Kihlstrom, John F.; Barnhardt, Terrence M.; Tataryn, Douglas J. (1992). The psychological unconscious. American Psychologist, 47, 788-791.

In response to Greenwald’s article on contemporary research on unconscious mental processes, the authors address three issues: (a) the independence of much recent research and theory from psychodynamic formulations; (b) the broad sweep of the psychological unconscious, including implicit perception, memory, thought, learning, and emotion; and (c) the possibility that the analytic power of unconscious processing may depend both on the manner in which mental contents are rendered unconscious and the manner in which they are to be processed.
Kunzendorf, Robert; Carrabino, Carlene; Capone, Daniel (1992-93). ‘Safe’ fantasy: The self-conscious boundary between wishing and willing. Imagination, Cognition and Personality, 12, 177-188.

This experiment tested the hypothesis that a fantasy will impel people to ‘act out’ only if they fail to distinguish the fantasy from the anticipated reality. In the experiment, one task obtained a baseline measure of how long subjects could resist eating popcorn, then measured how long subjects could resist popcorn while fantasizing its taste. Another task instructed subjects to merge three circular images with three circular percepts of equal vividness, then presented subjects unexpectedly with only two of the three circular percepts. Some subjects thought that there were three circular percepts during the merger, and for these subjects, the length of resistance to popcorn was significantly shorter during the popcorn fantasy. But for subjects who self-consciously differentiated the two real circles from the three merging images, the normal ‘boundary’ between wishful fantasy and willful eating was intact.

This research investigated whether people can fantasize without acting out. The authors place the study in the context of theories proposed by Freud and William James. Kunzendorf’s source monitoring theory of self-consciousness suggests that “self- consciousness _that one is imaging_ is the phenomenal consequence of neurally monitoring the central source of one’s imaged sensations, and self-consciousness _that one is perceiving_ is the subjective quality of neurally monitoring the peripheral source of one’s perceived sensations” (p. 178).
The ability to carry out source monitoring varies. Those who have difficulty monitoring whether they are imaging or perceiving may also have trouble distinguishing wishful fantasy from anticipatory imagery, and therefore they might act on it.
This research “identified subjects with poor source monitoring–nondiscerners of reality–and investigated the effect of fantasy on their impulse control” (p. 179).
Subjects sat in front of a computer monitor for all tests; they completed Eysenck’s seventh impulsivity questionnaire for measures of impulsivity, venturesomeness, and empathy, Marks’ Vividness of Visual Imagery Questionnaire (VVIQ).
The study used a test in which subjects maintained in mental imagery a red, green, and yellow filled circle that had been on screen, with eyes closed; were instructed to open eyes and merge their 3 imaginary circles with the 3 on the screen (but when they opened eyes only 2 were there), and they were then asked questions about how many circles they saw when they opened their eyes.
Then they were given a taste of popcorn, told to resist eating any more (but could press a key to receive a little if they couldn’t resist), and then were told to resist by imagining that they were eating popcorn.
Those who discerned the two real circles while imaging a third circle of equal vividness (the Discerners), could resist eating popcorn for 137 sec in the baseline condition and 132 sec in the fantasy condition. Those who could not discern two real circles while imagining a third (Nondiscerners) could resist eating popcorn for 127 sec in the baseline treatment but only 95 sec in the fantasy treatment.
Discerners could identify the missing circle as the red one, whereas nondiscerners could not do so with any certainty; there was no effect of “image vividness”.
“Vivid imagers” whose imagery matched real yellow circles of greater illuminance, exhibited more vivid imagery on the VVIQ as well.
In their Discussion, the authors suggest that “fantasy impels people to ‘act out’ only if they fail to distinguish fantasized sensations from perceived sensations. … [the theory] is applicable to sexual fantasy and aggressive fantasy as well. This theory– Kunzendorf’s ‘source monitoring’ theory of self-consciousness–implies that fantasies of the sensory consequences of a behavior should not lead to the behavior, so long as the fantasies are self-consciously known to be imaginal and are not expected to be perceptual… But for people who cannot self-consciously distinguish between wishful images of pure fantasy and anticipatory images of perceptual reality, between wishing and willing, fantasies of gastronomical, sexual, or aggressive sensations are implicitly unsafe.
“Indeed, as Baars notes, ‘the issue of voluntary control is at the very core of human psychopathology’ [31, p. 254]. But recently, Baars’ and others’ theories of volition have emphasized the computer-metaphoric distinction between conscious ‘willful’ behavior and unconscious ‘automatic’ action [31, 39-40], and have neglected James’ distinction between conscious willing and conscious wishing. Decades ago, when pre- computational theorists like Janet used the term ‘automatism’ to describe psychopathological behavior, they meant that an abnormally behaving patient was _consciously ‘possessed’ by a fantasy_–a wishful image, a hypnotic suggestion, or a fantasized personality [41]. In reemphasizing the phenomena of wishing, willing, and possession by fantasies, the present article redefines the latter phenomenon as possession by ‘unmonitored’ fantasies, which are distinguishable from anticipatory images impelling action” (pp. 184-185).

Levitan, Alexander A. (1992). The use of hypnosis with cancer patients. Psychiatric Medicine, 10, 119-131.

