1

Cardeña, E., & Krippner, S. (2010). Culture and hypnosis. In S. J. Lynn, J. W. Rhue, & I.

Kirsch, (Eds.), Handbook of clinical hypnosis (2nd ed.; pp. 743-771). Washington, DC:

American Psychological Association.

CULTURE AND HYPNOSIS1

ETZEL CARDEÑA, Ph. D.* AND STANLEY KRIPPNER, Ph. D.**

* Thorsen Professor in Psychology, Lund University, Sweden

** Alan Watts Professor of Psychology, Saybrook Graduate School and Research

Center, USA

Corresponding author: Etzel Cardeña, Ph. D. Thorsen Professor

Department of Psychology

University of Lund

P.O. Box 213 SE-221 00

Lund, Sweden

Telephone number: (0)46 46 2228770

fax (department of psychology) 46 46 222 4209

email: Etzel.Cardena@psychology.lu.se

webpage: http://www.psychology.lu.se/Personal/e_cardena/

1 The authors dedicate this chapter to the memory of David Bakan, Ph. D., the

quintessential archetypal wise man, and thank Jeffrey Kirkwood and Devin Terhune, M.

Sc., for their editorial assistance. Stanley Krippner expresses his gratittude to the

Saybrook Graduate School’s Chair for the Study of Consciousness for supporting his

participation in the preparation of this chapter.

2

HYPNOSIS AS A CULTURAL CONSTRUCT

Culture has been defined as "the organized system of knowledge and beliefs that allows a

group to structure its experiences and choose among alternatives" (Tseng, 1997, p. 4).

Over the course of our lives we are immersed in a specific culture, yet it is often assumed

that whereas biological factors are essential, cultural variables can be treated superficially

or taken for granted. In fact, cultural concepts are multilayered and complex, and any

notion of an easily definable culture is misleading. Instead, we have groups that can be

more (e.g., tribal groups) or less (e.g., New York city inhabitants) homogeneous, more

(e.g., the Hassidim) or less (e.g., “metrosexual” males) traditional, more (e.g., traditional

Japanese) or less (e.g., (urban US citizens) communal and, in the case of immigrants,

more or less acculturated to their new homeland. And even within a culture there are

important socio-economic differences that may, for instance, make the experience of an

inner-city African-American more similar to that of a denizen of a Brazilian favela than

that of his/her wealthy suburb counterpart. Yet a lot of what passes for cross-cultural

psychological research is mostly research on middle-class, formally educated groups that

happen to live in different countries.

Another important consideration is that cultural analyses are often framed within etic

(presumably universal) or emic (culturally relative) explanations and constructs. The

former are typically based on Western rationality and are context-poor, whereas the latter

tend to be more culturally and historically “thick.” Research shows that etic explanations

are neither obvious nor easy to establish (e.g., van Duijl, Cardeña, & de Jong, 2005). We

will aim to maintain these considerations in mind as we discuss the cultural construct

3

known as “hypnosis.” It is worth mentioning that disregarding cultural variables may

produce implausible conclusions such as accepting that individuals who show impressive

hypnotic-like phenomena (e.g., analgesia) in the midst of a Thaipusam ritual are “low

hypnotizables” because they scored below average on a Western created, but not

validated in their culture, measure of hypnosis (Kok, 1989). In this chapter we focus on

hypnotic and hypnotic-like phenomena in non-Western cultures, rather than comparing,

hypnotizability evaluations in Western countries (e.g., Cardeña, Kallio, Terhune,

Buratti,& Lööf, under review; Perry, Nadon, & Button, 1997).

Locke and Kelly (1985) provided a valuable framework for understanding how cultural

variables undergird states of consciousness, whether or not the reader considers that

hypnotic processes can effect an “alternate” state of consciousness. In their model,

culture shapes an experience through a number of interrelated processes. They include

ethnoepistemology (the basic metaphysical and epistemological axioms held by a culture,

such as whether shamanic experiences refer to “another reality” or are just fantasy), its

signs, symbols, and metaphors (e.g., indicators of special powers or attributes, such as a

shaman holding a magical pouch or a physician having an M.D. degree from Harvard),

predisposing factors (e.g., having been socialized by the media or rituals to have specific

expectations about what may happen in hypnotic or vodou contexts), situational factors

(e.g., the general context of a hypnosis experiment or a ritual), and the specific patterning

of experiential, behavioral, and phenomenological changes (e.g., the hypnotic

suggestions themselves or specific drumming beats in a vodou ceremony). This

4

framework will help us understand better in what ways mesmerism, hypnosis, and

possibly related phenomena such as shamanism are similar or differ from one another.

