Dave Elman - Hypnotherapy (Work in Progress)

Of course, this is not a factual account of how hypnosis work, but about how Dave Elman saw hypnosis from his own model. (Well, and a whole lot of stories told from his perspective. ) Regardless, there’s a few small tips worth remembering from this book, and it’s neat to chew through a bit of history here.

Introduction

Misconceptions, Reasons, and Beginnings

Interestingly, Dave Elman considers himself to be removing the clock of mysticism from hypnosis in his writing. I still need to see when this was actually written, it appears that the book was not authorized by Dave Elman himself.

Elman says hypnotist could be more accurately described as a Hypnotic Operator, as you teach the subject how to enter trance. The subject is in control at all times, and there is a single exception to self-suggestion - when the critical faculty is suspended.

Since there is really no such thing as a hypnotist, this is obviously impossible. As a practitioner employing this tool, all you can ever do is to show a patient how to go over the hurdle from a normal waking or sleeping state into the peculiar state of mind known as hypnosis.

As I read this, I’m realizing that while Elman is cited as ‘authoritarian,’ it’s unlikely he saw himself this way. Since he is working with the subject, he is simply giving them instructions and guiding them.

They highlight three requisites for hypnosis:

Consent
Communication
Freedom from fear and reluctance

…you might say that there is no way in which you cannot hypnotize a person once you know how to utilize suggestion.

After trying eye fixation on themselves on a right light, they recount a story where they asked their doctor about it… and their doctor demonstrated.

He explained that the human eye sees in leaps and darts. If you prevent the eyes from following the natural habit of leaping and darting, the muscles quickly tire. As a demonstration, he placed his hand just above my eyes and very close to my forehead; then he brought his hand down slowly, instructing me to keep watching it as he did so. By the time his hand was under my chin, I realized that my eyes felt very sleepy. Now I knew how to tire a person’s eyes quickly - without using fixation.

1 - My First Important Findings

Dave is surprisingly forthcoming about not being a clinical expert. He cites that he is teaching professional hypnosis, not giving medical knowledge.

On Dave’s word, he was able to uncover that a woman was able to remember what was said to her during surgery, and that the surgeon made negative remarks about her gall bladder. Both the doctors and Elman were perplexed that patients would respond to things experienced under anesthesia. (He allegedly verified he was able to access memories of what happened under anesthesia with multiple people, surprising the medical community.)

The chapter continues with more entertaining stories of Elman’s antics.

I can safely say that in the first four or five years of teaching I never failed to correct an impotence case.

Ya know. Just Elman things. This is turning quickly into Elman story hour - which I’m hella down for, but I’d be pissed off if I was reading this as a clinician looking to help a patient. (Also uh - don’t get drunk and joke about being impotent to your wife. When she gets pregante anxiety would be a reasonable response.)

2 - Why I Started Teaching Hypnosis

In writing this book, it is my aim to do more than entertain.

Yeah. With a title like Hypnotherapy I bet.

I am confident that the doctors among you, after reading about my observations, will test their validity through clinical research, and will thereby prove the truth of my theories.

About that…

…And we’re back to Elman story time. 🤣

Elman was granted an opportunity to see a lecture on hypnosis for dentists, and this is relatable AF…

I accompanied him to the meeting-and was completely astounded at the misinformation which was being given to these sincere men. The teacher was a very fine gentleman and a sincere teacher. He just didn’t know the subject he was trying to teach. Now as then, misinformation is broadcast as gospel in many hypnosis lectures.

There is… some irony in hearing misinformation in a clinical setting, then stepping in with authority, likely being slightly more correct than the state theory of the 50’s, but providing an unverified but likely more effective model.

Dave goes on an entertaining rant about restricting hypnosis to psychiatrists.

There is also a silly notion that the use of hypnosis should be restricted to psychiatrists. Who is going to prevent the physician or the dentist from giving patients suggestions for their welfare?

3 - How to Study Hypnosis

Man Dave’s got some attitude (and some classic sexist 50’s language.)

Some tips from Dave:

When you’re starting out - only allow yourself one minute to get the state. Practice a lot and prioritize speed to learn fast.
Don’t expect perfect results from the start.

Failure to obtain the hypnotic state during the first few attempts is often caused by a lack of confidence. The remedy: Try again.

Occasionally, a doctor will say at the second or even the third session, “No, Mr. Elman, I haven’t started practicing yet, I’m waiting to learn more about the subject.” This is the phoniest excuse for laziness or timidity in the world, and your teacher knows it.

