Hypnogenesis,Chronic Pain and Peircean Habit: Implications for Clinical Endeavors

Introduction

The scientific field of hypnosis is presented with a significant separation between research and clinical practice (Neubern, 2017). Recent researches relating to hypnosis and chronic pain have been vastly focused in measuring efficacy of specific hypnotic techniques (Langlois et al., 2022). Although they play an important role of highlighting hypnosis as a legitimate treatment alternative, ¹ such researches broadly disregard the subjective dimension of chronic pain experience, which is relevant to therapeutic achievements, such as long-lasting reduction of physical and emotional pain (Bioy & Lignier, 2020; Erickson & Rossi, 1980; Neubern, 2018b). Meanwhile, clinical considerations of the hypnotherapeutic process meet considerable difficulties in being published due to the fleeting and diaphanous nature of hypnotic processes that encumbers the legitimation of interpretations constructed on such grounds.

In qualitative researches, it is common for the legitimacy of information produced about a subject’s experience to rely on its capacity to report it (Gonzalez Rey, 2005), such criteria presents itself as severely flawed when applied to hypnotherapeutic processes because of the possibility of two related hypnotic phenomena manifesting themselves: amnesia and conscious/unconscious dissociation. It is possible for assimilation processes to become more malleable amidst the dynamics of hypnotic experiences, allowing long-lasting or temporary partial amnesia to spontaneously occur or to be evoked by the therapist (Erickson & Rossi, 1980). It is also not uncommon for hypnotherapeutic interventions to evoke dissociation of modes of agency (Gallagher, 2012) conventionally named as conscious mind and unconscious mind (Havens, 2005), where the attention and rational comprehension of the subject, namely his conscious mind, is unaware of other actions or communications taking place with the unconscious mind. Therefore, the subject’s report of the hypnotherapeutic process can be faulty, or, in the very least, partial, considering the hypnotic experience as a whole.

Reportability aside, hypnotic processes still transpire in a relational context where communicational phenomena act differently upon the dispositions of both therapist and subject, in such manner that elements in arising experiences cannot be properly distinguished as fabricated or revealed, imaginary or real. Trance experience is constituted by a merge of transmitted suggestions, imaginary creations and experiential resources, similar to a dream, where multiple instances of agency are involved in its making, but do not necessarily disclose their exertions to the subject’s ego. Such shifting grounds are treacherously averse to modern science’s craving of objective data and reproduceable results, which aim for a universal conclusion. According to hypnosis’ relational nature (Bioy & Wood, 2008; Bioy & Servillat, 2017), the method by which it is approached greatly affects the hypnotic experience in itself and phenomena that will manifest from it (Neubern, 2020). The notion of hypnogenesis (Melchior, 1998; Neubern, 2021; Stengers, 2001) covers how a therapeutic relationship tends to reproduce the ideas and theories of the therapist in the subject’s subjectivity, relating to this aspect of hypnosis and its implications to clinical processes overall.

We are, then, faced with three major questions concerning hypnosis: (1) how to strengthen the legitimacy of information constructed from hypnotherapeutic processes; (2) what does hypnogenesis imply in terms of constitution of the self and; (3) what does hypnogenesis imply in clinical relationships, especially in chronic pain care. Charles Peirce’s work (Peirce, 1958, 1998) has recently been taken into account to further discuss these matters in hypnosis. His phenomenological categories embrace subtle, concrete and symbolic dimensions, whereas his semiotics articulates these dimensions in phenomena that act upon the subject’s mind, producing meaning of different logical orders. Lately, studies that have taken Peircean conceptions into their discussion have progressed in matters of hypnotic communication and subjective processes (Neubern, 2017; Neubern & Gonçalves, 2019). Besides rehearsing a method of research in hypnosis inspired in Peirce’s work (Neubern, 2018a), seeking coherence between accountable impressions, accurate description and pertinent interpretation of the respective experiences.

