Dissociation in hypnosis and multiple personality disorder.

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Dissociation in Hypnosis and Multiple Personality Disorder Kenneth S. Bowers

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University of Waterloo , Waterloo, Ontario, Canada Published online: 31 Jan 2008.

To cite this article: Kenneth S. Bowers (1991) Dissociation in Hypnosis and Multiple Personality Disorder, International Journal of Clinical and Experimental Hypnosis, 39:3, 155-176, DOI: 10.1080/00207149108409632 To link to this article: http://dx.doi.org/10.1080/00207149108409632

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The l n t c r M I i o M / juurnal of C/lnicdand EIpcdmantul Hypnor* 1991. Vol. .L.?(I.Y.No. 3. 155170

DISSOCIATION IN HYPNOSIS AND MULTIPLE PERSONALITYDISORDER’ KENNETH s. BOWERS~ Downloaded by [Universitaets und Landesbibliothek] at 04:02 13 November 2013

Unioersity of Waterloo, Waterloo, Ontario, Canada Abstract: The first part of this paper examines the concept of dissociation in the context of hypnosis. In particular, the neodissociative and social psychological models of hypnosis are compared. It is argued that the social psychological model, in describing hypnotic enactments as purposeful, does not adequately distinguish between behavior that is enacted “on purpose” and behavior that serves or achieves a purpose. 2 recent dissertations (Hughes, 1988; Miller, 1986) from the University of Waterloo are summarized, each of which supports the neodissociative view that hypnotic behavior can be purposeful (in the sense that the suggested state of affairs is achieved) and nonvolitional (in the sense that the suggested state of affairs is not achieved by high level executive initiative and ongoing effort). The second part of the paper employs a neodissociative view of hypnosis to help understand the current epidemic of multiple personality disorder (MPD). In particular, it is argued that many symptoms of MPD are implicitly suggested effects - particularly prone to occur in persons who have a lifelong tendency to use dissociative type defenses. The present author believes that this account is easier to sustain conceptually and empirically than the current view, which states that a secondary (tertiary, etc.) personality accounts for the striking phenomenological discontinuities experienced by MPD patients.

In preparing this presidential address, I found myself in a curious position. On one hand, as someone who has been conducting research in hypnosis for more than 25 years, I am clearly and appropriately identified with the neodissociative views of E. R. Hilgard (1977), whose book Divided consciousness:Multiple controls in h u m n thought and action has been so influential with both researchers and clinicians. I am thus favorably disposed toward the concept of dissociation, both historically and as a fruitful way of understanding hypnosis. On the other hand, as a clinician, I have become increasingly skeptical of some of the claims made about how dissociation functions in psychopathology, especially insofar as it has become a central consideration in understanding multiple personality disorder (MPD). Moreover, I find myself quite dismayed about the dramatic increase in the incidence and prevalence of MPD (see e.g., Aldridge-Morris, 1989; Greaves, 1980; Kluft, 1983, and, later in this Manuscript submitted March 6, 1990; final revision received January 2, 1991. ‘An earlier version of this paper was presented as the Presidential Address at the 40th Annual Meeting of the Society for Clinical and Experimental Hypnosis, St. Louis, Missouri, November 1989. ‘Reprint requests should be addressed to Kenneth S. Bowers, Ph.D.. Department of Psychology, University of Waterloo. Waterloo, Ontario N2L 3G1,Canada. 155

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paper, I will try to explain why I think my concern is justified. First of all, however, I want to indicate just how I think dissociation functions in the context of hypnosis, the better to appreciate its role in psychopathology.

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COMPARING THE SOCIAL PSYCHOLOGICAL AND DISSOCIATIVE MODELS OF HYPNOSIS Most serious students of hypnosis realize that a large contingent of investigators have not been very receptive to the entire concept of dissociation (e.g., Spanos & Chaves, 1988).Spanos (1986)is the current torchbearer of this social psychological tradition. According to Spanos, high hypnotic responsiveness does not reflect an enduring cognitive ability. Rather, it reflects a predilection to interpret the suggested state of affairs as something that must be actively and purposefully achieved, together with a motivation to behave in accordance with the hypnotic suggestions. Why, then, do hypnotized individuals typically experience their suggested behavior as nonvolitional? Spanos argues that a hypnotized person simply misconstrues intentional behavior as having been caused by some concomitant of the behavior (e.g., by accompanying fantasies or vivid images, Spanos, 1986). In sum. Spanos' social psychological model of hypnosis argues that hypnotic behavior is strategically and effortfully produced, and that the experience of nonvolition is an attributional error. E. R. Hilgard's (1973,1977,1979)neodissociation model of hypnosis is of course quite different. According to this view, executive control of thought and behavior is at the top of a control hierarchy, with various subsystems of control ordinarily being subject to executive initiative and monitoring. When the control hierarchy is operating in an integrated, seamless manner, a person's goals, intentions, and purposes are realized in action. Typically, action that flows from such an integrated network of control is experienced as conscious and volitional. Under certain circumstances, however, lower levels of control can be dissociated from executive initiative and/or monitoring. To illustrate, when people sleep, executive and monitoring functions are in abeyance; nevertheless, subsystems of control continue to operate: people typically do not fall out of bed, they awaken to the cry of a distressed newborn, and respond to bladder pressure by waking up and going to the bathroom. They may even wake up at an appropriate time in the morning if the alarm clock fails to go off. Note that each of these sleep-enacted behaviors serves an important purpose; however, it stretches a point to argue that they are enacted on purpose. Performing a behavior on purpose implies a conscious intention to perfbrm it, something that a sleeping person cannot readily achieve. Accordingly, behaoior that serues u purpose is not always performed on purpose. This is a distinction that we shall return to later.

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E. R. Hilgards neodissociation model proposes that hypnotic responsiveness involves a somewhat reduced influence of executive initiative and control over hypnotically enacted behavior (Gill & Brenman, 1959; G. A. Miller, Galanter, & Pribram, 1960;Shor, 1959,1970). “Theplanning function is inhibited, and the hypnotized person does not independently undertake new lines of thought or action [E. R. Hilgard, 1979, p. 501.” Instead, suggestive communications directly activate subsystems of control. Since the experience of volition is closely tied to executive initiative and effort, suggested behaviors that bypass such initiative and effort are typically experienced as nonvolitional. Weitzenhoffer (1978, 1980) has called the experience of nonvolition that ordinarily accompanies hypnotic responding the “classic suggestion effect.” To summarize, the neodissociative view of hypnosis recognizes that not everything people do or achieve is consciously intended, initiated, or controlled (Kihlstrom, 1984, 1987). This does not mean that hypnotized persons exercise no control at all over their thought and behavior only that the control being exercised can be dissociated from conscious intentions and purposes. Such “dissociated control” (Bowers, 1990; Bowers & Davidson, in press) occurs in everyday life as well, and is particularly well revealed in various mental and action lapses (e.g., Norman, 1981; Reason, 1979). When an individual dials a more familiar telephone number rather than the intended one, a controlled sequence of behavior has clearly occurred; but just as clearly, the resulting behavior does not correspond to the person’s conscious intentions and purposes. Perhaps an analogy to physical theories of motion usefully highlights the difference between a social psychological and a neodissociation account of hypnotic responsiveness. Aristotle proposed that a constant force was necessary to keep an object moving at a constant rate. Newton, on the other hand, proposed that an object in motion stayed in motion until opposed by a countervailing force - friction, for example. 3 There is a sense in which the social psychological theory of hypnosis has an Aristotelian flavor. Spanos, for example, proposes that an ongoing cognitive “force” (read strategic enactment) is required to achieve a hypnotic response. For example, when hypnotic suggestions for analgesia are successful, it is ?o be more historically accurate, it was Galileo who introduced the modern views of motion; Newton formalized the conceptual shift. Butterfield (1957) has written with particular insight about the two competing concepts of motion. One of the points he makes is how difficult it was to proceed from Aristotelian to Galilean views of motion on the basis of observation. Rather, “it required a different kind of thinking-cap, a transposition in the mind of the scientist himself [Butterfield, 1957: p. 171.”The current difficulties in resolving the differences between a neodissociative and social psychological model of hypnosis on the basis of observation (see, e.g.. Spanos, 1886. and commentaries thereto) implies that there are different “thinking caps” that are involved iqhow hypnotic phenomena are approached. Holton (1973) has been especially effective in showing how what he terms the “thematic dimension” in science can predominate over observation in forming the basis for discussion in a given domain of scientific investigation.