Every patient you work with is a new experience and chance to learn.
The man who learns from instruction and practice will learn much faster than one who learns from theory alone. (Fine Dave, call me out from your fucking grave.)

Ahaha 🤣 three don’ts:

Don’t try to hypnotize your wife
Don’t try to hypnotize your family
Don’t try to hypnotize your friends

Dave says after three or four weeks you can forget about these restrictions. (Ahaha… hm. This advice is very contextual.)

Hypnosis is a scientific study when it’s properly conducted, and if you respect hypnosis as you should, you will not use it for parlor tricks. It has a great value in medicine.

LOOK JUST BECAUSE I LIKE TO HAVE SOME FUN- oh back to the book.

Here’s Elman’s five signs of hypnosis:

Body warmth
Fluttering of the eyelids
Increased lacrimation
The whites of the eyes getting red or pinkish
The eyeballs going up into the head

4 - Interesting Facts About Hypnosis

Facts. Let’s have ‘em.

Dave recounts an incredibly brief history of hypnosis touching on Mesmer, Braid, and Charcot. He highlights that the stage performer had both the advantage of numbers and being able to use the state lighting for fixation, and clinicians were working with the odds weighted against them.

He says that modern texts falesly attest:

The only reliable technique is fixation.
Fixation requires between thee minutes and two hours.

5 - The Handshake Technique

Starting out with a few techniques to achieve eye closure…

“I’m going to shake your hand three times. The first time your eyes will get tired… let them. The second time, they’ll want to close… let them. The third time they will lock and you won’t be able to open them… Want that to happen, and watch it happen…

Now, one…

two… now close your eyes…

now three… and they’re locked and you’ll find they just won’t work, no matter how hard you try.

The harder you try, the less they’ll work. Test them, and you’ll find they won’t work at all… That’s right. Now, that’s perfect eye-closure.”

Another way they did this was…

I would shake hands with a person as I placed my other hand in front of his forehead, with the little finger of my left hand next to his face. Then I would say, “Keep your eyes on my hand as I bring it down under your chin,” and I would then bring my hand down along the profile of his face until it was under his chin. “Now, close your eyes and relax the muscles around your eyes, relax them to the point where they will not work. When you’re sure they won’t work, test them.”

Dave starts out by saying that eye closure in and of itself is not hypnosis, but a ‘wedge’ into hypnosis. According to them - hypnosis as a condition is separate from the hypnotic state of mind. Eye closure merely creates the ‘mood’ of hypnosis, but hypnosis as a condition is only created when the ‘critical faculty’ is bypassed.

Hypnosis is a state of mind in which the critical faculty of the human is bypassed, and selective thinking established.”

-Dave Elman - Hypnotherapy p26

This selective thinking - bypassing the critical faculty - is the important part. Put less poetically, complete faith in the suggestion.

From the times - Dave mentions that hypnosis textbooks of the time listed signs of fear as signs of hypnosis - a more rapid heartbeat and respiration. He said this was a response of anxiety, not hypnosis. (Although, it’s very clear now that hypnotic suggestions can absolutely occur in combination with anxiety and fear - but it’s unwise in a clinical context to mention that.)

They uh, TMI brag about how well they could give themselves hypnotic anesthesia when someone was working on a rectal abscess…

I have also had a rectal abscess opened, and those of you who are in medicine know that the rectal area is one of the most difficult areas of the human body to anesthetize. The proctologist said to me afterwards, “Mr. Elman, how did you do that? I’ve never seen such good anesthesia in my life.”

6 - Preliminary Instructions

Some tips from Elman about giving suggestions and preventing questioning…

Don’t ask ‘Doesn’t that feel good?’ Try - “And you’ll notice just how good that feels.” (Avoid eliciting a response.)
Instead of mentioning ‘hurt, pain, knife, needle, sharp, incision, stitches,’ say “I think we can do this without you feeling it at all,” or “without it bothering you a bit.” Avoid implanting the suggestions of what you don’t want.

7 - Two-Finger Eye-Closure Method

Semantics of Hypnosis

Nothing super interesting in here…

They use their thumb and forefinger to close the subject’s eyes, and suggest that they imagine them being locked shut and unable to open.
Elman tells more tales of how patients didn’t need anesthesia with his methods.