However, hypnogenesis, which is not limited to hypnosis, raises questions concerning the potential developments of iatrogenesis, here portrayed as clinical acts or interventions that are prejudicial to the subject (Bioy & Wood, 2008). These matters will be discussed in the context of subjects with chronic pain. Le Breton (2012) explains how the division of areas in the health system is unfavorable to subjects with chronic pain by focusing on specific organ systems and acute pain care, leading to a cyclical redirection to doctors, services, procedures, and allopathic treatments whose benefit is sometimes minimal. The setbacks of the search generate a growing sense of helplessness that can intensify pain and develop into depression and anxiety. This scenario is reflected in Milton Erickson’s cases, where patients describe their journeys through various hospitals, specialists, numerous examinations and, as a result, display a general hostility to health care professionals (O’Hanlon & Hexum, 1990; Zeig, 1980).

Therefore, this study’s objective is to discuss hypnogenesis parting from one of Erickson’s chronic pain cases, analyzing hypnogenesis involvement in iatrogenesis and in the therapeutic interventions. It is worth noting that this study is aware that its theoretical approximations are very new in the field of research and still in its initial stages, laying out theoretical possibilities and alternative routes of thought. The ideas articulated here, as well as the relations made between Peirce, a philosopher, and Erickson, a psychiatrist, are yet risky, although necessary for the refinement of the discussions concerning hypnotic experiences and communications.

Basic Concepts

Hypnosis is here comprehended as a phenomenon composed by two intrinsic processes: trance experience and hypnotic communication (Neubern, 2020). Trance experience refers to the alteration of ego-world relations, like time, space, body, alterity, matter and cause. In trance, the dominating ego-world relations can be depreciated, arising commonly inhibited processes that can establish their own relations to these references. Meanwhile, hypnotic communication involves the communicational processes related to trance experience evocation, maintenance and conduction. These communicational processes can be internal, such as the subject’s deliberations pertaining to suggestions and image productions, or external, concerning the technique and the context in which they take place.

In turn, Peirce’s concept of sign assumes a central role to understand his work (Santaella, 2000). Sign being something that represents an object to the mind, generating in it an effect - the interpretant. The interpretant is a new sign that can carry the subjectivity involved in the act of interpretation, an approximation to the object, but never a full representation of the object. This process of sign action is called semiosis, where the mind constantly produces and reformulates interpretants in the synthesis of a meaning (Peirce, 1958, 1998).

Peirce’s habit is a broad concept, considering a wide range of living and non-living phenomena, material and abstract, as well as physical and mental phenomena. Habit here refers to the tendency of phenomena to acquire generalities, which can form systems of ideas, constitute laws, and rule other processes (Nöth, 2016; Pickering, 2016). When it comes to the constitution of mental habits, the mind does not necessarily differentiate between interpretants originating from material or non-material signs, as so, habits can also be influenced by mental rehearsals and inner world reiterations (Peirce, 1998, p. 413), as Peirce explained exert:

An expectation is a habit of imagining. A habit is not an affection of consciousness; it is a general law of action, such that on a certain general kind of occasion a man will be more or less apt to act in a certain general way. […] Of course, every expectation is a matter of inference. […] For our present purpose it is sufficient to say that the inferential process involves the formation of a habit. For it produces a belief, or opinion; and a genuine belief, or opinion, is something on which a man is prepared to act, and is therefore, in a general sense, a habit. A belief need not be conscious. […] A belief habit formed in the imagination simply, as when I consider how I ought to act under imaginary circumstances, will equally affect my real action should those circumstances be realized. […] Under a logical aspect your opinion in question is that general cognitions of potentialities in futuro, if duly constructed, will under imaginary conditions determine schemata or imaginary skeleton diagrams with which percepts will accord when the real conditions accord with those imaginary conditions; or, stating the essence of the matter in a nutshell, you opine that percepts follow certain general laws. (Peirce, 1958, vol. 2, p. 222) ²

Thus, expectations, beliefs, opinions carry a role in habit formation and in how certain dispositions will, if they should, abide by certain general laws. Mental laws are habits with various levels of mutability, adequacy and integration, whose formations and developments come from the experiences undergone in relation to the world and relation to oneself through mental rehearsals (Colapietro, 1989; Nöth, 2016). However, our semiosis and our ways of interpreting and relating to the world are also ruled by habits, as they constitute past learnings that alter the formation of interpretants under certain conditions, marking a movement of systemic retroaction.

