The Collected Papers of Milton H. Erickson

Brief Editor's Neuroscience Edition Preface

This New Neuroscience Edition of Milton H. Erickson's Complete Works has been updated with current concepts of neuroscience for students, clinicians, and researchers who wish to explore in depth the work of one of the most seminal minds in the history of hypnosis and psychotherapy. When Erickson began publishing his studies in the early 1930s, hypnosis was in a curious position: most investigators agreed that hypnosis had played a central role in the early studies of psychopathology and our first efforts at psychotherapy, but the authoritative approaches associated with hypnosis were supplanted on the one hand by the seemingly more sophisticated approaches of the psychoanalytic schools, and on the other hand by experimental psychology. The situation might have continued in just this manner, with hypnosis regarded as nothing more significant than a colorful curiosity in our therapeutic history. Into this situation, however, came the accident that was Milton H. Erickson. He was an accident of nature born with a number of congenital sensory-perceptual problems that led him to experience the world in ways so different that his acute mind could survive only by realizing at a very early age the relativity of our human frames of reference To these early problems was added the rare medical tragedy of being stricken by two different strains of polio at the ages of 17 and 51. His efforts to rehabilitate himself led to a personal rediscovery of many classical hypnotic phenomena and how they could be utilized therapeutically. Erickson's experimental and therapeutic explorations with the hypnotic modality span more than 50 years. His successful rejuvenation of the entire field may be attributed to his development of the non-authoritarian approaches to suggestion wherein subjects learn how to experience hypnotic phenomena and how to utilize their own potentials to solve problems in their own way. The contents of these volumes can be best understood as working papers on a journey of discovery. There is little that is fixed, final, or permanently validated about them. Most of these papers are heuristics that can stimulate the mind to evoke the awe of discovery, which is unlimited in the realm of human consciousness. The problem of how to present Erickson’s papers could have been solved in many ways. A simple chronological order seemed unsatisfactory because the record of much of Erickson's earliest work was published only at a later date. Many papers dealing with the same theme, which should obviously be grouped together, were published in different phases of his career. The editor decided to make a balanced presentation wherein each volume identifies a major area of exploration with appropriate sections wherein the papers are presented in an approximation of chronological order. Each section has a brief introduction to the concepts of current neuroscience that are of relevance for updating our understanding of Erickson’s approaches to therapeutic hypnosis and suggestion. A summary of the 12 key concepts of current neuroscience and a mini-concordance of important terms of shared by neuroscience and therapeutic hypnosis that were presented in detail in volume one are appended here for easy reference by the readers who wish to apply them to the papers of this volume as an exercise in active learning by doing. News, research, continuing education, and consultation on the new neuroscience of Erickson’s approaches to therapeutic hypnosis, psychotherapy, and www.ErnestRossi.com or rehabilitation are available on [email protected].

1

KEY NEUROSCIENCE CONCEPTS OF THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY AND REHABILITATION 1.

SPECIAL STATES: A NEW SCIENCE OF THE STATES OF CONSCIOUSNESS AND CREATIVITY IS EMERGING FROM CURRENT RESEARCH ON THE FUNCTIONAL CONCORDANCE OF CO-EXPRESSED GENES ASSESSED WITH DNA MICROARRAYS AND BRAIN IMAGING. THE EMERGING DISCIPINE OF INFO-KINETICS RELATES INFORMATION TO THE KINETICS (ACTIVITY, MOTION, DYNAMICS, ENERGY) OF MOLECULAR-GENOMIC TRANSFORMATIONS.

2.

ELEVATED GENE EXPRESSION LEVELS GENERATE ELEVATED LEVELS OF NEURONAL ACTIVITY AND BRAIN PLASTICITY THAT DISTINGUISH HUMAN FROM NON-HUMAN PRIMATE BRAINS. THIS ELEVATED GENOTYPE IS AN ADAPTIVE SELECTION MECHANISM FOR THE EVOLUTION OF THE COGNITIVE-BEHAVIORAL PHENOTYPE COMMONLY CALLED “CURIOITY AND THE SEARCH FOR THE HIDDEN MEANING OF THINGS” SO CHARACTERISTIC OF HUMAN CONSCIOUSNESS.

3.

CLOCK GENES AND THEIR ASSOCIATED PROFILES OF CO-EXPRESSED GENES INTERACT WITH PSYCHOLOGICAL AND BEHAVIORAL STATES TO CO-CREATE THE CIRCADIAN AND ULTRADIAN RHYTHMS OF CONSCIOUSNESS, CREATIVITY, EMOTIONS, MOODS, AND PERFORMANCE.

4.

THE POSITIVE AND NEGATIVE PSYCHOLOGICAL EXPERIENCES OF AROUSAL AND BEHAVIORAL ACTIVITY EVOKE IMMEDIATE-EARLY GENES, ACTIVITY-DEPENDENT GENE EXPRESSION, AND BRAIN PLASTICITY IN A WIDE RANGE OF PSYCHOSOCIAL PROCESSES THAT MODULATE MIND-BODY COMMUNICATION AND HEALING.

5.

THE NOVELTY-NUMINOSUM-NEUROGENESIS EFFECT. NOVELTY, ENRICHING LIFE EXPERIENCES, AND EXERCISE ASSOCIATED WITH A POSITIVE SENSE OF CURIOSITY AND WONDER CAN TURN ON ACTIVITY-DEPENDENT GENE EXPRESSION TO CONSTRUCT AND RECONSTRUCT THE NEURAL NETWORKS OF THE PHYSICAL BRAIN THROUGHOUT OUR ENTIRE LIFETIME. CONSCIOUSNESS IS A NOVELTY RESPONSIVE MODALITY OF PSYCHOLOGICAL EXPERIRNCE.

6.

SLEEP, DREAMING AND OFFLINE NEURAL REPLAY IN ERICKSONIAN APPROACHES TO POSTHYPNOTIC SUGGESTION AND THE RECONSTRUCTION OF NEGATIVE FEAR, STRESS, AND TRAUMATIC MEMORIES.

7.

THE MEMORY TRACE REACTIVATION AND RECONSTRUCTION THEORY OF THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY, AND REHABILITATION. SHOCK, SURPRISE, AND THE UNEXPECTED IN ERICKSON’S NEURO-PSYCHO-PHYSIOLOGY OF THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY, AND REHABILITATION.

8.

CREATIVE REPLAY, RESYNTHESIS, AND RECONSTRUCTION AT THE MOLECULARGENOMIC LEVEL OF THE 4-STAGE CREATIVE PROCESS, WHICH ENGAGES DARWINIAN NATURAL VARIATION AND SELECTION ON ALL LEVELS FROM MIND TO GENE, IS THE ESSENCE OF THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY, AND REHABILITATION AS WELL AS THE CREATIVE ARTS AND HUMANITIES.

9.

IMPLICIT PROCESSING HEURISTICS (INDIRECT SUGGESTIONS) FACILITATE THE 4STAGE CREATIVE PROCESS ON ALL LEVELS FROM GENE EXPRESSION TO BRAIN PLASTICITY AND MIND-BODY HEALING IN THE RECREATION OF MIND, MEMORY, LEARNING, BEHAVIOR, AND SELF-IDENTITY. NEURONS AND EMPATHY: RAPPORT, RESPONSE ATTENTIVENESS, AND RESPONSIVE BEHAVIOR IN ERICKSON’S THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY, AND REHABILITATION.

10. MIRROR

11. A

FUTURE ORIENTATION TO THE CREATION AND RECONSTRUCTION OF MEMORY VIA IMPLICIT PROCESSING HEURISTICS FACILITATES MIND-BODY HEALING VIA THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY, AND REHABILITATION.

2

SELF-FACILITATION OF EACH PERSON’S UNIQUE PSYCHOSOCIAL GENOMIC RESOURCES OF CONSCIOUSNESS, CREATIVITY, AND HAPPINESS IS THE ESSENTIAL DRAMA AND DYNAMIC OF HUMAN DESTINY AS PORTRAYED IN THE ARTS, HERO MYTHS, AND HUMANITIES OF ALL CULTURES.

12. THE

A CONCORDANCE OF THERAPEUTIC HYPNOSIS AND NEUROSCIENCE This is a concordance of the concepts and processes of therapeutic hypnosis and neuroscience that intuitively cluster together at the levels of molecular-genomics, brain plasticity, and psychological experience. There are general and suggestive links but few exact one-to-one correspondences between the Therapeutic Hypnosis and the Neuroscience columns. Many of the most significant phenomena of therapeutic hypnosis are associated with Gene Expression (GE) and Brain Plasticity (BP). THERAPEUTIC HYPNOSIS

NEUROSCIENCE

The Molecular-Genomic State Concept Special State

Concordance of Co-Expressed Genes, GE & BP

Mesmerism, Trance

Behavioral State-Related Gene Expression, GE & BP

Monoideism

Heightened Gene Expression and Neuronal Activation, GE & BP

Dissociation

State Dependent Memory, Learning, & Behavior Hypnotic Induction

Focused Attention via Hand Levitation, Art, Beauty, Pantomime, Paradox

Immediate-Early Gene Expression, Heightened Neuronal Activation, GE & BP

Fascination, Absorption, Utilization

Novelty, Enrichment, GE & BP

Enchantment, Education

Enrichment, Brain Plasticity, GE & BP

Thinking & Feeling Along With

Neural Entrainment via Mirror Neurons, GE & BP

Metaphors, Stories, Dramas, Paradox

Implicit Processing Heuristics, Activity, GE & BP

Trauma, Shock, Stress, Surprise, Unexpected, Numinous

Alternative Gene Splicing, Immediate Early Genes, GE & BP

Sleep, Relaxation, Comfort, Fatigue, Boredom, Repetition, Rhythm

Behavior State-Related Gene Expression, Clock Genes

Groups, Rituals, Music, Song & Dance

Mutual Entrainment via Mirror Neurons, GE & BP

Repetition with Random Variation

Creative Replay, Brain Plasticity, GE & BP

Touch, Mesmeric Passes

Activity-Dependent Gene Expression, GE & BP 3

Hypnotic Phenomena Rapport, Empathy, Suggestibility

Mirror Neurons, Empathy, Entrainment, GE & BP

Dissociation, 2 Level Communication

State Dependent Memory & Learning

Amnesia, Automatism, Refresh Memory

Neural Trace Reactivation, GE & BP

Posthypnotic Suggestion

Offline Neural Replay, GE & BP

Role Playing, Time Distortion

Neural Replay and Reconstruction, GE & BP

Crisis, Intuition, Insight, Eureka!

Synaptogenesis, Neurogenesis, GE & BP

Indirect Suggestion, Implied Directive

Implicit Processing Heuristics, GE & BP

Mind-Body Relationships Ideo-Plastic Faculty

Gene Expression and Brain Plasticity

Ideodynamic Activity

Implicit Processing Heuristics, GE & BP

Ideomotor Activity, Doing

Activity-Dependent Gene Expression, GE & BP

Embodied Imagining

Psychobiology, Mind-Body Healing, GE & BP

Neuro-Psycho-Physiology

Psychoimmunology, GE & BP

Psychophysiology

Psycho endocrinology, GE & BP

Ernest Lawrence. Rossi Los Osos, California 2006

4

Original Copyrights The Nature of Hypnosis and Suggestion. The Collected Papers of Milton H. Erickson on Hypnosis, Volume 1

Copyright ©1980 by Ernest L. Rossi, Ph.D. All rights reserved. No part of this book may be reproduced in any manner whatever, including information storage, or retrieval, in whole or in part (except for brief quotations in critical articles or reviews), without written permission from the publisher. For more information write to Irvington Publishers, Inc., 551 Fifth Avenue, New York, NY 10017 Distributed by Halsted Press, a division of John Wiley & Sons, Inc., New York Library of Congress Cataloging-in-Publication Data Erickson, Milton H. The nature of hypnosis and suggestion. (The collected papers of Milton H. Erickson on hypnosis; v. 1) Bibliography: p. Includes index. 1. Hypnotism. 2. Mental Suggestion. I. Rossi, Ernest Lawrence. II. Title. RC495.E714 vol 1. 616.8’916’208s [154.7’08] 79-15942 ISBN 0-470-26721-6 Printed in the United States of America

Original Copyrights Hypnotic alteration of Sensory, Perceptual and Psychophysical Process. The Collected Papers of Milton H. Erickson on Hypnosis, Volume II

Copyright ©1980 by Ernest L. Rossi, Ph.D. All rights reserved. No part of this book may be reproduced in any manner whatever, including information storage, or retrieval, in whole or in part (except for brief quotations in critical articles or reviews), without written permission from the publisher. For more information write to Irvington Publishers, Inc., 551 Fifth Avenue, New York, NY 10017 Distributed by Halsted Press, a division of John Wiley & Sons, Inc., New York Library of Congress Cataloging-in-Publication Data Erickson, Milton H.

Hypnotic alteration of Sensory, Perceptual and Psychophysical Process. (The collected papers of Milton H. Erickson on hypnosis; v.2) Bibliography: p. Includes index. 1. Hypnotism. 2. Perception. 3. Hypnotism—Physiological effect. 4. Hypnotism—Research. I. Rossi, Ernest Lawrence. II. Title. RC495.E714 vol 2. 616.8’916’208s [61638’916’208] 79-15940 ISBN 0-470-26721-6 Printed in the United States of America

Hypnotic Investigation of Psychodynamic Processes. The Collected Papers of Milton H. Erickson on Hypnosis, Volume III Copyright ©1980 by Ernest L. Rossi, Ph.D. All rights reserved. No part of this book may be reproduced in any manner whatever, including information storage, or retrieval, in whole or in part (except for brief quotations in critical articles or reviews), without written permission from the publisher. For more information write to Irvington Publishers, Inc., 551 Fifth Avenue, New York, NY 10017

Library of Congress Cataloging-in-Publication Data Erickson, Milton H.

Hypnotic Investigation of Psychodynamic Processes. (The collected papers of Milton H. Erickson on hypnosis; v.3) Bibliography: p. Includes index. 1. Hypnotism. 2. Subconscoiusness. I. Rossi, Ernest Lawrence. II. Title. RC495.E714 vol I. 616.8’916’208s [616.8’916’208] 79-15939 ISBN 0-8290-0544-7 Printed in the United States of America

Innovative Hypnotherapy. The Collected Papers of Milton H. Erickson on Hypnosis, Volume IV Copyright ©1980 by Ernest L. Rossi, Ph.D. All rights reserved. No part of this book may be reproduced in any manner whatever, including information storage, or retrieval, in whole or in part (except for brief quotations in critical articles or reviews), without written permission from the publisher. For more information write to Irvington Publishers, Inc., 551 Fifth Avenue, New York, NY 10017 Distributed by Halsted Press, a division of John Wiley & Sons, Inc., New York I01.061Library of Congress Cataloging-in-Publication Data Erickson, Milton H.

Innovative Hypnotherapy. (The collected papers of Milton H. Erickson on hypnosis; v.4) Bibliography: p. Includes index. 1. Hypnotism—Therapeutic use. 2. Psychology, Pathological. 3. Pain—Psychological aspects. 4. Brain damage. I. Rossi, Ernest Lawrence. II. Title. RC495.E714 vol 4. 616.8’916’208s [616.8’916’208] 79-15941 ISBN 0-470-26724-0 Printed in the United States of America

How the Mind Heals the Brain: The New Neuroscience of Milton H. Erickson’s Therapeutic Hypnosis, Psychotherapy, and Rehabilitation By Ernest L. Rossi , Ph.D.

These neuroscience editions of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books offer a new perspective on his innovative contributions to therapeutic hypnosis, psychotherapy, and rehabilitation. Therapeutic hypnosis began almost 300 years ago with Anton Mesmer’s defense of his medical thesis Dissertatio Physico-Medica de Planetarum Influxu on May 27, 1766. Since that time every new generation has updated their understanding of the mysterious nature hypnosis in terms of the best scientific ideas of their day. This edition of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books continues this tradition by organizing his creative approaches to therapeutic hypnosis, psychotherapy, and rehabilitation within the context of modern neuroscience and functional genomics. The neuroscience of the modern molecular biology of human experience actually began with the Watson and Crick’s (1953a, b) Nobel Prize winning insight into the molecular structure and information coding of the DNA molecule as the physical basis of life. They originally described their insight informally but accurately as “the dogma of molecular biology” illustrated here in Figure 1a. The original dogma of molecular biology illustrated in Figure 1a proposes how (1) the linear sequence of nucleotides in our genes is a code of biological information that (2) generates the 3-dimensional structure of the proteins, which function as the physiological molecular machines of the brain and body. Notice that there was no place for mind, consciousness, and psychological experience in Watson and Crick’s dogma of molecular biology. There was no bridge between biology and psychology – the Cartesian dichotomy is still in place. There still is no clue about any possible relationship between molecular biology and the hard problem of how we can account for the subjective psychological experiences (the “qualia”) of human consciousness. More recently, however, Crick and his colleagues (Crick & Koch, 2003) have explored the “neural correlates of consciousness” as follows. “The most difficult aspect of consciousness is the so-called ‘hard problem’ of qualia – the redness of red, the painfulness of pain, and so on. No one has produced any plausible explanation as to how the experience of the redness of red could arise from the actions of the brain. It appears fruitless to approach this problem head-on. Instead we are attempting to find the neural correlate(s) of consciousness (NCC), in the hope that when we can explain the NCC in causal terms, that will make the problem of qualia clearer. In round terms, the NCC is the minimal set of neuronal events that gives rise to a specific aspect of a conscious percept.” (p. 119)

Even with this effort to explore the neural correlates of consciousness, however, there is still no direct link between neural correlates and the actual subjective experiences of the qualia of consciousness. More recently neuroscience research has documented how such a direct link between mind and molecules can be made by experimental demonstrations of how the physical and mental activities of the body and mind can turn on activity-dependent gene expression, protein synthesis, and brain plasticity. As will be reviewed in great detail throughout these volumes, neuroscience research demonstrates how psychological experiences of novelty (Eriksson et al., 1998), psychosocial enrichment (Kempermann et al., 1997), as well as mental and physical exercise (Van Praag et al., 1999) can evoke gene expression (genomics), protein synthesis (proteomics), brain plasticity, and the physiological functions of the body. While some of this research remains controversial because it has been done only on laboratory animals, there is much to indicate that it has important implications for mind-body communication and healing in humans as well (Zuo et al., 2005). This neuroscience research is the empirical basis for my adding the dimension of psychological experience, mind and cognition to Watson and Crick’s original linear dogma of molecular biology (Rossi, 1973a, b, & c, 2000, 2002, 2004a, 2005).

The circular mind-gene loop of psychosocial genomics in Figure 1b, illustrates how salient

psychological experiences of mind and consciousness modulate gene expression, protein synthesis, and brain plasticity. This is how the mind heals the brain. Cognition and behavior turn on what the molecular biologists call “activity-dependent gene expression” (or “experience-dependent gene expression”) and “activity-dependent brain plasticity,” which sculpts changes in our neural networks in the construction and reconstruction of the physical brain during significant psychological experiences. The most profound implication of this activity-dependent interaction between mind and body is that heightened subjective ideodynamic experiences of hypnosis could evoke gene expression, brain plasticity, and mind-body healing in the complex computations (molecular iterations) of psychophysiology, psychosomatic medicine, psychotherapy, and mind-body healing in general. This neuroscience connection between mind and molecules is a possible answer to the philosophical problem of the so-called “Cartesian gap” between mind and body.

The activity-dependent gene

expression/protein synthesis cycle and brain plasticity bridges the gap between mind and body in a manner that Descartes could not have imagined with the primitive physiology of his day. Figure 1b, which illustrates our updated model of Watson & Crick’s original dogma of molecular biology, contains the ideodynamic seed of a new moleculargenomic theory of the activity of all the so-called “healing powers” of spirit, mind, and magic in the history of therapeutic hypnosis, alternative, and complementary medicine.

Figure 1a: The Watson & Crick original linear dogma of molecular biology of 1953 with no explicit role for the qualia of consciousness and psychological experience. Figure 1b: How the Mind Heals the Brain #1. Erickson’s Neuro-Psycho-Physiology of Mind-Body Communication and Healing on the Molecular-genomic Level. The subjective qualia of consciousness (e.g. sensations, perceptions, emotions, cognition, etc.) experienced as novelty, psychological arousal, and stress can modulate (2) gene expression and the alternative splicing of the sequence of the gene code (genomics), (3) protein synthesis and structure (proteomics) of the body, and (4) the physiological functions of the brain and body. Erickson’s “neuro-psycho-physiology” emphasizes the right side of this mind-body circle of information transduction, which is balanced by the more usual “bottoms up” approach of molecular biology, behavioral genetics, evolutionary psychology, and sociobiology illustrated on the left side of the mind-body circle. (From Rossi, 2002, 2004, 2005, 2006) Notice how Figure 1b illustrates a “top-down” synthetic approach on the right hand side, which emphasizes how the qualia of consciousness (e.g. the subjective psychological experiences of positive states of joy as well as stress and trauma) can modulate biology. This is complemented by the scientifically more popular “bottoms-up” reductive approach of molecular biology, behavioral genetics, evolutionary psychology, and sociobiology illustrated on the left hand side of Figure 1b, which emphasize how biology modulates the mind and behavior via the evolutionary selection over many generations of time. Psychosocial genomics, by contrast, explores how psychological experiences and behavioral states in the here-and-now of this moment during therapeutic hypnosis, psychotherapy, dreaming and

heightened performances in the creative arts, sciences, work and play etc. can modulate gene expression, brain plasticity, and mind-body healing. An introductory overview of this new research foundation of therapeutic hypnosis, psychotherapy, and rehabilitation is outlined here with some key concepts, quotes, and images from the current scientific literature that will be used throughout the volumes of this neuroscience editions of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books.

KEY CONCEPTS OF THE NEUROSCIENCE OF THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY AND REHABILITATION

1. A NEW SCIENCE OF THE STATES OF CONSCIOUSNESS AND CREATIVITY IS EMERGING FROM CURRENT RESEARCH ON THE FUNCTIONAL CONCORDANCE OF CO-EXPRESSED GENES ASSESSED WITH DNA MICROARRAYS.

Eisen et al. (1998), are pioneers in the development and exploration of the deep implications of the DNA microarray revolution that allows molecular biologists to profile the entire pattern of gene expression within the cells of the brain and body at any moment in time with a single experiment. “A system of cluster analysis for genome-wide expression data from DNA microarrays . . . is described that uses standard statistical algorithms to arrange genes according to similarity in patterns of gene expression. The output is displayed graphically, conveying the clustering and the underlying expression data simultaneously in a form that is intuitive for biologists. We have found in the budding yeast Saccharomyces cerevisiae that clustering gene expression data groups together efficiently genes of known similar function, and we find a similar tendency in human data. Thus patterns seen in genome-wide expression experiments can be interpreted as indications of the status of cellular processes. Also, co-expression of genes of known function with poorly characterized or novel genes may provide a simple means of gaining leads to the functions of many genes for which information is not currently available (14863). . . the functional concordance of co-expressed genes imparts biological significance to the broad patterns seen in images [of microarray data]. . . it is a comprehensive representation of the cell throughout. . . information on the state of many cellular processes can be inferred quickly by combining and comparing new experiments with the data presented here.” (14868, italics added). Eisen et al. discuss the functional concordance of co-expressed genes only within a molecular biological framework, however. The profound significance of DNA technology for psychotherapy is that it may enable us to assess any psychological state as the functional concordance of co-expressed genes interacting with the changes and challenges of our here and now psychosocial environment. Researchers have already utilized DNA microarrays to characterize psychological states associated with a variety of psychiatric conditions such as depression (Evans et al., 2004), post

traumatic stress (Segman et al., 2005), depression, aggression and playful social situations (Panksepp et al., 2002). This implies that the functional concordance of co-expressed genes assessed with DNA microarrays may become a new way of assessing the states of human consciousness and creativity during their transformations in therapeutic hypnosis, psychotherapy, and rehabilitation. The range and limitations of this new DNA microarray approach to specifying the states of consciousness is an empirical question that remains to be investigated (Wilber, 1993, 1997). When psychological researchers begin to include DNA microarray data in their factor analytic studies of the assessment tools that we use for guidance, counseling, and psychotherapy, for example, we may be able relate ongoing states of consciousness with profiles of gene expression, brain plasticity, and personality profiles with simple paper and pencil tests. Research will be needed to determine whether this approach could be applied to clinical interviews as well. This means that psychotherapy is not simply “talk therapy.” We now need to determine exactly how therapeutic hypnosis, psychotherapy, and rehabilitation can turn on gene expression to optimize brain plasticity and mind-healing throughout the body at the molecular level. Eric Kandel (1998), who received the Nobel Prize for Medicine and Physiology in 2000, described the intimate relationship between gene expression and brain plasticity in counseling and psychotherapy as follows. “Insofar as Psychotherapy or Counseling is effective and produces long-term changes in behavior, it presumably does so through learning, by producing changes in Gene Expression that alters the strength of synaptic connections and structural changes that alter the anatomical pattern of interconnections between nerve cells of the brain. As the resolution of brain imaging increases, it should eventually permit quantitative evaluation of the outcome of psychotherapy . . . Stated simply, the regulation of gene expression by social factors makes all bodily functions, including all functions of the brain, susceptible to social influences. These social influences will be biologically incorporated in the altered expressions of specific genes in specific nerve cells of specific regions of the brain. These socially influenced alterations are transmitted culturally. They are not incorporated in the sperm and egg and therefore are not transmitted genetically.” (p. 460, Italics added) An updated image from Kandel illustrates how meaningful experiences can evoke gene expression and brain plasticity in Figure Two. This is another image of how the mind can heal the brain. Important psychosocial experiences can turn on gene expression and new protein synthesis to facilitate the growth of synapses (connections) between neurons of the brain as illustrated by the label “Returning Pathway to the Genes” in Figure Two.

