuses attention by responding to the suggestion of the hypnotist. As attention is focused and magnified, the hypnotist's words are gradually accepted without the subject carrying any conscious censorship of what is being said. This is not unlike the athlete listening to the last pieces of advice from a coach minutes before an important sport event: Concentration filters out anything that is unimportant and magnifies what is said about what really matters for the subject.

It would be a complete misinterpretation to conclude from this that only gullible or weak-minded people are suggestible. Hypnotized subjects will go along with the suggestions of the hypnotist as long as this does not violate their beliefs and will wake up otherwise.

Informational theory

This theory applies the concept of the brain-as-computer model. In electronic systems, a system adjusts its feedback networks to increase the signal-to-noise ratio for optimum functioning, called a "steady state." Increasing the receptability of a receptor enables messages to be more clearly received from a transmitter primarily by trying to reduce the interference (noise) as much as possible. Thus, the object of the hypnotist is to use techniques to reduce the interference and increase the receptability of specific messages (suggestions).

Systems theory

This theory may be regarded as an extension of James Braid's original conceptualization of hypnosis as involving a process of greatly enhancing or depressing the activity of the nervous system. It takes and establishes the necessary organization of the nervous system into interacting subsystems. On that basis it develops a picture of hypnotic phenomena as involving not only increasing or decreasing of the activity of particular subsystems, but on their interaction. As a result it brings into centre stage the phenomenon of feed-back loops, familiar in systems theory, and thereby throws light on a mechanism for creating the more extreme of hypnotic phenomena.

Research on hypnosis

There is a long tradition (over a century) of hypnosis research which has allowed scientists to test key ideas in the debate. Much research has been conducted into the nature and effects of hypnosis and suggestion, and hypnosis continues to be a popular (if somewhat peripheral) tool in contemporary psychological research. A number of different strands of hypnosis research are apparent: that which examines the "state" of hypnosis itself, that which examines the effects and properties of suggestions in and out of hypnosis, and that which uses hypnotic suggestion as a tool to research other areas of psychological functioning.

Recently, there are reports that efforts to reduce obesity with hypnosis (when used in combination with cognitive behavioral therapy, exercise, and a low-fat diet) may be effective.

Clinical Studies

In 1996 The National Institutes of Health technology assessment panel judged hypnosis to be an effective intervention for alleviating pain from cancer and other chronic conditions. A large number of clinical studies also indicate that hypnosis can reduce the acute pain experienced by patients undergoing burn-wound debridement, enduring bone marrow aspirations and childbirth. An analysis published in a recent issue of the International Journal of Clinical and Experimental Hypnosis, for example, found that hypnotic suggestions relieved the pain of 75% of 933 subjects participating in 27 different experiments.

Brain Imaging

With the recent advent of new brain imaging techniques (chiefly MRI scans, with EEG and PET contributing to a lesser extent) there has been a resurgence of interest in the relationship between hypnosis and brain function. Any human experience is reflected in some way in the brain – seeing colors or motion is underscored by activity in the visual cortex, feeling fear is mediated by activity in the amygdala – and so hypnosis and suggestion are expected to have observable effects upon brain function. An important issue for researchers conducting brain imaging is to separate the effects of hypnosis and suggestion — knowing that a suggestion given during hypnosis affects brain area X does not just tell us about hypnosis, it tells us about the effects of the suggestion too. To account for this, experiments need to include a non-hypnotic-response-to-suggestion condition —only this way can the specific effects of hypnosis be examined.

A number of brain-imaging studies have been conducted on hypnotized subjects. A selection of these studies are explained and summarized below:

One controlled scientific experiment postulates that hypnosis may alter our perception of conscious experience in a way not possible when people are not "hypnotized," at least in "highly hypnotizable" people. In this experiment, color perception was changed by hypnosis in "highly hypnotizable" people as determined by positron emission tomography (PET) scans (Kosslyn et al., 2000). (This research does not compare the effects of hypnosis on less hypnotizable people and could therefore show little causal effect due to the lack of a control group.)

Another research example, employing event-related fMRI and EEG coherence measures, compared certain specific neural activity "...during Stroop task performance between participants of low and high hypnotic susceptibility, at baseline and after hypnotic induction." According to its authors, "the fMRI data revealed that conflict-related ACC activity interacted with hypnosis and hypnotic susceptibility, in that highly susceptible participants displayed increased conflict-related neural activity in the hypnosis condition compared to baseline, as well as with respect to subjects with low susceptibility." (Egner et al., 2005).