Peirce’s concept of habit (West & Anderson, 2016) demonstrates the affinity of the notion of a semeiotic self (Colapietro, 1989; 2017) with Erickson’s notion of self that is implicated throughout his work (Neubern, 2021). The notion of self implied in Peirce’s work shares common ground with Erickson’s in the manner it is permeated by the social dimension, organized in fallible dynamic processes involving subjective, vital and symbolic dispositions, making the self susceptible to reorganizations throughout lived compelling experiences (Colapietro, 1989, 2017; Neubern & Gonçalves, 2019). Erickson’s work implies similar conception, where life-long experiences compose a great wealth of resources for learnings regarding the various dimensions of existence, as emotional, relational, bodily, and symbolic learnings (Erickson & Rossi, 1980; Zeig, 1980). Whereas, in Peirce’s framework the agency over processes pertains to habits, Erickson saw them belonging to multiple levels of awareness, which he conveniently called the unconscious (Havens, 2005) and developed ways of engaging with it through hypnosis.

Hypnogenesis, despite the name, goes beyond hypnotherapy, it refers to the mirroring process one’s subjectivity can undergo in clinical relationships, in the semiotic context here presented, it can be conceived that it touches on organizational dynamics of habits in search of a better configuration through the reiteration of verbal, non-verbal and contextual communication. Moreover, it implicates the clinician and its representations into the subject’s comprehension of reality, inviting them and their interpretants to act upon one’s dispositions of relating to the world and oneself. In hypnosis this is radicalized to the point of comprising the evocation of hypnotic phenomena such as hallucinations and visualizations, granting it great therapeutic potential (Erickson & Rossi, 1980; Neubern, 2018b).

Case Summary

The following case is portrayed as one of the field experiments used to discuss a technique for resistant patients in one of Erickson’s articles (Erickson, 1964). She is characterized as so due to her hopelessness and disbelief in hypnosis, based on medical opinions, her diagnosis history and her own research from medical books. A brief comprehension of the technique has been inserted in the report to provide context to the reader.

The patient walked in Erickson’s office stepping softly. Her body was rigid, the right side of her face was controllably immobile, although the blink of her left eye was reduced. Her speech was clear and lucid, but spoken by left side mouthing words. Right arm movements were constrained and hesitant, especially when towards her face. She was immediately asked since when she had trigeminal neuralgia ³ and to answer slowly in few words. She replied “Mayos’, 1958, advised against surgery, against alcohol injections, told there was no treatment, have to put up with it and endure it all my life, (crying), a psychiatrist friend said maybe you help.” In a short-worded conversation she explained her need of help and Erickson asked if she would accept his pace. When asked if they could start, she answered “Yes, please, but no good, all clinics say hopeless, painful. Everybody enjoy himself but I can’t. I can’t live with my husband, nothing, just pain, no hope, doctors laugh at me see you for hypnosis” (Erickson, 1964, p. 25).

Erickson asked if anyone suspected psychogenic origin of pain and the patient explained that all clinics said it was organic. She did not believe hypnosis could help since hypnosis was psychological and her disease was organic. It was also learned she was eating liquids and it took her around 1 hour to drink a glass of milk. She had trigger spots at her cheeks, nose and forehead. Lastly, she was asked why she had gone to Erickson since she did not believe hypnosis could work, and answered that one last try would be just a bit more money, considering that nothing helps her, and medical books also state that her condition is incurable.