Hypnosis has proven to be extremely valuable in the treatment of cancer patients. Specific applications include: establishing rapport between the patient and members of the medical health team; control of pain with self-regulation of pain perception through the use of glove anesthesia, time distortion, amnesia, transference of pain to a different body part, or dissociation of the painful part form the rest of the body; controlling symptoms, such as, nausea, anticipatory emesis, learned food aversions, etc.; psychotherapy for anxiety, depression, guilt, anger, hostility, frustration, isolation, and a diminished sense of self-esteem; visualization for health improvement; and, dealing with death anxiety and other related issues. Hypnosis has unique advantages for patients including improvement of self-esteem, involvement in self-care, return of locus of control, lack of unpleasant side effects, and continued efficacy despite continued use.

Loftus, Elizabeth F.; Klinger, Mark R. (1992). Is the unconscious smart or dumb?. American Psychologist, 47, 761-765.

How sophisticated is unconscious cognition? This is one of the most fundamental questions about the unconscious that has been posed by research psychologists over the past century. Anthony Greenwald takes a contemporary look at this classical problem and concludes that unconscious cognition is severely limited in its analytic capability. In response, other leading scholars agree that the reality of unconscious processes is no longer questionable. Although there is some disagreement about just how sophisticated these processes are, the consensus is that exciting times are ahead for both research and theory concerning the mental processes involved in unconscious cognition.

Miller, Scott D.; Triggiano, Patrick J. (1992). The psychophysiological investigation of multiple personality disorder: Review and update. American Journal of Clinical Hypnosis, 35, 47-61.

A review and methodological critique. Updates Putnam, 1984. Currently, psychophysiologic differences reported in the literature include changes in cerebral electrical activity, cerebral blood flow, galvanic skin response, skin temperature, event- related potentials, neuroendocrine profiles, thyroid function, response to medication, perception, visual functioning, visual evoked potentials, and in voice, posture, and motor behavior. Reviews the new research on the psychophysiological investigation of MPD from published, unpublished, and ongoing studies, and attempts to place current findings into a conceptual framework. Authors note results from unpublished and ongoing studies and include a critical analysis of current research methodology as well as suggestions for future research.

Ofshe, Richard J. (1992). Inadvertent hypnosis during interrogation: False confession due to dissociative state; mis-identified multiple personality and the satanic cult hypothesis. International Journal of Clinical and Experimental Hypnosis, 40, 125-156.

Induction of a dissociative state followed by suggestion during interrogation caused a suspect to develop pseudo-memories of raping his daughters and of participation in a baby-murdering Satanic cult. The pseudo-memories coupled with influence from authority figures convinced him of his guilt for 6 months. During this time, the suspect, the witnesses, and all the evidence in the case were studied. No evidence supported an inference of guilt and substantial evidence supported the conclusion that no crime had been committed. An experiment demonstrated the suspect’s extreme suggestibility. The conclusion reached was that the cult did not exist and the suspect’s confessions were coerced- internalized confessions. During the investigation, 2 psychologists diagnosed the suspect as suffering from a dissociative disorder similar to multiple personality. Both psychologists were predisposed to find Satanic cult activity. Each concluded that the disorder was due to “programming” by the non-existent Satanic cult.

Perry, Campbell (1992). Theorizing about hypnosis in either/or terms. International Journal of Clinical and Experimental Hypnosis, 40, 238-252.

The present paper addresses 3 issues raised by Coe (1992). First, it maintains that the “altered state” issue of the 1960s remains buried in current dichotomous classifications of hypnosis theories as involving either “special processes” or the social- psychological position. Given the current diversity of the field, it appears imprudent to classify theorizing in either/or terms; additionally, despite a history of using the term “altered state” in a circular way, it is not an inherently circular formulation. It can be used descriptively simply to point to the observation that some individuals in hypnosis report subjective alterations. A second issue broached concerns the metaphorical status of the term “hypnosis”; it is accepted as a misleading metaphor inherited from 19th century investigators such as Braid, Faria, Puysegur, and Liebeault. Provided that it is recognized that this metaphor refers to a “domain” (E. G. Hilgard, 1973) of characteristically elicited behaviors, no problem ensues in retaining this metaphor derived from nocturnal sleep. A subsequent discussion of current conceptualizations of hypnosis indicates considerable agreement among investigators; there is much consensus that hypnosis is an individual differences phenomenon, in which imagination may, in some individuals, become so intense and so vivid, as to take on “reality value,” to the extent that a hypnotized person may have difficulty in distinguishing fantasy from reality. The S abilities of imagery/imagination, absorption, dissociation, and automaticity (which may be proved to be an index of dissociation) are proposed as being the main ingredients of the hypnotic experience. Finally, a synergistic approach is proposed as a means of progressing beyond the current impasse of either/or theorizing.

Bowers, Kenneth S. (1991). Dissociation in hypnosis and multiple personality disorder. International Journal of Clinical and Experimental Hypnosis, 39, 155-176.

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.