Skeptics dispute the significance of such findings, claiming that such changes cannot be shown to be particular to the hypnotized state, and that any other action such as daydreaming is also likely to alter brain activity in some manner. However, recent studies have shown that hypnotized subjects suggested to experience auditory hallucinations demonstrated via PET scans, regional blood flow in the same areas of the brain as real hearing, whereas in subjects merely engaged in vividly imagining hearing noises, this did not occur. The subject is still a matter of current research and scientific debate.

Hypnosis methodologies

Induction

Hypnosis is normally preceded by a "hypnotic induction" technique. Traditionally, this was interpreted as a method of putting the subject into a "hypnotic trance"; however, subsequent "nonstate" theorists have viewed it differently, seeing it as a means of heightening client expectation, defining their role, focusing attention, etc. The induction techniques and methods are depended on the depth of hypnosis trance level and for each stage of trance that in some sources ranges from 30 stages to 50 stages, there're different type of inductions. There are several different induction techniques. One of the most influential methods was Braid's "eye-fixation" technique, also known as "Braidism". Many variations of the eye-fixation approach exist, including the induction used in the Stanford Hypnotic Susceptibility Scale (SHSS), the most widely used research tool in the field of hypnotism. Braid's original description of his induction is as follows:

Take any bright object (e.g. a lancet case) between the thumb and fore and middle fingers of the left hand; hold it from about eight to fifteen inches from the eyes, at such position above the forehead as may be necessary to produce the greatest possible strain upon the eyes and eyelids, and enable the patient to maintain a steady fixed stare at the object.

The patient must be made to understand that he is to keep the eyes steadily fixed on the object, and the mind riveted on the idea of that one object. It will be observed, that owing to the consensual adjustment of the eyes, the pupils will be at first contracted: They will shortly begin to dilate, and, after they have done so to a considerable extent, and have assumed a wavy motion, if the fore and middle fingers of the right hand, extended and a little separated, are carried from the object toward the eyes, most probably the eyelids will close involuntarily, with a vibratory motion. If this is not the case, or the patient allows the eyeballs to move, desire him to begin anew, giving him to understand that he is to allow the eyelids to close when the fingers are again carried towards the eyes, but that the eyeballs must be kept fixed, in the same position, and the mind riveted to the one idea of the object held above the eyes. In general, it will be found, that the eyelids close with a vibratory motion, or become spasmodically closed.

Braid later acknowledged that the hypnotic induction technique was not necessary in every case, and subsequent researchers have generally found that on average it contributes less than previously expected to the effect of hypnotic suggestions. Variations and alternatives to the original hypnotic induction techniques were subsequently developed. However, this method is still considered authoritative.^{[citation needed]} In 1941, Robert White wrote: "It can be safely stated that nine out of ten hypnotic techniques call for reclining posture, muscular relaxation, and optical fixation followed by eye closure."

Suggestion

When James Braid first described hypnotism, he did not use the term "suggestion" but referred instead to the act of focusing the conscious mind of the subject upon a single dominant idea. Braid's main therapeutic strategy involved stimulating or reducing physiological functioning in different regions of the body. In his later works, however, Braid placed increasing emphasis upon the use of a variety of different verbal and non-verbal forms of suggestion, including the use of "waking suggestion" and self-hypnosis. Subsequently, Hippolyte Bernheim shifted the emphasis from the physical state of hypnosis on to the psychological process of verbal suggestion:

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Bernheim's conception of the primacy of verbal suggestion in hypnotism dominated the subject throughout the 20th century, leading some authorities to declare him the father of modern hypnotism.

Contemporary hypnotism uses a variety of suggestion forms including direct verbal suggestions, "indirect" verbal suggestions such as requests or insinuations, metaphors and other rhetorical figures of speech, and non-verbal suggestion in the form of mental imagery, voice tonality, and physical manipulation. A distinction is commonly made between suggestions delivered "permissively" and those delivered in a more "authoritarian" manner. Harvard hypnotherapist Deirdre Barrett writes that most modern research suggestions are designed to bring about immediate responses, whereas hypnotherapeutic suggestions are usually post-hypnotic ones that are intended to trigger responses affecting behaviour for periods ranging from days to a lifetime in duration. The hypnotherapeutic ones are often repeated in multiple sessions before they achieve peak effectiveness.