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because ongoing cognitive effort to reduce the pain has been mobilized throughout the duration of the painful stimulus. By way of contrast, E. R. Hilgard’s neodissociative view is more Newtonian, since it implies that hypnotic analgesia to cold pressor pain is not something that requires ongoing executive effort, but is set into motion by suggestions which more or less directly activate subsystems of pain control. Once activated, hypnotic analgesia has a psychological momentum that does not require e ”maintain it. a continuing conscious effort or “ f ~ r ~to The question is whether the distinction highlighted in this analogy can be sustained by productive research. What follows are summaries of two doctoral dissertations recently completed at the University of Waterloo hypnosis laboratory. Each study in its own way addresses the issue of whether or not high-level cognitive initiative and ongoing effort is required to achieve a hypnotically suggested state of affairs.

Some Empirical Findings in Support of the Neodissociatioe Model of Hypnosis

A neodissociatioe inoestigation of hypnotic analgesia. M . Miller’s (1986) doctoral dissertation compared hypnotic and one form of nonhypnotic analgesia. She assumed that if executive initiative and ongoing effort were involved in the production of hypnotic analgesia, some considerable portion of the subject’s cognitive resources would be allocated to the business of reducing pain (cf. Kahneman, 1973).Such an ongoing allocation of high-level cognitive work to reduce pain should in turn diminish the available resources for performing a concurrent, cognitively demanding task. The idea here is that if two concurrent tasks both require high-level cognitive effort, full attention to one of them will impair performance of the other. Suppose hypnotic analgesia were achieved, however, not by an ongoing allocation of high-level cognitive resources, but by a suggestion-activated subsystem of pain control. If that were true, a high hypnotizable person administered suggestions for hypnotic analgesia could perhaps reduce pain without impairing performance on a concurrent, cognitively demanding task. To examine this possibility, Miller (1986) utilized 36 Ss who were first carefully selected for their low and high hypnotizability on two different the Harvard Group Scale of standardized scales of hypnotic ability Hypnotic Susceptibility, Form A (HGSHS:A)of Shor and E. Orne (1962), and a group form‘ of the Stanford Hypnotic Susceptibility Scale, ?he m a n d and scoringbooklet for the group version of SHSS:C (W-SGSHS:C) used in

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the present study (revised 8/82) BS well as data concsrning the adaptation for small group administration of the Stanford Hypnotic Susceptibility Scale. Form C have been deposited with the National Auxiliary Publications Service (NAPS). For 38 pages, order document No. 04632 from ASIS-NAPS. do Microfiche Publications, P.0. Box 3513, Grand Central Station, New York, NY 101653513. Remit in advance in U.S. funds only $13.15 for photocopies or $4.00 for microfiche and make checks payable to Microfiche Publications NAPS. Outside the United States and Canada, add postage of $6.50 for a photocopy and $1.50 for a fiche. There is a $15.00 invoicing fee for orders not prepaid.

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c) covering d) crown

e) contest FIG.1. An example of an item from the Nelson-Denny Reading Test.

Form C (SHSS:C) of Weitzenhoffer and E. R. Hilgard (1962).The 18 high and 18 low hypnotizable Ss were then administered selected items from the Nelson-Denny Reading Test (Brown, Bennett, & Hanna 1973). In this test, S is given a word to define and five single-word definitions to choose from, only one of which is correct. Figure 1 is an example of one such item. After this initial baseline assessment of vocabulary, S was administered a second version of the vocabulary test, this time while S’s forearm was submerged in circulating ice water. It was assumed that pain caused by immersion in the cold pressor would impair an individual’s ability to perform well on the vocabulary test. And that it is what happened: from its baseline assessment, average performance on the multiple choice vocabulary test declined significantly by about 35% during this first immersion in cold pressor. Clearly, the pain of cold pressor adversely affected Ss’ ability to perform a cognitively demanding task. After this first exposure to cold pressor pain, Ss were either hypnotized and administered suggestions for hypnotic analgesia, or instructed in the use of various cognitive strategies for coping with pain (in a manner closely patterned after the stress inoculation procedures used by Turk, Meichenbaum, & Genest, 1983). Then they were exposed to another immersion in cold pressor, the pain of which they were to reduce either by hypnotic analgesia, or by active cognitive strategies of pain control. During this second immersion in cold pressor, Ss took yet a third form of the vocabulary test. The design of this study permitted Miller (1986) to answer the following question: Assuming that the two treatments were about equally effective in reducing pain, does hypnotic analgesia interfere less with performance on the vocabulary test than a treatment requiring the purposeful marshalling of cognitive strategies? Looking first at the pain data, Ss gave retrospective pain ratings from 1-10 concerning the level of pain experienced in the first, middle, and

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FIG.2. Adjusted mean retrospective pain ratings for high and low hypnotizable Ss across both treatment conditions.

final third of the cold pressor immersion. There was no difference in the effectiveness of hypnotic analgesia and cognitive strategies, and, as Figure 2 shows, both interventions were more effective for high than for low hypnotizable Ss. Since the two treatments were equally effective in reducing the pain of cold pressor, it is legitimate to ask whether, as predicted, the cognitive cost of reducing pain was greater for Ss in the cognitive strategy condition than it was for Ss in the hypnotic analgesia condition. We can answer this question by examining the effect of the two different treatment interventions on vocabulary test performance during the last cold pressor immersion. Recall that the pain of cold pressor,. without any specific training or instruction in how to reduce pain, led to a 35% reduction in Ss’performance on the vocabulary test. Figure 3 displays the vocabulary test scores during the two cold pressor immersions, with the initial score on this test covaried out. We can see that Ss in the cognitive strategy condition



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FIG.3. Adjusted mean vocabulary scores for Ss high and low in hypnotic ability exposed to hypnotic and stress inoculation conditions during pre- and posttreatment immersion in cold pressor.