The term hypnosis is often used to refer to a variety of structured, goal oriented

procedures in which the suggestibility or motivation of an individual or a group is

enhanced by another person, words, a mechanical device, a conducive environment, or by

oneself. These procedures attempt to blur, focus, or amplify attention or mentation (e.g.,

imagination or intention), in order to produce suggested or spontaneous behaviors or

experiences. In a simpler formulation, one of the great hypnosis researchers, T. X. Barber

(1984) defined hypnosis as a procedure to disregard extraneous concerns and focus on

specific suggestions to alter one’s experience, behavior, and/or physiology. This mostly

atheoretical formulation allows us to more easily look at the hidden cultural variables in

hypnosis (Cardeña, 1999).

It is common, although arguable, to state that what we now term “hypnosis” had its

modern birth in the theory and practice of mesmerism, as first enunciated by Franz Anton

Mesmer in the 18th Century, yet at the same time trace its historical roots back to tribal

rites and shamanic practices (Brown & Fromm, 1986, p. 3). For example, Agogino

(1965) stated that “the history of hypnotism may be as old as the practice of shamanism”

(p. 31) and described hypnotic-like procedures used in the court of the pharaoh Khufu in

3766 B.C. He added that priests in the healing temples of Asclepius (beginning in the 4th

century B.C.) induced their clients into “temple sleep” by “hypnosis and auto-suggestion”

and that the ancient druids chanted over their clients until the desired effect was obtained.

5

Vogel (1970/1990) pointed out that herbs were used by native healers in pre-Columbian

Central and South America to enhance verbal suggestion. How can we make sense of

such disparate statements?

One way is, following Locke and Kelly’s model, to propose that although the specific

patterning of experience in hypnosis (e.g., suggestion) has some historical parallels, the

ethnoepistemology of hypnosis as a secular process involving a “natural” mechanism (in

the case of Mesmer, a proposed “animal magnetism;” in the case of the Abbé Faria and

others, the use of psychosocial variables such as suggestions) may be traced to Mesmer.

Nonetheless, even earlier discussants of what was then considered demonic possession

pointed to suggestions and other psychosocial rather than metaphysical explanations

(Duncan, 1634, in de Certeau, 2000). Laurence and Perry (1988) mention that

Mesmerism was in fact heir to the exorcist practices of the time, although in his case

couched in the scientific terms of the time (i.e., “magnetism”). The emotional and social

displays during Mesmer’s healings, so different from the physically passive and isolated

contemporary practice of hypnosis, were also likely influenced by other religious ecstatic

movements in Europe (cf. Rosen, 1969). How the original theory and practices of

Mesmerism were transformed into contemporary “hypnosis” would require a whole

book, but the interested reader can consult excellent histories of hypnosis (e.g., Gauld,

1992; Laurence & Perry, 1988).

What we now call “hypnosis” is embedded in a network of implicit meanings and

ontological assumptions about the nature of reality, what does or does not constitute

6

hypnosis (e.g., Hilgard, 1973), and so on. Too often authors commit the categorical

fallacy (Kleinman, 1988) of using Western constructs such as “hypnosis” or “trance” and

superimposing them on other cultures without first evaluating whether such constructs

are valid or reliable in their new environment. Even though within our own specific

culture there are disagreements as to the base nature of “hypnosis,” (Lynn & Rhue,

1991), some authors will use the term as a facile explanation for manifestations in other

cultures, or conclude that “clinical hypnosis… is simply a cultural and historical

adaptation of shamanism” (Overton, 1998, p. 151), where it would be questionable to use

it even as a descriptive term in other cultural contexts than the current Western one.

“Trance” is good example of a term that is often used as an explanatory term despite its

being unclear even within our own cultural framework. Although the term is often

assumed to connote some kind of etic category, perhaps of a biological predisposition to

“enter” into a hypnotic state, Table 1 shows that there are multiple meanings of “trance”

just within the English language This has not prevented authors in psychology and

anthropology from using it as a foundational or even explanatory concept, despite its

multivocality. Directly transferring such an ambiguous concept to other cultures

disregards its semantic networks and intertextuality. Gergen (1985) observed that the

terms in which the world is understood are social artifacts, “products of historically

situated interchanges among people” (p. 267).

Considerable theory and research data suggest that the response to hypnosis involves

various interpersonal, sociocultural, and cognitive factors (e.g., Shor, 1962; Woody,

7

Bowers, & Oakman, 1992). Among them are behaviors and experiences that reflect

expectations and role enactments on the part of the “hypnotized” individuals or groups,

who attend (often with questionable awareness) to their own personal needs and to the

interpersonal or situational cues that shape their responses (Barber, 1969; Brown &

Fromm, 1986, Spanos & Chaves, 1989). Other research data have emphasized the part

that attention (whether it is diffuse, concentrated, or expansive) plays in hypnosis,by

enhancing the salience of the suggested task or experience (Krippner & Bindler, 1974;

Balthazard & Woody, 1992). Both of these bodies of hypnosis literature have

underscored the interaction of several variables in hypnosis and can help better

understand healing indigenous practices that involve either overt or covert suggestive and

motivational dynamics.