Figure 2: How the Mind Heals the Brain #2. The Typical Time Frames of Gene Expression and Brain Plasticity in Therapeutic Hypnosis, Psychotherapy, and Rehabilitation at the Neural Level. (1) Memory, learning, habituation, and extinction are illustrated at the synaptic level labeled Extinction/Habituation, which requires about 15 minutes. (2) Short term memory (~1-20 minutes) is based upon reverberating circuits of neurotransmission and neurotransmitters that operate on the millisecond time scale that is the primary focus of Crick and Koch’s neural correlates of consciousness (NCC). (3) Novel, strong, salient, and surprising stimuli of the qualia of consciousness, by contrast, take a much longer molecular pathway (labeled “Returning Pathway to the Genes”) to the nucleus of the neuron where a series of early and late genes are transcribed generating the proteins that are used for the “Growth of New Synaptic Connections,” which is the basis of long term memory that requires about 90-120 minutes. (4) feedback between neurons maintain the dynamics of “Long Term Potentiation” that spreads over longer time frames that may continue for years in the construction and creative reconstruction of the qualia of memory and consciousness (Rossi, 2002, updated from Squire & Kandel, 1999).

It is enlightening to recognize how Kandel implies a deeper understanding of the nature of genes and how they interact with human behavior and psychological experience. From this new psychosocial perspective genes can no longer be regarded simply as the hardwire source of biological traits passed from one generation to another by the classical laws of Mendelian heredity. Current research on the functional genomics of gene ontology traces the progressive development of molecular pathways and their transformations within cells of the brain and body. Psychosocial gene ontology is a 4-step process whereby salient environmental stimuli evoke and interact with (1) gene

transcription (expression) leading to (2) protein translation (the formation and folding of proteins into their functional structures), (3) the subsequent creation of physiology at the cellular level from these proteins, and finally (4) brain plasticity and the many mind-body levels of psychological and behavioral experience outlined in our “How the Mind Heals the Brain” series of illustrations in Figures 1b through eight. From the perspective of psychosocial gene ontology we can now recognize how many genes are better understood as “inner resources” that are activated by the challenges and stresses of daily life to generate the proteins to reconstruct our neural networks for creative adaptation. In this sense genes are inner resources mediating a continual dialogue between our psychosocial environment and brain plasticity in the hourly (ultradian) and daily (circadian) dynamics of mind-body adaptation and healing in everyday life. Psychosocial genomics conceptualizes genes as space-time-energy-information transducers in the transformations of mind, memory, consciousness, and creativity with their ultimate domain and range of efficacy defined in terms of the powers of ten (Morrison, 1994). We await some future Einstein who will summarize all of this for us with a simple mathematical equation (Rossi, 1996, 2002, 2004a, 2005a). Meanwhile the implications of activating gene expression and brain plasticity via therapeutic hypnosis, psychotherapy, and rehabilitation are vast as suggested by our next key concept.

2. ELEVATED GENE EXPRESSION LEVELS GENERATE ELEVATED LEVELS OF NEURONAL ACTIVITY THAT DISTINGUISH HUMAN FROM NON-HUMAN PRIMATE BRAINS.

How can we account for the differences between human consciousness and other primates when they both have about the same number of genes (~24,000) which are more than 99% alike? A DNA microarray revolution is currently exploring the special qualities of human brain evolution (Preuss et al., 2004). Cáceres et al. (2003), summarize their research in this area as follows. “Little is known about how the human brain differs from that of our closest relatives. To investigate the genetic basis of human specializations in brain organization and cognition, we compared gene expression profiles for the cerebral cortex of humans, chimpanzees, and rhesus macaques by using several independent techniques. We identified 169 genes that exhibited expression differences between human and chimpanzee cortex, and 91 were ascribed to the human lineage by using macaques as an outgroup. Surprisingly, most differences between the brains of humans and non-human primates involved up-regulation, with ~90% of the genes being more highly expressed in humans. By contrast, in the comparison of human and chimpanzee heart and liver, the numbers of upand down-regulated genes were nearly identical. Our results indicate that the human brain displays a distinctive pattern of gene expression relative to non-human primates, with higher expression levels for many genes belonging to a wide variety of functional classes. The increased expression of these genes could provide the basis for

extensive modifications of cerebral physiology and function in humans and suggests that the human brain is characterized by elevated levels of neuronal activity.” (pp. 13030, italics added) These elevated levels of gene expression and neuronal activity in the human brain remind us of the heightened psychological experiences of focused consciousness (monoideism) and fascination, which were key concepts in early descriptions of the psychophysiology of therapeutic hypnosis by James Braid (1855/1970) outlined in his book, The Physiology of Fascination, as follows. “With the view of simplifying the study of reciprocal actions and reactions of mind and matter upon each other . . . the [hypnotic] condition arose from influences existing within the patient's own body, viz., the influence of concentrated attention, or dominant ideas, in modifying physical action, and these dynamic changes re-acting on the mind of the subject. I adopted the term ‘hypnotism’ or nervous sleep for this process . . . And finally as a generic term, comprising the whole of these phenomena which result from the reciprocal actions of mind and matter upon each other, I think no term more appropriate than ‘psychophysiology’.” (In Tinterow, 1970, Pp. 369372, italics added). Cáceres et al. (2003) do not discuss therapeutic hypnosis in their paper on elevated gene expression and heightened neuronal activity in the human brain but their research has important implications for a theory of hypnosis at the evolutionary molecular-genomic level. Here is a brief summary of the types of genes they found related to the higher levels of neuronal activity that may contribute to heightened behavioral, emotional and cognitive states of consciousness. “The identification of the genes that exhibit regulatory changes in adult human cortex provides clues to the biochemical pathways and cell-biological processes that were modified during evolution. The apparent upregulation of so many different genes suggests, among other things, that the general level of neuronal activity and the metabolic processes that support it may be unusually high in human cortex. Consistent with this is the upregulation of genes involved in synaptic transmission, including the control of glutamatergic excitability (SYN47, also known as Homer 1b), plasticity at glutamatergic synapses (CAMK2A), phosphatidylinositol signaling (IMPA1, CDS2), synaptic vesicle release (RAB3GAP, ATP2B1), axonal transport along microtubules (KIF3A, DCTN1), microtubule assembly (MAP1B), and targeting of proteins to postsynaptic densities (USP14). We have also found expression changes related to energy metabolism. For example, CA2, which is expressed in glia, has been related to the generation and transport of lactate by astrocytes for use by neurons as an energy source. To our knowledge, the possibility that the human brain has an unusually high metabolism has not been previously considered. Typically, larger brains have lower metabolic rates (per unit of tissue) than smaller brains. Nevertheless, recent studies with imaging techniques to measure cerebral glucose metabolism in the conscious state suggest that metabolic rates are

as high as or even higher in humans than in macaques. Higher levels of neuronal activity are likely to have important consequences in cognitive and behavioral capacities, and of the genes up-regulated in humans, CAMK2A is involved in learning and memory, and mutations of GTF2I (Williams syndrome), CA2 (marble brain disease), and SC5DL (lathosterolosis) have been linked to mental retardation.” (pp. 13034) At the present time it is not known to what degree these genes and their associated states of neuronal activity are related to human experiences of consciousness and therapeutic hypnosis. Their DNA microarray approach could be applied in many interesting ways to current theories of consciousness and its activities at the molecular-genomic level, however. Crick and Koch (2005), for example, have proposed that the claustrum is a little known part of the brain that may be a key to understanding the dynamics of consciousness. The claustrum is a thin layer of gray matter that that functions as a two-way street between the higher cortex of the brain and the lower sub-cortex involved in processing sensations, emotions and other activities involved in consciousness. Crick and Koch interpret the probable function of claustrum to the role of an orchestra conductor who integrates the activities of the individual musicians into the holistic experience of consciousness (Stevens, 2005).

It will be a challenge to design research with brain imaging in

combination with DNA microarrays to determine to what degree the claustrum preferentially expresses the 196 genes, which Cáceres et al. (2003), found associated with the heightened activation of neural activity in the human brain. It will be an even greater challenge to assess our molecular-genomic theory of therapeutic hypnosis, psychotherapy, and rehabilitation with such research. Another research approach, as outlined in this neuroscience edition of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books, is now needed to determine to what extent elevated gene expression levels can be detected with the DNA microarray technology that can assess the entire human genome from a sample of blood during the often dramatic and motivating experiences of therapeutic hypnosis, psychotherapy, and rehabilitation. I hypothesized that such elevated levels of gene expression and neuronal activity generate the higher activation of consciousness – what Carl Jung and Rudolph Otto (1923/1950) would call “the numinosum,” the special experience of fascination, mystery, and tremendousness – associated with creative states of heightened consciousness that will be reviewed here (Rossi, 2002, 2004a, b, 2005a).

3. CLOCK GENES AND THEIR ASSOCIATED PROFILES OF CO-EXPRESSED GENES INTERACT WITH PSYCHOLOGICAL AND BEHAVIORAL STATES TO CO-CREATE THE CIRCADIAN AND ULTRADIAN RHYTHMS OF CONSCIOUSNESS, CREATIVITY, EMOTIONS, MOODS, AND PERFORMANCE.

Our daily (circadian) and hourly (ultradian) changing profiles of gene expression are a new method of assessing our psychological states of being awake, asleep, or dreaming as well as during high performance, stress and relaxation

throughout the day. Cirelli and Tononi (2004) describe the differences in gene expression and function when we are awake and asleep as follows. “Wakefulness and sleep are accompanied by changes in behavior and neural activity, as well as by the upregulation of different functional categories of genes. However, the mechanisms responsible for such statedependent changes in gene expression are unknown. Here we investigate to what extent state-dependent changes in gene expression depend on the central noradrenergic [system], which is active in wakefulness and reduces its firing during sleep. . . These results indicate that the activity of the central noradrenergic [system] during wakefulness modulates neuronal transcription to favor synaptic potentiation and counteract cellular stress, whereas its inactivity during sleep may play a permissive role to enhance brain protein synthesis.” (p. 5410, Italics added) In brief: when we are awake gene expression is oriented to heightening synaptic neural activity and dealing with the immediate challenges of outer world activity and stress. When we are asleep and dreaming gene expression and brain protein synthesis is updating and re-synthesizing the inner world of our mind-brain in preparation for the next day.

Figure 3: How the Mind Heals the Brain #3. Erickson’s Neuro-Psycho-Physiology Portrayed as a 4-stage Cycle of Ultradian (~90-120 minutes) Mind-Gene Communication and Healing. The periodic flow of messenger molecules of the neuroendocrine system (hormones associated with stress, relaxation, sexual hormones, immune system, etc.) mediates communication between the mind-brain, brain-body and cellular genomic levels in ultradian time (~90-120 minutes). (1) Information from the outside world experienced as the qualia of consciousness (on an explicit level) and the neural correlates of consciousness (on an implicit level) is transformed within the limbichippocampal-hypothalamic-pituitary system into the hormones (messenger molecules) that travel through the blood stream to signal receptors on cells of the brain and body. (2) The receptors on the surface of cells transmit the signal via 2nd messengers to the nucleus of the cell where activity-dependent genes to transcribe their code into messenger RNAs (mRNAs). (3) mRNAs serve as blueprints for the synthesis of proteins that make up (a) the structure of the body, (b) enzymes to facilitate energy dynamics and (c) cell receptors and messenger molecules for the informational dynamics of the cell. (4) Messenger molecules from the body flow back to the NCC to facilitate the construction and reconstruction of the qualia of consciousness (illustrated as the rectangular array of letters A to L on the top) through the Extra Cellular Fluid (ECF) of the brain (From Rossi, 2002, 2004, 2005).

Figure Three illustrations of the ultimate outcome of the expression of clock genes in regulating and integrating mind-body communication and healing. As such, clock genes can be understood as bridges between the mind-brain, brain-body, and the cell-gene levels that mediate the creative molecular-genomic replays of therapeutic hypnosis, psychotherapy, and rehabilitation (Rossi, 2002, p. 482). As indicated in Figure Three it takes about 90-120 minutes to complete one natural ultradian cycle of communication between mind and gene. It is noteworthy in this regard that Erickson’s therapeutic sessions typically ranged between 90-120 minutes, which he believed was needed for a complete unit of “neuro-psycho-physiological” work.

4. THE

POSITIVE AND NEGATIVE PSYCHOLOGICAL EXPERIENCES OF AROUSAL AND BEHAVIORAL ACTIVITY EVOKE

IMMEDIATE-EARLY GENES, ACTIVITY-DEPENDENT GENE EXPRESSION, AND BRAIN PLASTICITY IN A WIDE RANGE OF PROCESSES THAT MODULATE MIND-BODY COMMUNICATION AND HEALING.

This is the essence of how mental activity can modulate molecular activity and physiology illustrated in our update of Watson and Crick’s original dogma of molecular biology in Figure 1b. This is the neuroscience research that bridges the Cartesian gap between mind and body, which accounts for the efficacy of therapeutic hypnosis, psychotherapy, and rehabilitation in facilitating mind-body healing.

Any salient and interesting psychological

experience of arousal from sensation and perception to emotion, cognition, and imagination turns on gene expression and the possibility of brain plasticity for good or for ill. This is the mind-body basis for psychosomatic medicine as well as all schools of therapeutic hypnosis, psychotherapy, and rehabilitative medicine. The wide range of biological and psychological activities that are evoked by psychobiological arousal is indicated in Figure Four. The positive experiences of memory, learning, art, beauty, love, and truth as well as the negative experiences of pain, stress and illness can turn on a range of approximately 100 immediate-early genes (Rossi, 2004a, b). As indicated in Figure Four, many significant subject areas of psychology are integrated with biology on the most fundamental molecular-genomic level via immediate-early genes and mind-body rhythms.

Figure 4: How the Mind Heals the Brain #4. The Central Role of Immediate Early Genes (IEGs) in Psychobiological Arousal that May Be Facilitated by Therapeutic Hypnosis, Psychotherapy, and Rehabilitation in Complementary Medicine. Many arousing stimuli from the physical and psychosocial environment can signal IEGs within seconds to initiate the gene expression/protein synthesis cycle within neurons of the brain and other cells of the body to simultaneously modulate many integrated biological and psychological processes. The reciprocal relationships between psychological arousal, IEGs, and mind-body rhythms are windows into the continuum of Erickson’s neuro-psycho-physiology of mind-body communication and healing (Rossi, 2002).

Stendhal’s syndrome, for example, which is an overwhelming feeling of dizziness, panic, paranoia, or madness caused by a powerful positive aesthetic experience of viewing deeply meaningful artistic or historical artifacts in too brief and concentrated a time, is of particular interest in Figure Four because it illustrates a general psychobiological principle. The pleasure of a positive experience of art, beauty, and truth can develop only to an optimal intensity, beyond which it becomes a negative stress (Rossi, 1996, 2005a). Many so-called “ordinary people” recoil from their most vivid sensations, perceptions, insights, and truths because they cannot handle the intense psychobiological arousal their own genius stimulates. I hypothesize that Stendhal’s syndrome is the outer observable phenotypic behavioral manifestation of the overintense stimulation of gene expression, gene ontology, and brain plasticity that spills over into stress and many of the behavioral manifestations of psychopathology (Rossi, 2002, 2004, 2005). Indeed, Stendhal’s syndrome implies a new theory of psychopathology on the molecular-genomic level of gene ontology.

From this molecular-genomic perspective we may describe all subjective psychological, social, artistic and cultural experiences ranging from the positive to the negative as phenotypes of the varying levels of psychological arousal generating the phenomenology of psychosocial gene ontology (Rossi, 2006). The important word here is “subjective.” There has never been a truly satisfactory science of the subjective phenomenology of conscious human experience. The subjective phenomenology of the flow of conscious human experiencing has been consigned to the realm of philosophy, schools of introspection, and existential psychologies because there has been no way of reifying scientifically valid and reliable data on personal conscious experience. It remains to be seen to what degree replicable DNA microarray data can provide snapshots of subjective psychological states in term of the expression of immediateearly genes, behavioral state-related genes, alternative patterns of gene splicing etc. As will be explored further in the later volumes of this series, DNA microarrays are a key research methodology that may enable us to explore the precise details of how the mind can heal the brain on the molecular-genomic level. Many of the IEGs of Figure Four are associated with clock genes, which account for the circadian and ultradian mind-body rhythms in health and illness described above. Immediate-early genes are special class of genes that can respond to psychosocial cues and significant life events in an adaptive manner within minutes. Immediate early genes have been described as the newly discovered mediators between nature and nurture. They are mind-body transducers that receive sensory signals from the environment and molecular signals from the body to activate the target genes that code for the formation of proteins, which then carry out the adaptive functions of the cell in health and illness. Immediate early genes integrate mind and body; they are key players in psychosomatic medicine and mind-body healing via therapeutic hypnosis, psychotherapy, rehabilitation, and complementary medicine. The common applications of therapeutic hypnosis and psychotherapy for the treatment of trauma, stress, posttraumatic stress (PTSD), environmental, and psychosocial challenges (e.g. occupational and relationship issues, phobias, examination stress, sports performance, etc) implies there are deep psychobiological associations between stress and its reduction by hypnosis on the molecular-genomic level. Recent research by Lichtenberg et al. (2000, 2004) confirms this implication by documenting how certain variations in the COMT (Catechol-O-Methyltransferese) gene that code for the neurotransmitter dopamine are associated with hypnotizability (Raz, 2005). Further research is now required to more directly assess the hypothesis that COMT and other genes are more highly expressed during therapeutic hypnosis as reviewed in Volume Five of this series. One of the most common approaches to the experimental study of stress across many model organisms ranging from yeast to humans is described as the stress induced alternative splicing of genes.

Acute and chronic

environmental and psychosocial stress can induce a series of changes in the alternative splicing of the acetylcholinesterase (AChE) gene that gives rise to the gene ontology of the posttraumatic stress disorders (PTSD) and

many related mind-body dysfunctions (Kaufer et al.1998; Soreq & Seidman, 2001). This means that psychosocial stress actually changes the way a gene is organized to alter its sequence, which in turn generates the structure of alternative proteins and their physiological functions. This is a functional but temporary change in the way the DNA code of the AChE gene is expressed to alter protein structure and physiological functions. This is not a permanent change in the DNA code (such as a gene mutation) that would be transmitted genetically to the next generation. Sternfeld et al. (2000) describe how many forms of stress induced alternative gene splicing produce the alternative messenger RNA (mRNA) that is then translated into alternate proteins and physiological processes that will be described in greater detail in a later volume of this series.

5. THE POSITIVE NOVELTY-NUMINOSUM-NEUROGENESIS EFFECT. NOVELTY,

ENRICHING LIFE EXPERIENCES, AND

EXERCISE ASSOCIATED WITH A POSITIVE SENSE OF CURIOSITY AND WONDER CAN TURN ON ACTIVITY-DEPENDENT GENE EXPRESSION TO CONSTRUCT AND RECONSTRUCT THE NEURAL NETWORKS OF THE PHYSICAL BRAIN THROUGHOUT OUR ENTIRE LIFETIME.

This is the psychobiological essence of the relationship between the conscious creative psychological experience, gene expression, and brain plasticity (synaptogenesis and neurogenesis) – it is a psychosynthetic process of updating and recreating ourselves in everyday life as well as in the arts, humanities, and sciences. Again, this is the mindmolecular association that makes it possible for the mind to heal the brain and body.

The positive novelty-

numinosum-neurogenesis effect documents how highly motivated states of self-reflective consciousness can turn on and focus gene expression, protein synthesis, neurotransmitters, synaptogenesis, and neurogenesis in our daily creative work of building a better brain (Rossi, 2002, P. 482). From this molecular-genomic perspective consciousness may be conceptualized as a novelty responsive modality focusing gene expression and ontology for optimizing creatively adaptive brain plasticity (Rossi, 2006). Neuroscientists have identified three factors relating psychological experience to gene expression and brain plasticity: 1. Novelty (Eriksson et al., 1998; Kempermann & Gage, 1999); 2. Environmental enrichment (Kempermann et al., 1997; Van Praag et al. 2000); 3. Physical exercise (Van Praag et al., 1999). A generation of research by the Nobel Laureate Eric Kandel and others found that messenger molecules (e.g. neurotransmitters, hormones, growth factors etc.) can facilitate the molecular-genetic basis of memory, learning, and behavior within neurons of the brain and cells of the body as illustrated above in Figure Two. Activity-dependent gene expression in response to novelty, social enrichment, and exercise can double the number of neurons and connections between them generated in the hippocampus leading to the construction of new memory, learning, and behavior (Gould et al., 1999). In a series of remarkable drawings Lüscher et al. (2000) have shown how

the number of synapses can double during the growth process over a period of approximately 60 to 90 minutes as illustrations in Figure Five.

This is the typical time frame of most clinical sessions of therapeutic hypnosis,

psychotherapy, and rehabilitation in general, and Milton H. Erickson’s leisurely 90-120 minute sessions in particular.

Figure 5: How the Mind Heals the Brain #5. The Ultradian Time Frame of Activity-Dependent Memory, Learning, and Behavior at the Neuronal Level of Brain Plasticity via Synaptogenesis as Proposed by Lüscher, et al. (2000). Notice how the formation of new synapses requires same time frame as Erickson’s typical 90-120 minute clinical sessions of therapeutic hypnosis, psychotherapy, and rehabilitation as illustrated in Figures 2, 3, and 7.

Within the first 10 minutes after receiving appropriate stimulation there are measurable changes in gene expression and the growth of receptors that are involved in synaptic communication via neurotransmitters in the brain. Within 30 minutes the size of the synaptic spine increases and receptors move to the postsynaptic membrane; this leads to an increase in the size of the postsynapse. Within an hour, some postsynapses divide in two. This leads, in turn, to further growth in presynaptic multiplication and remodeling that eventually create new neural networks encoding memory, learning, and behavior change that is psychobiological essence of creative human experiences in the arts and sciences as well as therapeutic hypnosis and psychotherapy. This activity of gene expression and brain plasticity in the creation and recreation of the neural networks of the brain continues throughout the daily cycle of awaking consciousness as well as sleep. In Section One of this volume we will witness how Milton H. Erickson used his own self-reflective capacity to facilitate the development of his own consciousness from childhood to advanced age. We will study how he used hypnosis to enhance multilevel self-reflectiveness in Aldous Huxley, one of the most brilliant writers of his age. This multilevel self-reflectiveness is especially evident in dreams, which often demonstrate positive creative replay and reconstruction as described in our next neuroscience principle. The multi-levels of self-reflective and multiple cultural reflections in artistic artifacts is of particular interest in light of the style whereby even today many psychotherapists and healers with a holistic orientation frequently display such

artistic artifacts in their therapy rooms. This tradition was already evident in the special therapeutic areas of healers and shaman since ancient times, the alters of most spiritual traditions, and continues at the present time in the artistic and cultural displays in the homes and therapeutic rooms of many psychotherapists beginning with Sigmund Freud and Carl Jung up to Milton H. Erickson. At this point we can only speculate on how this artistic and cultural continuity associated with mind-body healing throughout the ages is itself an expression of gene expression and ontology on all levels from mind to molecule could be assessed with DNA microarray technology.

6. DREAMING,

AND OFFLINE

POSITIVE CREATIVE NEURAL REPLAY

IN

ERICKSONIAN APPROACHES

TO THE

RECONSTRUCTION OF NEGATIVE FEAR, STRESS, AND TRAUMATIC MEMORIES.

Recent neuroscience research has found that when we experience significant novelty, environmental enrichment and exercise during the awake state, the zif-268 gene is expressed during our REM sleep (Ribeiro et al., 2002, 2004). Zif268 is an immediate-early gene and behavioral-state related gene that is associated with the generation of proteins and growth factors that facilitate brain plasticity. Ribeiro et al (2004) summarized their results as follows. “The discovery of experience-dependent brain reactivation during both slow-wave (SW) and rapid eyemovement (REM, dream) sleep led to the notion that the consolidation of recently acquired memory traces requires neural replay during sleep … Based on our current and previous results, we propose that the 2 major periods of sleep play distinct and complementary roles in memory consolidation: pretranscriptional recall during SW sleep and transcriptional storage during REM sleep … In conclusion, sustained neuronal reverberation during SW sleep, immediately followed by plasticity-related gene expression during REM [dreaming] sleep, may be sufficient to explain the beneficial role of sleep on the consolidation of new memories.” (p. 126 -135, italics added) I recently outlined how this “sustained neuronal reverberation during SW sleep, immediately followed by plasticityrelated gene expression during REM sleep” may be an important process in the reconstruction theory of fear, stress, and traumatic memories and symptoms via therapeutic hypnosis (Rossi, 2005b). Let us review how Erickson used the process of re-dreaming a traumatic dream to reconstruct it in a therapeutic manner with a psychotic patient he called “Edward C.” “Dream the same dream with the same meaning, the same emotional significance, but with a different cast of characters. This time maybe it won’t be so dark. Maybe you can see a bit more clearly. It won’t be pleasant, but maybe it won’t hurt so much. So go ahead as soon as you can and have your dream.’ Within four minutes the dream developed; 20 minutes later, streaming with perspiration, Edward said, ‘It was bad. It was awful bad. But it didn’t hurt so much. . . Again he was asked to dream the same dream, but to dream it with less pain, less discomfort, and to dream more clearly – to see the characters more plainly. His fingers tightened on my hand, and

the dream developed immediately. The observed behavior was essentially the same. The duration was again about 20 minutes.” (pp. 62-63) Such intense states of psychobiological arousal were characteristic of many of Erickson’s (1948) case histories wherein he described the role of suggestion in hypnosis as a neuro-psycho-physiological process as follows. “. . . therapy results from an inner resynthesis of the patient’s behavior achieved by the patient himself. . . this experience of re-associating and reorganizing his own experiential life that eventuates in a cure, not the manifestation of responsive behavior, which can, at best, satisfy only the observer. . .The same principle holds true in psychotherapy. The chronic alcoholic can be induced by direct suggestion to correct his habits temporarily, but not until he goes through the inner process of reassociating and reorganizing his experiential life can effective results occur. . .Not until sometime later did the therapist [Erickson] learn by what train of thought he had initiated the neuro-psycho-physiological processes. . .” (pp. 38-39, italics added). Aye, here now is the fundamental question! What, exactly, are the “neuro-psycho-physiological processes” that Erickson initiated in his patients so they could go through “the inner process of reassociating and reorganizing” that led to a cure? How, exactly, does the mind heal the brain? From our current neuroscience perspective these “neuropsycho-physiological processes” engage the entirely naturalistic dynamics of gene expression, new protein synthesis, and brain plasticity that has been described as the “memory trace reactivation and reconstruction theory” of memory and learning. Erickson always maintained that his therapeutic approach engaged naturalistic processes; I now propose that this is the essence of Erickson’s “neuro-psycho-physiological processes” of healing at the molecular-genomic level (Rossi, 2005b) to which we will now turn our attention.