showed an additional significant drop of about 30% in their vocabulary performance from pre- to posttreatment immersion in the cold pressor. This reduction occurred despite the fact that Ss successfully reduced pain - presumably through the use of cognitive strategies that further interfered with their ability to deal with the vocabulary test. The situation in the hypnotic analgesia condition was quite different. The low hypnotizable Ss showed only a slight additional decrease (8%)in their vocabulary test performance from the pre- to posttreatment immersion in cold pressor; the high hypnotizable Ss, on the other hand, showed a slight (10%)increase in their vocabulary performance from the pre- to posttreatment immersion. In other words, despite the fact that hypnotic analgesia is quite effective in reducing the pain of high hypnotizable Ss, it does so in a manner that does not require diverting conscious attention and effort from the vocabulary test. Miller’s (1986) study demonstrates that active cognitive strategies to reduce pain are successful; but these strategies impair performance on a competing task in a manner that is not true of hypnotic analgesia. The fact that hypnotic analgesia does not impair performance on the competing task implies that its effectiveness does not depend on S’s utilization of high-level cognitive strategies. Rather, hypnotic analgesia seems to involve the dissociated control of pain - that is, control which is relatively free of the need for high-level, executive initiative and effort. Miller’s findings thus give striking support to the notion that the suggested state of &airs can serve a purpose without any implication that it is enacted on purpose. Hypnotic analgesia reduces pain and is therefore beneficial to the hypnotized person; in this sense, it clearly serves or achieves an important purpose. Because hypnotic analgesia minimizes the degree of executive initiative and ongoing effort required to reduce pain, however, it seems inappropriate to view such reductions as something achieved on purpose. Spanos and his colleagues often refer to the suggested state of affairs as being “purposefully achieved,” but this phrase does not distinguish


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between behavior that “achieves a purpose” and behavior performed “on purpose.’’ As the Miller (1986) investigation clarifies, however, this distinction may be critical to an understanding of how hypnotic responsiveness can be both purposeful (in the sense that the suggested state of &irs is achieved)and nonvolitional (in the sense that the suggested effect is not produced ‘‘on purpose”). The possibility that the suggested state of &airs can be achieved both purposefully and nonvolitionally thus makes perfectly good sense in terms of E. R. Hilgard’s neodissociation model of hypnosis, while seeming contradictory to advocates of a social psychological model of hypnosis. Cardiac concomitants of cognitive effort. The second dissertation Erom my laboratory that I want to describe further documents the point that hypnotic suggestions can engender behavior that is both purposeful and nonvolitional. Hughes (1988) used heart rate to index the amount of cognitive work involved in generating a suggested effect. She employed heart rate in this way because past research conducted by Lacey (1967) and others (e.g., Kahneman, Tursky, Shapiro, & Crider, 1969)had demonstrated that cognitive effort involved in generating imagery and other internal information is accompanied by an increase in heart rate - the more effort, the greater the heart rate increase. The idea behind Hughes’ (1988) investigation is straightforward: the more cognitive effort required to generate hypnotically suggested imagery, the more heart rate should increase. Accordingly, heart rate increases should be positively correlated with the cognitive effort required to produce hypnotically suggested imagery. Such an outcome would confirm the “Aristotelian view” that ongoing high-level cognitive work achieves the suggested state of affairs. As mentioned earlier, Spanos’ social psychological model of hypnosis implies that suggested effects are achieved by this kind of ongoing allocation of high-level cognitive force or work. To examine these predictions, Hughes (1988)carefully selected 30 low (scores of 0-4)and 30 high (scores of 8-12) hypnotizable men on the same two standardized scales of hypnotic ability used in the Miller (1986)study (HGSHS:A and a group version of SHSS:C). The Ss were then hypnotized and administered three trials of neutral and three trials of fearful imagery in counterbalanced order. Each imagery trial lasted 1minute. After each imagery trial, Ss were asked to rate the vividness of imagery, the effort required to produce the imagery, and the amount of fear they experienced. Heart rate was continuously monitored before and during each imagery trial. For each S, the mean amount of heart rate change from a pretrial baseline was calculated for the three fearful imagery trials and for the three neutral imagery trials. Heart rate change was then averaged to get a final heart rate index for each kind of imagery for each S. As expected, the average rating of imagery vividness was significantly higher in high than in low hypnotizable Ss; this was true for both the


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FIG.4. Correlations of heart rate change and ratings of cognitive effort by high and low hypnotizable Ss engaged in neutral and fear imagery.

neutral and the fear imagery. For low hypnotizable Ss, the average vividness rating across both kinds of imagery was 3.4; for high hypnotizables, the mean rating was 4.6. That high hypnotic ability is associated with higher vividness of imagery is consistent with previous reports in the literature (Monteiro, Macdonald, & E. R. Hilgard, 1980; Nadon, Laurence, & Perry, 1987; Wilson & Barber, 1983). It is the correlation between heart rate increase and ratings of cognitive effort involved in producing the imagery, however, that is of most immediate concern. These data are presented in Figure 4. Focus first on the data from the neutral imagery condition, represented by the white bars in Figure 4. These two bars indicate the direction and magnitude of the correlation between heart rate increases and ratings of cognitive effort for the 30 low and 30 high hypnotizable Ss. For the low hypnotizables, there is a moderately high correlation (r = .52) between heart rate increase and ratings of cognitive effort; however, for the high hypnotizable Ss, there is effectively a zero correlation between these two variables. In other words, for low but not high hypnotizable Ss, we find the predicted positive relationship between a cardiac indicator of cognitive effort and the ratings of cognitive effort involved in producing neutral imagery. Consider now the fear imagery condition as represented by the diagonally striped bars. For low hypnotizable Ss engaged in fear imagery, there


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is a correlation of .49 between ratings of effort and heart rate increase almost identical to the analogous correlation for low hypnotizables in the neutral imagery condition. Thus, the most parsimonious account of these findings for low hypnotizable Ss is that regardless of imagery type, an increase in heart rate seems to index the cognitive effort required to produce hypnotically suggested imagery - the more effort expended, the more the heart rate increases. This “Aristotelean” pattern of data is precisely what Spanos’ social psychological model of hypnosis would predict. For high hypnotizable Ss engaged in fear imagery, however, the correlation between ratings of effortfulness and heart rate increase is minus .52 - indicating that the less effort involved in imagining a fearful scene, the more heart rate increases. Incidentally, the correlations indicated by the two diagonally striped bars in Figure 4 are significantly different ( z = 4.09, p < .001). It appears on the face of it that while increases in heart rate reflect increases in cognitive effort for the low hypnotizable Ss, something quite different is going on for the high hypnotizables. Just why high and low hypnotizable Ss differ in their pattern of heart rate correlates is perhaps better revealed by several findings not depicted in Figure 4. First, for low hypnotizables engaged in fear imagery, ratings of effort are correlated .66 with ratings of fear. In other words, the more low hypnotizable Ss work to produce a fearful image, the more frightening the image is. Second, for high hypnotizables engaged in fear imagery, the correlation between ratings of fear and ratings of effort is minus .68indicating that the less effort high hypnotizable Ss report in producing fear imagery, the more frightened they become. Finally, for high hypnotizables, the correlation between ratings of fear and heart rate increase is .59, indicating that the more fear high hypnotizable Ss experience when engaged in fear imagery, the more their heart rate increases (the comparable figure for low hypnotizables is .16). In sum,for high hypnotizable Ss, the less effort involved in generating fear imagery, the more they experience it as frightening, and the more emotionally (cardiac) reactive they become. For low hypnotizable Ss, however, the reverse seems to be true: the more effort involved in producing a fearful image, the more they experience it as frightening and the more emotionally reactive they become. This pattern of findings is consistent with the view that for high hypnotizable Ss, an increase in heart rate registers the emotional arousal accompanying fear imagery, whereas for low hypnotizables, increased heart rate seems to index the cognitive effort required to produce the imagery.’ As we have already seen, this ‘It is well known that heart rate responds to fear1e.g.. Bauer & Craighead, 1979). as well as to cognitive effort. Whether it responds best to cognitive effort or fear depends on circumstances. To neutral imagery, heart rate change indexes cognitive effort rather than fear. To fear imagery, however, heart rate increases seem to index fear for high hypnotizable Footnote 5 a n t . pg. 165.