As an example of the fact that behavior that serves a purpose is not always performed on purpose, the author cites not falling out of bed while sleeping, and waking up in response to signals from the bladder to go to the bathroom. Lower levels of control can be dissociated from executive initiative and/or monitoring. “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” (p. 157). Dissociated control occurs under waking conditions also, as when one dials a very familiar phone number rather than the one that they intended to dial. In this case, the behavior that is enacted is not what one consciously intended.
Miller’s dissertation, also published as Miller & Bowers, 1986, is described on p. 158 ff. Without hypnosis, cold pressor pain (cold water immersion) reduced accuracy of performance on a multiple choice vocabulary test 35%. Both hypnotic analgesia and cognitive pain management strategies were equally effective in reducing pain of cold pressor test (and both interventions were more effective for high than for low hypnotizable Ss). However, the cognitive strategy group showed an additional drop of 30% in vocabulary performance from pre- to posttreatment cold water immersion (despite successfully reducing their pain). In the hypnosis condition, lows showed only a slight additional decrease (8%) while highs showed a slight (10%) _increase_ in their vocabulary performance from pre- to posttreatment immersion.
Thus, the effect of hypnosis in pain control “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. … 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” (p. 161).
Hughes’ dissertation is described on p. 162 and ff. Instead of performance decrement on a cognitive task like vocabulary testing, she used increased heart rate as an index of cognitive effort. If heart rate increases when Ss successfully use hypnotic imagery, that would confirm the social psychological view that “suggested effects are achieved by this kind of ongoing allocation of high-level cognitive force or work” (p. 162).
Highs and lows were hypnotized and administered three trials of neutral and three trials of fearful imagery in counterbalanced order. Each imagery trial lasted 1 minute, after which Ss rated vividness of imagery, effort required, and amount of fear experienced.
Average imagery vividness was higher in highs than lows, for both neutral and fear imagery. For lows the correlation between heart rate increases and ratings of cognitive effort were .54 (neutral imagery) and .49 (fear imagery). For highs, the correlations were -.05 (neutral) and -.52 (fear). Thus, “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” (p. 163).
“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 effort is minus 68– indicating that the less effort highs 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)” (p. 164).
The authors discuss why the pattern of correlations is different for people high and low in measured hypnotizability, and summarize the implications of both Miller’s and Hughes’ research. Both investigations indicate that, at least for high hypnotizable people, less initiative and effort are required to effect a response to hypnotic suggestion than one would expect. The show how behavior can be both purposeful and nonvolitional (in the sense of not exhibiting conscious intention and strategic efforts). By noting that the sense of nonvolition that accompanies a response to suggestion is an actual alteration in executive control, they provide a model for dissociative psychopathology such as MPD. For although executive control is dissociated, these experiments do not suggest that there is a second executive system or ‘personality’ that is responsible for the behavior.
Patients diagnosed with MPD have very high measured hypnotizability (Bliss, 1984). In fact, they seem to engage in self hypnosis, withdrawing into a trance or a dissociated state (Bliss, 1984). The authors quote Wilson & Barber (1983) as indicating that highly hypnotized, fantasy-prone normal individuals may become so absorbed in a character being imagined that they lose awareness of their own identity.
The authors offer a neodissociative account of MPD: “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). … Fantasied alternatives to reality (including a fantasied alter ego … ) can become increasingly complex and differentiated. Gradually, these fantasied alternatives begin to activate subsystems of control more 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. … 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” (pp. 168-169).
923, Bowers, 1992 NOTES: Tart allegedly taught ESP skills based on reinforcement, using a machine that projected display and gave feedback immediately, so the subjects could learn to anticipate the picture better. But the picture presented next was time-linked to the S’s response (so S could learn it).
1987 Behavioral and Brain Sciences review, with 2 target articles, makes one doubt strength of findings. ESP research doesn’t distinguish between description of an observation and it’s proposed cause.
MPD shares with ESP a tendency to predispose toward a certain explanation. Feeling like one has a separate personality leads to finding evidence for one. But an MPD account is wrong-headed because the diagnosis misconstrues a notion of personality, which is a developmental concept (a pattern of thought, feeling, and behavior). Mischel’s (1968) account of human functioning competed with trait theory, so “personality” concept became extraneous.
Defining personality in terms of one’s experiences or beliefs about oneself has lead to further problems, encouraged by the descriptive approach of DSM III (which depends on patient reports). Drew Weston distinguished between the self and self representation. One can’t argue that a computer programmed to describe itself is the same as it’s descriptions.
Personality can’t be reduced to person’s beliefs about themselves. A secondary personality cannot be reduced to bizarre experiences a person believes are due to a second personality. Clinicians do not accept as valid the beliefs of a paranoid schizophrenic; or of an anxious neurotic. With multiple personality disorder (MPD) the patient becomes the expert and the clinician the student.
William Smith’s 1986 SCEH paper: case study of patient who was convinced her problems were due to unresolved problems from a previous life. He didn’t challenge her system but still worked with her successfully, communicating respect without validating her belief.
Advocates of MPDs think the observation that it is associated with high hypnotizability indicates great dissociation; critics think the association indicates great suggestibility. There is a historical parallel: Mesmer probably didn’t suggest seizure-like episodes, but implicit suggestions for seizures were probably partially responsible. Mistaken attribution permitted Mesmer to see this as validation of his theory of animal magnetism.
Clinicians are not the only ones to “suggest” MPD syndrome. High profile cases are in the media. We should also remember Orne’s 1959 research showing that students who received false information a week earlier in lecture on hypnosis showed the behavior when they were hypnotized.
Janet’s disaggregation (dissociation) theory said hysterics and hypnotized people responded to ideas dissociated from the main stream of consciousness. So his contemporaries thought that spontaneous amnesia was a defining feature of hypnosis; yet it is not thought to be so in our era. The idea may have circulated in Janet’s time, by popular culture.
MPDs are always highly suggestible so can respond to circulating accounts in the media, and every account that reaches the media can influence these people.
We could abandon the diagnosis of MPD in favor of Spiegel’s “disorder of self integration.” It is less provocative, does not imply any clinical benefit in the benefits of seeking out more personalities. This might reduce the incidence of this disorder, or likelihood that a suggestible person would develop the disorder iatrogenically.