Therefore, don’t make the mistake of the old-time practitioners and talk down to your patient. Talk across to him. He isn’t beneath your dignity. He’s a human being with whom you are in rapport. Therefore, do not violate his sense of dignity by being condescending or patronizing. Talk to him just as if he were not in the suggestible state; it will increase the rapport and he will be far more willing to take your suggestions

8 - Hypnosis as an Adjunct to Chemical Anesthesia

Doctor Henry Murno began to hypnotize his patients around the 1900s with hypnosis on top of the usual chemical anesthesia, ether. (CW on the video - if the thought of surgery in the 40s makes you queasy, including needles, other equipment, and breath control, give it a pass.) He found that he could use 10-25% of the usual amount of ether using this combined approach.

Dr. Murno wrote…

“In the Journal of Surgery, Gynecology and Obstetrics of December, 1906, Alice Magaw says: ‘Suggestion is a great aid in producing a comfortable narcosis. The anesthetist must be able to inspire confidence in the patient, and a great deal depends on the manner of approach… The secondary or subconscious self is particularly susceptible to suggestive influence; therefore, during the administration, the anesthetist should make those suggestions that will be most pleasing to this particular subject. Patients should be prepared for each stage of the anesthesia with an explanation of how the anesthetic is expected to affect him -“talk him to sleep” with the addition of as little ether as possible.

9 - Countless Methods of Induction

Oh hell. Did this chapter just start with a double entendre of hypnotic amnesia and forgetting the numbers?

There is no way in which you cannot hypnotize a patient, provided you know the art of suggestion.

In Elman’s framework - the first thing you need for somnambulism is eye closure. They write that - the good news is that any device, provided the subject expects to be hypnotized, will likely work.

There’s a transcript in the book of a teaching session they did, explaining how they do this - including both taking three puffs off a cigarette, or by taking three sips of water. He doesn’t demonstrate this as techniques for you to us - just to demonstrate how flexible your approach can be. There’s this gem of a video where you can see his approach below, covering most of the same ideas.

Another Dave Elman-ism that’s handy is…

Want it to happen and watch it happen…

Continuing in the transcript, they go through “the Elman induction.” It’s indeed not labeled as such - and it’s neat to see how Elman very directly coaches the patient through the process…

Here’s a quick excerpt for the other hypno-nerds out there.

I’m going to lift your hand and drop it and if you’ve followed orders up to this point that hand will be just as limp as a dishrag and will just plop into your lap… No, let me lift it-don’t you lift it-let it be heavy-that’s good-but let’s open and close the eyes again and double that relaxation and send it right down to your toes. Let that hand be heavy as lead… You’ll feel it when you’ve got the real relaxation… Now you’ve got it. You could feel that, couldn’t you?

For a bit more on this - Graham Old’s The Elman Induction is a solid read, with a more modern look at Elman’s approach.

Contrary to what I’ve heard from other sources on the Elman induction, Dave Elman himself appeared to switch techniques when they couldn’t get numeric amnesia. He has his patient write their name down in their mind’s eye, erasing it letter by letter. I’d actually recommend reading Pg 64 in it’s entirety, but here’s a neat snip of him using the technique…

Elman: Now I’m going to do something I think you’ll like. I’m going to erase it from your finger and from the blackboard and from your mind all at the same time. I rub it off your finger and it is completely gone… Now try to tell me what I took off your hand.

They suggest fully checking for amnesia, not aphasia. (The difference being - they need to be unable to recall the number, not just ‘too darn tired’ to say it out loud.) They suggest not doing difficult work with this “artificial somnambulism” indicated by a lack of amnesia.

10 - Waking Hypnosis and Waking Suggestion

To frame the idea of ‘waking hypnosis,’ Dave tells a story about his son experiencing nightmares. To ‘cure’ it, he ‘ordered dream medicine’ from the drug store, suggesting it (water he put in a bottle and labeled) was bitter, and gave it to their kid before bed. Much later, their son in their 30s reported that they still drank a small sip of water to this day before bed to relax, being fully aware it was a suggestion.

Despite the age (and lack of academic backing) in this book, Elman still dispels some solid advice…

Waking hypnosis can be one of your most valuable allies… it is my firm belief that no one can know hypnosis without knowing waking hypnosis.

The true use of waking hypnosis should be this: When you find resistance to the trance state, use waking hypnosis. Where you are trying to save time, use waking hypnosis. You’ll get your short-range results just as well. But where time is not of the essence, you will find that in the long run the trance state will serve you better for many purposes than the waking state.

There’s some truth to this! Even Irving Kirsch, a strong believer in the placebo and socio-cognitive non-state theories of hypnosis, still uses an induction, as it shows measurable improvement in 20% of people.

Elman, continuing, also defines waking hypnosis put simply as bypassing the critical faculty and giving suggestion without inducing trance.