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Frc. 5. Heart rate increases for high and low hypnotizable Ss engaged in neutral and fear imagery.

interpretation for fear imagery is substantiated by the findings in the neutral imagery condition, where heart rate increases seem to index cognitive effort only in the low hypnotizable Ss. Why should the pattern of heart rate correlates differ so much for high and low hypnotizables? One possibility is that experiencing fear imagery as effortless and nonvolitional is alarming in its own right, a state of affairs that would differentially contribute to the emotional arousal of high hypnotizable Ss. Figure 5 bears further on this hypothesis. It depicts in graphic form the average change in heart rate for low and high hypnotizable Ss under conditions of neutral and fear imagery. The important finding here is the significant interaction (p < .05) of hypnotic ability and imagery type: High hypnotizables are more responsive than low hypnotizable Ss to fear imagery, whereas to neutral imagery, there is practically no difference at all. Fear imagery is especially prone to increase the heart rate of high, as opposed Footnote 5 cont.

Ss, whereas it continues to be a better index of cognitive effort for low hypnotizables. The impression that fear is more important to heart rate increase for high than for low hypnotizable Ss is further confirmed by appropriate partial correlations. When ratings of fear are partialled out of the relationship between effort ratings and heart rate increase. the relationship remains virtually unchanged for low hypnotizables (r changes from .49 to .52). whereas for high hypnotizable Ss a similar procedure reduces the correlation between effort ratings and heart rate from - .52 to -.20. In other words, for low hypnotizables, the relationship between cognitive effort and increased heart rate is not mediated by fear, but for high hypnotizable Ss it is fear that seems largely responsible for the substantial negative correlation between effort ratings and heart rate increase.


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to low hypnotizable Ss. Partly, this may be due to the fact that high hypnotizables have more vivid imagery than low hypnotizables do. As well, however, high hypnotizable Ss may experience explicitly suggested fear imagery as unwilled and peremptory - as a visitation having its own psychological momentum that is relatively independent of conscious intention, effort, and control. Experiencing fear imagery in this way may well make it more emotionally arousing than fear imagery experienced as consciously produced and controlled. This rather “Newtonian”account of the findings from high hypnotizable Ss challenges a straightforward social psychological view of hypnosis, which regards ongoing cognitive effort as crucial to understanding how suggested effects are achieved. Spanos’ model of hypnosis seems to fit the data of low hypnotizable Ss quite nicely, but it is not readily apparent how it deals with the findings from the high hypnotizables, for whom cognitive effort does not seem to function in the manner his model predicts.

Summarizing the Implications of Miller’s and Hughes’ Research The social psychological model of hypnosis will doubtless find a way to reconcile itself with Miller’s (1986)and Hughes’ (1988) findings; however, it is heartening that such novel but strdightforward predictions from E. R. Hilgard’s neodissociation model of hypnosis were so clearly confirmed in two quite different dissertations. Moreover, their work has considerable relevance for our understanding of dissociation - not only in the context of hypnosis, but also in the context of psychopathology. First, both studies emphasize the idea that subsystems of control can be activated by suggestions, and that in high hypnotizable Ss, at least, executive initiative and ongoing effort are less involved in producing the suggested state of dairs than is usually the case. Similarly, I will argue that many of the symptoms and reported experiences of MPD are in fact implicitly suggested effects. which are relatively independent of executive initiative and control. Second, both Miller (1986) and Hughes (1988) provide a way of thinking about how behavior can be both purposeful (in the sense that the suggested state of &airs is realized in controlled sequences of action), and nonvolitional (in the sense that the control being exercised is not due to S’s conscious intentions and ongoing strategic efforts). These studies thus serve as a model of how some forms of psychopathology can be experienced as a peremptory visitation that operates at cross-purposes with the patient’s selfkoncept and conscious intentions. Finally, both of the studies view the experience of nonvolition, which ordinarily accompanies the suggested state of affairs, as reflecting a genuine alteration in control; however, in neither case is there any implication that the suggested behavior is an outcome of a second executive system or personality that is responsible for initiating or guiding the suggested outcome. The significance of this last remark will soon become apparent.


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Despite the hct that hypnotic phenomena provide a helpful way of thinking about some forms of psychopathology, I want to emphasize that high hypnotic ability is not by itself evidence for psychopathology. That is a mistake that Pierre Janet made at the turn of the century. We know now, however, that many high hypnotizable individuals have no significant pathology (J. R. Hilgard, 1979), though they may be unusual in the extent to which they enjoy a rich and satisfying fantasy life (Wilson & Barber, 1983). As well, many normal activities require dissociated control of behavior; indeed, if normal functioning meant that we had to be conscious of everything we did, we would have a very impoverished response repertoire indeed (Underwood, 1982). There is nevertheless an emerging consensus that some forms of psychopathology, especially MPD, are typified by high hypnotic ability. For example, Bliss (1984), has reported that patients diagnosed as MPD are extremely hypnotizable. One sample of 28 such patients had an average score of 10.1 on SHSS:C, which has a maximum score of 12. That is an extremely high level of hypnotic ability, consistent with the possibility of distorting reality quite significantly -hearing things that are not there, not seeing things that are, not smelling ammonia, and so on - all as a response to explicit suggestions. By way of contrast, control Ss in this investigation had a mean SHSS:C score of about 6.0. Bliss adds, “In my personal experience with over 100 patients whom I deemed to be multiple personalities . . . all have been clinically excellent hypnotic subjects [Bliss, 1984, p. 1971.” He further adds about MPD that “the fundamental dysfunction appears to be ‘self-hypnosis’ [Bliss, 1984, p. 1991.” By selfhypnosis, Bliss means a “rapid, unpremeditated withdrawal into a trance. It is a ‘dissociation’ - a primitive defensive reflex - which excellent hypnotic subjects may experience when they become agitated in response to some psychological or physical threat [p. 1991” (see Frankel, 1976; Spiegel, Hunt, & Dondershine, 1988; and Watkins & Johnson, 1982 for variations on this theme). It might be argued that the co-occurrences of high hypnotic ability with MPD needs to be systematically replicated before it is accepted unequivocally. Nevertheless, most advocates and skeptics of MPD seemingly agree that patients suffering the syndrome tend to be characterized by high hypnotizability. Typically, however, advocates of MPD celebrate this apparent fact with less enthusiasm than Bliss (1984) does, and it is not hard to understand why, Bliss interprets the high hypnotic ability of MPD patients as evidence of their ability to dissociate defensively. It is also evidence, however, that they are very suggestible - that they can transform ideas and fantasies into suggested effects, which can be experienced as being unwilled, as subjectively very vivid and compelling, and %ee Hilgard (1982) for an illuminating discussion regarding the difference between coOccurrence and correlation.