Brown, Jason W. (1991). Self and process: Brain states and the conscious present. New York: Springer-Verlag.

Author, from the Department of Neurology at New York University Medical School, presents a theory about the genetic unfolding of mental content (mind) through stages, from mental state into consciousness or into behavior. He relates the genesis of mind to brain development but avoids assuming that there is a straightforward correlation between brain development (e.g. myelination) and cognitive development or perception. To some degree, the theory is based on subjective report data and psychological symptoms. The author discusses issues that bear on the phenomena of nonvoluntary responding and dissociation that are reported or described by hypnotized persons.
“The nature of the mental state will determine the relation between self and world, and thus the interpretation given to agency and choice. … The crossing of the boundary from self to world is a shift from one level in mind to another” (pp. 10-11).
“… if we begin with mind as primary and seek to explain objects from inner states and private experience, the discontinuity between inner and outer evaporates: mind is everywhere, a universe. … Whereas before we thought to perceive objects, now we understand that we think them” (p. 19).
“The concept of a stratified cognition is central to the notion of a mental state …. This entails an unfolding from depth to surface, not from one surface to the next, a direction crucial to agency and the causal or decisional properties of consciousness” (p. 52). By unfolding from depth to surface, he means from Core, through Subconscious, then Conscious Private Events, and finally Extra-Personal Space.
He goes on to provide a definition of mental states. “A mental state is the minimal state of a mind, an absolute unit from the standpoint of its spatial and temporal structure. … The state also has to include the prehistory of the organism. … The concept of a mental state implies a fundamental unit that has gestalt-like properties, in that specific contents– words, thoughts, percepts–appear in the context of mind as a whole (p. 53).
“The entire multitiered system arborizes like a tree, with levels in each component linked to corresponding levels in other components. For example, an early (e.g., limbic) state in language (e.g., word meaning) is linked to an early stage in action (e.g., drive, proximal motility) and perception (e.g., hallucination, personal memory) …. In sum, a description of the spatial and temporal features of a _single_ unfolding series amounts to a description of the minimal unit of mind, the _absolute_ mental state” (p. 54).
The author’s discussion of an individual’s physical movement relates to the concept of nonvoluntary movement (or movement without awareness of volition) in hypnosis. “More precisely, levels in the brain state constitute the action structure. As it unfolds, this structure generates the conviction that a self-initiated act has occurred. This structure–the action representation–does not elaborate content in consciousness. … As with the sensory-perceptual interface, the transition to movement occurs across an abrupt boundary. In some manner, perhaps through a translation of cognitive rhythms in the action to kinetic patterns in the movement, levels in the emerging act discharge into motor (physical) events” (p. 57).
“The self has the nature of a global image or early representation within which objects-to-be are embedded. … The self is the accumulation of all the momentary cognitions developing in a brain configured by heredity and experience in a particular way (p. 70).
“The deposition of a holistic representation … creates the deception of a self that stands behind and propagates events. The feeling of the self as an agent is reinforced by the forward thrust of the process and the deeper locus of the self in relation to surface objects. The self appears to be an instigator of acts and images when in fact it is given up in their formation. The self does not cause or initiate, it only anticipates (p. 70).
The foregoing notes cover only the first five chapters, less than half the book. Other chapters relevant to hypnosis would be those titled ‘The Nature of Voluntary Action,’ ‘Psychology of Time Awareness,’ ‘From Will to Compassion,’ and ‘Mind and Brain.’

Brown, Peter (1991). The hypnotic brain: Hypnotherapy and social communication. New Haven, CT: Yale University Press.

NOTES: Notes are taken from a review of this book: Diamond, Michael (1993). Book review. Bulletin of the Menninger Clinic, 57 (Winter), 120-121.
Brown “posits that because the fundamental matrix of the human brain is metaphoric, hypnosis results from skillful matching of metaphorical communication with the brain’s biological, rhythmic alterations. The most significant feature of trance experience is thereby located in the hypnotist-subject interaction” (p. 120).
“The middle section [of the book is comprised largely of] literature reviews in support of Rossi’s (1986) ultradian rhythm theory of hypnosis and Lakoff and Johnson’s (Johnson, 1987; Lakoff & Johnson, 1980) experientialist theory of conceptual thought” (p. 120). The final section includes “research evidence on medical uses of hypnosis, a theory of dissociation and multiple personality disorders, and an uncritical discussion of Milton Erickson’s naturalistic hypnotherapeutic approach … [and also] a brief discussion of the social-cultural functions of possession states among the Mayotte culture” (p. 120).