Taking into account her disbelief, how conditioned she was to uncontrollable pain, and how respected medical authorities stated he condition as incurable, Erickson explains how this constitutes an unfavorable condition for direct hypnosis. She had already established a background of learning and conditioning associated with long-term pain experience. So, he employs the technique for resistant patients described in the respective article in which this case is included. In short, the technique lures the subject’s attention in the therapist’s speech of apparent explanation while indirectly suggesting how her conscious mind know very little about the problem, unlike her unconscious mind, later establishing means of communication with the unconscious mind. This occurs by discussing, in the guise of explanation, how body movements of agreement or disagreement frequently take place without conscious awareness, and that unconscious mind could reply choosing to let the conscious mind know its answers, or not. Throughout this explanation, it is often stated how easily the conscious mind gets bored, and how unimportant its opinions on the matter or its current actions are. The context is constructed in such a way that: (1) if the conscious mind is aware of the answers, it’s because the unconscious mind allowed it; (2) any movement made, voluntary or not, can be understood as an answer and; (3) unconscious processes are on the forefront of importance, while conscious awareness and comprehension are highly demotivated (Erickson, 1964, pp. 9–17).

In the current case, statements that an inadequate history had been taken were added to technique, and that “there should be a careful search of her unconscious mind of all possible ways and means of controlling, altering, changing, modifying, reinterpreting, lessening, or in any other way doing whatever was possible to meet her needs” (Erickson, 1964, p. 26). Suggestions were also given that her unconscious mind would freely communicate any desired information. The patient responded well to the technique, answering in head movements and having arm catalepsy. She aroused from trance slowly after Erickson asked again if it was alright that he gave general explanations before beginning. She replied affirmatively with ease and no guarded movements, which startled her. It did not hurt to talk, and she no longer felt air breezing on her trigger points. A spasm of extreme pain came after touching her nose. Once she realized 1 hour had passed since her arrival, she exclaimed it was “utterly impossible,” to which Erickson replied “Yes, it is quote utterly impossible unquote but not in this office” (p. 26), also instructed her to come the next day and ushered her out of the office.

Upon arrival, she was asked how she slept and if she dreamt. Her reply was “No, no dreams, but I kept waking up over and over all night long, and I kept having the funny thought that I was waking up to take a rest from sleeping or something”. Erickson complimented her unconscious mind on the hard work it was doing and asked her for a full history. The patient reported her life events and that she was a psychiatric social worker. Her pain started in 1958 and continued for 18 months, she sought clinics from many specialties that ruled out psychogenic factors and condemned hypnosis when questioned. At work, she was well-liked and had the habit of whistling merry tunes. She added how meeting a doctor who uses hypnosis helped her, now she could talk easily and, that morning, it took her less than 5 minutes to finish a glass of milk. She went into a deep trance after Erickson replied “I’m glad of that.”

Various activities were described disguising instructions in their implications. For example, Erickson said that cracking brazil nuts with her teeth, especially on the right side of her mouth, would be very painful and “not at all like eating.” Then, ensued into another activity. After he finished, she aroused from trance and was shocked that an hour went by, again. Erickson replied “the lost time went to join the lost pain,” and ushered her out of the office.

On day three, she came in celebrating how she had filet mignon for dinner and that while combing her hair, she felt the urge to jerk her locks, noticing that her forehead is not a trigger spot anymore, and demonstrates how she can touch it anywhere now. At the fifth sessions her pain was gone and she started raising the subject of going back home. In a playful manner, Erickson says she has not learned how to get over the recurrences, and that sends her into deep trance. “It always feels good so good when you stop hitting your thumb with a hammer,” he remarks. Soon after, her body stiffens in pain, relaxes, and she smiles. Erickson flippantly told her to “work up a sweat” with half a dozen times, so she realizes she has had really good practice. Once she was done, it was suggested she would dry her face with tissues nearby, the patient did so in a briskly manner, indifferent to her nose and right cheek. After vaguely complimenting her job well done, she was aroused from trance and again dismissed.

In the sixth day, Erickson said it was her ‘doubt day’ and asked her to slap her left cheek hard, which she promptly did. Stretching and yawning he asked to do the same for the right side. She hesitated and slapped it with reduced strength. She was mocked for pulling her slap and asked how her face felt, her trigger points were clearly gone. Then, she was asked to do it again without holding back. She slapped her face hitting her right cheek and nose, and added a hit on the forehead with her fist by herself. “Well, there’s the end of doubts,” she declared pleased. After brief light-hearted conversation, Erickson suddenly sent her into trance. He instructed her to make up a song that she could whistle containing the lyrics ‘I can have you anytime I want you, But, Baby there ain’t never gonna be a time when I want you’, she nodded and aroused from trance. Unaware of the time passed, before she could speak, Erickson said a wordplay phrase suggesting that what is done is done, things from the past should stay there and one more session would make her go home with many good tomorrows.