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as having a life and momentum of their own. Accordingly, I want to propose that at least some of the rather bizarre symptoms and experiences reported by MPD patients are due to implicitly suggested effects. The claim that MPD might be due in part to suggestion is usually offered and received as a ciiticism that it is an iatrogenic disorder. What I would like to stress, however, is that iatrogenesis is not the only way in which the experiences and symptoms of MPD can be engendered as suggested effects. Various ideas and fantasies stimulated by a given culture can also produce suggested effects that are manifested both in and out of a treatment context. For example, Ellenberger (1970). in his book the Discovery of the unconscious, argues that the crises and seizures that Mesmer saw in his salon were “nothing but an attack of oapeurs [emphasis in original, p. 1871,” which was a kind of fashionable neurotic reaction that manifested itself as swooning and fainting. The idea of swooning and fainting - imported into an exotic situation, and amplified by the trappings of lavender robes, glass harmonicas, and a legitimizing theory of animal magnetism - produced the implicitly suggested crises. Similarly, many of the bizarre experiences and symptoms of MPD can also be conceptualized as implicitly suggested effects. Thus, the current high profile of MPD - due in part to the publication and dramatization of Sybil (Schreiber, 1973) and similar case studies (see Greaves, 1980)can in vulnerable people serve as the ideational basis for implicitly suggested effects that are experienced as independent of executive initiative and effort. The more complex the fantasies, the more complex the suggested effects. Relevant here is the engaging paper by Wilson and Barber (1983) on very high hypnotizable, fantasy-prone individuals. The authors note that sometimes these individuals pretend to be someone else, and “While they are pretending, they become totally absorbed in the character and tend to lose awareness of their real identity [Wilson & Barber, 1983, p. 3541.” Most of the 26 fantasy-prone women in their investigation were regarded as normal; but when a seriously disturbed individual is also fantasy-prone, “multiple personality” may well be the result. Briefly, then, a neodissociative account of MPD proceeds as follows: People prone to MPD are very high in hypnotic ability and are, therefore, vulnerable to the suggestive impact of ideas, imaginings, and fantasies; what is more, they are high in hypnotic ability because they have learned to use dissociative defenses as a way of dealing with inescapable threat such as physical and sexual abuse (Kluft, 1987). The chronic tendency to indulge in solacing fantasy, or to employ fantasy as a substitute for outward expressions of rage and revenge, makes it increasingly diflicult for such a person to deal effectively with reality. Fantasied alternatives to reality (includinga fantasied alter ego -stimulated, perhaps, by media accounts of MPD) can become increasingly complex and differentiated. Gradually, these fantasied alternatives begin to activate subsystems of control more



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or less directly - that is, with minimal involvement of executive level initiative and control. Such “dissociated control” of behavior does not necessarily eliminate consciousness of it, though one’s actions are apt to be experienced as increasingly ego-alien. If and when the activating fantasies and resulting behaviors become sufficiently threatening, however, they can also be repressed into an unconscious (i.e., amnesic) status, thus further separating high-level executive and monitoring functions from the dissociated, ego-alien aspects of oneself. The fully realized result of this process is an individual who is subject to profound discontinuities in his or her sense of self. In sum, various ideas and fantasies can function implicitly as suggestions, producing emotional and behavioral outcomes that can be quite disturbing and ego-alien, such that the individual may assert, “I was not myself when I did that.” This assertion may sometimes have the ring of truth about it, but it does not follow that the disturbed and disturbing behavior was literally enacted by a secondary personality, or by a separate system of executive control. The experience of behaving in an outwardly uncharacteristic manner requires only that subsystems of control are more or less directly activated by ideas and fantasies in a manner that effectively bypasses executive initiative and control. The claim that the symptoms and experiences of MPD are implicitly suggested effects provides a plausible account of the disorder - one that takes seriously the fact that MPD patients are most likely high in hypnotic ability and are, therefore, highly responsive to suggestion. It assumes that external events and information can generate internal ideas and fantasies, which in turn can have a suggestive impact on perception and behavior. As well, invoking suggestion as an important basis for MPD helps to account for the extraordinary increase in its incidence and prevalence in the last quarter century (Aldridge-Morris, 1989). As Thigpen and Cleckley (1984) put it, “a diagnosis of multiple personality attracts a good deal more attention than most other diagnoses [p. 641.” Accordingly, the more MPD gets diagnosed, the more attention is drawn to it. The more widespread the idea of MPD becomes, the more such an idea can serve as an implicit suggestion to people whose natural endowments and life circumstances have honed dissociative defenses as a way of dealing with profound threat. That internal ideas and fantasies can serve as implicit suggestions in high hypnotizable individuals who are prone to utilize dissociative defenses is a relatively weak assumption. The competing assumption (currently accepted by many advocates of MPD) is that a second, third, or even a 20th or 50th personality accounts for the bizarre, ego-alien behavior of a disturbed individual. This is a very strong assumption indeed - one that requires commensurately strong evidence. It is a strong assumption because personality is a quintessentially developmental concept, which


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means that adult personality develops gradually out of a constitutional and historical matrix (see, e.g., Block, 1977, 1982). Should not the same be true of a secondary tertiary, or 50th personality? Yet advocates of MPD have steadfastly resisted placing MPD on Axis I1 of the DSM-1114 (American Psychiatric Association, 1987) diagnostic scheme.’ Confining the diagnosis of MPD to Axis I means that the primary grounds for diagnosing MPD is evidence that the patient sometimes behaves in a manner that is completely out of character, often with acompelling experience that another person inside the same body initiated the deviant, egoalien action. It seems much simpler and more parsimonious to assume that a dissociated system of ideas of fantasies generates these ego-alien experiences and behavior as implicitly suggested effects8 It is appropriate at this point to comment critically on two arguments that frequently surface in defense of the MPD diagnosis. Kluft (1987). in a recent review of MPD, asserts that “On the whole, the skeptical literature consists of opinions that, however eloquent, do not constitute scientific data [p. 3651.” He goes on to imply that MPD is scientifically valid because researchers who diagnose MPD patients typically use DSM-Ill (American Psychiatirc Association, 1980) criteria. ’Axis I1 of DSM-Ill-R is reserved for developmental and personality disorders, the latter of which includes anti-socialand borderline disorders. It would also seem to be a reasonable axis for MPD. particularly since most instances of the syndrome may well have their origins in physical and sexual abuse suffered in childhood (see for example Putnam. Curoff, Silberman. Barban. & Post, 1986). One possible reason for resisting an Axis I1 designation for MPD is that it would no longer be officially categorized as a dissociative disorder. Since MPD is widely considered the “flagship” dissociative disorder, moving it to Axis I1 would substantially reduce the size and status of the dissociativedisorders in psychiatry. It should be emphasized that even if MPD were aligned on Axis I1 in future editions of D S M , the most direct and straightforward implication would be that the syndrome has a developmental course (Watkins & Johnson, 1982) that needs to be recognized in the diagnosis of MPD. It would not necessarily mean that a secondary or tertiary personalfty was fully realized, developmentally speaking;whether an alternate personality had a legitimate claim to being genuine in the developmental sense would need to be further substantiated. In other words, deciding that a secondary personality is developmentally genuine requires more and stronger evidence than that required for a decision to place MPD on Axis I1 of DSM. ‘It should be acknowledged that there is an even more skeptical position regarding MPD than the one I have outlined. Spanos’social psychological position conceptualizes MPD as a kind of motivated role-playing in accordancewith demand characteristics(Spanos,Weekes, & Bertrand, 1985; Spanos, Weekes, Menary, & Bertrand, 1986). An informed and critical review of the literaturebn MPD m m s largely to agree with him (Aldridge-Morris, 1989). The main differen- between Spanos’ view of MPD and mine concerns my preference for, and Spanos’ rejection of, dissociation and suggestion as important to the formation of what appear to be alternate penonalities. We agree, however, that various pathogenic fantasies. inspired by television, for example, can result in MPD-type symptoms prior to any thempeutic intervention. Finally. there LC the possibility that at least some cases of MPD are simply faked, especially when such a diagnosis has immediate benefit for the patient (see for a possible example M. T.Orne, Dinges, t E. C. Orne, 1984).