In an example of poor suggestion - they mention that when doctors are unable to find a physiological cause for pain, they send the patient to a psychologist, suggesting it’s “in their head.” This causes difficulty in the sense that - in order for the therapist to help them with their pain, they now have the road-block of overcoming the suggestion. For the pain to go away, the client would need to admit they were somehow faking or insane. This lines up with a medical journal from John F Chavez in Clinical Hypnosis and Self Regulation.

There’s a bit here about suggesting a reduction in the gag reflex by holding a pencil with both hands. I don’t think the pencil is very important, but… some of you weirdos might benefit from this tip. 😅

Interestingly - they suggest that - in the case someone is anxious about something, mention it! They describe a glass of ice water, and a set of cotton swabs as both perfectly normal to a group of doctors. Then, they suggest that, in an new process - they put the anesthesia directly into the alcohol. They demonstrated this as effective with the doctors, highlighting that this is less likely to work with laymen, since the layman is less likely to wish this to work.

11 - Applications of Waking Hypnosis

This chapter starts out with an absolute banger, with Elman suggesting that the (rectally administered) barium medication be wonderfully soothing.

The radiologist refused to tell patients anything so “absurd” until one day he had to work on a man who was already in terrible discomfort. Out of desperation, he tried my approach. The patient was relieved, and, in fact, actually enjoyed the barium enema. The radiologist now uses this approach consistently. The only problem he has encountered is that some patients so thoroughly enjoy the “soothing medication” that they retain the barium and refuse to let it go. He solves this by telling them it will feel as beneficial leaving as it did entering.

There’s some talk of alleviating the pain of an injection site, reducing muscle spasms, reducing bleeding - all through suggestion. Dave Elman highlights that you can alleviate a symptom, but never mask it - meaning that it will still be there to some degree.

At the end of the chapter - he mentions a story where during WWII, a tank of nitrous oxide was empty for hours before they realized - the patients still believing they were receiving anesthesia. Maybe folks in the 40s were more suggestible. Hell, my 40s are coming soon, maybe I’ll become more suggestible too. 😇

12 - Somnambulism and the Compounding of Suggestion

Dave Elman thoughts on hypnotic depth:

These only apply to those who do not automatically go into somnambulism.
Physical relaxation is “light hypnosis.”
Mental relaxation is to “think of yourself an instant before you fall asleep… nothing disturbs, nothing bothers… the mind is completely blank.”
The combination of physical and mental relaxation creates “the state of somnambulism.”
You only need a moment where the mind is blank on a specific thing - in their example, numbers.

Elman defines…

Artificial somnambulism is created when the patient has aphasia - they are too relaxed to say the numbers.
True somnambulism is created when they are truly unable to remember.

They provide the four states of hypnosis as…

The light or superficial
The somnambulistic
The coma (Esdaile)
Hypnosis attached to sleep (hypnosleep)

In the transcript - they describe how their technique is equivalent to “five visits to Doctor Bernheim.” We call this fractionation now, but here they call it the “repeated induction technique.” They also entertainingly light a cigarette in the transcript and bind it to increasing their anesthesia - I keep thinking this dude just wanted an excuse to take a smoke break during a demonstration.

You’re not missing much here - they continue to sell their technique to their captive audience of doctors like a stage hypnotist. 9.9 (They do describe how to compound and build suggestions by just building on a previous suggestion, but at this point it’s obvious.)

Further along in the transcript they uh - well, they describe themselves bringing back the memory of learning to walk through a metaphor. I’m uncomfortably watching this dude carelessly and confidently create a false memory.

This is also where we get this gem of a quote… with debatable usefulness and accuracy…

Elman: [to doctors] Let me show you again the technique I use when the numbers don’t disappear. I lift his hand and say, “When I drop your hand the lights will go out and you won’t see any more numbers… There you are… The lights are out and all the numbers are gone… , That’s how you change artificial to true somnambulism.

Goddamn, and this is savage…

But what do you do when you meet with resistance on the part of the patient? Don’t try to produce the hypnotic state. Since hypnosis is a consent state, it is useless to carry on when resistance is there. In certain cases, a doctor can eliminate much of this resistance by saying to the patient, “Too bad. You don’t want treatment the easy way. You’ll have to have it the hard way.” The patient usually becomes apologetic-afraid of the pain that may ensue if treatment is given the hard way-and will try to cooperate. With resistance gone you will be able to gain the state for many of these difficult patients.