Cornell, William F.; Olio, Karen A. (1991). Integrating affect in treatment with adult survivors of physical and sexual abuse. American Journal of Orthopsychiatry, 61 (1), 59-69.

Presents a theoretical and technical model for affectively centered treatment of adults abused as children, focusing on the function of denial and dissociation as central defense mechanisms. The concept is introduced of working at an “affective edge.” At this experiential point, a client can maintain both cognitive understanding and emotional and bodily awareness without triggering denial and dissociation. This approach fosters careful monitoring of the client’s functioning both during and between therapeutic sessions. The proposed therapeutic approach uses noninvasive touch and body-centered techniques. Focus is on integrating affect and on the importance of the therapeutic relationship.

Dixon, Norman F.; Henley, Susan H. (1991). Unconscious perception: Possible implications of data from academic research for clinical practice. Journal of Nervous and Mental Disease, 179 (5), 243-252.

Evidence for the reality of unconscious perception and perceptual defense suggests that the experimental paradigms used to investigate these phenomena might play a role in the understanding and treatment of mental disorders. The literature on applying subliminal stimulation to problems of diagnosis and therapy indicates that data support the view that the meaning of external stimuli of which the recipient is unaware may be responded to and determine emotional responses, lexical decisions, overt behavior, and subjective experience. Data confirm the reality of psychopathology as a substrate of emotionally colored, stored information with a potential for producing somatic symptoms and disorders of thinking, affect, and behavior. To the extent that psychopathology is screened from conscious scrutiny and thus impervious to supraliminal information, it may be accessed and ameliorated by drive-related stimuli of which the S is not aware.
Frankel, Fred H. (1991). Comments on hypnotizability and dissociation. American Journal of Psychiatry, 148 (6), 814-815.

NOTES: Responds to comments by D. Spiegel and E. Cardena (see PA, vol 78:29491) concerning F. H. Frankel’s (see PA, vol 77:27535) article in which he cautioned against over interpreting the relationship between hypnotizability and dissociation. It is reiterated that the concept of dissociation has been elaborated in recent years to an exaggerated degree.

Frischholz, Edward J.; Braun, Bennett (1991, August). Diagnosing dissociative disorders: New methods. [Paper] Presented at the annual meeting of the American Psychological Association, San Francisco.

Five new methods which have proven useful in the differential diagnosis of dissociative disorders from other psychiatric syndromes are identified. The first method involves the use of the Dissociative Experiences Scale, a self-report questionnaire which significantly discriminates dissociative psychopathology from normal dissociative experiences. The second method involves the use of various measures of hypnotizability (e.g., Hypnotic Induction Profile; Stanford Hypnotic Susceptibility Scale, Form C; self-ratings of hypnotizability) in discriminating between various psychiatric groups. The third method involves the use of qualitative responses to individual test items (e.g., instructed posthypnotic amnesia) to discriminate between different psychiatric syndromes. The fourth method involves the use of an implicit memory test to measure the amount of between-personality state amnesia in patients suffering from Multiple Personality Disorder. The fifth method involves the use of special hypnotic phenomena (e.g., the Orne double person hallucination and the Hilgard hidden observer item) to discriminate between dissociative disorder patients and subjects simulating dissociative psychopathology. (ABSTRACT from Bulletin of Division 30, Psychological Hypnosis, Provided by former Editor, James Council.)

Five new methods have proven useful in the differential diagnosis of dissociative disorders. The first method involves the use of the Dissociative Experiences Scale, a self-report questionnaire which significantly discriminates dissociative psychopathology from normal dissociative experiences.
The second method involves the use of various measures of hypnotizability in discriminating between various psychiatric groups.
The third method involves the use of qualitative responses to individual test items (e.g., instructed posthypnotic amnesia) to discriminate between different psychiatric syndromes.
The fourth method involves the use of an implicit memory test to measure the amount of between-personality state amnesia in patients suffering form Multiple Personality Disorder.
The fifth method involves the use of special hypnotic phenomena (e.g., the Orne double person hallucination and the Hilgard hidden observer item) to discriminate between dissociative disorder patients and subjects simulating dissociative psychopathology.

Barabasz, Marianne (1990). Treatment of bulimia with hypnosis involving awareness and control in clients with high dissociative capacity. International Journal of Psychosomatics, 37, 53-56.

The details of an easily replicable intervention using hypnosis in the treatment of bulimia are presented. Follow-ups at 1, 3, 6, and 12 months indicated the intervention appeared effective in two out of the three cases presented. Factors affecting treatment outcomes are discussed.

Bartis, Scott P.; Zamansky, Harold S. (1990). Cognitive strategies in hypnosis: Toward resolving the hypnotic conflict. International Journal of Clinical and Experimental Hypnosis, 38, 168-182.