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It is fair to say that with the advent of DSM-Ill and -111-R,there is more reliability in psychiatric diagnosis than there used to be. As the authors of DSM-11I recognize, however, reliability is a necessary, but not a sufficient, basis for validity. Highly reliable observation or categorization can be achieved without any guarantee that reality has been carved at its joints. However many independent observers may agree that whales swim, it is insufficient grounds for a claim that whales are fish. The fact is that many of the most vociferous advocates of MPD were authors of the DSM-111-R section on dissociative disorders, so it is not surprising that they would appeal to that section as supporting the scientific validity of multiple personality. I am reminded here of a comment that Karl Shapiro, the eminent American poet and critic, once made about T. S. Eliot. He said that Eliot spent many years developing critical standards by which poetry should be judged; then he wrote poetry that accorded with these standards. It’s good work if you can get it. Another defense of MPD is that when clinicians do not treat MPD patients for the disorder, they do not get better; conversely, accepting the fact that a patient suffers MPD, and treating hindher accordingly, typically leads to improvement or cure. Thus, treatment success validates diagnosis. While I can understand the impetus behind this argument, it simply does not hold water. By that logic, headaches are caused by the lack of aspirin. As well, Mesmer’s dramatic cures imply the validity of his claim that animal magnetism exists, and that realigning a patient’s magnetic equilibrium is the basis for healing. It is undeniably true that patients’ beliefs about the nature of their problems can adversely affect their psychological, and even their physical health. People have died because of an absolute conviction that they had been hexed, or that they had sinned irredeemably (Ellenberger, 1970; Sargant, 1973). It is also true that a sensitive clinician can profoundly alter the course of disorder and disease by responding appropriately to the patient’s subjective reality. But it is not necessary to share patients’ beliefs in order to treat them successfully. Several years ago at one of this Society’s meetings, Smith (1986)presented a thoughtful paper in which he reported going along with a patient’s need to view her current psychological problems as a consequence of events that occurred in a previous life. He somewhat reluctantly engaged in past-lives therapy, and it was evidently quite successful. Smith, who did not believe for one moment that the patient’s past lives were objectively true. was quite thoughtful in his summarizing remarks: And what of the therapist and his role? Should I have attempted to abort the process instead of facilitating it, not allowed the patient to feel that I was endorsing the reality of her experience? Should I have confronted the patient with the defensive nature of her retreat to the past, interpreted her behavior and thus encouraged her to attempt more conventional understandings of her conflicts? I am convinced that such an interven-

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tion would have come to nothing. In essence, I accepted the patient’s reality while regarding it as a useful metaphor. respecting her apparent need to use the vehicle of past lives to carry out her treatment aims. These were the terms, the conditions under which this patient at this time could feel differently about herself and her life. I occasionally felt a twinge of conscience. a worry that I was being dishonest by “playing along” when I was not actually a believer, but my urge to confess was stifled by the patient‘s absorption in the process and what appeared to be meaningful. productive work [Smith, 19861. Clearly, it is unnecessary for the therapist to share the patient’s belief in the literal existence of a post life or personality in order to respond sensitively and effectively to the patient’s need for such a belief. Similarly, it is unnecessary to believe in the literal existence of an alternate life or personality to deal effectively with a so-called MPD patient. Moreover, even when past lives therapy is successful, or when a patient diagnosed as MPD is successfully integrated, it does not scientificallyvalidate beliefs in reincarnation or in multiple personality - no matter how much the patient, or the clinician, might wish that it did. Finally, the common assertion that MPD patients have been successfully treated by fusing or integrating the various personalities is no substitute for scientific evidence that this is the typical outcome of therapy. Indeed, in a recent book on multiple personality, Putnam (1989) frankly states that with perhaps one or two exceptions, “there are no clear indications of treatment outcomes for MPD patients. This lack of outcome data is both surprising and dismaying [p. 2971.’’ He later asserts: “It is my belief that the current lack of systematic outcome data has created a vacuum currently filled by unrealistic expectations and assumptions about integration such as those seen in The Three Faces of Eoe [p. 2981.” As we have already seen, advocates of MPD have in the past not hesitated to wrap themselves in the mantle of science when making claims about the reality of MPD; I hope in the future, they will have as much tenacity (and more success) in establishing the scientific validity of their claim that identifying and then integrating various personalities is a truly effective therapeutic procedure for MPD patients. I am frankly skeptical about the possibilities in this regard (cf. Halleck, 1990). CONCLUSION In concluding this presidential address, I would like to emphasize that while the gap between the scientist and the clinician can sometimes be a chasm, one of the real benefits of the Society for Clinical and Experimental Hypnosis (SCEH) is that communication between scientist and clinician is built right into our Constitution, and into the fabric of the annual SCEH meetings. Accordingly, I have,tried to highlight just how the scientific enterprise can help us to think clearly about current issues in psychopathology particularly about multiple personality. It should also be recognized, however, that clinicians are sometimes quite prescient in identlfying important psychological realities that scien-

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tists dismiss as fanciful projections of uncritical muddleheadedness. After all, despite his fallacious theory, Mesmer was often quite helpful to his patients -a fact that the Franklin Commission did not wish to emphasize in their decidedly negative report on animal magnetism (reprinted in Tinterow, 1970).It took more than 150 years for the scientific investigation of hypnosis to reconsider this judgment, and to appreciate that there was an important phenomenon to understand and harness. Sometimes even a patently erroneous belief - in animal magnetism, for example - can partially reveal an important aspect of reality that scientists prematurely dismiss, because they often do not readily discern what is true in what is false.

