Another factor to be mentioned is the heightening of memory, to which Vogt and Brodmann, but Breuer and Freud specially, have called attention. I shall return to this when I come to deal with the cathartic method recommended by Breuer and Freud.

But the most important point in connection with hypnotic therapeutics is the direct action of suggestion, or, to use Vogt and Brodmann's words, the subject's heightened susceptibility to psychic influence. Both these authors prefer the latter expression because it is not only the subject's susceptibility to suggestion that is increased in hypnosis, but to other psychotherapeutic agencies as well - for example, to praise or blame, to logical argument, emotional stimulation, therapeutic exercises, etc. Still, increased suggestibility is undoubtedly the most important factor, and we will now proceed to discuss it in a more detailed manner so that we may understand its true therapeutic significance.

Let us take as a simple example the case of a woman suffering from a functional headache. We wish to cure the headache by suggestion - i.e., by arousing in the subject the idea that the headache is gone. Spontaneous reflection would prevent this in most waking people, but in hypnosis it is relatively easy to induce, or suppress, sensations by means of suggestion. Consequently, the suggestion that the headache is gone will be more readily accepted in hypnosis, and the first result will be that the patient feels free from pain while in the hypnotic state. But the great point is to prevent the return of the pain after waking. Either external post-hypnotic suggestion or auto-suggestion will do this. As we have already seen, suggestions can be made to persist post-hypnotically. It is, therefore, not surprising that we can do as much with the idea that the pain is gone after waking. Of course, the patient need not be conscious of this idea in the sense of remembering it; on the contrary, the less conscious the idea is, the more . effect it will probably have. Auto-suggestion is the second plan.

The patient, finding herself without pain in hypnosis, may convince herself that pain is not a necessary consequence of her state, and this idea may under some circumstances be strong enough to prevent the return of the pain.

The more easily an idea can be established in a subject the quicker a therapeutic result can be induced. And the deeper the hypnosis the more easily therapeutic suggestions can be established. But we must certainly agree with Vogt that the persistence of suggestions that are momentarily successful needs a subject of a different character to that which is necessary for a suggestion only to prove temporarily successful. Hence it often happens that the therapeutic result only amounts to a temporary disappearance of the symptoms of a disease without preventing their return shortly after the patient wakes. On the other hand, there are cases in which the acceptance and continuance of a therapeutic suggestion is brought about by superficial hypnosis without any very strong suggestibility. It follows from this that superficial hypnoses must be taken into consideration, quite apart from the fact that they often lead to deeper hypnoses. However, we may take it to be the rule that suggestibility, and also the persistence of suggestions, increases with the depth of the hypnosis.

Suggestion provides us with the key to suggestive therapeutics. When the hypnotized subject does not accept the suggestion, or refuses it, which sometimes happens, it will hardly ever be possible to obtain a therapeutic result. In addition to external suggestion we must certainly also take into account auto-suggestion on the patient's part, for its action does not merely take effect after the termination of the hypnosis in the manner described above. Even during the hypnosis itself, auto-suggestion may be the essential influence that produces the result, although, of course, this auto-suggestion proceeds indirectly from the external suggestion. A person who has himself hypnotized in the belief that the hypnosis will cure him, often suggests the cure himself, without any external suggestion during the hypnosis being really necessary. I have already mentioned pre-hypnotic suggestion (p. 68). Since pre-hypnotic suggestion becomes auto-suggestion during hypnosis, it plays an important part in therapeutics in the manner just described, and the results obtained which are ascribed to hypnosis as such - i.e., without suggestion, are often due to pre-hypnotic suggestion.

Similarly, emotional influences are closely related to auto-suggestions. The patient's expectant attention, and in some cases also the apparent mystery attaching to the whole proceeding and the excitement which that causes, may tend to support the influence of suggestion.

We find on investigation that the number of diseases in which hypnotic treatment is indicated is very great. This is not meant to imply that hypnosis is a universal panacea. There are numerous diseases in which the employment of suggestion comes in question, but in which it is sometimes necessary first of all to ascertain by experiment whether a hypnosis can be induced and hypnotic suggestion thereby rendered possible. Ewald, who wanted to leave suggestive therapeutics to shepherd-boys, likewise refused to concede the same rank to hypnotic treatment as to other methods, because it was impossible to establish definite indications for its use. Let us see how other therapeutic methods stand in this respect. When we find that the same disease can be influenced beneficially in one case by cold water, in another by warm, in one case by douches, in another by hip-baths, in this case by the galvanic current, in that by the faradic, sometimes by static electricity and sometimes by electric light baths, then all these facts should make us somewhat more tolerant in our attitude to hypnotism. We know from experience that patients suffering from the same disease get relief by totally different methods of treatment.