To use the term “hypnosis” to describe exorcisms, the laying-on of hands, dream

incubation, and the like does an injustice to the varieties of cultural experience and their

historic roots. “Hypnosis” and “the hypnotic state” have been too often reified (Spanos &

Chaves, 1991, p. 71), distracting serious investigators from ingenious uses of human

imagination and motivation that are worthy of study in their own right. Nonetheless, a

survey of the social science literature, as well as our observations in several traditional

societies, suggests that there are frequently elements of native healing procedures that can

be termed “hypnotic-like.” This is due, in part, to the fact that alterations in

consciousness (i.e., observed or experienced changes in people’s patterns of perception,

affect, or cognition, especially awareness, attention, and memory) are sanctioned and

deliberately fostered by virtually all indigenous groups. For example, Bourguignon and

8

Evascu (1977) found that 89% of 488 sampled societies displayed socially-approved

altered states of consciousness. The ubiquitous nature of hypnotic-like procedures in

native healing is also the result of the ways in which human capacities, such as the

abilities to strive toward a goal and imagine a suggested experience can be channeled and

shaped differentially by social interactions (Murphy, 1947, Chapter 8).

Concepts of sickness and of healing are also socially constructed and modeled in various

ways. The models found in traditional cultures frequently identify such etiological factors

of sickness as “soul loss,” “breach of taboo,” or spirit “possession,” “intrusion,” or

“invasion,” all of which are diagnosed, at least in part, by observable changes in the

victims’ behavior as related to their mentation or mood (Frank & Frank, 1991, Chapter

5). Unlike infectious diseases and disabilities resulting from physical trauma, these

conditions, including those with a physiological predisposition, are socially constructed.

Similarly, the alterations in consciousness identified by Bourguignon and Evascu (1977)

are shaped by historical and social forces within a culture. For example, there is no

Western equivalent of wagumuma, a Japanese emotional disorder characterized by

childish behavior, emotional outbursts, apathy, and negativity. Susto is a malaise,

commonly referred to in several parts of Latin America, thought to be caused by a shock

or fright and often connected with breaking a spiritual taboo. Conversely, some Western

eating disorders can be considered “culture-bound” (Keel & Klump, 2003).

Cross-cultural studies of native healing have only started to take seriously the importance

of understanding indigenous models of sickness and treatment, perhaps because of the

9

prevalence of behavioral, psychoanalytic, and medical models, none of which have been

overly sympathetic to the explanations offered by traditional practitioners (Ward, 1989).

In contrast, we may consider the proposition that Western knowledge is only one of

several viable representations of nature (Gergen, 1985). Kleinman (1980) commented

that the habitual, and frequently unproductive way researchers try to make sense of

healing, especially indigenous healing, is by speculating about psychological and

physiological mechanisms of therapeutic action. These are then applied to case material

in an ethnocentric fashion that conforms particular instance to putative, etic principles.

The latter are primarily derived from the concepts of biomedicine and individual

psychology. By reducing healing to the language of biology, other human aspects (i.e.,

psychosocial and cultural significance) are eliminated leaving behind something that can

be expressed in biomedical terms, but that disregards the language of experience, which

is a major aspect of healing. (pp. 363-364).

An example of Kleinman’s observation is the overly facile equation of the Eskimo

pibbktoq (in which individuals tear off their clothes and wander aimlessly in inclement

environments) with a “hysterical disorder” (Gussow, 1985). In much the same way,

hsieh-ping, a Taiwanese condition marked by disorientation and auditory hallucinations,

has been considered a “depressive condition’’ (Hughes, 1985). Ward (1989a) remarked

that in both instances, it is prematurely assumed that Western classifications of mental

disorders are universal, even though their manifestations may be shaped by culture.

Gergen (1990) warned against using these terms as if they depict actual occurrences; the

10

vocabulary of the mental health professions serves “to render the alien familiar, and thus

less fearsome” (p. 358).

The value of a truly cross-cultural approach is to understand the range of individual and

social variation in the scientific search for an understanding of human capacities (Price-

Williams, 1975). Therefore, in this chapter we concentrate on the similarities and

differences between hypnotic virtuosos and traditional shamans and describe the

hypnotic-like aspects of native healing procedures using the definition of hypnosis

already stated, while only incidentally making interpretive analyses of the procedures

from the standpoint of Western science and therapy. Most illnesses in a society, as well

as alleged changes in consciousness are socially constructed, at least in part. Because

some native models of healing assume that practitioners, to be effective, must shift their

attention and awareness (e.g., “journeying to the upper world,” “traveling to the lower

world,” “incorporating spirit guides,” “conversing with power animals,” or “retrieving a

lost soul”), the hypnosis literature can illuminate these processes and be illuminated by

them.