7. ERICKSON’S

NEURO-PSYCHO-PHYSIOLOGICAL PROCESS OF THERAPEUTIC HYYPNOSIS:

THE

MEMORY TRACE

REACTIVATION AND RECONSTRUCTION THEORY OF THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY, AND REHABILITATION.

Neuroscience research documents how the classical process of Pavlovian fear conditioning requires the recall and re-activation of a conditioned memory before it can be extinguished and/or reconstructed at the level of gene expression and protein synthesis. Nader et al. (2000) summarize their research in this area as follows. “Our data show that consolidated fear memories, when reactivated, return to a liable state that requires de novo [gene expression] and protein synthesis for reconsolidation. These findings are not predicted by traditional theories of memory consolidation.” (p.723, italics added). Such research has important implications for understanding the controversial tradition of using hypnosis to facilitate memory recall and emotional re-experiencing. I hypothesized that the common psychotherapeutic practice of intentionally recalling the memory of a traumatic experience and then reframing it is precisely what took place during

many historical approaches to reactivating traumatic memory recall and their “Mental Liquidation” (Pierre Janet’s original words, 1925/1976, pp. 589) via therapeutic hypnosis (Rossi, 2002). I proposed that this activity-dependent process of reactivating a fear, stress and traumatic memory in order to re-construct it on the level of gene expression, protein synthesis, and brain plasticity is the psychosocial genomic essence of therapeutic hypnosis, psychotherapy, and many types of rehabilitation as illustrated in Figure Six (Rossi, 2004, 2005a, b).

Figure 6: How the Mind Heals the Brain #6. A neuroscience update of Erickson’s neuro-psycho-physiology of therapeutic hypnosis, psychotherapy, and rehabilitation. Erickson’s most activity-dependent approaches to therapeutic suggestion and hypnosis such as hand levitation, psychological shock, surprise, pantomime, confusion, implication, etc. function as (1) implicit processing heuristics (ideodynamic action) to (2) stimulate the activitydependent gene expression/protein synthesis cycle, which (3) facilitates activity-dependent brain plasticity for the (4) creative therapeutic reconstruction of fear, stress, and traumatic memory and symptoms. These newly reconstructed memories may then function as implicit processing heuristics for further iterations of this 4-stage creative psychobiological cycle of mind-body healing, problem solving, and new identity creation.

In his monumental search of the historical literature of hypnosis, Weitzenhoffer (2000, 2001) concluded that the classical “ideodynamic hypothesis of hypnosis,” is the closest approximation that we have of a general theory of hypnosis. In the historical literature of hypnosis a variety of terms have been used for this concept of the ideodynamic such as “ideomotor, ideosensory, or ideoplastic faculty” to describe how the subjective mental experiences can influence the physiology of the body (Tinterow, 1970). Figure 6 illustrates how many of Erickson’s activity-dependent approaches to therapeutic suggestion and hypnosis such as hand levitation, psychological shock, surprise, pantomime, confusion, implication, etc. function as (1) implicit processing heuristics (ideodynamic action) to (2) stimulate the activity-dependent gene expression/protein synthesis cycle, which (3) facilitates activity-dependent brain plasticity for the (4) eventual therapeutic reconstruction of fear, stress, and traumatic memory and symptoms (Rossi, 2002). Figure

6 illustrates how the activity-dependent gene expression/protein synthesis cycle and brain plasticity could be the basis of what Erickson called the “neuro-psycho-physiological process” of therapeutic hypnosis. DNA microarray research is now needed to assess the actual range and limitations of this molecular-genomic concept of Erickson’s “neuropsycho-physiological process” of therapeutic hypnosis, psychotherapy, and rehabilitation. Neuroscience recognizes the role of replaying life experiences in the construction and reconstruction of mind and memory on the levels of molecular-genomics and brain plasticity. Hoffman and McNaughton (2002), for example, describe how memories are made by being replayed “offline” during sleep and dreaming. “Neural ensembles in the rat hippocampus and neocortex show memory trace reactivation during "offline periods" of quiet wakefulness, slow-wave sleep, and in some cases REM sleep. Reactivation of recent memory traces is also observed during sleep in motor areas of the zebra finch brain…neuro-imaging in humans reveals that brain areas with increased signal during a task have continued or reappearing activity after the task is completed.” (p. 2070, italics added) Lisman and Morris (2001) summarize the essential dynamics of “repeated replaying” between the cortex and hippocampus of the brain in the construction and reconstruction of memory, learning - what Crick and Koch would regard as the neural correlates of consciousness – as follows. “Newly acquired sensory information is funneled through the cortex to the hippocampus. Surprisingly, only the hippocampus actually learns at this time — it is said to be online. Later, when the hippocampus is offline (probably during sleep), it replays stored information, transmitting it to the cortex. The cortex is considered to be a slow learner, capable of lasting memory storage only as a result of this repeated replaying of information by the hippocampus. In some views, the hippocampus is only a temporary memory store — once memory traces become stabilized in the cortex, memories can be accessed even if the hippocampus is removed. There is now direct evidence that some form of hippocampal replay occurs . . . These results support the idea that the hippocampus is the fast online learner that ‘teaches’ the slower cortex offline.” (p. 248-249, italics added) Since activity in the human anterior cingulate cortex (associated with pain) has been implicated in the experience of hypnosis (Rainville et al., 1997, 1999, 2002), we would predict that future research will confirm that some form of neural replay takes place between the hippocampus and the anterior cingulate cortex during the amelioration of pain and negative affects via therapeutic hypnosis. We would also hypothesize that such offline neural replay on an implicit (unconscious) level could be the mechanism by which posthypnotic suggestions are maintained until they are carried out as described in many of Erickson’s vivid demonstrations in this volume. This repetition and replay between the hippocampus and cortex of the brain reminds us of the important activity of repetition, replay, and role playing in the history of hypnosis. Emile Coué (1922), for example, created a popular sensation

with his recommendation to repeat autosuggestion “Every day in every way I am getting better and better.” Neuroscience research is now needed to determine if such autosuggestion actually facilitates creative replay (or a dialogue) between the hippocampus and the cortex in humans to evoke gene expression and brain plasticity. Repetition in hypnosis continues in our present day usage of repeated suggestions for sleep and relaxation in the standardized hypnotic susceptibility scales. We now need to use of DNA microarrays of the blood (Whitney et al., 2003) and other relatively non-invasive techniques of molecular-genomics to assess whether the repetition of such suggestion during hypnotic induction actually can facilitate gene expression and alternative gene splicing to optimize brain plasticity and mind-body healing. Such DNA microarray research could determine whether we can generalize the molecular-genomic essence of repetition in therapeutic suggestion to the dynamics of repetition in prayer and meditation during the rituals and spiritual practices of many cultures. They may all evoke salient psychobiological arousal and the ideodynamic recall and replay of memory in the therapeutic reconstruction of memory, learning, emotions, and behavior at the levels of gene expression and brain plasticity. Table One is a listing of some gene candidates for assessing the role of therapeutic hypnosis, psychotherapy, and rehabilitation in modulating gene expression, brain plasticity and mind-body healing via DNA microarray technology.

Table One A brief sampling of gene candidates for assessing Erickson’s neuro-psycho-physiology of therapeutic hypnosis, psychotherapy, and rehabilitation in modulating gene expression, brain plasticity and mind-body healing via DNA microarray technology.

COMT THRA Per 1

Therapeutic Hypnosis, Absorption, Personality Dynamics Lichtenberg et al., 2000, 2004 Rossi, 2004c

Brain Plasticity in Consciousness, Memory, Learning and Behavior Change c-fos, c-Jun, krox, NGFI-A & B Bentivoglio & Grassi-Zucconi, 1999 CREB Kandel, 2001 BDNF Russo-Neustadt, 2001 ~ 100 Immediate Early Genes Rossi, 2002 Heightened Gene Expression in the Human Cortex SYN47 DCTN1 MAP1B KIF3A CAMK2A USP14 CDS2 IMPA1 RAB3GAP ATP2B1

Cáceres et al. 2003, Preuss et al., 2004

Replay in the Reconstruction of Fear, Stress and Traumatic Memories Zif-268

Ribeiro et al., 2002, 2004 Nader et al., 2000a, b Acute and Chronic Psychosocial Stress

Nerve Growth Factor (NGF) Membrane Glycoprotein 6a (M6a)

Alfonso et al., 2004 Alejel et al., 2002

CDC-like Kinase 1 (CLK-1) G-protein alpha q (GNAQ) CRE- dependent reporter gene Acetylcholinesterase (AChE-S & AChE-R)

Soreq & Seidman, 2001

Psychoneuroimmunology Interleukin 1, 2, 1ß, Cox-2

Kiecolt-Glaser et al. 2001 Clock Genes & Behavior State-Related Genes Cirelli et al., 2004 Rossi, 2004 Rosbash & Takakshi, 2003

~100 sleep related genes Clock, Period 1, BMAL Period 2

Relationships, Maternal Behavior, Therapeutic Touch ODC gene CYP-17

Schanberg, 1995 Ridley, 1999 Sociobehavioral Sexual Bonding, Trust Witt, 1995; Kosfeld et al., 2005 Pennisi, 2005; Hammock, Young, 2005

Oxytocin gene V1aR gene

Principle Seven emphasizes that the neural repetition and replay between the hippocampus and cortex is a creative process on the molecular-genomic level. From this perspective, the entirely natural process of Darwinian variation and selection at the levels of gene expression, protein synthesis, and brain plasticity that takes place during the offline replay between the hippocampus and the cortex functions as a creativity generator on an implicit (unconscious) level. My emphasis on the word “creative” goes beyond the current research literature cited above, which simply demonstrates repetition and replay without any reference to creativity. I hypothesize that creativity enters the process by the core Darwinian principles of random variation and natural selection that constantly taking place at the molecular-genomic and neural level of brain plasticity. The neuroscientist Gerald M. Edelman (1987, 1992), who received the Nobel Prize for Physiology or Medicine in 1972, has described this creative process as “Neural Darwinism.”

8. CREATIVE REPLAY, RESYNTHESIS, AND RECONSTRUCTION AT THE MOLECULAR-GENOMIC LEVEL OF THE 4-STAGE CREATIVE PROCESS, WHICH ENGAGES DARWINIAN NATURAL VARIATION AND SELECTION ON ALL LEVELS FROM MIND TO GENE, IS THE

ESSENCE

OF

THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY,

AND

REHABILITATION

AS WELL AS THE

CREATIVE ARTS AND HUMANITIES.

Replaying the 4-stage Creative Process for the resynthesis and reconstruction of experience is the fundamental dynamic of psychotherapy and all the healing arts. Our emerging models of creativity, optimal performance, stress, and healing engage Darwinian natural variation and conscious selection on all levels from mind to gene in the natural ultradian cycle (~90-120 minutes) of human experiencing from mind to gene as illustrated in Figure Seven. Immediate early genes, behavioral state-related and activity-dependent gene expression are bridges between the body, brain, and

mind that can be accessed to facilitate the creative replays of therapeutic hypnosis, psychotherapy, and rehabilitation (Rossi, 2002, p. 482). As noted Erickson’s therapeutic sessions typically ranged between 90-120 minutes, which he believed was needed for a complete unit of inner work. The classical and well documented 4-stage Creative Process of (1) Problem Recognition, (2) Incubation, (3) Illumination and (4) Verification is the outer expression of the normal process of development and adaptation from mind to gene expression and brain plasticity during the 90-120 minute ultradian basic rest-activity cycle throughout the day outlined in Figure Seven. As illustrated in Figure Seven, both positive and negative emotions are natural, intrinsic aspects of the 4-stage Creative Process: Negative emotions are the usual accompaniment of our conflicts and struggles in Stages 1 and 2, while the positive emotions accompany our successful resolution of problems in Stages 3 and 4 as illustrated in Figure Seven.

With his hardworking family background in farming, it was perhaps natural that Erickson frequently

commented that a job well done (Stage Three of the Creative Process) was the source of true happiness in life. Thus while Figure Seven is ostensibly an outline of the 4-stage Creative Process, it also outlines a new functional theory of the entire range of emotions from negative to positive that is operative on all levels from the cognitive-behavioral to the molecular-genomic.

Figure 7: How the Mind Heals the Brain #7. A Profile of Erickson’s Neuro-Psycho-Physiology During the 4Stage Creative Process. The ultradian profile (90-120 minutes) of the 4-stage Creative Process as it is typically experienced on the subjective psychological level is illustrated in the top most portion of the upper curve. The proteomics (protein) profile in middle curve depicts the energy landscape for protein folding within neurons of the brain into the correct structures needed for brain plasticity (adapted and redrawn from Cheung, et al. 2004). This proteomic profile arises from the functional concordance of co-expressed genes illustrated by the genomics profile below it (adapted from Levsky, et al., 2002). This genomics curve represents the actual gene expression profiles of the immediate-early gene c-fos and 10 other genes (alleles) over the typical Basic Rest-Activity (BRAC) period of 90-120 minutes. The lower diagram illustrates how these ultradian dynamics of the qualia of consciousness are typically experienced as Kleitman’s 90-120 minute Basic Rest-Activity Cycle within the normal circadian cycle of waking and sleeping (Rossi, 2002, 2004 a; Rossi and Nimmons, 1991).

Students of music will note the striking similarity between the 4-stage creative cycle profiled in Figure Seven, and the 4 parts of the sonata form profiled in Figure Eight. The term “sonata form” refers to the first movement of a symphony. The opening fast movement of a classical symphony (sonata-allegro), for example, is usually in sonata form. The sonata form illustrates how composers of the classical period (1750-1820) such as Hayden, Mozart, Beethoven, and their followers expressed human conflict, crisis, and their resolution in music for over 200 years (Kamien, 2006). This leads me to propose that Figure Eight is a striking illustration of how the creative arts may be understood as performance modalities for the therapeutic replay, reconstruction, and reframing of negative human experiences into positive perspectives that many cultures have called “wisdom.” Numinous experiences of art, beauty, and truth become positive experiences after their initial unexpected shock wears off precisely because they generate the creative reconstruction of the mind-brain at the molecular-genomic level (Rossi, 2002, 2004a, 2004b, 2005a). The following brief outline of the 4-stage Creative Process focuses on the subject’s experiences at each stage along with the therapist’s shifting task in facilitating the process. Each of the succeeding volumes of this neuroscience edition of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books will enrich our understanding and facilitate our skills in optimizing this creative process. Stage 1: Preparation, Data Gathering. Intense and deeply meaningful psychological states of arousal --- such as trauma, pain, stress, novelty, dreaming (REM sleep), and creative moments in everyday life, as well as all the arts and sciences, can initiate the activity of Immediate Early Genes, Activity (or Experience) Dependent, and Behavior-State Related Genes in our brain and body. Our genes are not always in an active state; genes have to be stimulated in everyday life by internal and external environmental and psychosocial signals to generate the proteins that are the molecular machines of life that do creative work. Stage One of the Creative Process includes a search for the problem the mind-body is attempting to solve on an unconscious or implicit level that often are initially perceived as sensations or symptoms. Sensations stimulate neural activity and curiosity, the desire to learn more, that sets us forth on deeply motivating outer and inner journeys of discovery and self-creation on all levels from mind to gene expression. A natural initiation to mind-body healing begins with the typical history taking at the beginning of any form of psychotherapy. The typical tears and distress in an initial interview, for example, indicate that the person is already

accessing state dependent memory and emotional arousal that evoke gene expression, new protein synthesis a potentially healing adventure. The therapist’s main job at this point is to recognize that therapy has already begun and simply facilitate it by letting people to tell their own story. Stage Two: Incubation. The Dark Night of the Soul. This is the valley of shadow, symptom, doubt, and depression that leads many people to psychotherapy. This is “the storm before the light” that portrayed in drama, poetry, myth and song in many cultures. Stage Two is the crux of creative replay and reconstruction that is frequently manifested as emotional conflict, crisis, and psychosomatic symptoms. Stress induced alternative pathways of gene expression and protein synthesis often generate conflict in the period of private inner work, creative replay, and reconstruction of feelings and cognitions at this stage. I hypothesize that in the natural processes of alternative gene expression, brain plasticity, and the transformations of consciousness during life transitions one invariably falls into anxiety (Sklan et al., 2004) and conflict (Birikh et al., 2003), in the reconstruction of memory and learning (Cohen et al., 2003). This incubation stage of the creative process is often experienced as the struggle on the hero’s journey when many people experience discouragement and failure. Conflicts, however, are not always a struggle with the outside world; most conflicts emerge between the old and the new during the spontaneous generation of new perspectives, insights and feeling that are a natural outcome of each round of gene expression and brain plasticity that takes place in every ultradian 90120 minutes cycle throughout the 24 hour day (Rossi, 2002, 2004, 2005). We may sleep but we are not at rest. We are forever in creative reconstruction whether we like it or not. The therapist's main job in Stage Two is (1) to offer open-ended therapeutic questions designed to access the emotional complexes and archetypal patterns encoding symptoms and (2) to support the person through the sometimes painful arousal that makes them abort their natural cycle of creativity, problem solving and healing in everyday life. After a painful emotional crisis and catharsis many people naturally slip into a private period of creative inner work that should be recognized but not be intruded upon by the therapist. Less is often more at this delicate stage of inner transformation. Respectful listening and emotional support is required to encourage people to reengage their numinous dream dramas with the creative replays of imagination to facilitate their development and healing on all levels from mind to gene (Rossi, 2004a-c). Stage Three: Illumination, Peak Experiencing, Creative Insight, Problem Solving, and Healing. This the famous “Ah-ha” or “Eureka” experience celebrated in ancient and modern literature when the intuitive function is manifest in the arts, sciences, and creative moments of everyday life.

People are surprised when they receive a creative thought and

automatically dismiss their originality as worthless if it was never reinforced in their early life. I hypothesize that gene expression and new protein synthesis at this numinous stage generates brain plasticity – the making and braking of neural connections – the actual synthesis of new synapses and connections between brain cells that encode new human

experience and the creative transformations of consciousness. It is of essence that people learn how to recognize and support these new developments in their consciousness that often are heralded by little smiles and joyful experience that breaks through the clouds of previous conflict. Psychosomatic symptoms tend to disappear dramatically as personal problems are resolved with the new perspectives. The therapist’s main job at this stage is to help the subject recognize and appreciate the value of the “new” that often appears to emerge spontaneously and unheralded. Often the subject may have already thought of the options that come up for problem solving at this stage but dismissed them since they were never validated. This lack of validation sometimes keeps people in a mild sisyphean struggle with themselves between Stage Two and three for years when they do not appreciate that the resolution of their problem is already at hand and they only need to reality test it in Stage Four of the Creative Process. Stage Four: Verification and Reality Replays. In this final stage of the creative cycle the person needs to verify the value of the new experiences of Stage Three by exercising them with creative reconstructive tests in real world as well as dreams and active imagination.

New experiences and insights are often fragile and can be easily lost. It is

ironic that our family and friends, who wish us well, often do not recognize the new that develops within us. Because of this the people who are closest to us often do not know how to support us in the realization of our new reality. Thus adolescents experience the generation gap when they have difficulties with their family and friends. Falling in love can be fragile and fickle. Innovators and creative workers have been perpetually misunderstood and persecuted throughout history for daring to assert their new consciousness. The therapist’s job in this stage is to (1) facilitate a follow-up discussion to validate the value of the psychotherapeutic process, (2) reframe symptoms into signals and psychological problems into inner resources, and (3) prescribe further “reality homework” to test, extend and reinforce the new neural connections being synthesized. Evidence suggests that 4 weeks to 4 months are required to stabilize these new neural networks (Van Pragg et al., 2002)

9. IMPLICIT PROCESSING HEURISTICS

FACILITATE THE

4-STAGE CREATIVE PROCESS

ON ALL LEVELS FROM GENE

EXPRESSION TO BRAIN PLASTICITY AND MIND-BODY HEALING IN THE RECREATION OF MIND, MEMORY, LEARNING, BEHAVIOR, AND SELF-IDENTITY.

While Erickson used direct suggestion, particularly during the early, experimental stage of his career, he later emphasized that attempting to directly program people without understanding their individuality was “a very uninformed way” of doing therapy” (Erickson & Rossi, 1979, p. 288). In our first collaborative effort to describe his use of indirect suggestion we found that his “implied directive” was the most useful for conceptualizing the essence of therapeutic suggestion. We soon came to believe that implication contributed to therapeutic suggestion because it is not what the therapist says that is important as much as what the patient does with what the therapist says (Erickson et

al., 1976, p. 59-60). An understanding of how Erickson uses implication provides us with the clearest model of his indirect approach to hypnotic suggestion. Since his use of “implication” appeared to involve something more than the typical dictionary definition of the term, I assumed that he was developing a special form of what I called “psychological implication” in his work. For Erickson, psychological implication is a key that automatically turns the tumblers of a patient’s associative processes into useful solutions without awareness of how it happened. The implied thought or behavioral response seems to come up all by itself on an spontaneous, involuntary, autonomous, or implicate (unconscious) level within people, as if it were their own inner creation rather than a suggestion initiated by the therapist. Psychological implication is a heuristic for facilitating a person’s associative processes when they cannot do it for themselves. The therapeutic use of this approach is obvious. If people have problems because of learned limitations in their ability to utilize their own inner resources, then psychological implications are a way of helping them bypassing these limitations.

Figure 8. How the Sonata Form of Classical Music Portrays the 4-Stage Creative Process. The Sonata Form, which is an approximately 20 to 45 minutes of classical symphony, is usually profiled in 3 or 4 movements. Kamien (2006, 163-164) describes the sonata form in the following quotations: “The amazing durability and vitality of sonata form result from it capacity for drama. The form moves from a stable situation toward conflict (in the exposition), to heightened tension (in the development), and then back to stability and resolution of the conflict.” I propose that the durability and vitality of the sonata form also comes from its integration of muti-levels of creative human experiencing from cognition and emotion to the molecular-genomic. (1) “The exposition sets up a strong conflict between the tonic key and the new key. It begins with the first theme in the tonic, or home, key. There follows a bridge, or transition, leading to the second theme, in a new key.” This initial stage of the sonata form corresponds to Stage One of the Creative Process when therapist and patient seek to identify the problem (first theme) and the life changes (second theme) that are at the source of patient’s conflicts of Stage Two. (2) “The development is often the most dramatic section of the movement. The listener may be kept off balance as the music moves restlessly through several different keys. Through these rapid modulations, the harmonic tension is heightened. In this section, themes are developed, or treated in new ways. They are broken into fragments, or motives, which are short musical ideas developed within the composition. A motive may take on different and unexpected emotional meanings.” This second part of the sonata form corresponds to Stage Two, the incubation stage of the Creative Process with its characteristic conflicts, negative emotions, and symptoms. (3) “The beginning of the recapitulation brings resolution, as we again hear the first theme in the tonic key. . . .Earlier in the exposition, there was a strong contrast between the first theme in the home key and the second theme and closing section in a new key; that tension is resolved in the recapitulation. . .” This third section of the sonata form

obviously corresponds to Stage Three of the Creative Process when there is an initial resolution of the conflict, problems, and symptoms of Stage Two. (4) “An even more powerful feeling is attained by following the recapitulation with yet another section. The coda rounds off a movement by repeating themes or developing them further. It always ends in the tonic [home] key.” This fourth and final part of the sonata form corresponds to Stage Four of the Creative Process in psychotherapy when the patient returns home to reality test the new problem and symptom solutions found in Stage Three. (All quotations from Kamien, 2006, pp. 163-164.)