Two experiments were carried out to assess the relative contributions of dissociation and absorption as cognitive strategies employed by high and low hypnotizability Ss in responding successfully to hypnotic suggestions. Of special interest was the manner in which Ss deal with conflicting information typically inherent in hypnotic suggestions. In the first experiment, Ss rated their attentional focus and the involuntariness of their experience after responding to a number of hypnotic suggestions administered in the usual manner. In the second experiment, the level of conflict was varied by instructing some Ss to imagine a circumstance that was congruent and other Ss to imagine a circumstance that was incongruent with the suggested behavioral response. The results of the 2 experiments were consistent in suggesting that, depending upon the nature of the hypnotic suggestion, high hypnotizability Ss are able to employ dissociation or absorption in order to respond successfully. Low hypnotizability Ss, on the other hand, seem to be relatively ineffective dissociators. When the structure of the hypnotic suggestion precludes the use of absorption, the performance of low hypnotizables deteriorates.

Briere, John; Runtz, Marsha (1990). Augmenting Hopkins SCL scales to measure dissociative symptoms: Data from two nonclinical samples. Journal of Personality Assessment, 55, 376-379.

Describes a 13-item dissociation scale (DS) that uses numerical ratings and presents preliminary data regarding its reliability. The DS was administered to 2 samples of undergraduate women (N=569). Ss also completed the SCL-90 or the Hopkins Symptom Checklist (HSCL). The DS was found to be reliable, and there was a correlation of the DS with self-reported child abuse history. Designed to complement the SCL-90 and the HSCL, the DS may be useful in research on the effects of psychological trauma.

Counts, R. M. (1990). The concepts of dissociation. Journal of American Academy of Psychoanalysis, 18, 460-479.

Reviews conceptualizations of dissociation. Dissociation is the underlying mechanism in a number of defensive mechanisms. Repression, intellectualization, splitting, and other defense mechanisms rely upon dissociation to accomplish their specific tasks. Dissociation is thus believed to be the underlying and basic mechanism of many aspects of mental functioning.

Demitrack, Mark A.; Putnam, Frank W.; Brewerton, Timothy D.; Brandt, Harry A.; et al. (1990). Relation of clinical variables to dissociative phenomena in eating disorders. American Journal of Psychiatry, 147 (9), 1184-1188.

Compared 30 female patients (aged 16-39 yrs) with eating disorders with 30 age-matched normal female Ss, using the Dissociative Experiences Scale (E. M. Bernstein and F. W. Putnam; see PA, Vol 74:14407) and additional self-report measures such as the Beck Depression Inventory. The patients demonstrated significantly higher levels of dissociative psychopathology compared with controls. Furthermore, the presence of severe dissociative experience appeared to be specifically related to a propensity for self-mutilation and suicidal behavior. Findings are discussed in light of recent data suggesting that neurochemical systems shown to be abnormal in patients with eating disorders may be key pathophysiologic substrates for dissociative experience.

Downs, John M.; Dahmer, Sharon K.; Battle, Allen O. (1990). Multiple personality disorder in India. American Journal of Psychiatry, 147 (9), 1260.

Comments on the article by Adityanjee et al (see PA, Vol 77:12344) on multiple personality vs possession syndrome in India. The history of the trends of these disorders is presented, and the differences between multiple personality and possession are described. The only fundamental difference between the 2 disorders may be in the voluntary type.

Fellows, Brian J. (1990). Current theories of hypnosis: A critical overview. British Journal of Experimental and Clinical Hypnosis, 7, 81-92.

The present state of theory in hypnosis is reviewed and observations are made concerning future prospects. The state- non-state issue continues to dominate theoretical debate, although no satisfactory reply has yet been made to T. X. Barber’s criticisms of the ‘hypnotic trance’ concept. The impact of social-psychological theory has been considerable and the results of Spanos’s hypnotic training programme could have significant implications for our understanding of hypnosis. Future theorizing should see a move towards a more integrated sociocognitive approach. Neodissociation theory has generally not fulfilled its early promise and is encumbered with the ‘hidden observer’ concept. The role of imaginative processes continues to be a dominant theme in hypnosis theory, although the relatively small correlation between imaginative and hypnotic abilities remains a problem. The links between hypnosis, sleep and relaxation deserve further research, although, as theories of hypnosis, their scope seems limited. Suggestibility and role enactment theories have shown few signs of development in recent years. Theoretical problems over the interpretation of hypnosis need to be more widely recognized and the use of question-begging terminology curtailed. One advantage of the imagination hypothesis is that it provides a bridge, or a point of convergence, between state and non-state approaches (Spanos & Barber, 1974). It also handles certain hypnotic phenomena very well. For example, the known facts of age regression can be readily interpreted, together with the oddities of age progression and past life regression, as imaginative reconstructions (Barber, 1979). However, other phenomena, such as amnesia and analgesia, are less easily explained.

Fischer, Donald G.; Elnitsky, Sherry (1990). A factor analytic study of two scales measuring dissociation. American Journal of Clinical Hypnosis, 32, 201-207.

The present study was designed to investigate the construct validity of dissociation. We administered the PAS and the DES to 507 male (48%) and female (52%) undergraduate students. Factor analysis on each scale separately showed that neither the PAS nor the DES adequately measures the three dimensions hypothesized to underlie dissociative experience. For both scales, a single factor emerged as replicable and reliable. Use of the scales, in their present form, therefore, should be limited to a single dimension representing disturbances in affect-control in the case of the PAS and disturbances in cognition-control if the DES is used at least with normal populations. Analysis of the combined items showed that the scales are measuring conceptually different but statistically correlated dimensions of dissociation. Further development of both scales is desirable, and further research should investigate the effect of different response formats on the internal structure of the scales.