The seventh and final day was as follows:

The final interview was simply one of a deep trance, a systematic, comprehensive review by her within her own mind of all of her accomplishments and the gentle request to believe with utter intensity in the goodness of her own body’s potentials in meeting her needs and to be “highly amused when the skeptics suggest that you have had remissions before followed by relapses.” (The author is well aware of the deadliness of skeptical disparaging remarks and of the engendering of iatrogenic disease). ⁴ Correspondence received since her return home has confirmed her freedom of pain and also that a neurologist, antagonistic toward hypnosis, offered her a long argument to the effect that the relief she experienced would be most transient and that there would be a relapse (an unwitting effort to produce iatrogenic disease). She related this, stating that his argument had made her feel “highly amused,” thereby quoting directly from the author’s own posthypnotic suggestion. (Erickson, 1964, p.27)

Habits, Hypnogenesis and Iatrogenesis

One key question surrounding hypnogenesis is how are clinical or therapeutic relationships different from the day-to-day experiences to allow such level of influence to take place. What, in this context, shapes a greater openness towards another’s conception of reality to, in some way, assimilate it as their own. Possible answers could be a relation of both a state of vulnerability and the role of trust in such interaction. Vulnerability seems to permeate to habit systems as a sentimental disposition related to inadequacy, fallibility of their exertions, and need of aid or a new perspective. Pain itself is sufficient to establish vulnerability, but chronicity threatens life projects and goals, long-term body integrity, social relations, freedom and autonomy of choice.

Subjects with chronic pain find themselves in great state of vulnerability and commonly seek out sources of knowledge that may provide understanding, relief and meaning to their suffering, such as scientific articles, alternative treatments, religion and spirituality (Neubern, 2018b). The matter of trust appears to befall the relationship with said knowledge and its representatives by already partaken experiences and belief in its arguments, where one’s deliberative processes determine if said knowledge is legitimate according to their personal criteria. Medical doctors stand not only as representatives of themselves but as signs of medical knowledge, same to how priests, gurus and sages are representatives of their respective religious knowledge. Being a psychiatric social worker herself, Mrs. L might have been more inclined to accept medical discourse as a legitimate explanation of her situation than the explanation provided by a religion she never belonged to.

Considering a semiotic perspective of self and habits, the chronicity of chronic pain changes the meaning of the passage of time, associating it with sufferance. The pain forcibly inserts itself in everyday experiences, taking part in semiotic processes and interpretant production of important dimensions of the ego-world relation, including identity defining processes (Bioy, 2017; Neubern, 2018b). Erickson himself warned how prolonged pain experience can form protective habits that change the interpretation of stimuli in a certain area of the body to painful sensations, such habits can persevere regardless of the presence or motive of the original pain (Erickson & Rossi, 1980). Consequently, expectance plays a big role concerning chronic pain, on account of most of chronic pain’s semiotic production being time driven and future oriented.

Erickson’s comment about the production of iatrogenic diseases most likely concerns the combination of prejudicial determinations imposed over one’s capabilities and expectations in a state of vulnerability, where these interpretants are more susceptible to be integrated ‘as is’ in the subject’s habits. Viewing habits as interwoven systems, critical life moments like Mrs. L’s trigeminal neuralgia depict a semiotic system in crisis, undergoing searches of new elements through which a reorganization becomes possible, electing new mental laws and subsidizing new relations to varying dispositions. “An expectation is habit of imagining” (Peirce, 1958, vol. 2, p. 222), ⁵ a mental rehearsal that is not always conscient, and lays the ground for future exertions. The reiteration of events such as treating the subject as their illness, communicating messages as ‘nothing can be done about it, it’s incurable’, ‘endure it for life’ and ‘the pain will return’, when said by a source the subject considers legitimate and knowledgeable, afflicts the subject with mental rehearsals, preparing vital and subjective dispositions for the likelihood of such events.