Conscious and unconscious mind

Some hypnotists view suggestion as a form of communication that is directed primarily to the subject's conscious mind, whereas others view it as a means of communicating with the "unconscious" or "subconscious" mind. These concepts were introduced into hypnotism at the end of the 19th century by Sigmund Freud and Pierre Janet. Sigmund Freud's psychoanalytic theory describes conscious thoughts as being at the surface of the mind and unconscious processes as being deeper in the mind. Braid, Bernheim, and other Victorian pioneers of hypnotism did not refer to the unconscious mind but saw hypnotic suggestions as being addressed to the subject's conscious mind. Indeed, Braid actually defines hypnotism as focused (conscious) attention upon a dominant idea (or suggestion). Different views regarding the nature of the mind have led to different conceptions of suggestion. Hypnotists who believe that responses are mediated primarily by an "unconscious mind", like Milton Erickson, make use of indirect suggestions such as metaphors or stories whose intended meaning may be concealed from the subject's conscious mind. The concept of subliminal suggestion depends upon this view of the mind. By contrast, hypnotists who believe that responses to suggestion are primarily mediated by the conscious mind, such as Theodore Barber and Nicholas Spanos, have tended to make more use of direct verbal suggestions and instructions.

Ideo-dynamic reflex

The first neuropsychological theory of hypnotic suggestion was introduced early by James Braid who adopted his friend and colleague William Carpenter's theory of the ideo-motor reflex response to account for the phenomenon of hypnotism. Carpenter had observed from close examination of everyday experience that, under certain circumstances, the mere idea of a muscular movement could be sufficient to produce a reflexive, or automatic, contraction or movement of the muscles involved, albeit in a very small degree. Braid extended Carpenter's theory to encompass the observation that a wide variety of bodily responses besides muscular movement can be thus affected, for example, the idea of sucking a lemon can automatically stimulate salivation, a secretory response. Braid, therefore, adopted the term "ideo-dynamic", meaning "by the power of an idea", to explain a broad range of "psycho-physiological" (mind–body) phenomena. Braid coined the term "mono-ideodynamic" to refer to the theory that hypnotism operates by concentrating attention on a single idea in order to amplify the ideo-dynamic reflex response. Variations of the basic ideo-motor, or ideo-dynamic, theory of suggestion have continued to exercise considerable influence over subsequent theories of hypnosis, including those of Clark L. Hull, Hans Eysenck, and Ernest Rossi. In Victorian psychology the word "idea" encompasses any mental representation, including mental imagery, memories, etc.

General methods

The act of inducing a hypnotic state is referred to as an induction procedure. Currently, there is not a consensus for which method is the most effective induction procedure. Some practitioners use simple calming techniques, while others use complex triggers (for example mechanical devices).

Many experienced hypnotists claim that they can hypnotize almost anyone. They also claim it is a myth that people with strong will power cannot be hypnotized, as they claim these generally make the best participants. This is based on the idea that those who are most intelligent are also the most creative and as such they will make strong associations with the structure of language used by the hypnotist and by the visual or auditory representations inside of their mind. On the other hand, there is a common claim that no one can really be hypnotized against his or her will. The counter-claim given by many hypnotists is that while you cannot make someone do anything against their will, you can change what it is that they wish to do.

Many religious and cultural rituals contain many similarities with techniques used for hypnotic induction and induce similar states in their participants.

General effects

Focused attention

This school of thought holds that hypnosis as a state is very similar to other states of extreme concentration, where a person becomes oblivious to his or her surroundings while lost in thought. Often suggested as an example is when a driver suddenly finds his or her self much further down the road without any memory of driving the intervening distance (see highway hypnosis), when a person is watching television and focuses so intently on the program that he or she ceases to be aware of the sides of the screen, or when a person is thinking about another subject while reading, then realizes that he or she has read several pages without consciously doing so, or taking in any of the content.

The act of hypnotizing, is, in effect, the act of deliberately and mechanically inducing a similar state.

Suggestibility

Psychologists have developed studies that show a strong correlation between the ease of putting someone in a state of hypnosis and their level of suggestibility. Some of these studies have produced the Harvard scale, Stanford scale, and eye-roll test; all of which are supposed to predict how easily a person can be put in a hypnotized state.

Hypnosis has further been described as "The suspension of the critical factor" which expands on the idea of "increased suggestibility." A person who claims to be hypnotized may accept statements as true that he or she would normally reject.

For example, when told "you have forgotten your name," the subject in a normal state would react with disbelief, but hypnotized individuals have claimed that they have, indeed, forgotten their own names.