CLINICAL AND FORENSIC APPLICATIONS

Although not without its limitations (Cardeña, 1995), Winkelman (1992) has proposed an

important typology based on archival data from dozens of traditional societies,

identifying four general groups of spiritual practitioners: shamans and shamanic healers,

priests and priestesses, mediums and diviners, and malevolent practitioners (some culture

may have more nuanced typologies, such as the 40 different types of Náhuatl healers in

11

ancient México or the current variations of healers and shamans in the Sierra Mazateca;

Miranda, 1997). With the exception of priests and priestesses, these practitioners

purportedly cultivate the ability to regulate or shift their patterns of perception, affect,

and cognition for benevolent (e.g., healing or divining) or malevolent (e-g., casting spells

or hexing) purposes.

Shamanism and hypnosis

Hypnotic-like procedures are often apparent in the healing practices of native shamans.

Shamans can be defined as socially sanctioned practitioners who claim to voluntarily

regulate their states of consciousness so as to access information not ordinarily available,

using it to facilitate appropriate behavior and healthy development-as well as to alleviate

stress and sickness among members of their community or the community as a whole. In

this chapter we include within the rubric of shamans both those who manifest the

classical “soul journey” as well as those who can be “possessed by the spirits” in a

controlled way (cf. Cardeña, 1996). Among the shaman’s many roles, that of healer is the

most common. The functions of shamans may differ in various locations, but all of them

have been called on to predict and prevent afflictions or to diagnose and treat them when

they occur. Shamanic healing procedures may be highly scripted in a manner similar to

the way that hypnotic procedures are carefully sequenced and structured. The

expectations of the shaman’s or hypnotist’s clients can enable them to decipher task

demands, interpret relevant communications appropriately, and translate the practitioner’s

suggestions into personalized perceptions and images. Shamans themselves display what

Kirsch (1990), in discussing the hypnosis literature, called “learned skills”; their

12

introduction to hypnotic-like experiences during their initiation and training generalizes

to later sessions, and they can ultimately engage in “journeying” or invite spirits to

possess them virtually at will. For instance, Japanese shamans of the Tohoku region

believe that they can contact the Buddhist goddess Kan’non, who assists with their

diagnosis, producing visual or auditory imagery that the shaman experiences and reports.

This is an example of the “translation” that characterizes both hypnotic sessions and

shamanic imagination. Achterberg (1985) studied these shamanic “translations” and

considers dreams, visions, and similar processes a venerable source of vital information

about human health and sickness. So ubiquitous is their process of gleaning pertinent

information from fantasy-based symbols and metaphors that Krippner (1987) suggested

that shamans, as a group, might be considered “fantasy prone.”

A systematic comparison between shamans and hypnotic virtuosos reveals both

similarities and differences (Cardeña, 1996):

* The proposed typology of high hypnotizables as either fantasy prone or

dissociator virtuosos (Barrett, 1990) is similar to that of “classical” shamans and

“mediums” (Eliade, 1964; Winkelman, 1992).

* Hypnotizability shows a genetic contribution (Morgan, 1973), and family

incidence has been found among various types of healers (Campos Navarro, 1997;

Eliade, 1964).

* The developmental paths for high hypnotizability of either punishment (or

trauma) or encouragement of fantasy (J. Hilgard, 1979) have a parallel in the described

13

common history of illness and training of imagination among shamans (Halifax, 1980;

Noll, 1983).

* Hypnotic virtuosos often have a propensity for the arts and for cognitive

flexibility (J. Hilgard, 1979), as do shamans (Cardeña & Beard, 1996; Shweder, 1972).

* Many but not all (e.g., mention of plants and animals) of the phenomena

reported in shamanism such as kaleidoscopes and out-of-body experiences (Lewis

Williams & Pearce, 2005) are also mentioned spontaneously by hypnotic virtuosos

(Cardeña, 2005).

* Hypnosis and shamanism been associated with reputed psi events (Angoff &

Barth, 1973; Stanford, 1992).

There are, however, important sociocultural differences. Whereas hypnosis typically

occurs within a one-on-one clinical or research individual setting and has a secular

ethnoepistemology, shamanism usually occurs in a social, ritual context of service,

embedded within a metaphysical framework (Cardeña, 1996).