This hypnogenic scenario is similar to a hypnotic suggestion, where the mention of something happening opens the possibility of such phenomena being evoked, and coming to fruition. In chronic pain cases like Mrs L’s, this can result in stricter relations with vital dispositions, suggesting further immobility, as well as bigger presence of pain in day-to-day experiences and in identity processes. The subject is rendered helpless before the pain, more likely to submit to it, since a law stipulated that he is unresourceful and a passive element, unable to intervene in causal laws as like stimuli-response.

Hypnogenesis and Habit Reorganization

Whereas Mrs. L’s previous experiences of medical care suggested her case was hopeless and untreatable, Erickson met her in her current state, immediately recognizing her neuralgia, adapting conversation style to spare her from pain and offering to start therapeutic work. This display of empathy appears to pervade the treatment, in as much as Erickson is both entirely present, contemplating her as whole, and suggests therapy is possible without displaying any doubt. It is likely that expectations are already being conveyed at this stage, despite Mrs L’s conflicting thoughts on hypnosis. Erickson shows, in a short period of time, knowledge on how to handle and provide comfort to someone in her condition, and resolute confidence that something can be done in her case. Possibly, his conduct as a sign acted as a strong argument, towards Mrs. L’s rigid set of habits concerning her illness, creating an opening for future reorganizations.

The trance in Mrs. L’s first session is interwoven with many suggestions regarding the history she presented in different ways. Mrs. L was inducted to trance by suggesting how limited her conscious knowledge about her condition was, whilst her unconscious could have a much better grasp at it and the unconscious knowledge and modes of agency are slowly brought to the forefront of the trance experience. The suggestion ‘an inadequate history has been taken’ has the means to enact both as ‘inadequate anamnesis’ and ‘inadequate experience’, questioning the validity of said history. As he instructs the unconscious to go through past experiences, some general guidance of means of meeting her needs are already provided in the verbs utilized: “controlling, altering, changing, modifying, reinterpreting, lessening”. Although, it becomes Mrs. L’s task to find experiential resources in her past and meet her needs.

It would be and overstatement to say that Mrs. L’s conscious conception of her condition constituted habits directly involved in the experience of pain. Nevertheless, such conception seems to hinder semiosis from producing interpretants that would affect her experience once they do not follow the general laws of strict physiological causality to which she learned she was subjected to. Erickson’s initial conduct hinted his knowledge in chronic pain in ways unknown to Mrs. L, putting in question the adequacy of such set of habits. Then, the first trance experience demotivated these habits further while promoting a reorganization of her experience. The term reorganization is not used here without thought, Mrs. L’s memories, values, experiential knowledge, and learnings compose a complex network of habits whose relations to each other determine, in many ways, subjective processes and how to relate to the world. Erickson’s intervention sets a context of flexibilization of such network, encouraging reinterpretations, new forms of relations and arrangements of mostly the same elements. The hypnotic phenomena that are evoked emerge from her own experiential resources, for example, previous vital disposition schematics, such as body movements from a time in which she moved in a less guarded fashion, or having pleasant sensations in an area that became a trigger spot. This resource is revisited first in a mental rehearsal during trance, which increases its availability to new habit organizations, and later experienced again after trance when conscious awareness recognizes it, consisting in a new experience to different modes of agency as a new and recent iteration. This way, meaningful experiential resources are made available to habits organizing Mrs. L’s experience, and reintroduced as a new experience to be accounted for in future semiosis. This flow of evocation of an experiential resource in trance experience and then reexperience in a out of trance scenario marks form of habit reorganization present throughout Mrs. L’s entire treatment.