The therapist only provides an opportunity or stimulus for psychological implication; the “hypnotic aspect” of psychological implication is created on an unconscious, implicate level by the listener. Erickson wrote that the most effective aspect of therapeutic suggestion is that which stirs the listener’s own mental processes into creative activity that generates the so-called “miracle” of healing as follows (1964). “In each instance hypnosis was used for the specific purpose of placing the burden of responsibility for therapeutic results upon the patient himself after he himself had reached a definite conclusion that therapy would not help and that a last resort would be a hypnotic "miracle." In this author's understanding of psychotherapy, if a patient wants to believe in a "hypnotic miracle" so strongly that he will undertake the responsibility of making a recovery by virtue of his own actual behavior and continue his recovery, he is at liberty to do so under whatever guise he chooses, but neither the author nor the reader is obligated to regard the success of the therapy as a hypnotic miracle. The hypnosis was used solely as a modality by means of which to secure their cooperation in accepting they wanted. In other words, they were induced by hypnosis to acknowledge and act upon their own personal responsibility for successfully accepting the previously futilely sought and offered but actually rejected therapy . . . . Three of a long series of similar cases are reported here to illustrate the use of hypnosis as a technique of deliberately shifting from the therapist to the patient the entire burden of both defining the psychotherapy desired and the responsibility for accepting it.” (Pp. 269–271, italics added). From our current neuroscience perspective it is the patient’s own creative activity that evokes activity-dependent gene expression, brain plasticity, and the so-called “miracles of mind-body healing.” It is the deeply meaningful and numinous replaying of the listener’s own mental processes that creates hypnotic experience, problem solving, and “spiritual healing.” The locus of healing is within the patient; the therapist has no mysterious or extra-ordinary powers of control or healing. Patients heal themselves when they are fortunate enough to receive appropriate “therapeutic suggestions,” that function as “implicit processing heuristics,” which evoke the numinous experiences of novelty, enrichment, and activities that generate activity-dependent gene expression, brain plasticity, and mind-body healing. Many years after I formulated the concept of the implied directive and psychological implication as important keys to Erickson’s successful use of therapeutic hypnosis (Erickson, Rossi & Rossi, 1976), the central role of implication became recognized in neuroscience. Squire and Kandel (1999), for example summarize of implication in understanding the difference between conscious (declarative knowledge) and unconscious (implicate or non-

declarative knowledge) in the dynamics of memory and learning as follows. “The question of interest is: What kind of memory underlies the ability to knowledge about categories? The surprising answer is that at least some kinds of category learning are non-declarative. Category learning can be independent of and parallel to declarative memory, rather than simply derivative from it. People can acquire knowledge about categories implicitly even when their declarative memory for the instances that define the category is impaired.” (p. 183, italics added). Recent research efforts to assess the value of Erickson’s approaches to psychological implication in therapeutic suggestion remain controversial, however. Some researchers failed to find any superiority of indirect suggestion over direct suggestion (Matthews, 2000), but many clinicians dispute the validity of the research methods used (Peter & Revenstorf, 2000). Erickson’s indirect approaches to therapeutic suggestion involved the patient’s “experience of reassociating and reorganizing his own experiential life that eventuates in a cure, not the manifestation of responsive behavior, which can, at best, satisfy only the observer” (Erickson’s, 1948). The research that purports to demonstrate that indirect suggestion was not superior to direct suggestion, however, used the so-called objective measures of responsive behavior on standardized scales of hypnotic susceptibility that typically restricted the creative replay and reconstruction of the subject’s subjective associations. When investigators compared the subjective perceptions of subjects to their own hypnotic experiences with the objective behavioral measures of direct and indirect suggestion, however, they came to these interesting conclusions (Matthews et al. 1985). “While the behavioral data failed to show significant differences between the two methods, however, subjects did report feeling more deeply hypnotized during the indirect procedure than during the direct procedure. This result is in support of an Ericksonian view . . . of indirect suggestion in that a wider latitude for responding is offered to subjects than is typically available with direct suggestion.

Thus, the subject’s unique responses to indirect

suggestions can be interpreted by them to be an indication of trance depth. If subjects fail to perform in accordance with a direct suggestion, however, there is some likelihood that they may perceive themselves as less deeply hypnotized.” (p. 222-223, italics added). It is precisely this “wider latitude for responding in the subject’s unique responses to indirect suggestions that Erickson wished to facilitate as a creative experience of re-associating and reorganizing their own experiential life that eventuates in a cure.” While indirect suggestion can facilitate the creative replay, re-association, and resynthesis of subjective experiences, indirect suggestion is not necessarily useful in the manipulation and control of the subject’s objective behavior as it is assessed with standardized scales of hypnotic susceptibility. Even with research that demonstrates the efficacy of indirect suggestion in facilitating the subject’s personal creativity, the misperception that indirect hypnotic suggestion is a covert method of programming the patient with the therapist’s goal remains an

important issue in professional practice as well as public perception. Because of this confusion between (1) programming and control by the therapist with direct suggestions versus (2) creative inner work by the patient via indirect suggestions, we need to make a special effort to distinguish between them. In my earliest publications with Erickson I emphasized how the classical, directive concept of hypnotic suggestion could be complemented with indirect suggestion. Because of the ambiguity of the concept of “indirect suggestion,” however, I now will replace it with the concept of “implicit processing heuristics” wherever appropriate in this edition of Milton H. Erickson’s Complete Works. Implicit processing heuristics designate how “suggestion” in every day life and the arts as well as therapeutic hypnosis, psychotherapy, and rehabilitation can facilitate gene expression, brain plasticity, and mind-body healing via the 4-stage Creative Process within the subject. We now need brain imaging and DNA microarray research to document the full range and limitations of implicit processing heuristics in modulating the molecular-genomic pathways of therapeutic hypnosis and other approaches to mind-body healing and rehabilitation.

10. MIRROR NEURONS

AND

EMPATHY: RAPPORT, RESPONSE ATTENTATIVENESS,

AND

RESPONSIVE

BEHAVIOR IN

GROUP EXPERIENCES, RITUAL, METAPHOR, DRAMA, AND STORY TELLING. Recent research in neuroscience has documented the activity of “mirror neurons in primates and humans that function as “a potential neural mechanism for empathy, whereby we understand others by mirroring their brain activity” (Miller, 2005, p. 946). This neural basis of empathy finds support in research on dysfunctions in the mirror systems of humans with autism and fMRI research designed to assess emotional empathy. Such empathy research at the neural level and trust at the genomic and hormonal levels (Kosfeld et al., 2005) is consistent with descriptions of the “rapport” – the sympathetic relationship – between therapist and subject that has been used as an explanatory principal to account for many of the classical phenomena of hypnosis for over 200 years. It is important to realize how this multi-level lock of rapport on at least 4 levels (molecular-genomic, hormonal, neural, and experiential) is a new model for all complex psychosocial experiences whose subjective aspect has made them seemingly refractory to objective measurement and scientific study.

This understanding of rapport is entirely consistent with our first

neuroscience principle above, which outlined how the functional concordance of co-expressed families of genes as measured by DNA microarrays could become a new scientific approach to quantifying the varying subjective states of consciousness, creativity, and private implicit processing that we call “therapeutic hypnosis.” The history of hypnosis beginning with Mesmer is rich in accounts of the special efficacy of therapeutic hypnosis when experienced in group experiences and demonstrations of stage hypnosis where people mirror, mimic, and role play each others behavior (Tinterow, 1970). In this volume Erickson describes how he can determine whether a person

will be a good hypnotic subject by assessing their natural “response or behavioral attentativeness” in an initial interview (Erickson, Haley, & Weakland, 1959). Research is now needed to determine the degree such response attentativeness actually reflects the activity of mirror neurons in everyday life as well as on our standardized hypnotic susceptibility scales. Erickson would also use “pantomime techniques” and sometime surround a “resistant” subject with highly suggestible subjects to induce hypnosis. It is now intimated that “the study of the brain’s mirror systems will do for psychology what the study of DNA has done for biology” (Miller, 2005 p. 945).

From this new

neuroscience perspective we can understand the psychosocial interactions between therapist, subject, and groups in therapeutic hypnosis as mutually empathetic entrainments at the level of gene expression and mirror neurons. We can now understand how a subject’s ability to “think and feel along with” the therapist’s words, metaphors, stories, and implicit processing heuristics in the induction of therapeutic hypnosis could be a measure of “hypnotic susceptibility” via the activity of mirror neurons. Likewise, the actions of story tellers, singers, dancers, orators, actors, and politicians of all sorts to “move” an audience are actually implicit processing heuristics that evoke gene expression and brain plasticity. All deeply meaningful psychosocial interactions between people – friends, couples, families, special interest groups, communities, and nations – are using implicit processing heuristics to engage and mutually entrain each other at the levels of gene expression and brain plasticity via mirror neurons.

We can now

better appreciate how the outer destructive events of war and social chaos can traumatize and stress individuals to loosen the psychosocial fabric at the fundamental levels of gene expression, brain plasticity and mind-body health.

11. A

FUTURE ORIENTATION TO THE CREATION AND RECONSTRUCTION OF MEMORY VIA IMPLICIT PROCESSING

HEURISTICS

FACILITATES

MIND-BODY

HEALING

VIA

THERAPEUTIC

HYPNOSIS,

PSYCHOTHERAPY,

AND

REHABILITATION.

In a recent essay Dudai and Carruthers (2005) discuss the “Janus face of Mnemosyne” where memory looks at the future as well as the past in a creative synthesis that integrates imagination, emotions and cognition in manner that psychotherapists facilitate in their daily work. “We all know from personal experience and introspection (research tools once cherished and now mostly disrespected) that mental excursions can be made not only to the past, but also to the future. It was even speculated (Tulving, 2005) that the ability to contemplate future scenarios was a driving force in the evolution of episodic memory. This proposed selection-for-imagination might even be blamed for the inherent fallibility of our recollective faculty. Despite this, attempts to liken imagination to memory are still considered shaky by many; the latter is considered factual data (which it is not), the former the subject matter of poets and an unsubstantiated, inferior form of knowledge.

In ancient Greek mythology, Memory (Mnemosyne) was the mother of all the muses. In the mortal world, Aristotle, Galen, and their medieval Arab commentators, emphasized the role of memory in the ethical virtue of 'prudence', the ability to make wise judgments and plan effectively. The word used by these scholars for concepts was 'phantasms' (in Greek, phantasiai; in Latin, imagines). Memory was also associated with prophetic writing, as in the Book of Ezekiel, whose prophecy consisted in recreating imaginatively [to] envision and motivate the future. . . Important in this planning effort is not accuracy of reproduction, but the act of imaginative recreation itself as a totally sensed and felt experience. . . There is a central role for imagination. In this, memories are not direct signature-traces that past experiences leave in the brain. Their function is not to provide an accurate trace of things past, but to provide materials for creative thinking. In medieval analysis, data from all the senses came through various channels into the brain and were received in the 'phantasy' or 'common sense' area. The impressions were simultaneously collected and formed into images by the activity of 'making forms'. The experience also was 'estimated' emotionally as benign or hurtful, a gut reaction part of the mental imago. The resulting 'phantasm' was thus both a product of imagination and also had definite emotional colour; there was no such thing as a fully neutral or objective conception, and virtually all thoughts were formed as complete mental episodes.” (p. 567, italics added). We could hardly find a better summary of how mind, memory, imagination and emotions are experienced as a continual reintegration of the meaning of our past as we recreate our current and future identity and well being in psychotherapy. The continual process of the creation and recreation of memory on all levels from the moleculargenomic to brain plasticity is the psychobiological basis of the metaphor, myth, and story making faculty of the human mind (Gazzaniga, 2000) that is the essence of drama, literature, poetry, and identity creation as well as psychotherapy. This ideoplastic (psychobiological) faculty of the human mind is the basis of all creativity in the positive sense (art, beauty, and truth) as well as the negative (confabulation, deceit, lying). Perhaps this is what motivated Milton H. Erickson to experiment so intensively with the hypnotic phenomena of time distortion wherein the subject was reoriented into the future as well as the past to facilitate the resolution of current problems and the recreation of new identity as described in many case examples throughout these volumes (e.g. Aldous Huxley in Volume One, and the February Man in Volume Five). From our current neuroscience perspective all the novel, interesting, and fascinating experiences of time distortion and hypnotic phenomena in general are evocative, creative processes that evoke activity-dependent gene expression, brain plasticity, and mind-body healing via implicit processing heuristics.

12. THE

SELF-FACILITATION OF EACH PERSON’S UNIQUE PSYCHOSOCIAL GENOMIC RESOURCES OF CONSCIOUSNESS,

CREATIVITY, AND HAPPINESS IS THE ESSENTIAL DRAMA AND DYNAMIC OF HUMAN DESTINY AS PORTRAYED IN THE

ARTS, HERO MYTHS, AND HUMANITIES OF ALL CULTURES.

The ultimate goal of all therapeutic practices and schools is to facilitate the individual’s skills in optimizing consciousness and facilitating their own creative resources on all levels from mind to gene expression and brain plasticity. Why do we seek adventurous experiences of art, beauty, and truth? In so far as art, beauty, truth, love, and spiritual experiences are numinous, they actually evoke gene expression, brain plasticity, and mind-body healing. On the negative side, however, the feverish activities of crime, exploitation, and war also turn on activity-dependent gene expression and perilous transformations of behavior, character, health, and illness via brain plasticity. This clearly indicates how our current advances in the molecular-genomics of neuroscience can help guide and cultivate of the best in human nature via education, philosophy, and the practice of the moral virtues.

The

neuroscience of these traditional humanistic disciplines is providing new insights about how they can be better facilitated. We now understand how our fascination with autobiography, drama, history, imagination, literature, metaphor, movies, music, myth, poetry, and song – virtually all deeply moving existential expressions of the human condition in every past and possible future medium and public media – are actually searches for models that could facilitate our personal consciousness, creative development, and contributions to others. The many examples of Milton H. Erickson’s creative approaches to facilitating the human condition via therapeutic hypnosis, psychotherapy, and rehabilitation throughout these volumes can help each of us find fresh inspiration along our way.

SUMMARY: A CONCORDANCE OF THERAPEUTIC HYPNOSIS AND NEUROSCIENCE

Our twelve principles integrating therapeutic hypnosis with neuroscience indicate the need for a concordance of the concepts and processes they share. This concordance cannot be static in any sense, however. The concepts of historical and therapeutic hypnosis blend imperceptibly into the fluid mainstream of current neuroscience so that it is often impossible to distinguish between them. A clear recognition of the general world-view they share in Table Two, however, can greatly enrich our understanding of both, and facilitate research for the future. Table Two This is a concordance of the concepts and processes of therapeutic hypnosis and neuroscience that intuitively cluster together at the levels of molecular-genomics, brain plasticity, and psychological experience. There are general and suggestive links but few exact one-to-one correspondences between the Therapeutic Hypnosis and the Neuroscience columns. THERAPEUTIC HYPNOSIS

NEUROSCIENCE

The Molecular-Genomic State Concept

Special State Mesmerism, Trance Monoideism Dissociation

Functional Concordance of Co-Expressed Genes Behavioral State-Related Gene Expression Heightened Gene Expression and Neuronal Activation State Dependent Memory, Learning, & Behavior Hypnotic Induction

Focused Attention via Hand Levitation , Art, Beauty, Pantomime, Paradox Fascination, Absorption, Utilization Enchantment, Education Thinking & Feeling Along With Metaphors, Stories, Dramas, Paradox Trauma, Shock, Stress, Surprise, Unexpected, Numinous Sleep, Relaxation, Comfort, Fatigue, Boredom, Repetition, Rhythm Groups, Rituals, Music, Song & Dance Repetition with Random Variation Touch, Mesmeric Passes

Immediate-Early Gene Expression, Heightened Neuronal Activation Novelty, Enrichment Enrichment, Brain Plasticity Neural Entrainment via Mirror Neurons Implicit Processing Heuristics, Activity Alternative Gene Splicing, Immediate Early Genes Behavior State-Related Gene Expression, Clock Genes Mutual Entrainment via Mirror Neurons, Creative Replay, Brain Plasticity Activity-Dependent Gene Expression

Hypnotic Phenomena Rapport, Empathy, Suggestibility Amnesia, Automatisms, Dissociation Memory Revivification Posthypnotic Suggestion Role Playing, Time Distortion Crisis, Intuition, Insight Indirect Suggestion, Implied Directive

Mirror Neurons, Empathy, Entrainment State Dependent Memory & Learning Neural Trace Reactivation Offline Neural Replay Creative Neural Replay, Reconstruction Creative Moment, Eureka! Implicit Processing Heuristics Mind-Body Relationships

Ideo-Plastic Faculty Ideodynamic Activity Ideomotor Activity, Doing Embodied Imagining Neuro-Psycho-Physiology Psychophysiology

Brain Plasticity, Synaptogenesis Implicit Processing Heuristics Activity-Dependent Gene Expression Psychobiology, Mind-Body Healing Psychoimmunology Psycho endocrinology

An initial glance at the mini-concordance of therapeutic hypnosis and neuroscience in Table Two may seem intimidating in its details to the uninitiated student. This new understanding of our emerging science of mind-body communication and healing is comprehensive, surprising, and profound for understanding how the mind can facilitate the deep psychobiological processes of the brain and body. Behind the apparent complexity of this concordance, however, there are only a few really new ideas of how the mind can heal the brain. Our most interesting and salient subjective psychosocial experiences of art, beauty, love, and truth evoke gene expression, brain plasticity, and mind-body healing. The apparent complexities of trauma, stress, and psychopathology all can be understood as the observable behavioral manifestations of gene expression, protein synthesis, and brain plasticity gone astray when we are overwhelmed in our interactions with ourselves and the world. We are on the threshold of understanding how our subjective psychological experiences of consciousness and free will are expressions of objective physical and biological processes. Table Two summarizes how many of Erickson’s activity-dependent approaches to therapeutic suggestion and

hypnosis such as hand levitation, surprise, pantomime, confusion, implication, etc., function as (1) implicit processing heuristics (ideodynamic action) to (2) stimulate the activity-dependent gene expression/protein synthesis cycle, which (3) facilitates activity-dependent brain plasticity for the (4) eventual therapeutic reconstruction of fear, stress, and traumatic memory and symptoms. These emerging principles of current neuroscience enable us to hypothesize how Erickson’s therapeutic work could facilitate the creative replay and resynthesis of meaningful life experiences to evoke the heightened mental activity that stimulates gene expression, brain plasticity, and mind-body healing, which enables people to solve their own problems in their own way. Research with brain imaging and DNA microarrays is now urgently needed to assess the range and limitations of therapeutic suggestion (that is, implicit processing heuristics) in optimizing mind-body healing at all levels from gene expression, protein synthesis, and brain plasticity to the subjective experiences of problem solving and healing via the 4-stage Creative Process. Most of us have but little awareness about how to manage the entirely natural 4-stage creative cycle that integrates our psychological experience with gene expression and brain plasticity in the constant reconstruction of our mind-brain every moment of our lives. Who has the time, energy, wit, and wisdom to catch up and be constantly current with the creative edge of our evolving self in our sleep and nightly dreams as well as our shifting everyday relationships with our families and others?

How many people really appreciate how this constant creative reconstruction at the

molecular-genomic and brain-plasticity levels is the essence of the apparently subjective experiences and dramas of our lives and what it means to be human? Erickson’s naturalistic approaches to hypnotic rapport and therapeutic suggestion illustrated throughout these volumes ranging from shock and surprise to story telling and metaphor are all implicit processing heuristics that engage and facilitate each person’s efforts to optimize mind-gene communication and healing in the various states of waking consciousness, sleep, and dreaming. Our mini-concordance with neuroscience in Table Two will guide us to a deepening appreciation, understanding, and skill in utilizing Milton H. Erickson’s creative approaches to therapeutic hypnosis, psychotherapy, and rehabilitation in this new edition of his Complete Works, Seminars books and the Erickson/Rossi books.

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Foreword This series of Milton Erickson's Collected Papers contains a fascinating array of original contributions related to every phase of hypnotic theory and practice. The papers contain stores of invaluable data that can be productively mined by researchers and clinicians for treasures useful in hypothetical structuring and experiment, as well as in catalyzing psychotherapy. Dr. Erickson is perhaps the most creative and imaginative contemporary worker in the area of hypnosis and his inspired writings in this series rank among the enduring classics in the field.

Lewis R. Wolberg, M.D. Clinical Professor of Psychiatry, New York University School of Medicine Emeritus Dean, Postgraduate Center for Mental Health

Clear Dream of a New Edition for a New Generation On January 24, 2005, in the early morning about 5 a.m., Ernest had big dream, an unusual dream that had a special sense of light, luminosity, clarity, and high consciousness about it. “On a bright clear day I am walking along a pleasant residential street, which has nice, somewhat old-fashioned houses with large porches. On many of the porches there is the furniture of another family who is living there on the porch—a refrigerator, stove, table, chairs, etc. All was very neat, clean and respectable, however. When I came to the end of the street there was one large house that had no furniture on the porch but instead had an English garden in a huge front yard with many large colorful flowers beautifully cultivated for optimum curb appeal and the sense of a good life.”

What could be the meaning of this dream and what precipitated it? Ernest realized it began the evening before in a conversation with me. We had shared a nice old-fashioned evening listening to Mozart and playing some of his simpler pieces on our Clavinova together. Just before going to sleep I asked him a very usual question: “What the happiest part of your day?” Ernest shared his original thoughts of the day.

He thought that a new updated edition of Erickson’s

collected papers and our co-authored books was needed. He intuited that he had grown far beyond the knowledge he had when he wrote the original Erickson/Rossi books a generation ago. He realized even then, however, that it

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was very important to make good indexes so he could come back some day and update them with a more adequate scientific framework. Ernest described how he was now writing a series of papers updating everything he had learned about therapeutic hypnosis and psychotherapy over the past 44 years (since receiving his Ph.D.) in terms of modern neuroscience, the psychosocial genomics of consciousness, and the creative process.

He

explained to me that he believed he now had achieved a more adequate understanding of what Erickson called the “neuro-psycho-physiological process of hypnosis.” This, he now feels, “is the most beautiful flower in the garden of my dreams”. Ernest went on to express his aspiration, “This update could become the truly scientific basis of a new edition of Erickson’s work and all our co-authored books that have long been out of print.” The dream suggests a need to integrate Erickson’s old-fashioned house (from our current perspective a generation after he passed on in 1980) and the new furniture his students have moved onto his porch. Each of his students placed the furniture of their understanding on his porch just like another family living with him. Erickson certainly was a great family man and would, and did, welcome students living on his porch. We believe that this new neuroscience edition is an expression of the wonderful home Ernest and I now live in. True to Erickson’s naturalistic and utilization orientation, we use all the space economically with home offices, music room, and libraries where we are now editing these new volumes and cultivating the flower gardens we share with everyone walking by.

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Kathryn L. Rossi, Ph.D., 2006 Los Osos, California

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Acknowledgements

The Editors wish to thank our esteemed colleague, Jeffrey Zeig, and the Milton H. Erickson Foundation for all of their support and love. We acknowledge the assistance and suggestions of many colleagues and members of the American Society of Clinical Hypnosis in the preparation of these Volumes. The following journal and publishers have generously permitted the replication of papers in these Volumes: American Journal of Clinical Hypnosis, American Journal of Psychiatry, American medical Association, American Psychiatric Association, American Psychological Association, Appleton-Century-Crofts, Achieves of Neurology and Psychiatry, British Journal of Medical Psychology, Bulletin of the Georgetown University Medical Center, Diseases of the Nervous System, Encyclopedia Britannica, Family Process, Harper and Row, Paul B. Hoeber, Inc, Journal of Abnormal and Social Psychology, Journal of Clinician and Experimental Hypnosis, Journal of Experimental Psychology, Journal of General Psychology, Journal of Genetic Psychology, Journal of Nervous and Mental Disease, Journal of the American Society of Psychosomatic Dentistry and Medicine, Journal Press, Julian Press, Macmillan Company, Medical Clinics of North America, Merck, Sharp and Dohme, Perceptual and Motor Skills, Physicians Postgraduate Press, Psychiatry, Psychoanalytic Quarterly, Psychosomatic Medicine, W.B. Saunders Company, Springer-Verlag, William Alanson White Psychiatric Foundation, Williams and Wilkins and Woodrow Press.