It often appears as if the hypnotized participant accepts the authority of the hypnotist over his or her own experience. When asked after the conclusion of such a session, some participants appear to be genuinely unable to recall the incident, while others say that they had known the hypnotist was wrong but at the time it had seemed easier just to go along with his instructions. (Richard Feynman describes this in his memoir Surely You're Joking, Mr. Feynman! as his own hypnotic experience.) The mechanism of this effect is however disputed: Some hypnotists would claim that this showed the difference between a deep and a shallow hypnotic trance, while skeptics would question the validity of this conclusion, citing that such effects can be duplicated in other circumstances where an agent holds authority, such as the Milgram experiment, and suggest that unreliability in results discredits a scientific theory of hypnosis.

Clinical observations of various depths of hypnosis

Breuer's absent pupillary reflex sign

An objective sign of hypnosis can be observed by a pupillary reflex test, which demonstrates a response that is opposed to the normal physiological response. When subjects are in a profound hypnotic state, they are asked to remain in hypnosis and open their eyes. The subjects' pupils are usually dilated and remain dilated or react poorly when a penlight is shone into them—the normal non-hypnotic response is a contraction of the pupil.

The esoteric publication Hypnotism, by Danish hypnotist Carl Septus, is an early reference work that notes the absent pupillary reflex sign. More specifically, it states that after subjects have been asked to open their eyes during a deep trance, light shone into the eyes does not cause pupil contraction. The hypnotist may use suggestion to keep the subject in hypnosis, but the hypnotist must avoid suggestions relating to eyes, visual focus, light, and the pupils' dilation or contraction.

Applications

There are numerous applications for hypnosis across multiple fields of interest, including medical/psychotherapeutic uses, military uses, self-improvement, and entertainment. The American Medical Association currently has no official stance on the medical use of hypnosis.

Hypnosis has been used as a supplemental approach to cognitive behavioral therapy since as early as 1949. Hypnosis was defined in relation to classical conditioning; where the words of the therapist were the stimuli and the hypnosis would be the conditioned response. Some traditional cognitive behavioral therapy methods were based in classical conditioning. It would include inducing a relaxed state and introducing a feared stimulus. One way of inducing the relaxed state was through hypnosis.

Hypnotism has also been used in forensics, sports, education, physical therapy, and rehabilitation. Hypnotism has also been employed by artists for creative purposes, most notably the surrealist circle of André Breton who employed hypnosis, automatic writing, and sketches for creative purposes. Hypnotic methods have been used to re-experience drug states and mystical experiences. Self-hypnosis is popularly used to quit smoking, alleviate stress and anxiety, promote weight loss, and induce sleep hypnosis. Stage hypnosis can persuade people to perform unusual public feats.

Some people have drawn analogies between certain aspects of hypnotism and areas such as crowd psychology, religious hysteria, and ritual trances in preliterate tribal cultures.

Hypnotherapy

Hypnotherapy is a term to describe the use of hypnosis in a therapeutic context. Hypnotherapy can either be used as an addition to the work of licensed physicians or psychologists, or it can be used in a stand-alone environment where the hypnotherapist in question usually owns his or her own business. The majority of certified hypnotherapists (C.Hts in the US, Diploma. Hyp in the UK) today earn a large portion of their money through the cessation of smoking (often in a single session) and the aid of weight loss (body sculpting). There is no evidence that 'incurable' diseases are curable with hypnosis (such as cancer, diabetes, and arthritis), but pain and other body functions related to the diseases are controllable. Some of the treatments practiced by hypnotherapists, in particular so-called regression, have been viewed with skepticism.

It is used by licensed physicians, psychologists, and others. Physicians and psychologists may use hypnosis to treat depression, anxiety, eating disorders, sleep disorders, compulsive gambling, phobias and posttraumatic stress, while certified hypnotherapists who are not physicians or psychologists often treat smoking and weight management. Hypnotherapy was historically used in psychiatric and legal settings to enhance the recall of repressed or degraded memories, but this application of the technique has declined as scientific evidence accumulated that hypnotherapy can increase confidence in false memories.

The American Medical Association and the American Psychological Association have both cautioned against the use of repressed memory therapy in dealing with cases of alleged childhood trauma, stating that "it is impossible, without other corroborative evidence, to distinguish a true memory from a false one", and so the procedure is "fraught with problems of potential misapplication". (See also false memory). This is why forensic hypnosis is not widely used in many countries' legal systems. Hypnosis is used a lot in modern life and is very helpful to some people.