Hence, a significant shift occurs in the initial trance experience, marking a new form clinical relationship to Mrs. L, almost opposing her previous ones. Her attention was necessary and welcomed during the early explanation disguising the induction, her experiential knowledge and her needs are taken into consideration, and she is invited to work in favor of her own health, acting as a protagonist in the therapeutic process, despite the lack of involvement of her conscious mind. Among the ideas being suggested, a recognition and use of her experiential background assumes her as resourceful and capable of carrying out the tasks for which guidance was provided.

The method through which the unconscious mind, or instances of agency, are brought into the clinical context might be of value concerning hypnogenesis and chronic pain. A context is constructed in which an unconscious answer must be given through ideomotor movements, implicating the development of different relations and experiences between the unconscious and bodily processes in favor of therapy. Next, Erickson gives them autonomy over what are the relevant experiential learnings to tend to their actual needs and to decide when and what information shall be disclosed to the ego. Erickson makes it clear that protagonism fulfills an important role in this case (Erickson, 1964), yet it is achieved through repeated processes of amnesia, and mediated exposition of the achieved changes to Mrs. L’s conscious mind. Perhaps, conscious participation in the therapeutic process would impose previous learnings, intervening and restricting the production of new interpretants in the hypnotic experience under inadequate rules. In other rules, making her notion of an impossible reality truly impossible to herself. This would justify why Erickson quickly ushered her out of the office after each session and gave her no time to elaborate on what transpired. However, there’s a clear coalition between Erickson and the patient’s unconscious, built over trust and learned means of communication where each recognizes the other’s work.

The first 4 days of Mrs. L’s case were of enough progress to resume day-to-day activities in a painless fashion. The activities Erickson described involved the body parts affected by the neuralgia, like eating, and composed mental rehearsals where he would suggest interpretants where distinctions could be drawn from the subject’s own resources. It is conceivable that developed habits that entangled all stimuli in such body regions as painful could, then, disentangle due to new mental experience and experiences from before the neuralgia, reorganizing step by step relations between vital and subjective dispositions that allowed her to lose her trigger spots.

From the fifth day on, once recurrences are mentioned, Erickson’s gestures and emotions play a bigger role in the suggestions made, adding it himself in the underlying article that his flippancy, yawns and stretches are not coincidental (Erickson, 1964). They relay onto the subject his comfort and sureness that harmful outcomes are not to be expected from the proposed tasks. Erickson’s conception of the fallout is conveyed by a multitude of collateral signs that demonstrate a certain coherence amongst themselves. Hence, these suggestions are based on social relations conventions, shared interpretants of culture wide habits of the “do’s and don’ts” related to professionalism and ethics. The structure of those suggestions can be exemplified as “No good doctor in his right mind would so comfortably trick me into slapping my own face if it involved real risk, he is a good doctor, so it is highly unlikely that it will”.

The therapeutic work related to recurrences as described seems to entail three separable processes: (1) an experiential proof that Mrs. L can produce, but also relief her own pain; (2) habits that protect her from further iatrogenic remarks from others and herself, and; (3) reassure her achievements in therapy. The hammering of the thumb hypnotic experience likely addressed the first point in a unconscious level, while the doubt day solidified the argument with the slap on her right side of the face. With such proof, guarding habits of movement could be fully abandoned, as they imply painful stimuli themselves. The second and third points are approached in post-hypnotic suggestions. Whistling the suggested song implicates both the subjective and vital aspects of the reorganization achieved, the lyrics relate to her autonomy over the pain, and the mouth movements required to do so established freedom over the previously immobilized muscle movements on the right side of her face. Moreover, the wordplay enounced as she was leaving the sixth session suggests future-oriented thinking and instills expectations of therapeutic gains following her way home.

Erickson’s final statements to Mrs. L alludes much to how hypnogenesis is involved in his treatment of chronic pain. To place upon her the request that she believes in her bodily potentials to meet her needs reenacts the perspective that Erickson has had of her therapeutic process since the start. It is to say, that Erickson, throughout Mrs. L’s entire process therapeutic process, acts as complex sign of the outcomes he desires to take place. His presence, which implies more than his speech, conveys a multitude of coherent signs leading, but not imposing, the experiences he wishes to evoke, and which are based on his own long-lived experiences with chronic pain.

