The Original Meaning of "Hypnotic Trance"

In this article, I wish to briefly correct certain historical and semantic misconceptions about hypnotism and to highlight an important sense in which research on hypnotism has come full circle.  Modern nonstate or cognitive-behavioural researchers of hypnotism tend to emphasise its similarity to normal psychological processes, and thereby its overlap with other psychological therapies such as CBT.  They avoid using terminology which implies an abnormal psychological state, like “trance” or “altered state of consciousness”, to describe the experiences and behaviour of hypnotic subjects.  Researchers like T.X. Barber nevertheless have conceded that in a small minority of “exceptional” cases, certain hypnotic subjects may exhibit unusual responses, although these may be individuals who exhibit unusual personality traits in general such as abnormally high levels of “fantasy proneness” or dissociative and amnestic tendencies in daily life.

According to James Braid, the founder of hypnotherapy, hypnotism is a state of “mental abstraction” (concentration) upon a dominant, expectant image or idea. In about 10% (reports vary between about 5-20%) of Victorian hypnotists' clients this was capable of inducing a (superficially) sleep-like state followed by profound (reversible) amnesia.

Braid later tried to reserve the term “hypnotism” for the 10% and referred to the others as sub-hypnotic or in a state of mono-ideism, i.e., a state of mental concentration upon a single (mono) dominant idea or train of thought. Braid was clear that multiple factors contributed to the hypnotic process, rather than a single cause or state, and that it was accompanied by a wide range of different subjective feelings and physiological states. He observed the role of expectation, social imitation, mental association, concentration, inattention, reverie, etc.

One notable point, from a modern perspective, is that Braid very seldom used the word “trance” to describe hypnosis. He did write a book entitled Observations on Trance or Human Hybernation (1850). However, as this book makes clear, in the Victorian era, the word “trance” was used to describe a disease, or rather medical symptom, synonymous with “catalepsy” or “coma”, and which Braid compared to the state of animal hibernation. Braid reserves the word “trance” for a very small minority of hypnotic clients who enter a state superficially resembling a coma. He was certainly talking about less than 10% and probably less than 1% of his subjects. The word “trance”, at that time, carried the connotation of being half-dead or on the verge of passing over to death. Etymologically, the English word “trance” comes, via old French, from the Latin verb “transire” meaning “to pass across” (to the other side of death) or simply “to die”. Hence, the association with the state of coma.  As Sarbin & Coe observe,

It is not inconsequential for our analysis [of hypnosis] that the earlier forms of the word trance (“traunce”, “trauns”, “trans”), were used to convey the meaning of a passage from life to death (probably from the Latin transire; trans = across + ire = to go).  At first a metaphor to denote an intermediate way station on the mystifying transit from the earthly to the spiritual world, “trance” was borrowed to index another intermediate condition – that between the mundane condition of waking and the perplexing condition of sleep.  In like manner, the term was employed to represent the total or partial immobility that sometimes characterises persons who suspend all actions under conditions of dread or of doubt and uncertainty. (1972: 107)

Over time, the somewhat sensational word “trance” became used more and more widely by hypnotists until it was taken, by Milton Erickson for example, to refer to the experiences of almost every hypnotic subject. The concept of the “naturalistic” or “everyday” trance was introduced, watering the term down to the extent that it went from referring to exceptionally rare comatose subjects to the experience of daydreaming or being engrossed in a newspaper story or movie, etc.  However, as far as I'm aware, Hippolyte Bernheim, the founder of the Nancy School of hypnotherapy, and probably the second most important person in 19th century hypnotism beside Braid, did not use the term “hypnotic trance” either.  Indeed, Alan Gauld, the author of the authoritative A History of Hypnotism, is struck by the same anomaly,

Curiously enough, the term “trance” (transe, Verzückung), which has such a popular vogue today, was somewhat rarely used, being most often adopted by mid-nineteenth-century English and American writers. (Gauld, 1992:xvi)

However, in the mid-nineteenth-century, Braid only used the term to refer to an exceptional state, and never to the normal states mediating hypnotic responses.  He opens his book on “trance” with the following quotation from the medical writer Robert MacNish,