With respect to inductions, Furst (1977) has described procedures by which North

American Native Americans sought alternative states of consciousness: “psychoactive

plants, animal secretions, fasting, thirsting, self-mutilation, exposure to the elements,

sweat lodges, sleeplessness, incessant dancing, bleeding, plunging into ice-cold pools,

and different kinds of rhythmic activity, self-hypnosis, meditation, chanting, and

drumming” (p. 70; compare with Ludwig’s 1966 general taxonomy of ways to induce an

altered state). Furst used non-Indian concepts (e.g., “self-hypnosis,” “trance,” and

14

“meditation”) that may not be directly comparable with the original experiences, and

went on to describe the use of “ecstatic trance” to determine the experients’ relationship

with the unseen forces of the universe. `Analogous hypnotic practices are the various

nondirective, permissive procedures in which hypnotized clients use their own fantasy

and imagery to work toward the desired goals (e.g., Kroger, 1977, Chapter 14).

The Nanaimo Indians of Vancouver Island expect their shamans to fall unconscious

during a ceremony in order to incorporate the tutelary spirits necessary for healing to

occur (Jilek, 1982, p. 30). Alaskan Eskimo shamans claim to “journey” to the spirit world

during a ceremony conducted in a darkened igloo, while they, stripped naked, sing and

beat drums (Rogers, 1982, p. 124). Rogers claimed that the shaman’s use of rhythmic

drumming and monophonic chanting induces “self-hypnosis” (apparently because of their

goal-directed nature) while also placing the client “in a hypnotic trance in which the

suggestions of recovery and cure are given” (p. 143). Although drumming is a common

feature in shamanism, Rouget (1985) offered a devastating critique to the theory that a

simple “acoustic driving” of the brain by drumbeats can explain the alterations of

consciousness observed.

In discussing the Ammassalik Eskimos of eastern Greenland, Kalweit (1988) observed

that their “continuous rubbing of stones against each other may be seen as a simple way

of inducing a trance. . . . The monotony, loneliness, and repetitive rhythmic movement

join with the desire to encounter a helping spirit. This combination is so powerful that it

erases all mundane thoughts and distracting associations” (p. 100; cf. T. X. Barber’s

15

definition mentioned earlier). Belo (1960) observed similarities between the behavior of

Balinese mediums and hypnotized participants. Although there was no trained observer

of hypnosis on Belo’s field trips, a hypnotic practitioner observed several of her films and

claimed to notice similarities between “hypnotic trance” and “mediumistic trance.”

Likewise, M. Bowers (1961) proposed similarities between vodou practices and hypnosis,

and there is experimental evidence that physical movement, characteristic of vodou and

other religious rituals, does not prevent Western hypnotic virtuosos from experiencing

substantial alterations of consciousness similar, but not identical, to those produced by a

quiescent procedure (Cardeña, 2005).

Kirsch’s (1990) discussion of the role of expectancies in hypnosis and psychotherapy is

relevant to each of these cases. Hypnosis, like many culturally based rituals, serves to

shape and bolster relevant expectancies that reorganize consciousness and produce

behavioral changes related to the goals of hypnotic subjects and shamanic clients. For

example, the ideomotor behavior that often characterizes hypnosis (e.g., arms becoming

heavier or lighter, or fingers moving to denote positive or negative responses) resembles

the postures, gestures, collapsing motions, and rhythmic movements that occur during

many native rituals. In both instances, the participants claim that the movements occur

involuntarily. Kirsch suspects that expectancy plays a major role, but admitted that these

responses are experienced as occurring automatically, without volition (p. 198). Also, the

drumming and many other ritual aspects help maintain a continuous focus of attention, as

compared with the usual shifting of attentional foci (cf. Cardeña & Spiegel, 1991).

16

Navajo Healing Procedures

Rogers (1982) divided native healing procedures into several categories (p. 112):

nullification of sorcery (e.g., charms and dances), removal of objects (e.g., sucking and

shamanic “surgery”), exorcism of harmful entities (e.g., fighting the entity or making the

entity uncomfortable), retrieval of lost souls (e.g., by “soul catchers’’ or by shamanic

journeying), eliciting confession and penance (e.g., to the shaman or to the community),

transfer of illness (e.g., to an object or a scapegoat), suggestion and persuasion (e.g.,

reasoning, use of ritual), and shock (e.g., a sudden change of temperature or a precipitous

physical assault). In all of these procedures, hypnotic-like techniques using symbols,

metaphors, stories, and rituals, especially those involving group participation, can play an

important role.

Despite attempts at acculturation, most Navajo men and women still believe in their

traditional cultural myths and participate in the corresponding rituals (Adair, Deuschle, &

Barnett, 1988). In the Navajo concept of illness, the universe is an interrelated whole in

which powers of both good and evil exist in a balanced and orderly relationship. When

this relationship is disturbed, disharmony occurs, producing illness. Its cause, therefore, is

basically metaphysical; illness takes place when the individual or group is out of

harmony with the natural and supernatural worlds (Topper, 1987).