I disagree with Elman’s perspective that if something doesn’t work, it’s a problem with a willingness to comply. I do agree that at some point, you should (more graciously than he does) cut your losses and stop amicably. Do it out of respect for validating your co-operator’s response.

13 - The Esdaile State

There’s some light historical ramblings - none of which I care to verify at this time. There’s certainly a twinge of irony in Elman opening up with a story of what even he calls a tall tale, and then proceeds with stories of hypnotic anesthesia so strong you could use it for surgery. (While this is a thing, it appears incredibly rare, and I really doubt Elman was as successful as he purports himself. If he was, we’d be using hypnotic anesthesia much more frequently. )

Elman describes people that would go into the Esdaile state spontaneously during his stage performances. In this, he observed…

Wax-like rigidity
Euphoria, not wanting to be disturbed
Spontaneous anesthesia

In the first place, few people, if any, find it possible to fall asleep in the hypnotic state. The statement that the coma will change to natural sleep is false.

Okay Elman, come wake up my fucking snoring subjects for me.

Ugh. 9.9

Well, here’s the technique. It’d be a shame to not stick it here for historical reasons.

As I remember, I spoke to the patient more or less like this: “I know how relaxed you are, but even in your relaxed state I’ll bet you sense in your own mind that there is a state of relaxation below the one you’re in right now. Can you sense that?

The patient answered, “Yes.”

I continued, “You know that you can clench your fist and make it tighter and tighter and tighter-and you might call that the height of tension. You can relax that same fist until you can’t relax it any more. You might call that the basement of relaxation. I’m going to try to take you down to the basement.

“To get down to floor A, you have to relax twice as much as you have relaxed already. To get down to floor B, you have to relax twice as much as you did at floor A, and to get down to C, you have to relax twice as much as you did at floor B. But when you reach floor C, that is the basement of relaxation, and at that point you will give off signs by which I will be able to tell that you are at the basement.

You don’t know what these signs are, and I’m not going to tell you what they are, but every person who has ever been at the basement of relaxation gave off those signs… Let’s get started. “You will ride down to floor A on an imaginary elevator and you will use that same elevator to get down to the basement of relaxation. You are on that elevator now. When I snap my fingers, that elevator will start down. If you relax twice as much as you have relaxed already you will be down at floor A. Tell me when you are at floor A by saying the letter A out loud.”

In about thirty seconds, he murmured “A” in an almost indistinguishable voice. I followed a similar procedure, taking him down to floor B. It was almost impossible for him to say the letter B out loud, but he formed the sound with his lips. When he reached floor C, he was unable to speak, and not a muscle moved.

Elman professes that hitting the Esdaile state is not a given… but they do brag about a generously high success rate with pregnant women. Helpfully, they also state something useful. Despite all the effects of Esdaile (catalepsy, spontaneous anesthesia, euphoria,) the co-operator can still bring themselves out.

We learned that despite the euphoria in the coma state, if something should happen to alarm a patient, he is quick to rouse himself and go into any necessary action. He is not helpless.

You can test for this level of ‘coma’ by verifying:

Spontaneous anesthesia (checking with allis clamps, pretty much pinchy clamps that look like scissors, ow.) If you need to give them the suggestion of anesthesia, they are not in a hypnotic coma.
Asking them to move a large muscle group - they should be unable to move.
Asking them to move a small muscle group like opening the eyes.
Catatonia. Conveniently - they don’t provide a test for this - but I’m pretty sure what they mean is check for the waxy-like rigidity of catalepsy. If you’re reading my guide to learn how to do surgical grade hypnotic anesthesia, I’d advise you to reconsider at this point.

They provide two methods for getting someone out of the Esdaile state:

Tell them… If you don’t open your eyes when I tell you, you can never have this state again.
Just bring them backwards through the floors/levels mentioned earlier.

At the end - they provide the nugget that you can go directly from physical relaxation in their induction technique, and directly move to the Esdaile deepener. This is contrary to Mark Wiseman’s take on Esdaile from Mind Play Study Guide - they suggest hammering the heck out of your subject first as deep as they can go, and then starting with the Esdaile deepener. See what works for you! If you’re tinkering recreationally, there’s no reason to not zonk the fuck outta your subject.

14 - Conditioning for Hypnotic Delivery and Surgery

Elman provides a pep-talk example of how to keep patients focused on their suggestions and avoid negative distractions. They also recommend that you don’t mention hypnosis while doing this due to the current (1950’s) lack of understanding around hypnosis.

Eventually - they advise the patient that they’ll look forward to their delightful contractions, focusing on the thought of seeing the face of their baby.