Milton H. Erickson dedicated his professional life to advancement of healing through hypnosis and psychotherapy. Writing professional papers and teaching were the two primary ways that he disseminated the knowledge he honed. Because his office was in our home, he could readily capture productive hours allowing the efficient integration of resources and circumstances that characterized his work. I remember being proud seeing our home address in the journals he edited and on the reprints that were constantly sent to colleagues. His letterhead displayed “32 West Cypress Street” and “ALpine 24-254” in the years when telephone numbers were still alpha-numeric and before Zip Codes were introduced. Throughout my childhood, Dad always seemed to be in the office writing, surrounded by piles of works in progress. The filing cabinet was within his arm’s reach. Under the desk was a box of scrap paper already used on one side that awaited use for further rough drafts. In the top drawer of his desk was a special pencil holder to hold stubs of pencils. Dad had a longstanding practice of collecting pencils that had been discarded by others as too short. A small Lucite box given to him by a patient housed the collection so that he could continue writing his unbroken thoughts as the small pencils were consumed. Our whole family supported this aspect of his life -- one of my jobs as a child was to sharpen pencil stubs. My sister gathered up scrap paper at school. As the rough drafts were replaced by next drafts, the trash basket that had been built by my brother in his woodshop class was emptied. The piles on the desk over-flowed into the dining room, where my mother carefully watched over them. A series of secretaries typed the endless

flow of correspondence, papers, and stories he wrote to entertain the family. In the late evening he would discuss ideas with my mother, and in the early mornings he would resume writing with renewed vigor. It was as if he was so filled with ideas that it was a struggle to get them all down quickly enough Dad’s quest for discovery was a constant, powerful force. The smallest elements of day to day life were re-defined as opportunities for further discovery. Whenever we brought him our dilemmas, he adeptly re-directed our inquiries into paths in which we could discover the answers. I learned to evaluate life’s difficult choices by examining them ¨on paper¨-- in my mind’s eye. My father’s professional ideas were integrated into his own life. Polio left his body frail, but his resolve and inquisitiveness turned the process of healing into a passion for investigation. He established such adroit perception that it left many wondering whether or not such insight could be possible for someone who had not suffered as he had. Every day he lived with the limitations of significant muscular weakness. Sometimes he suffered from the pain of progressive nerve and muscle loss. During such episodes, he worked extra hard , distracting himself from the pain -- seemingly even more driven to conclude papers he was writing. In the evenings he would retire early, and sometimes soak in a tub of tepid water. When he went to bed, he would call my mother or another family member in to discuss the nature of hypnosis and how it reached beyond the normal limits of consciousness. Sometimes he would talk about his pain directly; and other times he would talk about cases in which an unusual intervention had been successful. We all listened knowing he was working -- working to endure his debility at

the same time that discovering new ways to heal. The ideas that came to him at such times seemed to fuel the ingenious work that waited in the morning. Over the years, teaching worked its way to the forefront of his schedule. Though he found all of his teaching stimulating, particular colleagues inspired him in ways that led to more writing. Bernard Gorton M.D. was the first colleague whom I was old enough to remember having this effect on him. The collaboration that started at scheduled hours extended to animated conversations about ideas that reached far beyond the office. Our families went on picnics together where discussions were interspersed with the adventures of finding petroglyphs in the Estrella Mountains. Despite Dr. Gorton’s tragic and unexpected death, that relationship sparked a fire that seemed to accelerate Dad’s urgency to get his ideas on paper. Colleagues encouraged Dad to complete publications that he had left unfinished. Jay Haley was one to come as a student, and to emerge as a partner in writing. Like Gorton, Haley seemed to have a generative effect on my father and also became a treasured family friend. As my father aged, he had less energy to spend on writing. The move to East Hayward Street provided him with another home office to accommodate the growing groups of students. It was there that Ernest Rossi came to learn. Together my father and Rossi worked for nearly a decade. Rossi brought both invigorating energy and a new depth of insight. Rossi arrived with his background in chemistry during an era when academia was striving to understand the mechanism of neurotransmitters. Their talks about the physiological elements of change moved the discussion in the directions which Dad hungered for. Rossi´s insatiable curiosity

matched my father’s, and it was not long before the two of them were deeply engrossed in discussions that, of course, led to more writing. The papers presented here are works that my father generated over a lifetime of professional study. They reflect the growth of ideas and the honing of psychotherapeutic tools. The ideas reflect a richness that evolves through closely examining what was effective. Initially, Rossi´s part was to amass and organize ideas under Dad’s guidance. Yet in the same way that the unconscious holds the key to problem resolution for the individual, these works also contain the resources for moving forward. Rossi took these papers another step, and now gives us insight into the ideas within the context of contemporary neuroscience. I am deeply grateful to Ernest Rossi for being there at the right time; for infusing my father with energy; and especially for carrying Dad’s work to another level of insight. And like my father’s night-time struggles with aches and pains, our struggles to bring these works back into publication has also been fraught with aches and pains. Yet the friendship founded so many years ago has stood true. During the last several years I have been blessed with the abundant vitality of working with Ernest and Kathryn Rossi as we have labored to bring these works back into publication. Our efforts have proved fruitful, and we are now in a position to offer these important papers to you who wish to learn from them. It is our expectation that in so doing, we lay the groundwork for future insights Roxanna Erickson Klein R.N., Ph.D., 2006 Dallas Texas

Volume I - Contents Forward Acknowledgements Editor’s Neuroscience Edition Preface I. Exploring the Nature of Consciousness and Hypnosis 1. Editor’s Introduction: How the Mind Heals the Brain 2. Initial experiments investigating the nature of hypnosis 3. Further experimental investigation of hypnosis: Hypnotic and non-hypnotic realities 4. A special inquiry with Aldous Huxley into the nature and character of various states of consciousness 5. Autohypnotic experiences of Milton H. Erickson II. Naturalistic and Utilization Approaches to Therapeutic Hypnosis 6. Historical note on the hand levitation and other ideomotor techniques 7. Deep hypnosis and its induction 8. Naturalistic techniques of hypnosis 9. Further clinical techniques of hypnosis: utilization techniques III. Minimal Cues, Mirror Neurons, and Rapport in Therapeutic Hypnosis 10. Respiratory rhythm in trance induction: The role of minimal sensory cues in normal and trance behavior 11. An indirect induction of trance: Simulation and the role of indirect suggestion and minimal cues 12. The "surprise" and "my-friend-John" techniques of hypnosis Minimal cues and natural field experimentation IV. Observation and Training in Therapeutic Hypnosis 13. Expectancy and minimal sensory cues in hypnosis 14. Notes on minimal cues in vocal dynamics and memory 15. Clinical and experimental trance: Hypnotic training and time required for their development 16. Laboratory and clinical hypnosis: The same or different phenomena? 17. The experience of interviewing in the presence of observers

The Neuroscience Edition The Complete Works of Milton H. Erickson, M.D. On Therapeutic Hypnosis Psychotherapy and Rehabilitation Volume 1: The Nature of Hypnosis Edited by: Ernest Lawrence Rossi, Ph.D. Roxanna Erickson-Klein, Ph.D. Kathryn Lane Rossi, Ph.D.

Copyright © 2006 by Ernest Lawrence Rossi, Ph.D.

All text, photographic, graphic, audio and/or video material found on this CD cannot be published, broadcast, rewritten for broadcast, publication or redistributed directly or indirectly in any medium. All materials appearing on this CD are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of the Milton H. Erickson Foundation, Inc. You may not copy, reproduce, distribute, publish, display, perform, modify, create derivative works, transmit or in any way exploit any content on this CD, nor may you distribute any part of this content over any network, including a local area network, sell or offer it for sale, or use such content to construct any kind of database.

Contents Foreword Acknowledgements Editor’s Neuroscience Edition Preface I. Exploring the Nature of Consciousness and Hypnosis 1. Editor’s Introduction: How the Mind Heals the Brain 2. Initial experiments investigating the nature of hypnosis 3. Further experimental investigation of hypnosis: Hypnotic and non-hypnotic realities 4. A special inquiry with Aldous Huxley into the nature and character of various states of consciousness 5. Autohypnotic experiences of Milton H. Erickson II. Naturalistic and Utilization Approaches to Therapeutic Hypnosis 6. Historical note on the hand levitation and other ideomotor techniques 7. Deep hypnosis and its induction 8. Naturalistic techniques of hypnosis 9. Further clinical techniques of hypnosis: utilization techniques III. Minimal Cues, Mirror Neurons, and Rapport in Therapeutic Hypnosis 10. Respiratory rhythm in trance induction: The role of minimal sensory cues in normal and trance behavior 11. An indirect induction of trance: Simulation and the role of indirect suggestion and minimal cues 12. The "surprise" and "my-friend-John" techniques of hypnosis Minimal cues and natural field experimentation IV. Observation and Training in Therapeutic Hypnosis 13. Expectancy and minimal sensory cues in hypnosis 14. Notes on minimal cues in vocal dynamics and memory 15. Clinical and experimental trance: Hypnotic training and time required for their development 16. Laboratory and clinical hypnosis: The same or different phenomena? 17. The experience of interviewing in the presence of observers

Foreword This series of Milton Erickson's Collected Papers contains a fascinating array of original contributions related to every phase of hypnotic theory and practice. The papers contain stores of invaluable data that can be productively mined by researchers and clinicians for treasures useful in hypothetical structuring and experiment, as well as in catalyzing psychotherapy. Dr. Erickson is perhaps the most creative and imaginative contemporary worker in the area of hypnosis and his inspired writings in this series rank among the enduring classics in the field.

Lewis R. Wolberg, M.D. Clinical Professor of Psychiatry, New York University School of Medicine Emeritus Dean, Postgraduate Center for Mental Health

Acknowledgements

The Editors wish to thank our esteemed colleague, Jeffrey Zeig, and the Milton H. Erickson Foundation for all of their support and love. We acknowledge the assistance and suggestions of many colleagues and members of the American Society of Clinical Hypnosis in the preparation of these Volumes. The following journal and publishers have generously permitted the replication of papers in these Volumes: American Journal of Clinical Hypnosis, American Journal of Psychiatry, American medical Association, American Psychiatric Association, American Psychological Association, Appleton-Century-Crofts, Achieves of Neurology and Psychiatry, British Journal of Medical Psychology, Bulletin of the Georgetown University Medical Center, Diseases of the Nervous System, Encyclopedia Britannica, Family Process, Harper and Row, Paul B. Hoeber, Inc, Journal of Abnormal and Social Psychology, Journal of Clinician and Experimental Hypnosis, Journal of Experimental Psychology, Journal of General Psychology, Journal of Genetic Psychology, Journal of Nervous and Mental Disease, Journal of the American Society of Psychosomatic Dentistry and Medicine, Journal Press, Julian Press, Macmillan Company, Medical Clinics of North America, Merck, Sharp and Dohme, Perceptual and Motor Skills, Physicians Postgraduate Press, Psychiatry, Psychoanalytic Quarterly, Psychosomatic Medicine, W.B. Saunders Company, Springer-Verlag, William Alanson White Psychiatric Foundation, Williams and Wilkins and Woodrow Press.

Editor’s Neuroscience Edition Preface This New Neuroscience Edition of Milton H. Erickson's Complete Works has been updated with current concepts of neuroscience and psychosocial genomics for students, clinicians, and researchers who wish to explore in depth the work of one of the most seminal minds in the history of hypnosis and psychotherapy. When Erickson began publishing his studies in the early 1930s, hypnosis was in a curious position: most investigators agreed that hypnosis had played a central role in the early studies of psychopathology and our first efforts at psychotherapy, but the authoritative approaches associated with its use were supplanted on the one hand by the seemingly more sophisticated approaches of the psychoanalytic schools, and on the other hand by experimental psychology. The situation might have continued in just this manner, with hypnosis regarded as nothing more significant than a colorful curiosity in our therapeutic history. Into this situation, however, came the accident that was Milton H. Erickson. He was an accident of nature born with a number of congenital sensory-perceptual problems that led him to experience the world in ways so different that his acute mind could survive only by realizing at a very early age the relativity of our human frames of reference To these early problems was added the rare medical tragedy of being stricken by two different strains of polio at the ages of 17 and 51. His efforts to rehabilitate himself led to a personal rediscovery of many classical hypnotic phenomena and how they could be utilized therapeutically. Erickson's experimental and therapeutic explorations with the hypnotic modality span more than 50 years. His successful rejuvenation of the entire field may be attributed to his development of the non-authoritarian approaches to suggestion wherein subjects learn how to experience hypnotic phenomena and how to utilize their own potentials to solve problems in their own way. The contents of these Volumes can be best understood as working papers on a journey of discovery. There is little that is fixed, final, or permanently validated about them. Most of these papers are heuristics that can stimulate the mind of the reader and evoke the awe of discovery, which is unlimited in the realm of human consciousness. The problem of how to present these papers could have been solved in many ways. A simple chronological order seemed unsatisfactory because the record of much of Erickson's earliest work was published only at a later date. Many papers dealing with the same theme, which should obviously be grouped together, were published in different phases of his career. The editor decided to make a balanced presentation wherein each Volume identifies a major area of exploration with appropriate sections wherein the papers are presented in an approximation of chronological order. Each section has a brief introduction to orient the reader to the concepts of current neuroscience and psychosocial genomics that are of relevance for updating our understanding of Erickson’s therapeutic approaches together with suggestions of how clinicians may learn to apply his most innovative ideas. News, research, continuing education, and consultation on the new neuroscience of Erickson’s approaches to therapeutic hypnosis, psychotherapy, and rehabilitation are available on www.ErnestRossi.com.

Ernest Lawrence. Rossi Los Osos, California 2006

I. Exploring the Nature of Consciousness and Hypnosis

The papers of this first section provide a broad introduction to Erickson's lifelong quest for an understanding of the nature of consciousness and hypnotic experience. The first paper, "Initial experiments investigating the nature of hypnosis" (1964), is a retrospective report of Erickson's first studies of hypnosis as an undergraduate student during the 1923-24 seminars on hypnosis at the University of Wisconsin under the supervision of Clark L. Hull, Ph.D., one of the founding fathers of experimental psychology and learning theory in the United States. These studies as a student lay the groundwork for an understanding of therapeutic hypnosis and trance as normal experiences that can develop naturally during periods of introspection. There is no need for mysterious manipulations of subjects. One does not really control subjects in hypnosis; rather, one provides them with stimuli and opportunities for an intense inner absorption that sometimes leads to apparently different states of consciousness: what Erickson later called hypnotic and non-hypnotic realities. From our current neuroscience perspective this “intense inner absorption” can be regarded as the highly salient type of mental activity that generates activity-dependent gene expression, activity-dependent brain plasticity, and mind-body healing. Although Erickson certainly could not have been aware of these modern neuroscience concepts when he was a college undergraduate, his initial experiments hit upon the activity-dependent nature of therapeutic hypnosis. The next paper on Erickson's extended investigations of the nature of hypnotic and non-hypnotic realities yields extraordinary insights into deep trance (somnambulism) and the methodological problems involved in its study. One basic problem is that most workers in the field tend to confuse hypnosis and trance behavior with suggestibility. Because many hypnotized subjects tend to be complacent in accepting and carrying out suggestion, since the time of Liébeault and Bernheim there has been an uncritical acceptance of the view that hypnosis can be defined as a condition of heightened suggestibility. In the studies of this paper Erickson devises approaches that enable us to eliminate or at least minimize the effects of suggestion in order to explore the nature of hypnotic reality. In the process of this quest he presents some of the most controversial studies on the characteristics of hypnotic somnambulism ever published. He illustrates the approaches we can use to recognize deep hypnotic somnambulism and how investigators may train themselves to better facilitate its development. Because this report is so rambling and rich in its detailed examples, however, many readers may lose themselves as they breathlessly attempt to digest it in one or two sittings. Rest assured that cannot be done! It requires an extended period of study. This paper is actually a report covering more than four decades of intensive reflection and research on the most subtle issues of evaluating the nature and alterations of human consciousness. Consciousness usually does not recognize when it is in an altered condition. Consider how infrequently we realize we are dreaming during a dream. The situation is even more confusing and complex when it is realized that hypnotic and non-hypnotic realities may apparently coexist and fluctuate in their mutual relations from moment to moment. As Erickson states in his final sentence, "... this author feels that a somnambulistic hypnotic subject spontaneously apprehends the surrounding environment of realities differently than does a subject in the ordinary state of waking consciousness, [but] the one type of reality apprehension does not preclude the other type of reality apprehension." Many of the illustrations in this report demonstrate how somnambulistic subjects tend to mask their conditions from the operator as well as from themselves. Because of this we could well ask just how often hypnotic subjects may be experiencing somnambulistic states without being aware of it. It is intriguing questions like these that may inspire current and future students of neuroscience and consciousness with a fresh sense of exploratory wonder about their subject. The next paper on Erickson's initial exploration of consciousness, creativity, and the profoundly interesting hypnotic experiences of Aldous Huxley continue this intensive exploration of consciousness and hypnotic realities in a highly original manner. These papers are the most prolific demonstrations of Erickson’s prescience in anticipating most of the 12 neuroscience principles of facilitating the creative dynamics of consciousness by replaying and reconstructing mind, memory and behavior as outlined in our introduction. Huxley's description of his own state of "deep reflection" helps us gain a perspective on the utilization of hypnosis for facilitating creativity, while his independent discovery of the

"timeless and spaceless void" of deep trance verifies Erickson's previous findings. This together with Huxley's experience with hallucinations in all sense modalities, as well as his experiences with hypermnesia, two stage dissociative regression, time distortion, and post-hypnotic amnesia, illustrate what a talented mind can accomplish with hypnosis. These profound hypnotic phenomena now need to be investigated with all the modern tools of neuroscience such as brain imaging and DNA microarrays. Since the original publication of this paper in 1965, however, there has never been a systematic exploration and replication of its important implications for current neuroscience and consciousness studies. In Volume Five of this series of Erickson’s Complete Works, I offer The Implicit Processing Heuristics Scale (IPHS) as an initial step in developing such a systematic exploration of consciousness and hypnotic experience. The standardization of this scale would be an important project to create a new instrument for students, researchers, and clinicians interested in making original contributions to advancing Erickson’s initial research on the nature of consciousness and hypnosis. The final paper on the autohypnotic experiences of Milton H. Erickson provides a fascinating account of how his sensory and constitutional difficulties were a formative influence in leading him as a puzzled young lad to an early discovery of the relativity of perception and mental frames of reference. He outlines the successful approaches he has used to train himself as well as others in somnambulistic activity and the exploration of hypnotic realities. His discussion of the relation between hallucinatory experience and creative moments provides insight into the role of autohypnosis in life crises and identity problems. Erickson’s description of how he his used his early memories to cope with pain and the facilitation of his own physical rehabilitation from polio suggests important lines of neuroscience research on therapeutic hypnosis. His poignant account of his struggles in learning to cope with his personal infirmities reminds us of the archetype of the wounded physician who, in healing himself, learns to heal others.

How the Mind Heals the Brain: The New Neuroscience of Milton H. Erickson’s Therapeutic Hypnosis, Psychotherapy, and Rehabilitation

By Ernest L. Rossi, Ph.D.

These neuroscience editions of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books offer a new perspective on his innovative contributions to therapeutic hypnosis, psychotherapy, and rehabilitation. Therapeutic hypnosis began almost 300 years ago with Anton Mesmer’s defense of his medical thesis Dissertatio Physico-Medica de Planetarum Influxu on May 27, 1766. Since that time every new generation has updated their understanding of the mysterious nature hypnosis in terms of the best scientific ideas of their day. This edition of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books continues this tradition by organizing his creative approaches to therapeutic hypnosis, psychotherapy, and rehabilitation within the context of modern neuroscience and functional genomics. The neuroscience of the modern molecular biology of human experience actually began with the Watson and Crick’s (1953a, b) Nobel Prize winning insight into the molecular structure and information coding of the DNA molecule as the physical basis of life. They originally described their insight informally but accurately as “the dogma of molecular biology” illustrated here in Figure 1a. The original dogma of molecular biology illustrated in Figure 1a proposes how (1) the linear sequence of nucleotides in our genes is a code of biological information that (2) generates the 3-dimensional structure of the proteins, which function as the physiological molecular machines of the brain and body. Notice that there was no place for mind, consciousness, and psychological experience in Watson and Crick’s dogma of molecular biology. There was no bridge between biology and psychology – the Cartesian dichotomy is still in place. There still is no clue about any possible relationship between molecular biology and the hard problem of how we can account for the subjective psychological experiences (the “qualia”) of human consciousness. More recently, however, Crick and his colleagues (Crick & Koch, 2003) have explored the “neural correlates of consciousness” as follows. “The most difficult aspect of consciousness is the so-called ‘hard problem’ of qualia – the redness of red, the painfulness of pain, and so on. No one has produced any plausible explanation as to how the experience of the redness of red could arise from the actions of the brain. It appears fruitless to approach this problem head-on. Instead we are attempting to find the neural correlate(s) of consciousness (NCC), in the hope that when we can explain the NCC in causal terms, that will make the problem of qualia clearer. In round terms, the NCC is the minimal set of neuronal events that gives rise to a specific aspect of a conscious percept.” (p. 119)

Even with this effort to explore the neural correlates of consciousness, however, there is still no direct link between neural correlates and the actual subjective experiences of the qualia of consciousness. More recently neuroscience research has documented how such a direct link between mind and molecules can be made by experimental demonstrations of how the physical and mental activities of the body and mind can turn on activity-dependent gene expression, protein synthesis, and brain plasticity. As will be reviewed in great detail throughout these volumes, neuroscience research demonstrates how psychological experiences of novelty (Eriksson et al., 1998), psychosocial enrichment (Kempermann et al., 1997), as well as mental and physical exercise (Van Praag et al., 1999) can evoke gene expression (genomics), protein synthesis (proteomics), brain plasticity, and the physiological functions of the body. While some of this research remains controversial because it has been done only on laboratory animals, there is much to indicate that it has important implications for mind-body communication and healing in humans as well (Zuo et al., 2005). This neuroscience research is the empirical basis for my adding the dimension of psychological experience, mind and cognition to Watson and Crick’s original linear dogma of molecular biology (Rossi, 1973a, b, & c, 2000, 2002, 2004a, 2005).

The circular mind-gene loop of psychosocial genomics in Figure 1b, illustrates how salient

psychological experiences of mind and consciousness modulate gene expression, protein synthesis, and brain plasticity. This is how the mind heals the brain. Cognition and behavior turn on what the molecular biologists call “activity-dependent gene expression” (or “experience-dependent gene expression”) and “activity-dependent brain plasticity,” which sculpts changes in our neural networks in the construction and reconstruction of the physical brain during significant psychological experiences. The most profound implication of this activity-dependent interaction between mind and body is that heightened subjective ideodynamic experiences of hypnosis could evoke gene expression, brain plasticity, and mind-body healing in the complex computations (molecular iterations) of psychophysiology, psychosomatic medicine, psychotherapy, and mind-body healing in general. This neuroscience connection between mind and molecules is a possible answer to the philosophical problem of the so-called “Cartesian gap” between mind and body.

The activity-dependent gene

expression/protein synthesis cycle and brain plasticity bridges the gap between mind and body in a manner that Descartes could not have imagined with the primitive physiology of his day. Figure 1b, which illustrates our updated model of Watson & Crick’s original dogma of molecular biology, contains the ideodynamic seed of a new moleculargenomic theory of the activity of all the so-called “healing powers” of spirit, mind, and magic in the history of therapeutic hypnosis, alternative, and complementary medicine.

Figure 1a: The Watson & Crick original linear dogma of molecular biology of 1953 with no explicit role for the qualia of consciousness and psychological experience. Figure 1b: How the Mind Heals the Brain #1. Erickson’s Neuro-Psycho-Physiology of Mind-Body Communication and Healing on the Molecular-genomic Level. The subjective qualia of consciousness (e.g. sensations, perceptions, emotions, cognition, etc.) experienced as novelty, psychological arousal, and stress can modulate (2) gene expression and the alternative splicing of the sequence of the gene code (genomics), (3) protein synthesis and structure (proteomics) of the body, and (4) the physiological functions of the brain and body. Erickson’s “neuro-psycho-physiology” emphasizes the right side of this mind-body circle of information transduction, which is balanced by the more usual “bottoms up” approach of molecular biology, behavioral genetics, evolutionary psychology, and sociobiology illustrated on the left side of the mind-body circle. (From Rossi, 2002, 2004, 2005, 2006) Notice how Figure 1b illustrates a “top-down” synthetic approach on the right hand side, which emphasizes how the qualia of consciousness (e.g. the subjective psychological experiences of positive states of joy as well as stress and trauma) can modulate biology. This is complemented by the scientifically more popular “bottoms-up” reductive approach of molecular biology, behavioral genetics, evolutionary psychology, and sociobiology illustrated on the left hand side of Figure 1b, which emphasize how biology modulates the mind and behavior via the evolutionary selection over many generations of time. Psychosocial genomics, by contrast, explores how psychological experiences and behavioral states in the here-and-now of this moment during therapeutic hypnosis, psychotherapy, dreaming and

heightened performances in the creative arts, sciences, work and play etc. can modulate gene expression, brain plasticity, and mind-body healing. An introductory overview of this new research foundation of therapeutic hypnosis, psychotherapy, and rehabilitation is outlined here with some key concepts, quotes, and images from the current scientific literature that will be used throughout the volumes of this neuroscience editions of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books.

KEY CONCEPTS OF THE NEUROSCIENCE OF THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY AND REHABILITATION

1. A NEW SCIENCE OF THE STATES OF CONSCIOUSNESS AND CREATIVITY IS EMERGING FROM CURRENT RESEARCH ON THE FUNCTIONAL CONCORDANCE OF CO-EXPRESSED GENES ASSESSED WITH DNA MICROARRAYS.

Eisen et al. (1998), are pioneers in the development and exploration of the deep implications of the DNA microarray revolution that allows molecular biologists to profile the entire pattern of gene expression within the cells of the brain and body at any moment in time with a single experiment. “A system of cluster analysis for genome-wide expression data from DNA microarrays . . . is described that uses standard statistical algorithms to arrange genes according to similarity in patterns of gene expression. The output is displayed graphically, conveying the clustering and the underlying expression data simultaneously in a form that is intuitive for biologists. We have found in the budding yeast Saccharomyces cerevisiae that clustering gene expression data groups together efficiently genes of known similar function, and we find a similar tendency in human data. Thus patterns seen in genome-wide expression experiments can be interpreted as indications of the status of cellular processes. Also, co-expression of genes of known function with poorly characterized or novel genes may provide a simple means of gaining leads to the functions of many genes for which information is not currently available (14863). . . the functional concordance of co-expressed genes imparts biological significance to the broad patterns seen in images [of microarray data]. . . it is a comprehensive representation of the cell throughout. . . information on the state of many cellular processes can be inferred quickly by combining and comparing new experiments with the data presented here.” (14868, italics added). Eisen et al. discuss the functional concordance of co-expressed genes only within a molecular biological framework, however. The profound significance of DNA technology for psychotherapy is that it may enable us to assess any psychological state as the functional concordance of co-expressed genes interacting with the changes and challenges of our here and now psychosocial environment. Researchers have already utilized DNA microarrays to characterize psychological states associated with a variety of psychiatric conditions such as depression (Evans et al., 2004), post

traumatic stress (Segman et al., 2005), depression, aggression and playful social situations (Panksepp et al., 2002). This implies that the functional concordance of co-expressed genes assessed with DNA microarrays may become a new way of assessing the states of human consciousness and creativity during their transformations in therapeutic hypnosis, psychotherapy, and rehabilitation. The range and limitations of this new DNA microarray approach to specifying the states of consciousness is an empirical question that remains to be investigated (Wilber, 1993, 1997). When psychological researchers begin to include DNA microarray data in their factor analytic studies of the assessment tools that we use for guidance, counseling, and psychotherapy, for example, we may be able relate ongoing states of consciousness with profiles of gene expression, brain plasticity, and personality profiles with simple paper and pencil tests. Research will be needed to determine whether this approach could be applied to clinical interviews as well. This means that psychotherapy is not simply “talk therapy.” We now need to determine exactly how therapeutic hypnosis, psychotherapy, and rehabilitation can turn on gene expression to optimize brain plasticity and mind-healing throughout the body at the molecular level. Eric Kandel (1998), who received the Nobel Prize for Medicine and Physiology in 2000, described the intimate relationship between gene expression and brain plasticity in counseling and psychotherapy as follows. “Insofar as Psychotherapy or Counseling is effective and produces long-term changes in behavior, it presumably does so through learning, by producing changes in Gene Expression that alters the strength of synaptic connections and structural changes that alter the anatomical pattern of interconnections between nerve cells of the brain. As the resolution of brain imaging increases, it should eventually permit quantitative evaluation of the outcome of psychotherapy . . . Stated simply, the regulation of gene expression by social factors makes all bodily functions, including all functions of the brain, susceptible to social influences. These social influences will be biologically incorporated in the altered expressions of specific genes in specific nerve cells of specific regions of the brain. These socially influenced alterations are transmitted culturally. They are not incorporated in the sperm and egg and therefore are not transmitted genetically.” (p. 460, Italics added) An updated image from Kandel illustrates how meaningful experiences can evoke gene expression and brain plasticity in Figure Two. This is another image of how the mind can heal the brain. Important psychosocial experiences can turn on gene expression and new protein synthesis to facilitate the growth of synapses (connections) between neurons of the brain as illustrated by the label “Returning Pathway to the Genes” in Figure Two.