Hypnotherapy is viewed as a helpful adjunct by proponents, having additive effects when treating psychological disorders, such as these, along with scientifically proven cognitive therapies. The effectiveness of hypnotherapy has not yet been accurately assessed.

Menopause

There is evidence supporting the use of hypnotherapy in the treatment of menopause related symptoms, including hot flashes. The North American Menopause Society recommends hypnotherapy for the nonhormonal management of menopause-associated vasomotor symptoms, giving it the highest level of evidence.

Irritable bowel syndrome

Hypnotherapy has been studied for the treatment of irritable bowel syndrome. Hypnosis for IBS has received moderate support in the National Institute for Health and Clinical Excellence guidance published for UK health services. It has been used as an aid or alternative to chemical anesthesia, and it has been studied as a way to soothe skin ailments.

Pain management

A number of studies show that hypnosis can reduce the pain experienced during burn-wound debridement, bone marrow aspirations, and childbirth. The International Journal of Clinical and Experimental Hypnosis found that hypnosis relieved the pain of 75% of 933 subjects participating in 27 different experiments.

Hypnosis is effective in decreasing the fear of cancer treatment reducing pain from and coping with cancer and other chronic conditions. Nausea and other symptoms related to incurable diseases may also be managed with hypnosis. Some practitioners have claimed hypnosis might help boost the immune system of people with cancer. However, according to the American Cancer Society, "available scientific evidence does not support the idea that hypnosis can influence the development or progression of cancer."

Hypnosis has been used as a pain relieving technique during dental surgery, and related pain management regimens as well. Researchers like Jerjes and his team have reported that hypnosis can help even those patients who have acute to severe orodental pain. Additionally, Meyerson and Uziel have suggested that hypnotic methods have been found to be highly fruitful for alleviating anxiety in patients with severe dental phobia.

For some psychologists who uphold the altered state theory of hypnosis, pain relief in response to hypnosis is said to be the result of the brain's dual-processing functionality. This effect is obtained either through the process of selective attention or dissociation, in which both theories involve the presence of activity in pain receptive regions of the brain, and a difference in the processing of the stimuli by the hypnotised subject.

The American Psychological Association published a study comparing the effects of hypnosis, ordinary suggestion, and placebo in reducing pain. The study found that highly suggestible individuals experienced a greater reduction in pain from hypnosis compared with placebo, whereas less suggestible subjects experienced no pain reduction from hypnosis when compared with placebo. Ordinary non-hypnotic suggestion also caused reduction in pain compared to placebo, but was able to reduce pain in a wider range of subjects (both high and low suggestible) than hypnosis. The results showed that it is primarily the subject's responsiveness to suggestion, whether within the context of hypnosis or not, that is the main determinant of causing reduction in pain.

Entertainment/Stage application

Stage hypnosis is a form of entertainment, traditionally employed in a club or theatre before an audience. Due to stage hypnotists' showmanship, many people believe that hypnosis is a form of mind control. Stage hypnotists typically attempt to hypnotise the entire audience and then select individuals who are "under" to come up on stage and perform embarrassing acts, while the audience watches. However, the effects of stage hypnosis are probably due to a combination of psychological factors, participant selection, suggestibility, physical manipulation, stagecraft, and trickery. The desire to be the centre of attention, having an excuse to violate their own fear suppressors, and the pressure to please are thought to convince subjects to "play along". Books by stage hypnotists sometimes explicitly describe the use of deception in their acts; for example, Ormond McGill's New Encyclopedia of Stage Hypnosis describes an entire "fake hypnosis" act that depends upon the use of private whispers throughout.^{[citation needed]}

Professor G.F. Wagstaff, of the University of Liverpool, carried out research around the phenomenon of stage hypnotism or hypnotism for entertainment. He surmised that rather than the subject being in an 'altered state' rather they were affected significantly more by social factors and expectations.

Wagstaff's work explores how a hypnotist carefully chooses volunteers from the audience, puts them into a trance using hypnosis and then plants suggestions for them to perform. The critical factor in all stage hypnosis shows is the choice of enthusiastic and credulous individuals. Various techniques exist for discerning whether an individual is a likely candidate for a hypnosis stage act showing a higher than normal susceptibility. Often, the sheer willingness of audience members to volunteer is a sign that they will cooperate with the hypnotist's suggestions during the show, whether or not they ever really become hypnotized in the first place.