When someone knowingly or accidentally breaches taboos or offends dangerous powers,

the natural order of the universe is ruptured and causes “contamination” or “infection”

17

that must be redressed (Sandner, 1979). When the family has determined that treatment is

necessary, a hataali, or “singing shaman,” is called in, frequently accompanied by an

herbalist and/or a diagnostician (both of whom are of lower status). The herbalists gather

plants and make medicines, some of which are used directly and some of which are used

ceremonially by the hataali. The diagnosticians are usually women and “listen” to the

spirits for a statement of the problem. This procedure resembles self-hypnosis in that it is

a self-administered procedure that regulates one’s attention and is goal-oriented in nature.

Other diagnostic procedures that resemble self-hypnosis include hand trembling, star

gazing, candle gazing, and crystal gazing, all of which involve the focusing of attention

(e.g., on the perception of the mirror images), with the purpose of facilitating insight into

the nature of the problem.

Navajo hataali use a number of therapeutic procedures, most notably one or more of the

ten basic “chantways,” complex patterns of activities centered around cultural myths in

which heroes or heroines once journeyed to spiritual realms to acquire special

knowledge. The symptoms for which a given chant is prescribed are based on

connections with the specific chant myth. For example, “Hail Way” is prescribed for

muscular tiredness and soreness because the hero, Rain Boy, suffered from these

symptoms when he was attacked by his enemies, whereas “Big Star Way” protects the

client against the powerful influences of the stars and the dangers of the night. It takes

several years to learn major chants, some of which consist of hundreds of songs. Hosteen

Klah, a famous Navajo hataali who died in 1937, knew more chants than any other healer

of his era, one of which took 9 days to complete. The effectiveness of the chant is thought

18

to be the result of its accurate performance because it evokes healing power from the

spirits. For instance, the “Night Chant” uses 24 sequences containing a total of 324 songs;

its hero is Dawn Boy, who enters the presence of the gods at a sacred canyon. His song,

which must be sung perfectly by the hataali to be successful, appeals to the deities for

assistance. One can observe the resemblance of the storytelling aspect of the chant to the

use of narrative “teaching stories” in Ericksonian hypnotic procedures (e.g., Erickson,

Rossi, & Rossi, 1976). These stories are highly scripted and reflect the society’s

perspective on human nature (Lynn & Rhue, 1991). Like Milton Erickson’s “teaching

stories,” no formal “induction” procedures are used in chants. However, there is an

emphasis on the correctness of the procedures; as a result, the hataali is in an extremely

vigilant frame of mind. The ability to master the elements of a “chantway” has been

compared with memorizing a Wagnerian opera (Kluckholn & Leighton, 1962, p. 309).

An ability to remember the cultural myths used in the “chantway” is mandatory if a

hataali is to serve as an educator who can pass traditions and tribal wisdom on to the

younger generation (Dixon, 1908).

The absence of a formal “induction” does not prevent the client from becoming receptive

and motivated to follow the implicit and explicit suggestion of the ritual, just as most, if

not all, hypnotic phenomena can be evoked without hypnotic induction (Kirsch, 1990).

Contributing to this procedure is the multimodal approach that characterizes chants, as

well as their repetitive nature and the mythic content of the words, which are easily

deciphered by those clients well-versed in tribal mythology. Sandner (1979) described

how the various sensory modalities are combined: the visual images of the sand paintings

19

and the body painting, the audible recitation of prayers and songs, the touch of the prayer

sticks and the hands of the medicine man, the taste of the ceremonial musk and herbal

medicines, and the smell of the chant incense-all combine to convey the power of the

chant to the patient. A hataali usually displays a highly developed dramatic sense in

carrying out the chant but generally avoids the clever sleight of hand effects used by

many other cultural healing practitioners to demonstrate their abilities to the community.

The chant is considered by Sandner to facilitate suggestibility and shifts in attention

through repetitive singing and the use of culture-specific mythic themes. These activities

prepare participants for a healing session that may involve symbols and metaphors acted

out by performers, enacted in purification rites, or executed in “sand paintings” composed

of sand, corn meal, charcoal, and flowers, but destroyed once the healing session is over.

Some paintings, such as those used in “Blessing Way,” are crafted from ingredients that

have not touched the ground (e.g., corn meal, flower petals, and charcoal). Once again,

the client may “translate” the symbols and metaphors, while maintaining a continuous

focus of attention.