In addition, hypnogenesis can insert the clinician as a sign integrated with the subject’s habits, reinforcing the experience of care throughout internal dialogs and reminders in time. Similar to the way a learning is, at times, experientially associated with how it was acquired. In hypnosis, however, such level of presence may allow the therapist to evoke personal and cultural beliefs that make sense to the subject as resources for chronic pain. For example, a child’s suffering being soothed by the mother’s kiss, the scratch that stops hurting once a parent cleans it and puts the right type of band-aid on it, or the hand imposition and prayer by an elder. The rupture in otherness in trance experience may allow the therapist to evoke and articulate favorable organizations with those resources, since they pertain to the subject himself.

According to the dynamics in which habits become more or less integrated, looser or stricter in its relations to pertinent processes, hypnogenesis alludes to the depth to which the social dimension is implicated in habit change (Nöth, 2016). A clinician can communicate his own conception of reality affecting, in various degrees of influence, the subject’s experience and the condition in itself towards freer or more restricting organization. Subjects with chronic pain are already implicated with restricting relations with the world, hypnogesis allows, in certain ways, the nurturing of expectations of freer relations to the world, that do not consist on wishful thinking, but on the knowledge and use of experiential resources from the subject himself (Bioy & Lignier, 2020; Erickson & Rossi, 1980; Neubern, 2018a; 2018b).

Final Considerations

Hypnosis has historically proven itself a challenging field of research due to the ephemeral nature of its phenomena, the singularity of each experience and the means of assessing it. However, hypnosis provides a path both to further understand the constitution of the subject as well as to therapeutic changes with undeniable significance. Chronic pain experience presents vital and subjective processes that are interwoven in a complex manner that greatly benefits from hypnotherapeutic interventions. Charles Peirce’s work recognizes the modes of existence in which hypnosis’ abstract and fleeting phenomena take place, while providing means of classifying as signs to comprehend how they can produce meaning. Habit was especially highlighted out of Peirce’s work due to its aid in organizing subjective processes in a hierarchical mutable system, facilitating the comprehension of its dynamics for chronic pain experiences and undergoing changes throughout the hypnotherapeutic process. Although this study did not include Peirce’s work much further than his concept of habit due to its scope, it has shown to be sufficient to develop the concept of hypnogenesis and iatrogenesis in hypnosis.

Iatrogenesis was demonstrated as a form of hypnogenesis where experiences of care under professionals did not meet the persons needs and illustrated a lasting image of hopeless future, causing a prejudicial effect instead of therapeutic one while discouraging further searchers of treatment. Under a perspective of habit, the sentiments of vulnerability and trust were considered important elements in the development of hypnogenesis as it sets the context where the subject would search for trustworthy experiences and knowledge about his own condition in a clinical context. Having the clinical experience as one’s own reference, the knowledge and logical references being communicated in the clinical setting are more likely taken into the constitution of one’s habits. In counterpoint, hypnogenesis as a phenomenon plays a meaningful role on therapeutic practice as long as the patients’ needs are accounted for. In Mrs. L’s case, hypnogenesis is utilized as a part of Erickson’s suggestions, first hinting at a certain experience to be had, suggesting it in trance and having that experience occurring in a real-world situation.

Hypnogenesis stands as a complex phenomenon relating both to hypnosis relational nature as to the heterogeneity constitution of the self and its multiple instances of agency. It helps build the hypnotherapeutic experience, as much as it navigates it. To understand how it exerts such level of influence, we are obligated to address standing dichotomies in scientific paradigms as subject-object, inner-outer and mind-body, working on broader comprehensions where such dimensions do not stand isolated from each other, as if they did not pertain to one reality. Peirce’s and Erickson’s work, point toward that direction, each from its respective field.

The article does not mean, in any way, to suggest that hypnosis is boundless, or limitless, in its transformational capacity. It is no exception to the general laws dictating bodily and subjective processes. Hypnosis however reminds us to not subvert the order of pragmatic reasoning, assuming general laws are fully apprehensible and rendering experience predictable in such way that its singularity can be disregarded entirely.