The process used to ensure participants presenting themselves as adequate for the stage starts with the initial call for volunteers from the audience. The hypnotist will use carefully selected terms in the initial call for volunteers. There will be a certain number of chairs, or spots on the stage which will usually be less than the number of initial volunteers. This will set up an unconscious sense of competition among those volunteers who *really do* want to participate.

For example, the volunteers may be made to believe they are drunk, aliens speaking a strange alien language, naked or seeing others naked, 6-year-old children, ballet dancers etc. Such suggestions are designed to be temporary, lasting the duration of the show. Stage hypnosis is a unique performance in that it involves "real" people from the audience responding in a variety of ways, making no two shows the same. There has been debate over the years as to whether some degree of fraud or collusion may be involved in some stage hypnosis acts.

Sometimes a stage hypnosis begins with an induction in which the hypnotist asks the entire audience to close their eyes and listen to his words. He lulls everyone participating into a relaxed state with which he may observe who is more susceptible to be hypnotized. Often people are simply unable to relax and "go with" the hypnotist's instructions due to inability to relax and allow the mind to follow instructions without conscious thought or simply determination to not be induced.

There are many observations that can be made of those who do "go under": slumping in their seat, head lolling to the side, falling into the lap of someone next to them, eye lids flickering, and inability to wake when spoken to or prodded unless done so by the hypnotist himself. For those who are simply watching this show and seeing the person next to them become induced, it can be frightening to witness.

The people whom the hypnotist saw to be easily induced the deepest are approached individually. He will speak briefly to the person and learn their name at which time he may say a few words to them and command them to sleep. For example: "Are you tired, Jane? Would you like to sleep now? Go ahead - SLEEP." Normally this action will cause the individual to immediately appear to have fallen asleep, accompanied by the individual falling to the side. The hypnotist will then speak once more to the person and in the same manner command the person to wake. If this person seems to have been deeply hypnotized but can also wake easily seems unaware of what happened, he or she will be asked to go on the stage.

Once several people are assembled, the hypnotist will begin with inducing each of them and testing them to make sure they are perfectly under. If someone is not working well enough they may be asked to leave. Those who remain are the ones who cannot be woken, even by loud audiences and shouts. They only respond to the hypnotist. He will begin with small commands for action and move up to grand requests. For example, the subjects may first be told to act as if they were cold in a relatively warm room, and by the end of the night, they are showing the audience what their first kisses were like.

Self-hypnosis

Self-hypnosis (or autosuggestion) hypnosis in which a person hypnotizes himself or herself without the assistance of another person to serve as the hypnotist — is a staple of hypnotherapy-related self-help programs. It is most often used to help the self-hypnotist stay on a diet, overcome smoking or some other addiction, or to generally boost the hypnotized person's self-esteem. It is rarely used for the more complex or controversial uses of hypnotism, which require the hypnotist to monitor the hypnotized person's reactions and responses and respond accordingly. Most people who practice self-hypnosis require a focus in order to become fully hypnotized; there are many computer programs on the market that can ostensibly help in this area, though few, if any, have been scientifically proven to aid self-hypnosis.

Some people use devices known as mind machines to help them go into self-hypnosis more readily. A mind machine consists of glasses with different colored flashing LEDs on the inside, and headphones. The LEDs stimulate the visual channel while the headphones stimulate the audio channel with similar or slightly different frequencies designed to produce a certain mental state. A common occurrence is the use of binaural beats in the audio which is said to produce hypnosis more readily.

Self-hypnosis happens when a person hypnotises oneself, commonly involving the use of autosuggestion. The technique is often used to increase motivation for a diet, to quit smoking, or to reduce stress. People who practise self-hypnosis sometimes require assistance; some people use devices known as mind machines to assist in the process, whereas others use hypnotic recordings.

Self-hypnosis is claimed to help with stage fright, relaxation, and physical well-being.

Possible Dangers of Hypnosis

Abreaction

Some psychologists and other mental health professionals are concerned that practitioners of hypnosis who are unlicensed health professionals might evoke intense emotions in their clients that they are untrained to handle. These abreactions might occur when spontaneously or purposefully recalling traumatic events or, some believe, spontaneous mental breakdowns.

False Memory

False memory obtained via hypnosis has figured prominently in many investigations and court cases, including cases of alleged sexual abuse. There is no scientific way to prove that any of these recollections are completely accurate.