The stated purpose of this study was to investigate the internal structure of the Perceptual Alterations Scale (PAS) and the Dissociative Experiences Scale (DES) using a large sample from a normal population.
“Sanders (1986) conceived of dissociation as a personality trait that is characterized by modification of connections between affect, cognition, and perception of voluntary control over behavior, as well as modifications in the subjective experience of affect, voluntary control, and perception. She chose items from the MMPI to represent this trait. Bernstein and Putnam (1986), utilizing the DSM-III definition of dissociation, constructed items from information derived from interviews with patients and clinicians to represent a number of different types of dissociative experiences” (0. 202).
“The PAS (Sanders, 1986) is a 27-item scale; subjects respond by checking one of the following categories using a 4-point Likert format: never, sometimes, frequently, almost always. The items related to modifications of regulatory control, changes in self- monitoring, concealment from self and others, and modifications of sensory, perceptual, and affective experiences.
“The DES (Bernstein & Putnam, 1986) contains 28 items. Subjects indicate the percentage of time they experience the feelings or behavior described by the items on a 10- point scale. The items related to the experience of disturbances in identity, memory, awareness and cognition, and feelings of derealization or depersonalization” (pp. 202- 203).
Results were as follows. The one-factor solution for the PAS accounted for 18.5% of the total variance.; 11 of the 28 items did not load significantly on the factor. The one-factor solution for the DES accounted for 26.3% of the total variance; 7 of the 28 items did not load significantly on the factor.
“The 3-factor solution obtained by Sanders (1986) for the PAS was not replicated. An obvious reason for the different is that principal factor extraction was used in the present study, whereas principal components extraction was utilized by Sanders. … Even when principal components analysis is performed on the present data, however, there are difficulties with the 3-factor solution” (pp. 204-205).
“All of the criteria suggest that a single factor best represents the latent structure of dissociative experience as measured by the PAS and DES. Although the total amount of variance accounted for is low, the one-factor solutions for both scales are interpretable, replicable, and have high internal consistency. The items for the PAS appear to represent primarily the affect and control dimensions, whereas those for the DES represent the cognitive dimension” (pp. 205-206).
“Overall, both scales contain similar items, although the DES has more items relating to disturbances in memory and altered perception of time (i.e., cognition), whereas the PAS has more items reflecting specific disturbances in identity and control. It appears, therefore, that the scales are measuring conceptually separate but statistically correlated dimensions of dissociation” (p. 206).

Frankel, Fred H. (1990). Hypnotizability and dissociation. American Journal of Psychiatry, 147, 823-829.

Describes the multidimensionality of hypnosis and hypnotizability. He also points to the lack of clarity regarding the concept of dissociation and the extent to which its roots lie in the clinical experience of hypnosis. The concept of dissociation increasingly preempts repression and other defense mechanisms in current nosological thinking. The author cautions against equating hypnosis scores with dissociative capacity and advocates a clearer elaboration of the term “dissociation.” Meanwhile, restraint in the use of the term “dissociation” is recommended.

Freeman, William B., Jr.; Kessler, Marc; Vigne, Jeffery (1990). Random number generation, absorption, and hypnotizability: A brief communication. International Journal of Clinical and Experimental Hypnosis, 38, 10-16.

Graham and Evans (1977) found that a measure of random number generation (RNG) was related to hypnotizability. In 2 studies, the relationship between hypnotizability and Graham and Evans’ RNG (1977) index was examined. In Study 1 Evans’ (1981) measures of controlled and automatic absorption were also evaluated. In Study 1 no relationship was found between the measures of absorption or RNG and hypnotizability. Since Study 1 was carried out primarily to evaluate methods for modifying hypnotizability, Study 2 was designed to evaluate RNG measure directly. Study 2 found no consistent relationship between RNG and hypnotizability, or between RNG and measures of the experience of hypnotic depth and nonvolition.

Frischholz, Edward J.; Braun, B. G.; Sachs, R. G.; Hopkines, L.; Schaeffer, D. M.; Lewis, J.; Leavitt, F.; Pasquotto, J. N.; Schwartz, D. R. (1990). The dissociative experiences scale: Further replication and validation. Dissociation, 3, 151-153.

Interrater reliability for the DES was .96-.99, test-retest reliability was .93- .96, and internal consistency of DES scores was very high .93-.95. Both MPD and dissociative disorder NOS (DDNOS) patients scored significantly higher than students, and MPD patients scored significantly higher than DDNOS patients. A cutoff score of 45 to 55 maximizes the probability of distinguishing students from dissociative disorders (87%) while minimizing false positives (2%-6%) and false negatives (7%-11%). Suggestions for further research are made.

Gravitz, Melvin A. (1990). Adverse behavior associated with the eye-roll test of hypnotizability: Clinical and theoretical considerations. Psychotherapy: Theory, Research and Practice, 27, 267-270.

For 15 years, subjects’ response to the eye-roll test has been used to measure susceptibility without adverse effects. A case is described of a hospitalized young man who displayed dissociative behavior when asked to do the eye-roll as part of a diagnostic evaluation. Etiological and theoretical considerations, and implications for therapeutic strategy are discussed.