There are five steps in the typical “chantway” ceremony: preparation (in which the client

is “purified”); presentation of the client to the healing spirits; summoning of these spirits

to the place of the ceremony; identification of the clients with a positive mythic theme;

transformation of the clients into a condition where ordinary and mythic time and space

merge; and release from the mythic world and return to the everyday world where past

transgressions are confessed, where new learning is assimilated, and where life changes

are brought to fruition. These steps resemble Kirsch’s (1990, p. 163) three phases of the

20

use of hypnosis in psychotherapy: preparation, induction, and application. The client’s

purification and presentation are analogous to preparation, the evocation of the spirits

resembles induction, and the identification and transformation represent clinical

application. And throughout all of these procedures there is the assumption that the

healee transits into a special, sacred space, in a not dissimilar way to attending a Western

therapist’s office.

Hypnotic-like procedures affect the mentation of both the hataali and the client during

the chant. Sandner (1979) pointed out that the hataali‘s performance empowers the client

by creating a “mythic reality” through the use of chants, dances, and songs (often

accompanied by drums and rattles); masked dancers; purifications (e.g., sweats, emetics,

herbal infusions, ritual bathings, and sexual abstinence); and sand paintings. Campbell

(1990) described the colors of the typical sand painting as those “associated with each of

the four directions” and a dark center: “the abysmal dark out of which all things come

and back to which they go.” When appearances emerge in the painting, “they break into

pairs of opposites” In the context of this “mythic reality,” especially as made visible in

the designs created in sand by the hataali, the client is taken into “sacred time” and is

able to bring a total attentiveness to the healing ceremony. This resembles the focusing of

attention characteristic of many hypnotic procedures, and the presence of culturally

significant symbols may maximize clients’ imagination and motivation, empowering

their self-healing capacities through identification with symbols held to have therapeutic

consequences. This provides the “credible rationale” that Kirsch (1990) has found to

enhance treatment effectiveness (see also Torrey, 1986). The clients follow a specific

21

regimen for the next four days to protect members of the community from their newly

acquired powers. The role of the community is important in another way: The chants are

attended by large numbers of people, and many of them may be asked to participate. This

type of participation appears to increase the clients’ sense of personal power, magnify

their imagination as they attend to the chants, and provide social reinforcement and

increased motivation. The mentation of the practitioner, the client, and the community

may all be affected by the ceremony. Not only do clients believe that they derive

“energy” from the sand painting by sitting on it, but the hataali is (P. 30) and clients

claim to feel the power emanating from the sand painting (Sandner, 1979). This

resembles the enhancement of imagination common to several hypnotic procedures, and

is probably further augmented by the repetitive chanting.

Topper’s (1987) study of Navajo hataali indicated that they also raise their clients’

expectations through the example they set of stability and competence. Politically, they

are authoritative and powerful; this embellishes their symbolic value as “transference

figures” in the psychoanalytic sense, representing “a nearly omniscient and omnipotent

nurturative grandparental object” (p. 221; for a similar analysis to the hypnotic situation

see Shor, 1961). Frank and Frank (1991) put it more directly: “The personal qualities that

predispose patients to a favorable therapeutic response are similar to those that heighten

susceptibility to methods of healing in non-industrialized societies, religious revivals,

experimental manipulations of attitudes, and administration of a placebo” (p. 184). Also,

in his modern classic, Ellenberger (1970, p. 12) suggests three sine-qua-non essentials of

healing: the healer’s faith in his or her own abilities, the patient’s faith in the healer, and

22

communal acknowledgement of the disease, the healing method, and the healer.

Suggestion and expectancy are bolstered through reinforcement of the client’s belief in

the power of the chant and its symbols, a tight structuring of the ceremonial performance,

repetition (especially in chants, songs, and prayers), physical exhaustion, the

dramatization of a significant event in Navajo mythology, and, on rare occasions, the use

of psychotropic herbal substances (e.g., datura) to evoke a physical effect that convinces

the client of the power of the ritual.

As important as the impact of the chant and prayers on the hataali’s consciousness may

be, Sandner (1979) insisted that the Navajo practitioner “relies on knowledge, not trance

phenomena or magical effects. The chant work is a restrained and dignified procedure,

and for the most part the medicine man represents for the patient a stable, dependable

leader who is a helper and guide until the work is ended” (p. 258). In other words, two

crucial factors in the client’s treatment appear to be the personal qualities of the hataali

and the expectancies of the client; shifts in attending may be more useful in intensifying

the abilities of the practitioner and the receptivity of the client than in providing any type

of innate therapeutic effectiveness. However, the hypnotic-like procedures strengthen the

support by family and community members as well as the client’s identification with

figures and activities in Navajo cultural myths, both of which are powerful elements in

the attempted healing.