Figure 2: How the Mind Heals the Brain #2. The Typical Time Frames of Gene Expression and Brain Plasticity in Therapeutic Hypnosis, Psychotherapy, and Rehabilitation at the Neural Level. (1) Memory, learning, habituation, and extinction are illustrated at the synaptic level labeled Extinction/Habituation, which requires about 15 minutes. (2) Short term memory (~1-20 minutes) is based upon reverberating circuits of neurotransmission and neurotransmitters that operate on the millisecond time scale that is the primary focus of Crick and Koch’s neural correlates of consciousness (NCC). (3) Novel, strong, salient, and surprising stimuli of the qualia of consciousness, by contrast, take a much longer molecular pathway (labeled “Returning Pathway to the Genes”) to the nucleus of the neuron where a series of early and late genes are transcribed generating the proteins that are used for the “Growth of New Synaptic Connections,” which is the basis of long term memory that requires about 90-120 minutes. (4) feedback between neurons maintain the dynamics of “Long Term Potentiation” that spreads over longer time frames that may continue for years in the construction and creative reconstruction of the qualia of memory and consciousness (Rossi, 2002, updated from Squire & Kandel, 1999).

It is enlightening to recognize how Kandel implies a deeper understanding of the nature of genes and how they interact with human behavior and psychological experience. From this new psychosocial perspective genes can no longer be regarded simply as the hardwire source of biological traits passed from one generation to another by the classical laws of Mendelian heredity. Current research on the functional genomics of gene ontology traces the progressive development of molecular pathways and their transformations within cells of the brain and body. Psychosocial gene ontology is a 4-step process whereby salient environmental stimuli evoke and interact with (1) gene

transcription (expression) leading to (2) protein translation (the formation and folding of proteins into their functional structures), (3) the subsequent creation of physiology at the cellular level from these proteins, and finally (4) brain plasticity and the many mind-body levels of psychological and behavioral experience outlined in our “How the Mind Heals the Brain” series of illustrations in Figures 1b through eight. From the perspective of psychosocial gene ontology we can now recognize how many genes are better understood as “inner resources” that are activated by the challenges and stresses of daily life to generate the proteins to reconstruct our neural networks for creative adaptation. In this sense genes are inner resources mediating a continual dialogue between our psychosocial environment and brain plasticity in the hourly (ultradian) and daily (circadian) dynamics of mind-body adaptation and healing in everyday life. Psychosocial genomics conceptualizes genes as space-time-energy-information transducers in the transformations of mind, memory, consciousness, and creativity with their ultimate domain and range of efficacy defined in terms of the powers of ten (Morrison, 1994). We await some future Einstein who will summarize all of this for us with a simple mathematical equation (Rossi, 1996, 2002, 2004a, 2005a). Meanwhile the implications of activating gene expression and brain plasticity via therapeutic hypnosis, psychotherapy, and rehabilitation are vast as suggested by our next key concept.

2. ELEVATED GENE EXPRESSION LEVELS GENERATE ELEVATED LEVELS OF NEURONAL ACTIVITY THAT DISTINGUISH HUMAN FROM NON-HUMAN PRIMATE BRAINS.

How can we account for the differences between human consciousness and other primates when they both have about the same number of genes (~24,000) which are more than 99% alike? A DNA microarray revolution is currently exploring the special qualities of human brain evolution (Preuss et al., 2004). Cáceres et al. (2003), summarize their research in this area as follows. “Little is known about how the human brain differs from that of our closest relatives. To investigate the genetic basis of human specializations in brain organization and cognition, we compared gene expression profiles for the cerebral cortex of humans, chimpanzees, and rhesus macaques by using several independent techniques. We identified 169 genes that exhibited expression differences between human and chimpanzee cortex, and 91 were ascribed to the human lineage by using macaques as an outgroup. Surprisingly, most differences between the brains of humans and non-human primates involved up-regulation, with ~90% of the genes being more highly expressed in humans. By contrast, in the comparison of human and chimpanzee heart and liver, the numbers of upand down-regulated genes were nearly identical. Our results indicate that the human brain displays a distinctive pattern of gene expression relative to non-human primates, with higher expression levels for many genes belonging to a wide variety of functional classes. The increased expression of these genes could provide the basis for

extensive modifications of cerebral physiology and function in humans and suggests that the human brain is characterized by elevated levels of neuronal activity.” (pp. 13030, italics added) These elevated levels of gene expression and neuronal activity in the human brain remind us of the heightened psychological experiences of focused consciousness (monoideism) and fascination, which were key concepts in early descriptions of the psychophysiology of therapeutic hypnosis by James Braid (1855/1970) outlined in his book, The Physiology of Fascination, as follows. “With the view of simplifying the study of reciprocal actions and reactions of mind and matter upon each other . . . the [hypnotic] condition arose from influences existing within the patient's own body, viz., the influence of concentrated attention, or dominant ideas, in modifying physical action, and these dynamic changes re-acting on the mind of the subject. I adopted the term ‘hypnotism’ or nervous sleep for this process . . . And finally as a generic term, comprising the whole of these phenomena which result from the reciprocal actions of mind and matter upon each other, I think no term more appropriate than ‘psychophysiology’.” (In Tinterow, 1970, Pp. 369372, italics added). Cáceres et al. (2003) do not discuss therapeutic hypnosis in their paper on elevated gene expression and heightened neuronal activity in the human brain but their research has important implications for a theory of hypnosis at the evolutionary molecular-genomic level. Here is a brief summary of the types of genes they found related to the higher levels of neuronal activity that may contribute to heightened behavioral, emotional and cognitive states of consciousness. “The identification of the genes that exhibit regulatory changes in adult human cortex provides clues to the biochemical pathways and cell-biological processes that were modified during evolution. The apparent upregulation of so many different genes suggests, among other things, that the general level of neuronal activity and the metabolic processes that support it may be unusually high in human cortex. Consistent with this is the upregulation of genes involved in synaptic transmission, including the control of glutamatergic excitability (SYN47, also known as Homer 1b), plasticity at glutamatergic synapses (CAMK2A), phosphatidylinositol signaling (IMPA1, CDS2), synaptic vesicle release (RAB3GAP, ATP2B1), axonal transport along microtubules (KIF3A, DCTN1), microtubule assembly (MAP1B), and targeting of proteins to postsynaptic densities (USP14). We have also found expression changes related to energy metabolism. For example, CA2, which is expressed in glia, has been related to the generation and transport of lactate by astrocytes for use by neurons as an energy source. To our knowledge, the possibility that the human brain has an unusually high metabolism has not been previously considered. Typically, larger brains have lower metabolic rates (per unit of tissue) than smaller brains. Nevertheless, recent studies with imaging techniques to measure cerebral glucose metabolism in the conscious state suggest that metabolic rates are

as high as or even higher in humans than in macaques. Higher levels of neuronal activity are likely to have important consequences in cognitive and behavioral capacities, and of the genes up-regulated in humans, CAMK2A is involved in learning and memory, and mutations of GTF2I (Williams syndrome), CA2 (marble brain disease), and SC5DL (lathosterolosis) have been linked to mental retardation.” (pp. 13034) At the present time it is not known to what degree these genes and their associated states of neuronal activity are related to human experiences of consciousness and therapeutic hypnosis. Their DNA microarray approach could be applied in many interesting ways to current theories of consciousness and its activities at the molecular-genomic level, however. Crick and Koch (2005), for example, have proposed that the claustrum is a little known part of the brain that may be a key to understanding the dynamics of consciousness. The claustrum is a thin layer of gray matter that that functions as a two-way street between the higher cortex of the brain and the lower sub-cortex involved in processing sensations, emotions and other activities involved in consciousness. Crick and Koch interpret the probable function of claustrum to the role of an orchestra conductor who integrates the activities of the individual musicians into the holistic experience of consciousness (Stevens, 2005).

It will be a challenge to design research with brain imaging in

combination with DNA microarrays to determine to what degree the claustrum preferentially expresses the 196 genes, which Cáceres et al. (2003), found associated with the heightened activation of neural activity in the human brain. It will be an even greater challenge to assess our molecular-genomic theory of therapeutic hypnosis, psychotherapy, and rehabilitation with such research. Another research approach, as outlined in this neuroscience edition of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books, is now needed to determine to what extent elevated gene expression levels can be detected with the DNA microarray technology that can assess the entire human genome from a sample of blood during the often dramatic and motivating experiences of therapeutic hypnosis, psychotherapy, and rehabilitation. I hypothesized that such elevated levels of gene expression and neuronal activity generate the higher activation of consciousness – what Carl Jung and Rudolph Otto (1923/1950) would call “the numinosum,” the special experience of fascination, mystery, and tremendousness – associated with creative states of heightened consciousness that will be reviewed here (Rossi, 2002, 2004a, b, 2005a).

3. CLOCK GENES AND THEIR ASSOCIATED PROFILES OF CO-EXPRESSED GENES INTERACT WITH PSYCHOLOGICAL AND BEHAVIORAL STATES TO CO-CREATE THE CIRCADIAN AND ULTRADIAN RHYTHMS OF CONSCIOUSNESS, CREATIVITY, EMOTIONS, MOODS, AND PERFORMANCE.

Our daily (circadian) and hourly (ultradian) changing profiles of gene expression are a new method of assessing our psychological states of being awake, asleep, or dreaming as well as during high performance, stress and relaxation

throughout the day. Cirelli and Tononi (2004) describe the differences in gene expression and function when we are awake and asleep as follows. “Wakefulness and sleep are accompanied by changes in behavior and neural activity, as well as by the upregulation of different functional categories of genes. However, the mechanisms responsible for such statedependent changes in gene expression are unknown. Here we investigate to what extent state-dependent changes in gene expression depend on the central noradrenergic [system], which is active in wakefulness and reduces its firing during sleep. . . These results indicate that the activity of the central noradrenergic [system] during wakefulness modulates neuronal transcription to favor synaptic potentiation and counteract cellular stress, whereas its inactivity during sleep may play a permissive role to enhance brain protein synthesis.” (p. 5410, Italics added) In brief: when we are awake gene expression is oriented to heightening synaptic neural activity and dealing with the immediate challenges of outer world activity and stress. When we are asleep and dreaming gene expression and brain protein synthesis is updating and re-synthesizing the inner world of our mind-brain in preparation for the next day.

Figure 3: How the Mind Heals the Brain #3. Erickson’s Neuro-Psycho-Physiology Portrayed as a 4-stage Cycle of Ultradian (~90-120 minutes) Mind-Gene Communication and Healing. The periodic flow of messenger molecules of the neuroendocrine system (hormones associated with stress, relaxation, sexual hormones, immune system, etc.) mediates communication between the mind-brain, brain-body and cellular genomic levels in ultradian time (~90-120 minutes). (1) Information from the outside world experienced as the qualia of consciousness (on an explicit level) and the neural correlates of consciousness (on an implicit level) is transformed within the limbichippocampal-hypothalamic-pituitary system into the hormones (messenger molecules) that travel through the blood stream to signal receptors on cells of the brain and body. (2) The receptors on the surface of cells transmit the signal via 2nd messengers to the nucleus of the cell where activity-dependent genes to transcribe their code into messenger RNAs (mRNAs). (3) mRNAs serve as blueprints for the synthesis of proteins that make up (a) the structure of the body, (b) enzymes to facilitate energy dynamics and (c) cell receptors and messenger molecules for the informational dynamics of the cell. (4) Messenger molecules from the body flow back to the NCC to facilitate the construction and reconstruction of the qualia of consciousness (illustrated as the rectangular array of letters A to L on the top) through the Extra Cellular Fluid (ECF) of the brain (From Rossi, 2002, 2004, 2005).

Figure Three illustrations of the ultimate outcome of the expression of clock genes in regulating and integrating mind-body communication and healing. As such, clock genes can be understood as bridges between the mind-brain, brain-body, and the cell-gene levels that mediate the creative molecular-genomic replays of therapeutic hypnosis, psychotherapy, and rehabilitation (Rossi, 2002, p. 482). As indicated in Figure Three it takes about 90-120 minutes to complete one natural ultradian cycle of communication between mind and gene. It is noteworthy in this regard that Erickson’s therapeutic sessions typically ranged between 90-120 minutes, which he believed was needed for a complete unit of “neuro-psycho-physiological” work.

4. THE

POSITIVE AND NEGATIVE PSYCHOLOGICAL EXPERIENCES OF AROUSAL AND BEHAVIORAL ACTIVITY EVOKE

IMMEDIATE-EARLY GENES, ACTIVITY-DEPENDENT GENE EXPRESSION, AND BRAIN PLASTICITY IN A WIDE RANGE OF PROCESSES THAT MODULATE MIND-BODY COMMUNICATION AND HEALING.

This is the essence of how mental activity can modulate molecular activity and physiology illustrated in our update of Watson and Crick’s original dogma of molecular biology in Figure 1b. This is the neuroscience research that bridges the Cartesian gap between mind and body, which accounts for the efficacy of therapeutic hypnosis, psychotherapy, and rehabilitation in facilitating mind-body healing.

Any salient and interesting psychological

experience of arousal from sensation and perception to emotion, cognition, and imagination turns on gene expression and the possibility of brain plasticity for good or for ill. This is the mind-body basis for psychosomatic medicine as well as all schools of therapeutic hypnosis, psychotherapy, and rehabilitative medicine. The wide range of biological and psychological activities that are evoked by psychobiological arousal is indicated in Figure Four. The positive experiences of memory, learning, art, beauty, love, and truth as well as the negative experiences of pain, stress and illness can turn on a range of approximately 100 immediate-early genes (Rossi, 2004a, b). As indicated in Figure Four, many significant subject areas of psychology are integrated with biology on the most fundamental molecular-genomic level via immediate-early genes and mind-body rhythms.

Figure 4: How the Mind Heals the Brain #4. The Central Role of Immediate Early Genes (IEGs) in Psychobiological Arousal that May Be Facilitated by Therapeutic Hypnosis, Psychotherapy, and Rehabilitation in Complementary Medicine. Many arousing stimuli from the physical and psychosocial environment can signal IEGs within seconds to initiate the gene expression/protein synthesis cycle within neurons of the brain and other cells of the body to simultaneously modulate many integrated biological and psychological processes. The reciprocal relationships between psychological arousal, IEGs, and mind-body rhythms are windows into the continuum of Erickson’s neuro-psycho-physiology of mind-body communication and healing (Rossi, 2002).

Stendhal’s syndrome, for example, which is an overwhelming feeling of dizziness, panic, paranoia, or madness caused by a powerful positive aesthetic experience of viewing deeply meaningful artistic or historical artifacts in too brief and concentrated a time, is of particular interest in Figure Four because it illustrates a general psychobiological principle. The pleasure of a positive experience of art, beauty, and truth can develop only to an optimal intensity, beyond which it becomes a negative stress (Rossi, 1996, 2005a). Many so-called “ordinary people” recoil from their most vivid sensations, perceptions, insights, and truths because they cannot handle the intense psychobiological arousal their own genius stimulates. I hypothesize that Stendhal’s syndrome is the outer observable phenotypic behavioral manifestation of the overintense stimulation of gene expression, gene ontology, and brain plasticity that spills over into stress and many of the behavioral manifestations of psychopathology (Rossi, 2002, 2004, 2005). Indeed, Stendhal’s syndrome implies a new theory of psychopathology on the molecular-genomic level of gene ontology.

From this molecular-genomic perspective we may describe all subjective psychological, social, artistic and cultural experiences ranging from the positive to the negative as phenotypes of the varying levels of psychological arousal generating the phenomenology of psychosocial gene ontology (Rossi, 2006). The important word here is “subjective.” There has never been a truly satisfactory science of the subjective phenomenology of conscious human experience. The subjective phenomenology of the flow of conscious human experiencing has been consigned to the realm of philosophy, schools of introspection, and existential psychologies because there has been no way of reifying scientifically valid and reliable data on personal conscious experience. It remains to be seen to what degree replicable DNA microarray data can provide snapshots of subjective psychological states in term of the expression of immediateearly genes, behavioral state-related genes, alternative patterns of gene splicing etc. As will be explored further in the later volumes of this series, DNA microarrays are a key research methodology that may enable us to explore the precise details of how the mind can heal the brain on the molecular-genomic level. Many of the IEGs of Figure Four are associated with clock genes, which account for the circadian and ultradian mind-body rhythms in health and illness described above. Immediate-early genes are special class of genes that can respond to psychosocial cues and significant life events in an adaptive manner within minutes. Immediate early genes have been described as the newly discovered mediators between nature and nurture. They are mind-body transducers that receive sensory signals from the environment and molecular signals from the body to activate the target genes that code for the formation of proteins, which then carry out the adaptive functions of the cell in health and illness. Immediate early genes integrate mind and body; they are key players in psychosomatic medicine and mind-body healing via therapeutic hypnosis, psychotherapy, rehabilitation, and complementary medicine. The common applications of therapeutic hypnosis and psychotherapy for the treatment of trauma, stress, posttraumatic stress (PTSD), environmental, and psychosocial challenges (e.g. occupational and relationship issues, phobias, examination stress, sports performance, etc) implies there are deep psychobiological associations between stress and its reduction by hypnosis on the molecular-genomic level. Recent research by Lichtenberg et al. (2000, 2004) confirms this implication by documenting how certain variations in the COMT (Catechol-O-Methyltransferese) gene that code for the neurotransmitter dopamine are associated with hypnotizability (Raz, 2005). Further research is now required to more directly assess the hypothesis that COMT and other genes are more highly expressed during therapeutic hypnosis as reviewed in Volume Five of this series. One of the most common approaches to the experimental study of stress across many model organisms ranging from yeast to humans is described as the stress induced alternative splicing of genes.

Acute and chronic

environmental and psychosocial stress can induce a series of changes in the alternative splicing of the acetylcholinesterase (AChE) gene that gives rise to the gene ontology of the posttraumatic stress disorders (PTSD) and

many related mind-body dysfunctions (Kaufer et al.1998; Soreq & Seidman, 2001). This means that psychosocial stress actually changes the way a gene is organized to alter its sequence, which in turn generates the structure of alternative proteins and their physiological functions. This is a functional but temporary change in the way the DNA code of the AChE gene is expressed to alter protein structure and physiological functions. This is not a permanent change in the DNA code (such as a gene mutation) that would be transmitted genetically to the next generation. Sternfeld et al. (2000) describe how many forms of stress induced alternative gene splicing produce the alternative messenger RNA (mRNA) that is then translated into alternate proteins and physiological processes that will be described in greater detail in a later volume of this series.

5. THE POSITIVE NOVELTY-NUMINOSUM-NEUROGENESIS EFFECT. NOVELTY,

ENRICHING LIFE EXPERIENCES, AND

EXERCISE ASSOCIATED WITH A POSITIVE SENSE OF CURIOSITY AND WONDER CAN TURN ON ACTIVITY-DEPENDENT GENE EXPRESSION TO CONSTRUCT AND RECONSTRUCT THE NEURAL NETWORKS OF THE PHYSICAL BRAIN THROUGHOUT OUR ENTIRE LIFETIME.

This is the psychobiological essence of the relationship between the conscious creative psychological experience, gene expression, and brain plasticity (synaptogenesis and neurogenesis) – it is a psychosynthetic process of updating and recreating ourselves in everyday life as well as in the arts, humanities, and sciences. Again, this is the mindmolecular association that makes it possible for the mind to heal the brain and body.

The positive novelty-

numinosum-neurogenesis effect documents how highly motivated states of self-reflective consciousness can turn on and focus gene expression, protein synthesis, neurotransmitters, synaptogenesis, and neurogenesis in our daily creative work of building a better brain (Rossi, 2002, P. 482). From this molecular-genomic perspective consciousness may be conceptualized as a novelty responsive modality focusing gene expression and ontology for optimizing creatively adaptive brain plasticity (Rossi, 2006). Neuroscientists have identified three factors relating psychological experience to gene expression and brain plasticity: 1. Novelty (Eriksson et al., 1998; Kempermann & Gage, 1999); 2. Environmental enrichment (Kempermann et al., 1997; Van Praag et al. 2000); 3. Physical exercise (Van Praag et al., 1999). A generation of research by the Nobel Laureate Eric Kandel and others found that messenger molecules (e.g. neurotransmitters, hormones, growth factors etc.) can facilitate the molecular-genetic basis of memory, learning, and behavior within neurons of the brain and cells of the body as illustrated above in Figure Two. Activity-dependent gene expression in response to novelty, social enrichment, and exercise can double the number of neurons and connections between them generated in the hippocampus leading to the construction of new memory, learning, and behavior (Gould et al., 1999). In a series of remarkable drawings Lüscher et al. (2000) have shown how

the number of synapses can double during the growth process over a period of approximately 60 to 90 minutes as illustrations in Figure Five.

This is the typical time frame of most clinical sessions of therapeutic hypnosis,

psychotherapy, and rehabilitation in general, and Milton H. Erickson’s leisurely 90-120 minute sessions in particular.

Figure 5: How the Mind Heals the Brain #5. The Ultradian Time Frame of Activity-Dependent Memory, Learning, and Behavior at the Neuronal Level of Brain Plasticity via Synaptogenesis as Proposed by Lüscher, et al. (2000). Notice how the formation of new synapses requires same time frame as Erickson’s typical 90-120 minute clinical sessions of therapeutic hypnosis, psychotherapy, and rehabilitation as illustrated in Figures 2, 3, and 7.

Within the first 10 minutes after receiving appropriate stimulation there are measurable changes in gene expression and the growth of receptors that are involved in synaptic communication via neurotransmitters in the brain. Within 30 minutes the size of the synaptic spine increases and receptors move to the postsynaptic membrane; this leads to an increase in the size of the postsynapse. Within an hour, some postsynapses divide in two. This leads, in turn, to further growth in presynaptic multiplication and remodeling that eventually create new neural networks encoding memory, learning, and behavior change that is psychobiological essence of creative human experiences in the arts and sciences as well as therapeutic hypnosis and psychotherapy. This activity of gene expression and brain plasticity in the creation and recreation of the neural networks of the brain continues throughout the daily cycle of awaking consciousness as well as sleep. In Section One of this volume we will witness how Milton H. Erickson used his own self-reflective capacity to facilitate the development of his own consciousness from childhood to advanced age. We will study how he used hypnosis to enhance multilevel self-reflectiveness in Aldous Huxley, one of the most brilliant writers of his age. This multilevel self-reflectiveness is especially evident in dreams, which often demonstrate positive creative replay and reconstruction as described in our next neuroscience principle. The multi-levels of self-reflective and multiple cultural reflections in artistic artifacts is of particular interest in light of the style whereby even today many psychotherapists and healers with a holistic orientation frequently display such

artistic artifacts in their therapy rooms. This tradition was already evident in the special therapeutic areas of healers and shaman since ancient times, the alters of most spiritual traditions, and continues at the present time in the artistic and cultural displays in the homes and therapeutic rooms of many psychotherapists beginning with Sigmund Freud and Carl Jung up to Milton H. Erickson. At this point we can only speculate on how this artistic and cultural continuity associated with mind-body healing throughout the ages is itself an expression of gene expression and ontology on all levels from mind to molecule could be assessed with DNA microarray technology.

6. DREAMING,

AND OFFLINE

POSITIVE CREATIVE NEURAL REPLAY

IN

ERICKSONIAN APPROACHES

TO THE

RECONSTRUCTION OF NEGATIVE FEAR, STRESS, AND TRAUMATIC MEMORIES.