The most singular species, however, of suspended animation, is that denominated catalepsy, or trance. No affection, to which the animal frame is subject, is more remarkable than this. During its continuance, the whole body is cold, rigid, and inflexible; the countenance without colour; the eyes fixed and motionless: while breathing and the pulsation of the heart are, to all appearance, at an end. The mental powers, also, are generally suspended, and participate in the universal torpor which pervades the frame. In this extraordinary condition, the person may remain for several days, having all, or nearly all, the characteristics of death impressed upon him. […] There is such an apparent extinction of every faculty essential to life, that it is inconceivable how existence should go on during the continuance of the fit. (Macnish, 1830)

Braid later gives the following definition of “hypnotic coma”, by which he means “trance”,

[…] let the term hypnotic coma denote that still deeper stage of the sleep in which the patient seems to be quite unconscious at the time of all external impressions, and devoid of voluntary power, and in whom no idea of what had been said or done by others during the said state of hypnotic coma can be remembered by the patient on awaking, or at any stage of subsequent hypnotic operations. (Braid, 1855)

Braid uses the term “nervous coma” or “hypnotic coma” to refer specifically to a state which could be induced in “comparatively few” subjects in which they were completely insensible and unconscious during surgery, and experienced total spontaneous amnesia for the whole experience.  At this time the effects of surgical anaesthetics such as ether were also described as a “coma” state.  Hence, to recap, Braid defines “hypnotic trance” as being an exceptionally rare state, beyond normal focused attention, and beyond even the “somnambulistic” or amnestic state found in roughly 10% of his clients.  Instead of ordinary sleep, relaxation, or focused attention, he describes it as being analogous to,

1. The state of suspended animation or hibernation in certain species of animals.
2. The morbid state of certain catatonic or comatose patients.
3. The unconscious condition of subjects under general anaesthetics such as ether.
4. The alleged death-like state of Oriental fakirs who claim to be able to survive being buried alive by slowing down their bodily functions in meditation.

This is a far cry from the Ericksonian concept of an everyday trance. However, a controversy surrounds this extension of the word. Although hypnotherapists frequently refer to everyday states of reverie, etc., as “trance”, most ordinary people do not, and find this terminology confusing and possibly rather misleading. It adds a veneer of the supernatural to hypnotherapy which potentially makes it seem more dramatic (and hence popular with stage hypnotists) but also creates fear, confusion, and opposition among many people. Not least, it alienates hypnotherapists who use this terminology from other branches of psychological therapy, which do not. For example, most hypnotherapists would concede that in the majority of cases, the use of concentration, mental imagery, positive suggestions, relaxation, etc., in CBT resembles the same techniques in hypnotherapy, and research consistently shows that it achieves very similar results. However, CBT practitioners would be utterly baffled by the claim that their clients are “in a state of hypnotic trance.” The same applies to many humanistic and other therapies which use guided imagery, positive thinking, relaxation, etc., in ways which are not only similar to but often historically derived from hypnotherapy.

Another problem with the word “trance” is that it implies to the minds of many novice hypnotists that a single causal factor (depth of trance) accounts for most of the effects of hypnotic suggestion. This is almost certainly completely false and the cause of much confusion in practice. A multitude of ordinary psychological factors have been shown to contribute to the responses of hypnotic subjects, and hypnotherapists should be working with all of them in parallel in order to optimise their results. They include, for example, inter alia,

1. The quality of the relationship between hypnotist and subject, and the level of trust, authority, congruence, etc.
2. The personality traits of the client and relatively stable (long-standing) qualities such as intelligence, perseverance, fantasy proneness, trait neuroticism, dissociative tendencies, etc.
3. The wording of suggestions and delivery of other techniques and strategies.
4. The level of client motivation and the presence of performance anxiety or other counter-motivational factors or mixed feelings, etc.
5. The social setting, influence of persuasion and the pressure on the client to imitate, comply, etc.
6. The client's (cognitions) beliefs, attitudes, expectations about hypnosis, their role-perception, etc.
7. Previous experience of hypnotic suggestion and similar exercises, i.e., pre-existing skill levels.

Hence, when novice therapists say, “I tried to hypnotise someone but my suggestions didn't work; I need to try to get them deeper into trance next time”, as they often do, they are probably chasing a red herring. They would do better to discuss the client's expectations for the session, try to foster better communicaiton with them, reassure them, construct graduated trial and error skills training exercises to shape their responses in smaller steps and stages, mutually evaluate their use of suggestion and therapy techniques, and generally talk to them some more about things.