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389-103. BLISS. E. L. A symptom profile of patients with multiple personalities. including MhlPI results. J . nerw. ment. Dis., 1984. 172. 197-202. BLOCK, J . Liwes through time. Berkeley, CA: Bancroft, 1971. BLOCK,J. Assimilation. accommodation. and the dynamics of personality development. Child Deoelop.. 1982, 53, 281-293. BOWERS,K. S. Unconscious influences and hypnosis. In J. Singer (Ed.), Repression and dissociation: Implicationsfor personality theory, psychopathology. and health. Chicago: Univer. of Chicago Press, 1990. Pp. 143-179. BOWERS, K. S., & DAVIDSON. T. M. A neo-dissociative critique of Spanos's social psychological model of hypnosis. In S. J. Lynn & J. W. Rhue (Eds.), Theories of hypnosis: Current models and perspectioes. New York: Guilford, in press. BROWN, J. I.. BENNETT, J. M., & HANNA,G. Nelson-Denny Reading Test. Boston: Houghton-MifRin, 1973. BU-ITERFIELD, H. The origins of modern science 1300-1800. New York: Free Press, 1957. ELLENBERCER. H . The discovery of the unconscious: The history and eoolution of dynamic psychiatry. New York: Basic Books, 1970. FRANKEL. F. H. Hypnosis: Trance A( a coping mechanism. New York: Plenum, 1976. GILL, M. M., & BRENMAN,M. Hypnosis and related states. New York: International Universities Press, 1959. GREAVES, G. B. Multiple personality: 165 years after Mary Reynolds. /. nerw. ment. Dis., 1980,168,577-596. HALLECK,S. L. Dissociative phenomena and the question of responsibility. Int. J . clin. exp. Hypnosis, 1990. 38, 298314. HILGARD.E. R. A neodissociation theory of pain reduction in hypnosis. Psychol. Reo.. 1973. 80,396411. HILCARD,E. A. Dioided consciousness: Multiple controls in human thought and action. New York: Wiley, 1977. HILCARD,E. R. Divided consciousness in hypnosis: The implications of the hidden observer. In E. Fromm & R. E. Shor (Eds.). Hypnosis: Decclopments in research and new perspectioes. (Rev. 2nd ed.) New York: Aldine. 1979. Pp. 45-79.

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HILCARD.E. R. Illusion that the eye-roll sign is related to hypnotizability. Arch. gen. Psychol.. 198239,963-986. HILCARD.J. R. PerronaUty and hypnosis: A study of imaginatitw inwluement. Chicago: Univer. of Chicago Press, 1979. HOLTON,G. Thematic wtgtnr of acienrific thought: Keplcr to Einstein. Cambridge, MA: H a r d Univer. Press, 1973. HUGHES,D. Factors related to heart rate change for high and low hypnotimbles during imagery. Unpublished doctoraldissertation, Universityof Waterloo. Waterloo, Ontario, Canada, 1988. KAHNEMAN, D. Attention and effort. Englewood Cl&, N J: Prentice-Hall, 1973. KAHNEMAN. D., I~~RSKY, B.. SHAPIRO,D.. & CRIDER,A. Pupillary, heart rate, and skin resistance changes during a mental task. 1.cxp. Psychol., 1969. 79, 164-167. KIHLSTROM. J. F. Consdous, subconscious, unconscious: A cognitive perspective. In K. S. Bowers, & D. Meichenbaum (Eds.), The uncowciws reconsidered.New York: Wiley, 1984.

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KIHLSTROM. J. F. The cognitive unconscious. Science, 1987.237, 144S-1452. KLUFT,R. P. An update on multiple personality disorder. H o a p . comm. Psychiat.. 1987.38, 363473.

LACEY.J. Somatic response patterning and stress: Some revisions of activation theory. In M. H. Appley h R. Trumbell (Eds.), Psychological stress. New York: Appleton-Century-Crofts, 1967. Pp. 14-37. MILLER,G . A., GALANTER,E.,& PRIBRAM, K. H. Phw and the structure of behauior. New York: Holt. 1960. MILLER,M. Hypnotic analgesia and stress inoculation in the reduction of cold-pressor pain. Unpublished doctoral dissertation, University of Waterloo, Waterloo, Ontario, Canada, 1986.

MONTEIRO, K. P., MACWNALD, H., & HILCARD, E. R. Imagery. absorption, and hypnosis: A factorial study. 1.ment. Itnag.. 1980,4, -1. NADON. R., LAURENCE, J.-R. & PERRY,C. Multiple predictors of hypnotic susceptibility. ]. pen. soc. Psychol., 1987.53.948-960. NORMAN,D. Categorization of action slips. Paychd. Reo., 1981,88, 1-15. ORNE,M. T.. DINCES. D. F.. & ORNE. E. C. On the daerential diagnosis of multiple personality in the forensic context. Int.1. din. crp. Hypnosis,1984.32, 118-169. PUTNAM.F. W. Diagnosis and treatment of multiple personality disorder. New York: Guilford. 1989. PUTNAM. F.W., GUROFF.J. J,, SILBERMAN. E. K., BARBAN, L.. C POST, R. M. Theclinical phenomenology of multiple personality disorder: Review of 100 recent cases. J . clin. Psychiat., 1986.47.285-293, REASON, J. Actions not as planned: The price of automatization. In G. Underwood t R. Steven (Eds.), Aapecfs of cormbumem, 1 . New York: Academic Press. 1979. Pp. 67-89.

SARCANT,W.The mind possessed: A phyaiologyof possession, mysticism, andfaith heding. London: Heinemann, 1973. SCHREIBER.F. Sybil. Chicago: Regency, 1973. SHOR,R E. Hypnosis and the concept of the generalized reality orientation. Amer. J . Psychother., 1959,13, S32-602. SHOR.R. E. The three-factor theory of hypnosis ar applied to the book-reading fantasy and to the concept of suggestion. I t . ] . din. cxp. Hypnorb, 1970.28. M. SHOR,R. E.. t O m , E. C. Harwrd C m p Scak of Hypnotic Susceptibflity. Form A . Palo Alto, CA: Consulting Psychologists Press, 1982. SMITH.W.H. Spontaneous regression to part lives: Reincarnation or displacement? Paper presented at the 37th Annual Meeting of Society for Clinical and Experimental Hypnosis, Chicago, September 1986.