Recent neuroscience research has found that when we experience significant novelty, environmental enrichment and exercise during the awake state, the zif-268 gene is expressed during our REM sleep (Ribeiro et al., 2002, 2004). Zif268 is an immediate-early gene and behavioral-state related gene that is associated with the generation of proteins and growth factors that facilitate brain plasticity. Ribeiro et al (2004) summarized their results as follows. “The discovery of experience-dependent brain reactivation during both slow-wave (SW) and rapid eyemovement (REM, dream) sleep led to the notion that the consolidation of recently acquired memory traces requires neural replay during sleep … Based on our current and previous results, we propose that the 2 major periods of sleep play distinct and complementary roles in memory consolidation: pretranscriptional recall during SW sleep and transcriptional storage during REM sleep … In conclusion, sustained neuronal reverberation during SW sleep, immediately followed by plasticity-related gene expression during REM [dreaming] sleep, may be sufficient to explain the beneficial role of sleep on the consolidation of new memories.” (p. 126 -135, italics added) I recently outlined how this “sustained neuronal reverberation during SW sleep, immediately followed by plasticityrelated gene expression during REM sleep” may be an important process in the reconstruction theory of fear, stress, and traumatic memories and symptoms via therapeutic hypnosis (Rossi, 2005b). Let us review how Erickson used the process of re-dreaming a traumatic dream to reconstruct it in a therapeutic manner with a psychotic patient he called “Edward C.” “Dream the same dream with the same meaning, the same emotional significance, but with a different cast of characters. This time maybe it won’t be so dark. Maybe you can see a bit more clearly. It won’t be pleasant, but maybe it won’t hurt so much. So go ahead as soon as you can and have your dream.’ Within four minutes the dream developed; 20 minutes later, streaming with perspiration, Edward said, ‘It was bad. It was awful bad. But it didn’t hurt so much. . . Again he was asked to dream the same dream, but to dream it with less pain, less discomfort, and to dream more clearly – to see the characters more plainly. His fingers tightened on my hand, and

the dream developed immediately. The observed behavior was essentially the same. The duration was again about 20 minutes.” (pp. 62-63) Such intense states of psychobiological arousal were characteristic of many of Erickson’s (1948) case histories wherein he described the role of suggestion in hypnosis as a neuro-psycho-physiological process as follows. “. . . therapy results from an inner resynthesis of the patient’s behavior achieved by the patient himself. . . this experience of re-associating and reorganizing his own experiential life that eventuates in a cure, not the manifestation of responsive behavior, which can, at best, satisfy only the observer. . .The same principle holds true in psychotherapy. The chronic alcoholic can be induced by direct suggestion to correct his habits temporarily, but not until he goes through the inner process of reassociating and reorganizing his experiential life can effective results occur. . .Not until sometime later did the therapist [Erickson] learn by what train of thought he had initiated the neuro-psycho-physiological processes. . .” (pp. 38-39, italics added). Aye, here now is the fundamental question! What, exactly, are the “neuro-psycho-physiological processes” that Erickson initiated in his patients so they could go through “the inner process of reassociating and reorganizing” that led to a cure? How, exactly, does the mind heal the brain? From our current neuroscience perspective these “neuropsycho-physiological processes” engage the entirely naturalistic dynamics of gene expression, new protein synthesis, and brain plasticity that has been described as the “memory trace reactivation and reconstruction theory” of memory and learning. Erickson always maintained that his therapeutic approach engaged naturalistic processes; I now propose that this is the essence of Erickson’s “neuro-psycho-physiological processes” of healing at the molecular-genomic level (Rossi, 2005b) to which we will now turn our attention.

7. ERICKSON’S

NEURO-PSYCHO-PHYSIOLOGICAL PROCESS OF THERAPEUTIC HYYPNOSIS:

THE

MEMORY TRACE

REACTIVATION AND RECONSTRUCTION THEORY OF THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY, AND REHABILITATION.

Neuroscience research documents how the classical process of Pavlovian fear conditioning requires the recall and re-activation of a conditioned memory before it can be extinguished and/or reconstructed at the level of gene expression and protein synthesis. Nader et al. (2000) summarize their research in this area as follows. “Our data show that consolidated fear memories, when reactivated, return to a liable state that requires de novo [gene expression] and protein synthesis for reconsolidation. These findings are not predicted by traditional theories of memory consolidation.” (p.723, italics added). Such research has important implications for understanding the controversial tradition of using hypnosis to facilitate memory recall and emotional re-experiencing. I hypothesized that the common psychotherapeutic practice of intentionally recalling the memory of a traumatic experience and then reframing it is precisely what took place during

many historical approaches to reactivating traumatic memory recall and their “Mental Liquidation” (Pierre Janet’s original words, 1925/1976, pp. 589) via therapeutic hypnosis (Rossi, 2002). I proposed that this activity-dependent process of reactivating a fear, stress and traumatic memory in order to re-construct it on the level of gene expression, protein synthesis, and brain plasticity is the psychosocial genomic essence of therapeutic hypnosis, psychotherapy, and many types of rehabilitation as illustrated in Figure Six (Rossi, 2004, 2005a, b).

Figure 6: How the Mind Heals the Brain #6. A neuroscience update of Erickson’s neuro-psycho-physiology of therapeutic hypnosis, psychotherapy, and rehabilitation. Erickson’s most activity-dependent approaches to therapeutic suggestion and hypnosis such as hand levitation, psychological shock, surprise, pantomime, confusion, implication, etc. function as (1) implicit processing heuristics (ideodynamic action) to (2) stimulate the activitydependent gene expression/protein synthesis cycle, which (3) facilitates activity-dependent brain plasticity for the (4) creative therapeutic reconstruction of fear, stress, and traumatic memory and symptoms. These newly reconstructed memories may then function as implicit processing heuristics for further iterations of this 4-stage creative psychobiological cycle of mind-body healing, problem solving, and new identity creation.

In his monumental search of the historical literature of hypnosis, Weitzenhoffer (2000, 2001) concluded that the classical “ideodynamic hypothesis of hypnosis,” is the closest approximation that we have of a general theory of hypnosis. In the historical literature of hypnosis a variety of terms have been used for this concept of the ideodynamic such as “ideomotor, ideosensory, or ideoplastic faculty” to describe how the subjective mental experiences can influence the physiology of the body (Tinterow, 1970). Figure 6 illustrates how many of Erickson’s activity-dependent approaches to therapeutic suggestion and hypnosis such as hand levitation, psychological shock, surprise, pantomime, confusion, implication, etc. function as (1) implicit processing heuristics (ideodynamic action) to (2) stimulate the activity-dependent gene expression/protein synthesis cycle, which (3) facilitates activity-dependent brain plasticity for the (4) eventual therapeutic reconstruction of fear, stress, and traumatic memory and symptoms (Rossi, 2002). Figure

6 illustrates how the activity-dependent gene expression/protein synthesis cycle and brain plasticity could be the basis of what Erickson called the “neuro-psycho-physiological process” of therapeutic hypnosis. DNA microarray research is now needed to assess the actual range and limitations of this molecular-genomic concept of Erickson’s “neuropsycho-physiological process” of therapeutic hypnosis, psychotherapy, and rehabilitation. Neuroscience recognizes the role of replaying life experiences in the construction and reconstruction of mind and memory on the levels of molecular-genomics and brain plasticity. Hoffman and McNaughton (2002), for example, describe how memories are made by being replayed “offline” during sleep and dreaming. “Neural ensembles in the rat hippocampus and neocortex show memory trace reactivation during "offline periods" of quiet wakefulness, slow-wave sleep, and in some cases REM sleep. Reactivation of recent memory traces is also observed during sleep in motor areas of the zebra finch brain…neuro-imaging in humans reveals that brain areas with increased signal during a task have continued or reappearing activity after the task is completed.” (p. 2070, italics added) Lisman and Morris (2001) summarize the essential dynamics of “repeated replaying” between the cortex and hippocampus of the brain in the construction and reconstruction of memory, learning - what Crick and Koch would regard as the neural correlates of consciousness – as follows. “Newly acquired sensory information is funneled through the cortex to the hippocampus. Surprisingly, only the hippocampus actually learns at this time — it is said to be online. Later, when the hippocampus is offline (probably during sleep), it replays stored information, transmitting it to the cortex. The cortex is considered to be a slow learner, capable of lasting memory storage only as a result of this repeated replaying of information by the hippocampus. In some views, the hippocampus is only a temporary memory store — once memory traces become stabilized in the cortex, memories can be accessed even if the hippocampus is removed. There is now direct evidence that some form of hippocampal replay occurs . . . These results support the idea that the hippocampus is the fast online learner that ‘teaches’ the slower cortex offline.” (p. 248-249, italics added) Since activity in the human anterior cingulate cortex (associated with pain) has been implicated in the experience of hypnosis (Rainville et al., 1997, 1999, 2002), we would predict that future research will confirm that some form of neural replay takes place between the hippocampus and the anterior cingulate cortex during the amelioration of pain and negative affects via therapeutic hypnosis. We would also hypothesize that such offline neural replay on an implicit (unconscious) level could be the mechanism by which posthypnotic suggestions are maintained until they are carried out as described in many of Erickson’s vivid demonstrations in this volume. This repetition and replay between the hippocampus and cortex of the brain reminds us of the important activity of repetition, replay, and role playing in the history of hypnosis. Emile Coué (1922), for example, created a popular sensation

with his recommendation to repeat autosuggestion “Every day in every way I am getting better and better.” Neuroscience research is now needed to determine if such autosuggestion actually facilitates creative replay (or a dialogue) between the hippocampus and the cortex in humans to evoke gene expression and brain plasticity. Repetition in hypnosis continues in our present day usage of repeated suggestions for sleep and relaxation in the standardized hypnotic susceptibility scales. We now need to use of DNA microarrays of the blood (Whitney et al., 2003) and other relatively non-invasive techniques of molecular-genomics to assess whether the repetition of such suggestion during hypnotic induction actually can facilitate gene expression and alternative gene splicing to optimize brain plasticity and mind-body healing. Such DNA microarray research could determine whether we can generalize the molecular-genomic essence of repetition in therapeutic suggestion to the dynamics of repetition in prayer and meditation during the rituals and spiritual practices of many cultures. They may all evoke salient psychobiological arousal and the ideodynamic recall and replay of memory in the therapeutic reconstruction of memory, learning, emotions, and behavior at the levels of gene expression and brain plasticity. Table One is a listing of some gene candidates for assessing the role of therapeutic hypnosis, psychotherapy, and rehabilitation in modulating gene expression, brain plasticity and mind-body healing via DNA microarray technology.

Table One A brief sampling of gene candidates for assessing Erickson’s neuro-psycho-physiology of therapeutic hypnosis, psychotherapy, and rehabilitation in modulating gene expression, brain plasticity and mind-body healing via DNA microarray technology.

COMT THRA Per 1

Therapeutic Hypnosis, Absorption, Personality Dynamics Lichtenberg et al., 2000, 2004 Rossi, 2004c

Brain Plasticity in Consciousness, Memory, Learning and Behavior Change c-fos, c-Jun, krox, NGFI-A & B Bentivoglio & Grassi-Zucconi, 1999 CREB Kandel, 2001 BDNF Russo-Neustadt, 2001 ~ 100 Immediate Early Genes Rossi, 2002 Heightened Gene Expression in the Human Cortex SYN47 DCTN1 MAP1B KIF3A CAMK2A USP14 CDS2 IMPA1 RAB3GAP ATP2B1

Cáceres et al. 2003, Preuss et al., 2004

Replay in the Reconstruction of Fear, Stress and Traumatic Memories Zif-268

Ribeiro et al., 2002, 2004 Nader et al., 2000a, b Acute and Chronic Psychosocial Stress

Nerve Growth Factor (NGF) Membrane Glycoprotein 6a (M6a)

Alfonso et al., 2004 Alejel et al., 2002

CDC-like Kinase 1 (CLK-1) G-protein alpha q (GNAQ) CRE- dependent reporter gene Acetylcholinesterase (AChE-S & AChE-R)

Soreq & Seidman, 2001

Psychoneuroimmunology Interleukin 1, 2, 1ß, Cox-2

Kiecolt-Glaser et al. 2001 Clock Genes & Behavior State-Related Genes Cirelli et al., 2004 Rossi, 2004 Rosbash & Takakshi, 2003

~100 sleep related genes Clock, Period 1, BMAL Period 2

Relationships, Maternal Behavior, Therapeutic Touch ODC gene CYP-17

Schanberg, 1995 Ridley, 1999 Sociobehavioral Sexual Bonding, Trust Witt, 1995; Kosfeld et al., 2005 Pennisi, 2005; Hammock, Young, 2005

Oxytocin gene V1aR gene

Principle Seven emphasizes that the neural repetition and replay between the hippocampus and cortex is a creative process on the molecular-genomic level. From this perspective, the entirely natural process of Darwinian variation and selection at the levels of gene expression, protein synthesis, and brain plasticity that takes place during the offline replay between the hippocampus and the cortex functions as a creativity generator on an implicit (unconscious) level. My emphasis on the word “creative” goes beyond the current research literature cited above, which simply demonstrates repetition and replay without any reference to creativity. I hypothesize that creativity enters the process by the core Darwinian principles of random variation and natural selection that constantly taking place at the molecular-genomic and neural level of brain plasticity. The neuroscientist Gerald M. Edelman (1987, 1992), who received the Nobel Prize for Physiology or Medicine in 1972, has described this creative process as “Neural Darwinism.”

8. CREATIVE REPLAY, RESYNTHESIS, AND RECONSTRUCTION AT THE MOLECULAR-GENOMIC LEVEL OF THE 4-STAGE CREATIVE PROCESS, WHICH ENGAGES DARWINIAN NATURAL VARIATION AND SELECTION ON ALL LEVELS FROM MIND TO GENE, IS THE

ESSENCE

OF

THERAPEUTIC HYPNOSIS, PSYCHOTHERAPY,

AND

REHABILITATION

AS WELL AS THE

CREATIVE ARTS AND HUMANITIES.

Replaying the 4-stage Creative Process for the resynthesis and reconstruction of experience is the fundamental dynamic of psychotherapy and all the healing arts. Our emerging models of creativity, optimal performance, stress, and healing engage Darwinian natural variation and conscious selection on all levels from mind to gene in the natural ultradian cycle (~90-120 minutes) of human experiencing from mind to gene as illustrated in Figure Seven. Immediate early genes, behavioral state-related and activity-dependent gene expression are bridges between the body, brain, and

mind that can be accessed to facilitate the creative replays of therapeutic hypnosis, psychotherapy, and rehabilitation (Rossi, 2002, p. 482). As noted Erickson’s therapeutic sessions typically ranged between 90-120 minutes, which he believed was needed for a complete unit of inner work. The classical and well documented 4-stage Creative Process of (1) Problem Recognition, (2) Incubation, (3) Illumination and (4) Verification is the outer expression of the normal process of development and adaptation from mind to gene expression and brain plasticity during the 90-120 minute ultradian basic rest-activity cycle throughout the day outlined in Figure Seven. As illustrated in Figure Seven, both positive and negative emotions are natural, intrinsic aspects of the 4-stage Creative Process: Negative emotions are the usual accompaniment of our conflicts and struggles in Stages 1 and 2, while the positive emotions accompany our successful resolution of problems in Stages 3 and 4 as illustrated in Figure Seven.

With his hardworking family background in farming, it was perhaps natural that Erickson frequently

commented that a job well done (Stage Three of the Creative Process) was the source of true happiness in life. Thus while Figure Seven is ostensibly an outline of the 4-stage Creative Process, it also outlines a new functional theory of the entire range of emotions from negative to positive that is operative on all levels from the cognitive-behavioral to the molecular-genomic.

Figure 7: How the Mind Heals the Brain #7. A Profile of Erickson’s Neuro-Psycho-Physiology During the 4Stage Creative Process. The ultradian profile (90-120 minutes) of the 4-stage Creative Process as it is typically experienced on the subjective psychological level is illustrated in the top most portion of the upper curve. The proteomics (protein) profile in middle curve depicts the energy landscape for protein folding within neurons of the brain into the correct structures needed for brain plasticity (adapted and redrawn from Cheung, et al. 2004). This proteomic profile arises from the functional concordance of co-expressed genes illustrated by the genomics profile below it (adapted from Levsky, et al., 2002). This genomics curve represents the actual gene expression profiles of the immediate-early gene c-fos and 10 other genes (alleles) over the typical Basic Rest-Activity (BRAC) period of 90-120 minutes. The lower diagram illustrates how these ultradian dynamics of the qualia of consciousness are typically experienced as Kleitman’s 90-120 minute Basic Rest-Activity Cycle within the normal circadian cycle of waking and sleeping (Rossi, 2002, 2004 a; Rossi and Nimmons, 1991).

Students of music will note the striking similarity between the 4-stage creative cycle profiled in Figure Seven, and the 4 parts of the sonata form profiled in Figure Eight. The term “sonata form” refers to the first movement of a symphony. The opening fast movement of a classical symphony (sonata-allegro), for example, is usually in sonata form. The sonata form illustrates how composers of the classical period (1750-1820) such as Hayden, Mozart, Beethoven, and their followers expressed human conflict, crisis, and their resolution in music for over 200 years (Kamien, 2006). This leads me to propose that Figure Eight is a striking illustration of how the creative arts may be understood as performance modalities for the therapeutic replay, reconstruction, and reframing of negative human experiences into positive perspectives that many cultures have called “wisdom.” Numinous experiences of art, beauty, and truth become positive experiences after their initial unexpected shock wears off precisely because they generate the creative reconstruction of the mind-brain at the molecular-genomic level (Rossi, 2002, 2004a, 2004b, 2005a). The following brief outline of the 4-stage Creative Process focuses on the subject’s experiences at each stage along with the therapist’s shifting task in facilitating the process. Each of the succeeding volumes of this neuroscience edition of Milton H. Erickson’s Complete Works, Seminars books and the Erickson/Rossi books will enrich our understanding and facilitate our skills in optimizing this creative process. Stage 1: Preparation, Data Gathering. Intense and deeply meaningful psychological states of arousal --- such as trauma, pain, stress, novelty, dreaming (REM sleep), and creative moments in everyday life, as well as all the arts and sciences, can initiate the activity of Immediate Early Genes, Activity (or Experience) Dependent, and Behavior-State Related Genes in our brain and body. Our genes are not always in an active state; genes have to be stimulated in everyday life by internal and external environmental and psychosocial signals to generate the proteins that are the molecular machines of life that do creative work. Stage One of the Creative Process includes a search for the problem the mind-body is attempting to solve on an unconscious or implicit level that often are initially perceived as sensations or symptoms. Sensations stimulate neural activity and curiosity, the desire to learn more, that sets us forth on deeply motivating outer and inner journeys of discovery and self-creation on all levels from mind to gene expression. A natural initiation to mind-body healing begins with the typical history taking at the beginning of any form of psychotherapy. The typical tears and distress in an initial interview, for example, indicate that the person is already

accessing state dependent memory and emotional arousal that evoke gene expression, new protein synthesis a potentially healing adventure. The therapist’s main job at this point is to recognize that therapy has already begun and simply facilitate it by letting people to tell their own story. Stage Two: Incubation. The Dark Night of the Soul. This is the valley of shadow, symptom, doubt, and depression that leads many people to psychotherapy. This is “the storm before the light” that portrayed in drama, poetry, myth and song in many cultures. Stage Two is the crux of creative replay and reconstruction that is frequently manifested as emotional conflict, crisis, and psychosomatic symptoms. Stress induced alternative pathways of gene expression and protein synthesis often generate conflict in the period of private inner work, creative replay, and reconstruction of feelings and cognitions at this stage. I hypothesize that in the natural processes of alternative gene expression, brain plasticity, and the transformations of consciousness during life transitions one invariably falls into anxiety (Sklan et al., 2004) and conflict (Birikh et al., 2003), in the reconstruction of memory and learning (Cohen et al., 2003). This incubation stage of the creative process is often experienced as the struggle on the hero’s journey when many people experience discouragement and failure. Conflicts, however, are not always a struggle with the outside world; most conflicts emerge between the old and the new during the spontaneous generation of new perspectives, insights and feeling that are a natural outcome of each round of gene expression and brain plasticity that takes place in every ultradian 90120 minutes cycle throughout the 24 hour day (Rossi, 2002, 2004, 2005). We may sleep but we are not at rest. We are forever in creative reconstruction whether we like it or not. The therapist's main job in Stage Two is (1) to offer open-ended therapeutic questions designed to access the emotional complexes and archetypal patterns encoding symptoms and (2) to support the person through the sometimes painful arousal that makes them abort their natural cycle of creativity, problem solving and healing in everyday life. After a painful emotional crisis and catharsis many people naturally slip into a private period of creative inner work that should be recognized but not be intruded upon by the therapist. Less is often more at this delicate stage of inner transformation. Respectful listening and emotional support is required to encourage people to reengage their numinous dream dramas with the creative replays of imagination to facilitate their development and healing on all levels from mind to gene (Rossi, 2004a-c). Stage Three: Illumination, Peak Experiencing, Creative Insight, Problem Solving, and Healing. This the famous “Ah-ha” or “Eureka” experience celebrated in ancient and modern literature when the intuitive function is manifest in the arts, sciences, and creative moments of everyday life.

People are surprised when they receive a creative thought and

automatically dismiss their originality as worthless if it was never reinforced in their early life. I hypothesize that gene expression and new protein synthesis at this numinous stage generates brain plasticity – the making and braking of neural connections – the actual synthesis of new synapses and connections between brain cells that encode new human

experience and the creative transformations of consciousness. It is of essence that people learn how to recognize and support these new developments in their consciousness that often are heralded by little smiles and joyful experience that breaks through the clouds of previous conflict. Psychosomatic symptoms tend to disappear dramatically as personal problems are resolved with the new perspectives. The therapist’s main job at this stage is to help the subject recognize and appreciate the value of the “new” that often appears to emerge spontaneously and unheralded. Often the subject may have already thought of the options that come up for problem solving at this stage but dismissed them since they were never validated. This lack of validation sometimes keeps people in a mild sisyphean struggle with themselves between Stage Two and three for years when they do not appreciate that the resolution of their problem is already at hand and they only need to reality test it in Stage Four of the Creative Process. Stage Four: Verification and Reality Replays. In this final stage of the creative cycle the person needs to verify the value of the new experiences of Stage Three by exercising them with creative reconstructive tests in real world as well as dreams and active imagination.

New experiences and insights are often fragile and can be easily lost. It is

ironic that our family and friends, who wish us well, often do not recognize the new that develops within us. Because of this the people who are closest to us often do not know how to support us in the realization of our new reality. Thus adolescents experience the generation gap when they have difficulties with their family and friends. Falling in love can be fragile and fickle. Innovators and creative workers have been perpetually misunderstood and persecuted throughout history for daring to assert their new consciousness. The therapist’s job in this stage is to (1) facilitate a follow-up discussion to validate the value of the psychotherapeutic process, (2) reframe symptoms into signals and psychological problems into inner resources, and (3) prescribe further “reality homework” to test, extend and reinforce the new neural connections being synthesized. Evidence suggests that 4 weeks to 4 months are required to stabilize these new neural networks (Van Pragg et al., 2002)

9. IMPLICIT PROCESSING HEURISTICS

FACILITATE THE

4-STAGE CREATIVE PROCESS

ON ALL LEVELS FROM GENE

EXPRESSION TO BRAIN PLASTICITY AND MIND-BODY HEALING IN THE RECREATION OF MIND, MEMORY, LEARNING, BEHAVIOR, AND SELF-IDENTITY.

While Erickson used direct suggestion, particularly during the early, experimental stage of his career, he later emphasized that attempting to directly program people without understanding their individuality was “a very uninformed way” of doing therapy” (Erickson & Rossi, 1979, p. 288). In our first collaborative effort to describe his use of indirect suggestion we found that his “implied directive” was the most useful for conceptualizing the essence of therapeutic suggestion. We soon came to believe that implication contributed to therapeutic suggestion because it is not what the therapist says that is important as much as what the patient does with what the therapist says (Erickson et

al., 1976, p. 59-60). An understanding of how Erickson uses implication provides us with the clearest model of his indirect approach to hypnotic suggestion. Since his use of “implication” appeared to involve something more than the typical dictionary definition of the term, I assumed that he was developing a special form of what I called “psychological implication” in his work. For Erickson, psychological implication is a key that automatically turns the tumblers of a patient’s associative processes into useful solutions without awareness of how it happened. The implied thought or behavioral response seems to come up all by itself on an spontaneous, involuntary, autonomous, or implicate (unconscious) level within people, as if it were their own inner creation rather than a suggestion initiated by the therapist. Psychological implication is a heuristic for facilitating a person’s associative processes when they cannot do it for themselves. The therapeutic use of this approach is obvious. If people have problems because of learned limitations in their ability to utilize their own inner resources, then psychological implications are a way of helping them bypassing these limitations.

Figure 8. How the Sonata Form of Classical Music Portrays the 4-Stage Creative Process. The Sonata Form, which is an approximately 20 to 45 minutes of classical symphony, is usually profiled in 3 or 4 movements. Kamien (2006, 163-164) describes the sonata form in the following quotations: “The amazing durability and vitality of sonata form result from it capacity for drama. The form moves from a stable situation toward conflict (in the exposition), to heightened tension (in the development), and then back to stability and resolution of the conflict.” I propose that the durability and vitality of the sonata form also comes from its integration of muti-levels of creative human experiencing from cognition and emotion to the molecular-genomic. (1) “The exposition sets up a strong conflict between the tonic key and the new key. It begins with the first theme in the tonic, or home, key. There follows a bridge, or transition, leading to the second theme, in a new key.” This initial stage of the sonata form corresponds to Stage One of the Creative Process when therapist and patient seek to identify the problem (first theme) and the life changes (second theme) that are at the source of patient’s conflicts of Stage Two. (2) “The development is often the most dramatic section of the movement. The listener may be kept off balance as the music moves restlessly through several different keys. Through these rapid modulations, the harmonic tension is heightened. In this section, themes are developed, or treated in new ways. They are broken into fragments, or motives, which are short musical ideas developed within the composition. A motive may take on different and unexpected emotional meanings.” This second part of the sonata form corresponds to Stage Two, the incubation stage of the Creative Process with its characteristic conflicts, negative emotions, and symptoms. (3) “The beginning of the recapitulation brings resolution, as we again hear the first theme in the tonic key. . . .Earlier in the exposition, there was a strong contrast between the first theme in the home key and the second theme and closing section in a new key; that tension is resolved in the recapitulation. . .” This third section of the sonata form

obviously corresponds to Stage Three of the Creative Process when there is an initial resolution of the conflict, problems, and symptoms of Stage Two. (4) “An even more powerful feeling is attained by following the recapitulation with yet another section. The coda rounds off a movement by repeating themes or developing them further. It always ends in the tonic [home] key.” This fourth and final part of the sonata form corresponds to Stage Four of the Creative Process in psychotherapy when the patient returns home to reality test the new problem and symptom solutions found in Stage Three. (All quotations from Kamien, 2006, pp. 163-164.)