Halleck, Seymore L. (1990). Dissociative phenomena and the question of responsibility. International Journal of Clinical and Experimental Hypnosis, 38, 298-314.

There are many controversies regarding the prevalence, causation, possible iatrogenicity, and treatment of multiple personality disorder. Those who view the disorder as much more prevalent than has previously been suspected believe it is caused by experiences of severe child abuse and have used rather unorthodox techniques to help the patient relate the experience of abuse to current problems of dissociation. Other clinicians believe the disorder is overdiagnosed and that it may be created or made worse by therapists who unwittingly reinforce symptoms of dissociation. Many of the controversies about these issues can be clarified by considering the manner in which clinicians attribute responsibility for undesirable conduct associated with the disorder. In dealing with multiple personality patients, clinicians regularly must decide whether their therapeutic approach will emphasize the patient’s responsibility for undesirable conduct or will minimize it. Practical and theoretical arguments can be made for both approaches. There are important consequences to patients using either approach, and particularly harmful consequences with inconsistent approaches. Clinical experience and wisdom dictate that until we have more objective data about the results of various forms of treatment, the preferred method of treatment of multiple personality patients should continue to focus upon maximizing their responsibility for any type of undesirable conduct.

Hughes, Dureen J.; Melville, Norbert T. (1990). Changes in brainwave activity during trance channeling: A pilot study. Journal of Transpersonal Psychology, 22, 175-189.

Authors studied 10 people known trance channels–all had been channeling for more than one year. Used an anthropological field method. Electrode was placed only on left occipital (O1) area, referenced to left ear. Calculated difference between each S’s pre- trance and trance EEG beta percentages, for alpha and theta percentages also.
Basically, the pre-trance versus trance sums of differences scores were greater than the post-trance versus trance sums of different scores for each of the three frequency bands–indicating a residual of the trance state. There were large, statistically significant increases in amount and percentage of beta, alpha and theta brainwave activity, and some suggestion of a pattern. The large amount of beta differentiates these Ss from what has been observed with meditators (increases in alpha and theta). Among the Subjects, large amounts of beta activity were recorded continuously throughout the trance period and were coupled with large amounts of high amplitude alpha and theta (relative to the pre- and post-trance states).
The authors compare these results to older hypnosis literature. They conclude that the trance channeling state may be a distinctive state characterized by a particular EEG profile that differs from that found in certain meditative states, hypnotic states, various pathological states, or the waking states of the trance channel Subjects who participated in the study. Authors also liken the differences seen between trance and non-trance states of these Subjects to the differences seen for different alter personalities among people diagnosed with Multiple Personality Disorder.
DISCUSSION. The foregoing research suggests that the trance channeling state, as measured in the current study, is characterized by large, statistically significant increases in amount and percentage of beta, alpha and theta brainwave activity. There appear to be definite neurophysiological correlates to the trance channeling state, and furthermore there is some evidence that these correlates may be patterned. This pattern might be provisionally compared to those associated with other altered states of consciousness.


Alvarado, C. S. (1989). Dissociation and state-specific psychophysiology during the nineteenth century. Dissociation, 2, 160-168.

Reviews examples of state-specific psychophysiology in nineteenth century reports of dissociative disorders. These cases occurred in the context of rapid developments both in neurology and in the understanding of phenomena suggesting the possible influence of the mind, emotions, or psychological states on general health and specific bodily functions (e.g., the study of hypnosis and hysteria). It is argued that interest in such cases was part of a general concern with mind/body interactions. The explanations offered to account for these cases reflected different orientations to the mind/body problem prevalent during this era.

Carlson, Eve Bernstein; Putnam, Frank W. (1989). Integrating research on dissociation and hypnotizability: Are there two pathways to hypnotizability?. Dissociation, 2, 32-38.

Attention to the relationship between hypnotizability and dissociation has been limited to date. Reviews recent studies implying a relationship between “dissociativity” and hypnotizability, and places in context of J. Hilgard’s theory of two developmental pathways to hypnotizability (imagination/absorption and punishment). This might imply two subsets of hypnotizable persons, as Nadon et al. (1988) postulate–one with a dissociative style and one with an absorption style. Also, high capacity for imaginative involvement may be a necessary condition for a dissociative response to trauma. Branscomb (1988; unpublished) posits a genetic-stressor model for PTSD in which a history of dissociative-proneness and child abuse predispose one to PTSD when a trauma occurs in a non-supportive environment. Relates this theory to hidden observer research and to dissociative patients.

Gabel, Stewart (1989). Dreams as a possible reflection of a dissociated self-monitoring system. Journal of Nervous and Mental Disease, 177 (9), 560-568.

Argues that dreams may be thought of as dissociative phenomena of a particular type that reflect a monitoring of and reaction to internal and external conditions within the dreamer. Under conditions of sleep, memories, emotions, information processing, and judgments about internal and external events may occur independently of the usual waking conscious system’s information processing. Experimental and/or clinical work, related to hypnosis, REM phenomena, dreams, and hemispheric specialization are discussed to support this view. Dreams are described within the context of dissociation- based theories of personality organization.