Many individuals can and have been led by an errant hypnotist to believe in things that they later were able to show did not happen have retracted allegations of such abuse (for instance, [5]).

The American Medical Association and the American Psychological Association have both cautioned against the use of repressed memory therapy in dealing with cases of alleged childhood trauma, stating that "it is impossible, without other corroborative evidence, to distinguish a true memory from a false one", and so the procedure is "fraught with problems of potential misapplication". (See also false memory).

Modern Applications

Gustave Le Bon's study of crowd psychology compared the effects of a leader of a group to hypnosis. Le Bon made use of the suggestibility concept.

Hypnosis, which at the end of the 19th century had became a popular phenomenon, in particular due to Charcot's public hypnotism sessions, was crucial in the invention of psychoanalysis by Sigmund Freud, a student of Charcot. Freud later met Liébault and Hippolyte Bernheim. Back in Vienna he developed abreaction therapy using hypnosis with Josef Breuer. When Sigmund Freud discounted its use in psychiatry, in the first half of the last century, stage hypnotists kept it alive more than physicians.

Russian medicine has made extensive use of obstetric hypnosis. Platanov, in the 1920s, became well known for his hypno-obstetric successes. Impressed by this approach, Stalin later set up a nationwide program headed by Velvoski, who originally combined hypnosis with Pavlov techniques but eventually used the latter almost exclusively. Ferdinand Lamaze, having visited Russia, brought back to France "childbirth without pain through the psychological method," which in turn showed more reflexologic than hypnotic inspiration.

The use of hypnosis in the treatment of neuroses flourished in World War I, World War II and the Korean War. Hypnosis techniques were merged with psychiatry and was especially useful in the treatment of what is known today as Post Traumatic Stress Disorder.

The modern study of hypnotism is usually considered to have begun in the 1930s with Clark Leonard Hull (1884-1952) at Yale University. An experimental psychologist, his work Hypnosis and Suggestibility (1933) was a rigorous study of the phenomenon, using statistical and experimental analysis. Hull's studies emphatically demonstrated once and for all that hypnosis had no connection with sleep. The main result of Hull's study was to rein in the extravagant claims of hypnotists, especially regarding extraordinary improvements in cognition or the senses under hypnosis. Hull's experiments did show the reality of some classical phenomena such as hypnotic anaesthesia and post-hypnotic amnesia. Hypnosis could also induce moderate increases in certain physical capacities and change the threshold of sensory stimulation; attenuation effects could be especially dramatic.

In the 1940s, Andrew Salter (1914-1996) introduced to American therapy the Pavlovian method of contradicting, opposing, and attacking beliefs. In the conditioned reflex, he has found what he saw as the essence of hypnosis. He thus gave a rebirth to hypnotism by combining it with classical conditioning. Ivan Pavlov had himself induced an altered state in pigeons, that he referred to as "Cortical Inhibition," which some later theorists believe to be some form of hypnosis.

On April 23, 1955, the British Medical Association (BMA) approved the use of hypnosis in the areas of psychoneuroses and hypnoanesthesia in pain management in childbirth and surgery. At this time, the BMA also advised all physicians and medical students to receive fundamental training in hypnosis.

In 1958, the American Medical Association approved a report on the medical uses of hypnosis. It encouraged research on hypnosis although pointing out that some aspects of hypnosis are unknown and controversial. Two years after AMA approval, the American Psychological Association endorsed hypnosis as a branch of psychology.

Recent Innovators and Current Applications

Studies continued after the Second World War. Ernest Hilgard and André Weitzenhoffer created the Stanford scales in 1961, a standardized scale for susceptibility to hypnosis, and properly examined susceptibility across age-groups and sex. Hilgard went on to study sensory deception (1965) and induced anesthesia and analgesia (1975).

In 1967, Harry Arons, a self-taught professional hypnotist, wrote a textbook, Hypnosis in Criminal Investigation, dedicated to the application of hypnosis in the judicial system. Chapters include such applications such as memory, age regression, induction techniques and confabulation. Arons also traveled the country training law enforcement agencies. His teaching created national acceptance in the legal community and increased positive awareness to the practice of hypnosis for trial applications. He is best known today for introducing a scale that is used for measuring the 'depth' of trance in hypnosis, called the Arons scale, which recognizes six levels of trance depth: Hypnoidal, Light trance, Medium trance, Profound trance, Somnambulism, and Profound Somnambulism.