The therapist only provides an opportunity or stimulus for psychological implication; the “hypnotic aspect” of psychological implication is created on an unconscious, implicate level by the listener. Erickson wrote that the most effective aspect of therapeutic suggestion is that which stirs the listener’s own mental processes into creative activity that generates the so-called “miracle” of healing as follows (1964). “In each instance hypnosis was used for the specific purpose of placing the burden of responsibility for therapeutic results upon the patient himself after he himself had reached a definite conclusion that therapy would not help and that a last resort would be a hypnotic "miracle." In this author's understanding of psychotherapy, if a patient wants to believe in a "hypnotic miracle" so strongly that he will undertake the responsibility of making a recovery by virtue of his own actual behavior and continue his recovery, he is at liberty to do so under whatever guise he chooses, but neither the author nor the reader is obligated to regard the success of the therapy as a hypnotic miracle. The hypnosis was used solely as a modality by means of which to secure their cooperation in accepting they wanted. In other words, they were induced by hypnosis to acknowledge and act upon their own personal responsibility for successfully accepting the previously futilely sought and offered but actually rejected therapy . . . . Three of a long series of similar cases are reported here to illustrate the use of hypnosis as a technique of deliberately shifting from the therapist to the patient the entire burden of both defining the psychotherapy desired and the responsibility for accepting it.” (Pp. 269–271, italics added). From our current neuroscience perspective it is the patient’s own creative activity that evokes activity-dependent gene expression, brain plasticity, and the so-called “miracles of mind-body healing.” It is the deeply meaningful and numinous replaying of the listener’s own mental processes that creates hypnotic experience, problem solving, and “spiritual healing.” The locus of healing is within the patient; the therapist has no mysterious or extra-ordinary powers of control or healing. Patients heal themselves when they are fortunate enough to receive appropriate “therapeutic suggestions,” that function as “implicit processing heuristics,” which evoke the numinous experiences of novelty, enrichment, and activities that generate activity-dependent gene expression, brain plasticity, and mind-body healing. Many years after I formulated the concept of the implied directive and psychological implication as important keys to Erickson’s successful use of therapeutic hypnosis (Erickson, Rossi & Rossi, 1976), the central role of implication became recognized in neuroscience. Squire and Kandel (1999), for example summarize of implication in understanding the difference between conscious (declarative knowledge) and unconscious (implicate or non-

declarative knowledge) in the dynamics of memory and learning as follows. “The question of interest is: What kind of memory underlies the ability to knowledge about categories? The surprising answer is that at least some kinds of category learning are non-declarative. Category learning can be independent of and parallel to declarative memory, rather than simply derivative from it. People can acquire knowledge about categories implicitly even when their declarative memory for the instances that define the category is impaired.” (p. 183, italics added). Recent research efforts to assess the value of Erickson’s approaches to psychological implication in therapeutic suggestion remain controversial, however. Some researchers failed to find any superiority of indirect suggestion over direct suggestion (Matthews, 2000), but many clinicians dispute the validity of the research methods used (Peter & Revenstorf, 2000). Erickson’s indirect approaches to therapeutic suggestion involved the patient’s “experience of reassociating and reorganizing his own experiential life that eventuates in a cure, not the manifestation of responsive behavior, which can, at best, satisfy only the observer” (Erickson’s, 1948). The research that purports to demonstrate that indirect suggestion was not superior to direct suggestion, however, used the so-called objective measures of responsive behavior on standardized scales of hypnotic susceptibility that typically restricted the creative replay and reconstruction of the subject’s subjective associations. When investigators compared the subjective perceptions of subjects to their own hypnotic experiences with the objective behavioral measures of direct and indirect suggestion, however, they came to these interesting conclusions (Matthews et al. 1985). “While the behavioral data failed to show significant differences between the two methods, however, subjects did report feeling more deeply hypnotized during the indirect procedure than during the direct procedure. This result is in support of an Ericksonian view . . . of indirect suggestion in that a wider latitude for responding is offered to subjects than is typically available with direct suggestion.

Thus, the subject’s unique responses to indirect

suggestions can be interpreted by them to be an indication of trance depth. If subjects fail to perform in accordance with a direct suggestion, however, there is some likelihood that they may perceive themselves as less deeply hypnotized.” (p. 222-223, italics added). It is precisely this “wider latitude for responding in the subject’s unique responses to indirect suggestions that Erickson wished to facilitate as a creative experience of re-associating and reorganizing their own experiential life that eventuates in a cure.” While indirect suggestion can facilitate the creative replay, re-association, and resynthesis of subjective experiences, indirect suggestion is not necessarily useful in the manipulation and control of the subject’s objective behavior as it is assessed with standardized scales of hypnotic susceptibility. Even with research that demonstrates the efficacy of indirect suggestion in facilitating the subject’s personal creativity, the misperception that indirect hypnotic suggestion is a covert method of programming the patient with the therapist’s goal remains an

important issue in professional practice as well as public perception. Because of this confusion between (1) programming and control by the therapist with direct suggestions versus (2) creative inner work by the patient via indirect suggestions, we need to make a special effort to distinguish between them. In my earliest publications with Erickson I emphasized how the classical, directive concept of hypnotic suggestion could be complemented with indirect suggestion. Because of the ambiguity of the concept of “indirect suggestion,” however, I now will replace it with the concept of “implicit processing heuristics” wherever appropriate in this edition of Milton H. Erickson’s Complete Works. Implicit processing heuristics designate how “suggestion” in every day life and the arts as well as therapeutic hypnosis, psychotherapy, and rehabilitation can facilitate gene expression, brain plasticity, and mind-body healing via the 4-stage Creative Process within the subject. We now need brain imaging and DNA microarray research to document the full range and limitations of implicit processing heuristics in modulating the molecular-genomic pathways of therapeutic hypnosis and other approaches to mind-body healing and rehabilitation.

10. MIRROR NEURONS

AND

EMPATHY: RAPPORT, RESPONSE ATTENTATIVENESS,

AND

RESPONSIVE

BEHAVIOR IN

GROUP EXPERIENCES, RITUAL, METAPHOR, DRAMA, AND STORY TELLING. Recent research in neuroscience has documented the activity of “mirror neurons in primates and humans that function as “a potential neural mechanism for empathy, whereby we understand others by mirroring their brain activity” (Miller, 2005, p. 946). This neural basis of empathy finds support in research on dysfunctions in the mirror systems of humans with autism and fMRI research designed to assess emotional empathy. Such empathy research at the neural level and trust at the genomic and hormonal levels (Kosfeld et al., 2005) is consistent with descriptions of the “rapport” – the sympathetic relationship – between therapist and subject that has been used as an explanatory principal to account for many of the classical phenomena of hypnosis for over 200 years. It is important to realize how this multi-level lock of rapport on at least 4 levels (molecular-genomic, hormonal, neural, and experiential) is a new model for all complex psychosocial experiences whose subjective aspect has made them seemingly refractory to objective measurement and scientific study.

This understanding of rapport is entirely consistent with our first

neuroscience principle above, which outlined how the functional concordance of co-expressed families of genes as measured by DNA microarrays could become a new scientific approach to quantifying the varying subjective states of consciousness, creativity, and private implicit processing that we call “therapeutic hypnosis.” The history of hypnosis beginning with Mesmer is rich in accounts of the special efficacy of therapeutic hypnosis when experienced in group experiences and demonstrations of stage hypnosis where people mirror, mimic, and role play each others behavior (Tinterow, 1970). In this volume Erickson describes how he can determine whether a person

will be a good hypnotic subject by assessing their natural “response or behavioral attentativeness” in an initial interview (Erickson, Haley, & Weakland, 1959). Research is now needed to determine the degree such response attentativeness actually reflects the activity of mirror neurons in everyday life as well as on our standardized hypnotic susceptibility scales. Erickson would also use “pantomime techniques” and sometime surround a “resistant” subject with highly suggestible subjects to induce hypnosis. It is now intimated that “the study of the brain’s mirror systems will do for psychology what the study of DNA has done for biology” (Miller, 2005 p. 945).

From this new

neuroscience perspective we can understand the psychosocial interactions between therapist, subject, and groups in therapeutic hypnosis as mutually empathetic entrainments at the level of gene expression and mirror neurons. We can now understand how a subject’s ability to “think and feel along with” the therapist’s words, metaphors, stories, and implicit processing heuristics in the induction of therapeutic hypnosis could be a measure of “hypnotic susceptibility” via the activity of mirror neurons. Likewise, the actions of story tellers, singers, dancers, orators, actors, and politicians of all sorts to “move” an audience are actually implicit processing heuristics that evoke gene expression and brain plasticity. All deeply meaningful psychosocial interactions between people – friends, couples, families, special interest groups, communities, and nations – are using implicit processing heuristics to engage and mutually entrain each other at the levels of gene expression and brain plasticity via mirror neurons.

We can now

better appreciate how the outer destructive events of war and social chaos can traumatize and stress individuals to loosen the psychosocial fabric at the fundamental levels of gene expression, brain plasticity and mind-body health.

11. A

FUTURE ORIENTATION TO THE CREATION AND RECONSTRUCTION OF MEMORY VIA IMPLICIT PROCESSING

HEURISTICS

FACILITATES

MIND-BODY

HEALING

VIA

THERAPEUTIC

HYPNOSIS,

PSYCHOTHERAPY,

AND

REHABILITATION.

In a recent essay Dudai and Carruthers (2005) discuss the “Janus face of Mnemosyne” where memory looks at the future as well as the past in a creative synthesis that integrates imagination, emotions and cognition in manner that psychotherapists facilitate in their daily work. “We all know from personal experience and introspection (research tools once cherished and now mostly disrespected) that mental excursions can be made not only to the past, but also to the future. It was even speculated (Tulving, 2005) that the ability to contemplate future scenarios was a driving force in the evolution of episodic memory. This proposed selection-for-imagination might even be blamed for the inherent fallibility of our recollective faculty. Despite this, attempts to liken imagination to memory are still considered shaky by many; the latter is considered factual data (which it is not), the former the subject matter of poets and an unsubstantiated, inferior form of knowledge.

In ancient Greek mythology, Memory (Mnemosyne) was the mother of all the muses. In the mortal world, Aristotle, Galen, and their medieval Arab commentators, emphasized the role of memory in the ethical virtue of 'prudence', the ability to make wise judgments and plan effectively. The word used by these scholars for concepts was 'phantasms' (in Greek, phantasiai; in Latin, imagines). Memory was also associated with prophetic writing, as in the Book of Ezekiel, whose prophecy consisted in recreating imaginatively [to] envision and motivate the future. . . Important in this planning effort is not accuracy of reproduction, but the act of imaginative recreation itself as a totally sensed and felt experience. . . There is a central role for imagination. In this, memories are not direct signature-traces that past experiences leave in the brain. Their function is not to provide an accurate trace of things past, but to provide materials for creative thinking. In medieval analysis, data from all the senses came through various channels into the brain and were received in the 'phantasy' or 'common sense' area. The impressions were simultaneously collected and formed into images by the activity of 'making forms'. The experience also was 'estimated' emotionally as benign or hurtful, a gut reaction part of the mental imago. The resulting 'phantasm' was thus both a product of imagination and also had definite emotional colour; there was no such thing as a fully neutral or objective conception, and virtually all thoughts were formed as complete mental episodes.” (p. 567, italics added). We could hardly find a better summary of how mind, memory, imagination and emotions are experienced as a continual reintegration of the meaning of our past as we recreate our current and future identity and well being in psychotherapy. The continual process of the creation and recreation of memory on all levels from the moleculargenomic to brain plasticity is the psychobiological basis of the metaphor, myth, and story making faculty of the human mind (Gazzaniga, 2000) that is the essence of drama, literature, poetry, and identity creation as well as psychotherapy. This ideoplastic (psychobiological) faculty of the human mind is the basis of all creativity in the positive sense (art, beauty, and truth) as well as the negative (confabulation, deceit, lying). Perhaps this is what motivated Milton H. Erickson to experiment so intensively with the hypnotic phenomena of time distortion wherein the subject was reoriented into the future as well as the past to facilitate the resolution of current problems and the recreation of new identity as described in many case examples throughout these volumes (e.g. Aldous Huxley in Volume One, and the February Man in Volume Five). From our current neuroscience perspective all the novel, interesting, and fascinating experiences of time distortion and hypnotic phenomena in general are evocative, creative processes that evoke activity-dependent gene expression, brain plasticity, and mind-body healing via implicit processing heuristics.

12. THE

SELF-FACILITATION OF EACH PERSON’S UNIQUE PSYCHOSOCIAL GENOMIC RESOURCES OF CONSCIOUSNESS,

CREATIVITY, AND HAPPINESS IS THE ESSENTIAL DRAMA AND DYNAMIC OF HUMAN DESTINY AS PORTRAYED IN THE

ARTS, HERO MYTHS, AND HUMANITIES OF ALL CULTURES.

The ultimate goal of all therapeutic practices and schools is to facilitate the individual’s skills in optimizing consciousness and facilitating their own creative resources on all levels from mind to gene expression and brain plasticity. Why do we seek adventurous experiences of art, beauty, and truth? In so far as art, beauty, truth, love, and spiritual experiences are numinous, they actually evoke gene expression, brain plasticity, and mind-body healing. On the negative side, however, the feverish activities of crime, exploitation, and war also turn on activity-dependent gene expression and perilous transformations of behavior, character, health, and illness via brain plasticity. This clearly indicates how our current advances in the molecular-genomics of neuroscience can help guide and cultivate of the best in human nature via education, philosophy, and the practice of the moral virtues.

The

neuroscience of these traditional humanistic disciplines is providing new insights about how they can be better facilitated. We now understand how our fascination with autobiography, drama, history, imagination, literature, metaphor, movies, music, myth, poetry, and song – virtually all deeply moving existential expressions of the human condition in every past and possible future medium and public media – are actually searches for models that could facilitate our personal consciousness, creative development, and contributions to others. The many examples of Milton H. Erickson’s creative approaches to facilitating the human condition via therapeutic hypnosis, psychotherapy, and rehabilitation throughout these volumes can help each of us find fresh inspiration along our way.

SUMMARY: A CONCORDANCE OF THERAPEUTIC HYPNOSIS AND NEUROSCIENCE

Our twelve principles integrating therapeutic hypnosis with neuroscience indicate the need for a concordance of the concepts and processes they share. This concordance cannot be static in any sense, however. The concepts of historical and therapeutic hypnosis blend imperceptibly into the fluid mainstream of current neuroscience so that it is often impossible to distinguish between them. A clear recognition of the general world-view they share in Table Two, however, can greatly enrich our understanding of both, and facilitate research for the future. Table Two This is a concordance of the concepts and processes of therapeutic hypnosis and neuroscience that intuitively cluster together at the levels of molecular-genomics, brain plasticity, and psychological experience. There are general and suggestive links but few exact one-to-one correspondences between the Therapeutic Hypnosis and the Neuroscience columns. THERAPEUTIC HYPNOSIS

NEUROSCIENCE

The Molecular-Genomic State Concept

Special State Mesmerism, Trance Monoideism Dissociation

Functional Concordance of Co-Expressed Genes Behavioral State-Related Gene Expression Heightened Gene Expression and Neuronal Activation State Dependent Memory, Learning, & Behavior Hypnotic Induction

Focused Attention via Hand Levitation , Art, Beauty, Pantomime, Paradox Fascination, Absorption, Utilization Enchantment, Education Thinking & Feeling Along With Metaphors, Stories, Dramas, Paradox Trauma, Shock, Stress, Surprise, Unexpected, Numinous Sleep, Relaxation, Comfort, Fatigue, Boredom, Repetition, Rhythm Groups, Rituals, Music, Song & Dance Repetition with Random Variation Touch, Mesmeric Passes

Immediate-Early Gene Expression, Heightened Neuronal Activation Novelty, Enrichment Enrichment, Brain Plasticity Neural Entrainment via Mirror Neurons Implicit Processing Heuristics, Activity Alternative Gene Splicing, Immediate Early Genes Behavior State-Related Gene Expression, Clock Genes Mutual Entrainment via Mirror Neurons, Creative Replay, Brain Plasticity Activity-Dependent Gene Expression

Hypnotic Phenomena Rapport, Empathy, Suggestibility Amnesia, Automatisms, Dissociation Memory Revivification Posthypnotic Suggestion Role Playing, Time Distortion Crisis, Intuition, Insight Indirect Suggestion, Implied Directive

Mirror Neurons, Empathy, Entrainment State Dependent Memory & Learning Neural Trace Reactivation Offline Neural Replay Creative Neural Replay, Reconstruction Creative Moment, Eureka! Implicit Processing Heuristics Mind-Body Relationships

Ideo-Plastic Faculty Ideodynamic Activity Ideomotor Activity, Doing Embodied Imagining Neuro-Psycho-Physiology Psychophysiology

Brain Plasticity, Synaptogenesis Implicit Processing Heuristics Activity-Dependent Gene Expression Psychobiology, Mind-Body Healing Psychoimmunology Psycho endocrinology

An initial glance at the mini-concordance of therapeutic hypnosis and neuroscience in Table Two may seem intimidating in its details to the uninitiated student. This new understanding of our emerging science of mind-body communication and healing is comprehensive, surprising, and profound for understanding how the mind can facilitate the deep psychobiological processes of the brain and body. Behind the apparent complexity of this concordance, however, there are only a few really new ideas of how the mind can heal the brain. Our most interesting and salient subjective psychosocial experiences of art, beauty, love, and truth evoke gene expression, brain plasticity, and mind-body healing. The apparent complexities of trauma, stress, and psychopathology all can be understood as the observable behavioral manifestations of gene expression, protein synthesis, and brain plasticity gone astray when we are overwhelmed in our interactions with ourselves and the world. We are on the threshold of understanding how our subjective psychological experiences of consciousness and free will are expressions of objective physical and biological processes. Table Two summarizes how many of Erickson’s activity-dependent approaches to therapeutic suggestion and

hypnosis such as hand levitation, surprise, pantomime, confusion, implication, etc., function as (1) implicit processing heuristics (ideodynamic action) to (2) stimulate the activity-dependent gene expression/protein synthesis cycle, which (3) facilitates activity-dependent brain plasticity for the (4) eventual therapeutic reconstruction of fear, stress, and traumatic memory and symptoms. These emerging principles of current neuroscience enable us to hypothesize how Erickson’s therapeutic work could facilitate the creative replay and resynthesis of meaningful life experiences to evoke the heightened mental activity that stimulates gene expression, brain plasticity, and mind-body healing, which enables people to solve their own problems in their own way. Research with brain imaging and DNA microarrays is now urgently needed to assess the range and limitations of therapeutic suggestion (that is, implicit processing heuristics) in optimizing mind-body healing at all levels from gene expression, protein synthesis, and brain plasticity to the subjective experiences of problem solving and healing via the 4-stage Creative Process. Most of us have but little awareness about how to manage the entirely natural 4-stage creative cycle that integrates our psychological experience with gene expression and brain plasticity in the constant reconstruction of our mind-brain every moment of our lives. Who has the time, energy, wit, and wisdom to catch up and be constantly current with the creative edge of our evolving self in our sleep and nightly dreams as well as our shifting everyday relationships with our families and others?

How many people really appreciate how this constant creative reconstruction at the

molecular-genomic and brain-plasticity levels is the essence of the apparently subjective experiences and dramas of our lives and what it means to be human? Erickson’s naturalistic approaches to hypnotic rapport and therapeutic suggestion illustrated throughout these volumes ranging from shock and surprise to story telling and metaphor are all implicit processing heuristics that engage and facilitate each person’s efforts to optimize mind-gene communication and healing in the various states of waking consciousness, sleep, and dreaming. Our mini-concordance with neuroscience in Table Two will guide us to a deepening appreciation, understanding, and skill in utilizing Milton H. Erickson’s creative approaches to therapeutic hypnosis, psychotherapy, and rehabilitation in this new edition of his Complete Works, Seminars books and the Erickson/Rossi books.

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Initial Experiments Investigating the Nature of Hypnosis Milton H. Erickson Reprinted with permission from The American Journal of Clinical Hypnosis, October, 1964, 7, 152-162.

INTRODUCTION During the 1923-24 formal Seminar on Hypnosis at the University of Wisconsin under the supervision of Clark L. Hull, the author, then an undergraduate student, reported for the discussion by the postgraduate students of the psychology department upon his own many and varied experimental investigative findings during the previous six months of intensive work and on his current studies. There was much debate, argument and discussion about the nature of hypnosis, the psychological state it constituted, the respective roles of the operator and the subject, the values and significances of the processes employed in induction, the nature of the subjects' responses in developing trances, the possibility of transcendence of normal capabilities, the nature of regression, the evocation of previously learned patterns of response whether remote or recent, the processes involved in individual hypnotic phenomenon and in the maintenance of the trance state, and above all the identification of the primary figure in the development of the trance state, be it the operator or the subject. The weekly seminars were scheduled for two hours each, but usually lasted much longer, and frequently extra meetings were conducted informally in evenings and on weekends and holidays, with most of the group in attendance. No consensus concerning the problems could be reached, as opinions and individual interpretations varied widely, and this finally led the author to undertake a special investigative project in October 1923. This special study has remained unpublished, although it was recorded in full at the time, as were many other studies. One of the reasons for the decision not to publish at that time was the author's dubiousness concerning Hull's strong conviction that the operator, through what he said and did to the subject, was much more important than any inner behavioral processes of the subject. This was a view Hull carried over into his work at Yale, one instance of which was his endeavor to establish a “standardized technique” for induction. By this term he meant the use of the same words, the same length of time, the same tone of voice, etc., which finally eventuated in an attempt to elicit comparable trance states by playing "induction phonograph records" without regard for individual differences among subjects, and for their varying degrees of interest, different motivations, and variations in the capacity to learn. Hull seemed thus to disregard subjects as persons, putting them on a par with inanimate laboratory apparatus, despite his awareness of such differences among subjects that could be demonstrated by tachistoscopic experiments. Even so, Hull did demonstrate that rigid laboratory procedures could be applied in the study of some hypnotic phenomena. 1

Recently published papers concerning the realities of hypnosis have led to a rereading and analysis of the author's notebooks in which numerous unpublished studies were fully recorded. (Credit for this practice should be given to Dr. Hull, and the author often wonders what happened to the bookshelves of notebooks which Dr. Hull himself maintained, full of his own unpublished studies.) The rereading of this material produced the data upon which this paper is based, permitting this report on experimental investigations into some of the apparent misunderstandings of hypnosis which are still variously accepted without careful critical thinking.

EXPERIMENTAL PLAN As originally planned and executed, this early experiment to secure some of the answers to the intriguing questions confronting the seminar group was so organized that it did not involve the use of hypnosis. Rather, it was based upon a consideration of the concepts of introspection developed by E. B. Titchener, Wilhelm Wundt, W. B. Pillsbury, and others, and was organized as a direct inquiry into these concepts as a possible initial approach to a later identification of hypnosis or of some of its phenomena. A central consideration in the proposed experimental project was suggested by the well-known Biblical saying, “As a man thinketh in his heart, so is he,” a point made in the seminar discussions by several of the discussants. Professor Joseph Jastrow, who was then head of the psychology department, aided and advised the author in his plan of experimentation. Jastrow himself was only slightly interested in hypnosis, but he was interested in the author as a student. Hull was not consulted, nor did he know of the experiment until it was completed.

SUBJECT SELECTION The securing of subjects was relatively easy, since any college population offers a wealth of volunteers. Two elements of selectivity were employed. All students taking psychology were excluded. All students who were acquainted with the author were excluded for the reason that they might know that he was interested in hypnosis. Both male and female undergraduates were employed, most of them by mere chance being sophomores. Among them there was a predominance of agricultural, home economics, engineering, commerce, and liberal art students, with an approximately even distribution of sex, and of comparable ages. To these students individually, using prepared typewritten material, a plausible, somewhat interesting, but definitely superficial explanation was given of the concept of “introspection.” A comparably carefully worded invitation was extended to each of them to participate in an experiment; this embraced the idea that the experimenter proposed to do research consisting of “discovering the processes of thought in thinking through from beginning to end any specified task.” As an illustrative example, it was pointed out that people know the alphabet and can recite it fluently. However, the majority of those same people cannot recite the alphabet backward correctly from Z to A except by a slow “back-and-forth process of thinking.” To those who promptly demonstrated that they could recite the alphabet backward easily, a second example was offered, namely, the

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extreme difficulty that would be encountered in reciting backward the entire nursery rhyme of, “Mary had a little lamb —.” It was then explained that a much simpler task was in mind for them to do, and they were earnestly asked not to do any reading of Titchener's "work on thought processes" (Titchener's name was repeatedly mentioned to discover any previous awareness of his work, to emphasize "thought processes," and to distract their attention from the word "introspection "). They were individually apprised of the possibility that the task might take from one half to two hours, and a clock was indicated in full view, running silently, located directly in front of them on a shelf on the laboratory wall. The experimenter, it was explained, would sit quietly behind a screen some 12 feet to the rear and would not be visible; he could be spoken to or questioned if the desire or need arose, but it was preferred that the task once begun be done in complete silence, so that there would be no distractions or interferences. What the subjects did not know or observe was that a mirror was so arranged carelessly among odds and ends in a jumble of laboratory apparatus so that the author had a full view of the subjects' faces by means of an obscure peephole concealed by the patterned design on the screen. From a typewritten copy each subject was separately given the following instructions: “You are to seat yourself in this chair comfortably, just looking straight ahead. With your eyes open you are to imagine that there is a small table standing beside the right (left in the case of those left-handed) arm of the chair. Your arms are to be resting comfortably in your lap. On that imaginary small table you will imagine that there is a large fruit bowl filled with apples, pears, bananas, plums, oranges, or any other kind of fruit you like, but do not turn your head to look