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SPANOS.N. P. Hypnotic behavior: A social-psychological interpretation of amnesia, analgesia, and “trance logic.” Behao. Brain Sci.. 1986, 9, 449467. SPANOS,N. P.. & CHAVES.J. E Hypnosis: The cognitiue-behaoioral perspective. New York: Prometheus, 1989. SPANOS, N. P.. %EKES, J. R.. C BERTRAND. L. D. Multiple personality: A social psychological perspective. /. abnorm. Psychol., 1985,94,362-376. SPANOS,N. P., %EKES, J. R., MENARY, E., & BERTRAND.L. D. Hypnotic interview and age regression procedures in the elicitation of multiple personality symptoms: A simulation study. Psychiatry, 1986.49, 298311. SPIECEL,D., HUNT, T.. C DONDERSHINE, H. E. Dissociation and hypnotizability in posttraumatic stress disorders. Amer. /. Psychiat.. 1988. 145, 301305. ’T~ICPEN. C. H., C CLECKLEY.H. On the incidence of multiple personality disorder: A brief communication. 1nt.J. din. exp. Hypnosis, 1984, 32. 63-66. ~NTEROW M., M. Foundations of hypnosis. Springfield. I L Charles C Thomas. 1970. ’RJRK,D., MEICHENBAUM,D. H., & CENEST,M. Pain andbehaoioral medicine:A cognitioebehaoioral perspectioe. New York: Cuilford. 1983. UNDERWOOD, G. Attention and awareness in cognitive and motor skills. In C. Underwood (Ed.), Aspects of consdwsness. (Vol. 3.)New York: Academic Press, 1982. Pp. 111-145. WATKINS, J. C., & JOHNSON,R. J. We,the dioided self. New York: Irvington. 1982. WITZENHOFFER, A. M. Hypnotism and altered states of consciousness. In A. A. Sugarman C R. E. Tarter (Eds.). Expanding dimensions of consciousness. New York: Springer, 1978. Pp. 183-225. WITZENHOFFER. A. M. Hypnotic susceptibility revisited. A m r . /. clin. Hypnosis. 1980, 22, 130-146. WEITZENHOFFER, A. M., C HILCARD, E. R. Stanford Hypnotic Susceptibility Scale, Form C. Palo Alto, CA: Consulting Psychologists Press, 1962. WILSON,S . C., C BARBER, T.X. The fantasy-prone personality: Implications for understanding imagery. hypnosis, and parapsychological phenomena. In A. A. Sheikh (Ed.), Imagery: Current theory, research, and application. New York: Wiley. 1983. Pp. 340490. Dissoziation bei Hypnose und multiplen Persiinlichkeitsstiirungen Kenneth S. Bowers Abstrakt: Der erste Teil dieser Abhandlung priift den Begriff einer Dissoziation im Hypnosekontext. Im besonderen werden die neodissoziativen und sozial psychologischen Modelle der Hypnose verglichen. Man diskutiert, ob das sozial psychologische Modell. wihrend es die hypnotische Ausfiihrung ala vorsPtzlich beschreibt, nicht geniigend zwischen einem Benehmen unterscheidet, das ‘einem Vorsatz” entspringt und einem Benehmen, das einem Vorsatz dient oder ihn erfiillt. 2 Kiirzliche Dissertationen (Hughes, 1988; Miller, 1986) aus der Universittit von Waterloo werden hier zusammengefdt. in denen jede die neodissoziative Ansicht unterstiizt, d d hypnotisches Benehmen voniitzlich sein kann (in dem Sinn, daU die angedeutete Sachlage erreicht ist) und unfreiwillig (in dem Sinn, daS die angedeutete Sachlage weder durch hochgradige, exekutive Initiative noch durch fortdauernde Anstrengung erreicht worden ist). Der m ei t e Teil der Abhandlung benutzt eine neodissaiative Ansicht der Hypnose, um die augenblickliche Epidemie von Pers6nlichkeitsstiirungen (MPD) versthdlich zu machen. Im besonderen wid dishtiert, daU viele der MPD-Symptome unbedingt angedeutete Effehe sind besonders dazu geneigt bei Personen a u h t r e t e n , die eine lebenslange Tendenz zum Cebrauch von dissoziativartigen Verteidigungen aufweisen. Der gegenwhtige Autor glaubt, d d diese Beriichichtigung konzeptionell und empirisch einfacher aufrecht zu erhalten ist als die gegenwirtige Ansicht, die erklirt, daU eine sekundire (tertiare, usw.) Persiinlichkeit fur die schlagenden, phinomenologischen Diskontinuititen, die MPD-Patienten durchmachen, verantwortlich ist.

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Dcsordre & personnalitbs multiples at dissociation durant I'hypnose


Kenneth S. Bowdm RQumC La premibre partie de cet article analyse le concept de dissociationdans le cadre de I'hypnore. Les modbles de la nCodirsociation e t de la psychdogie socide de I'hypnose sont plus particulibrement compads. II est soutenu qua le modble de la psychologie d a l e , dans sa description des agin hypnotiques comme btant orient& vers un but, ne distingue par adhuatement entre un comportement qui est pod avec une intention volontaire et un comportement permettant d'atteindre un objectif. Deux thbses dcentes (Hughes, 1988; Miller, 1986) de I'UniversitC de Waterloo sont rCsumCes. Chacune s u p porte le modble nCodis+tif qui stipule qu'un comportement hypnotique est orient6 ven un but (dam le sens qu'un &at de fait suggCr6 est atteint) mair non volontaire (dans le sens que I'Ctat de fait sugg6rC n'est pas atteint par un niveau Clevb #initiative d'ex6cution et un effort continu). Lp seconde partie de I'article utilise le modble nbdbsociatif de I'hypnose afin de faciliter la comprChension de I'actuelle CpidCmie de dbsordres de personnalitbs multiples (DPM). II est particulibrement soutenu que plusieurs des symptb mes du DPM sont des effets ruggCrCs implicitement apparaissant plus particulibrement chez lea personner nyant une tendance naturelle A utilier des dbfenses de type dirsociatif. L'auteur croit que cette conception est plus facile A soutenir autant au niveau empirique que conceptuel. que I'actuelle conception voulant qu'une penonnalitb secondaire (tertiaire, etc. ) soit responsable des discontinuitbs phCnomCnologiques Ctonnantes affectant les patients souffrant de DPM.

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Desorden de personalidades multiples y di~ociaci6ndurante la hipnosis Kenneth S. Bowers Resumen: La primera parte de este artfeulo examina el concept0 de la dirociaci6n en el context0 de la hipnosis. L a modelm de la neodisociaci6n y de la sicologia social de la hipnosis son comparados de manera m b particular. El argument0 sostiene que el modelo de la sicologia social, en su descripci6n de actos hipnoticos orientadol hacia una meta, no distingue suficientemiente entre el comportamiento que se hace de proposito y entre el comportamiento que se hace para obtener un objectivo. Se resumen dos tesis nuevas (Hughes, 1988; Miller, 1986) de la Univenidad de Waterloo. Cada una apoya el modelo neodisociativo que sostiene que un comportamiento hipnitico puede ser orientado hacia una meta (en el sentido que el estado sugestivo es logrado) per0 no voluntario (en el sentido que el estado sugestivo no es logrado para una iniciativa de alto nivel ejecutivo y de esfueru, continuo). La segunda parte del articulo utiliia el modelo neodicocintivo de la hipnosis para mejor comprender la epidemia actual de desorden de personalidades multiples (DPM). Es particularmiente wstenido que muchos sintomas de DPM son efectos sugeritor de manera implicata apareciendo especialmente en personas que tienen una tendencia natural de utilisar defensas de tip0 d d t i v o . El autor piensa que es m b fhcil sostener esta concepcibn tanto como de un nivel emptrico que de un nivel conceptual, que la concepci6n corriente que dedara que una personalidad segundaria (tercera, etc.) es responsable para IMdemnblnuidader fenomenol6giclls experimentadas por lor pacientes atligidos de DPM.

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Dissociation in schizophrenia and borderline personality disorder.

Dissociation, borderline personality disorder, and childhood trauma.

The use of hypnosis in a deaf patient with multiple personality disorder: a case report.

The interface between multiple personality, spirit mediumship, and hypnosis.

Multiple personality disorder.

Multiple personality disorder.

Multiple personality disorder.

Multiple personality disorder.

Multiple personality disorder.

Manufacture of multiple personality disorder.

Neurophysiological correlates of hypnosis and dissociation.

SPECT imaging and multiple personality disorder.

Rorschach indicators of Multiple Personality Disorder.

Multiple personality disorder presenting as postpartum depression.

Treatment of a deaf multiple personality disorder.

Multiple personality disorder: where is the split?

Multiple personality disorder: a factual error.

Differential diagnosis of multiple personality disorder.

Schneiderian symptoms in multiple personality disorder and schizophrenia.

Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder.

The psychophysiological investigation of multiple personality disorder: review and update.

Abuse histories in 102 cases of multiple personality disorder.

Assessment of ego functioning in multiple personality disorder.

Accuracy of the MMPI in identifying multiple personality disorder.