Dave Elman (1900-1967) was one of the pioneers of the medical use of hypnosis. Elman's definition of hypnosis is still widely used today among many professional hypnotherapists. Although Elman had no medical training, he is known for having trained the most physicians and psychotherapists in America, in the use of hypnotism. He is also known for introducing rapid inductions to the field of hypnotism. One method of induction which he introduced more than fifty years ago, is still one of the favored inductions used by many of today's masters.

Popular culture

The notion of hypnotism has elicited many presentations in popular culture. Many works of fiction, such as movies, television programs, and comic books portray hypnotism as a form of total mind control; however, most authorities agree that this is an exaggeration. Portrayals in these forms of media foster a number of popular misconceptions are often taken to be true by the public at large, adding to the controversy surrounding hypnosis.

Misconceptions

Some believe that hypnotism is a form of mind control and/or brainwashing that can control a person's behavior and judgment and therefore could potentially cause them harm. These beliefs are not generally based on scientific evidence, as there is no scientific consensus on whether mind control even exists.. Due to the stage hypnotist's showmanship and their perpetuated illusion of possessing mysterious abilities, hypnosis is often seen as caused by the hypnotist's power. The reality is the hypnotist has no power other than to offer suggestions which the subject or client may choose to respond to or not to respond to.. The trance state is ultimately controlled by the client who may choose to terminate the hypnotic process at will. While a subject may want to enjoy the comfort of the trance state for as long as possbile, it is literally impossible to become stuck in hypnosis.. While the word 'Hypnosis' is derived from the Greek word for 'sleep' and many hypnotists still use the language of 'Sleep' and 'Awake', hypnosis is not sleep. From the mental standpoint, a hypnotic subject is relaxed yet alert and always aware at some level.. Due to the popular but incorrect notion of hypnosis as mind control, some people believe that the ability to experience hypnosis is related to strength and soundness of mind. However, scientists note that personality traits such as gullibility or submissiveness or factors such as low intelligence are not related to hypnotizability. Research studies suggest neither intelligence, sex, nor personality traits affect responsiveness to hypnosis and that hypnotizability may in fact be hereditary or genetic in nature.. Another misconception in popular culture is that hypnosis is often the product of vivid imaginations and that hypnotic phenomena is merely imagined in the mind. However, research indicates many imaginative people do not fare well as good hypnotic subjects. Furthermore, studies using PET scans have shown that hypnotized subjects suggested to have auditory hallucinations demonstrated regional blood flow in the same areas of the brain as real hearing, whereas subjects merely imagining hearing noise did not.

Hypnosis in Popular Media

Popular magician/mentalist, "The Amazing Kreskin", is noted to dispute the validity of Hypnosis and once offered a $100,000 to anyone who can prove such a thing as a 'hypnotic trance' exists to his satisfaction.

The Showtime Network television show Bullshit!, which features comedy duo Penn & Teller, took a skeptical look at hypnosis in one of their episodes.

The British car show Top Gear featured one of the presenters, Richard Hammond, getting hypnotized. He was put to sleep, and when he woke up he showed a number of personality and mental changes, including not remembering how to drive a car, and thinking that a miniature child's version of a Porsche 911 was his own car, and attempting to drive it around in the studio.

References

ISBN links support NWE through referral fees

• Braid, James. Neurypnology; or, The Rationale of Nervous Sleep. Ayer Co Publisher, 1976 (original 1843). ISBN 0405074182

External links

• Society of Clinical Hypnosis, Resources for Research and Teaching: Hypnosis and Related States Research Database
• HypnosisAndSuggestion.org Exploring the science behind hypnosis
• American Journal of Clinical Hypnosis
• Hypnosis, from the Skeptic's dictionary, skeptical review of the veracity of hypnosis.
• Scientific American Article on Hypnosis
• Hypnosis, from Howstuffworks.com
• The National Council for Hypnotherapy The only non-for-profit governing body in the UK
• The (British) National Register of Advanced Hypnotherapists
• American Psychotherapy and Medical Hypnosis Association
• American Society of Clinical Hypnosis, founded by Milton Erickson in 1957: "Promotes greater acceptance of hypnosis as a clinical tool with broad applications."
• National Guild of Hypnotists (USA)
• International Journal of Clinical and Experimental Hypnosis

British Society for Clinical Psychophysiology accreditation for clinical hypnotherapy courses and individual practitioners

• Society of Clinical Hypnosis, Resources for Research and Teaching: Hypnosis and Related States Research Database

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