Even though Navajo shamans use hypnotic-like procedures, they do not believe the

“chantway” or the healing prayers to induce an alteration in ordinary consciousness. To

23

deliberately enter an altered state, or to claim that they were in such a condition, would be

considered undignified by the Navajo healers. Nevertheless, the lengthy chants, songs,

and prayers are so repetitive and monotonous that an outside observer might justifiably

claim that they serve as consciousness-altering procedures. Furthermore, this example

demonstrates how each culture constructs the notion of altered states differently; the

spectrum of altered states is constricted and narrow among the Navajo, in contrast with

the complexities of construction found in many Eastern traditions. Tibetan Buddhism, for

example, contains five classes of meditation, each of which includes four levels that may

incorporate dozens of specific potential alterations with a variety of outcomes (i.e., ways

in which consciousness is reorganized following a meditative procedure; Brown, 1977).

At best, the hataali appear to modify their attentional states rather than to "alter" all of

their subsystems of consciousness, or their consciousness as a totality (cf. Tart, 1975).

Attention determines what enters someone's awareness. When attention is selective, there

is an aroused internal state that makes some stimuli more relevant than others and thus

more likely to attract one's attention. A trait that is more characteristic of shamans than an

"alternative state of consciousness" might be the unique attention that shamans give to

the relations among human beings, their own bodies, and the natural world, and their

willingness to share the resulting knowledge with others (Krippner 2002, 2005).

Afro-Brazilian and Afro-Caribbean healing procedures

Various early West African cultures considered that an individual was closely connected

with nature, the community, and his or her communal group. Each person was expected

to play his or her part in a web of kinship relations and community networks. Strained or

24

broken social relations were held to be the major cause of sickness; a harmonious

relationship with one’s community, as well as with one’s ancestors, was important for

health. At the same time, an ordered relationship with the forces of nature, as personified

by the lwas, orixas, or deities, was essential for maintaining the wellbeing of the

individual, the family, and the community. West Africans knew that disease often had

natural causes, but they believed that these factors were exacerbated by discordant

relationships between people and their social and natural milieu. Long before Western

medicine recognized the fact, Africa’s traditional healers took the position that ecology

and interpersonal relations affected people’s health (Raboteau, 1986).

West African healing practitioners felt that they gained access to supernatural power in

three ways: by making offerings to the spirits, by foretelling the future with the help of a

spirit, and by incorporating a spirit (or even an ancestor), who then diagnosed illnesses,

prescribed cures, and provided the community with warnings or blessings. The medium,

or person through whom the spirits spoke and moved, performed this task voluntarily,

claiming that such procedures as dancing, singing, or drumming were needed to surrender

their minds and bodies to the discarnate entities (Desmangles & Cardeña, 1996; Krippner,

1989), although it is a simplification to assume that spirit possession involves only one

type of consciousness alteration (Cardeña, 1989). The slaves brought these practices to

Brazil and the Caribbean with them; despite colonial and ecclesiastical repression, the

customs survived over the centuries and eventually formed the basis for a number of

Afro-Brazilian and Caribbean religions. Books by a French spiritualist, Alan Kardec,

were brought to Brazil, translated into Portuguese, became the basis for a related

25

movement (i.e., Kardecism). There were followers of Mesmer in this group, but Kardec

proposed that spirits, rather than Mesmer’s invisible fluids, were the active agent in

altering consciousness, removing symptoms, and restoring equilibrium (Richeport, 1992).

Contemporary shamans in Brazil, Haiti, and other countries still teach apprentices how to

sing, drum, and dance in order to incorporate the various deities, ancestors, and spirit

guides. They also teach their followers about the special herbs, teas, and lotions needed to

restore health, and about the charms and rituals needed to prevent illness (McGregor,

1962). The ceremonies of the various Afro-Brazilian groups (e.g., Candomblé, Umbanda,

Batuque, Caboclo, Quimbanda, and Xangó) differ, but all share three beliefs: Humans

have a spiritual body (that generally reincarnates after physical death), discarnate spirits

are in constant contact with the physical world, and humans can learn how to incorporate

spirits for the purpose of healing. After interviewing 40 spiritistic healing practitioners in

Brazil, Krippner (1989) identified five methods of receiving the “call” to become a

medium: (a) coming from a family having a history of mediumship, (b) being “called” by

spirits in one’s visions and dreams, (c) succumbing to a malady or “spiritual crisis” from

which one recovers to serve others, (d) having a revelation while reading Afro-Brazilian

spiritistic literature or attending spiritistic worship services, or (e) working as a volunteer

in a spiritistic healing center and becoming inspired by the daily examples of compassion.

If the call is rejected, severe illness or misfortune may result; as one candomblé medium

told Krippner, “Once the orixa calls, there is no other path to take” (p. 193). In a similar

fashion, a vodou oungan (vodou priest) told Cardeña that he had rejected his call until he

26

had an episode of amnesia and he found a machete wound in his leg, at which point he no

longer resisted…

Once the apprentices begin to receive instruction in mediumship, such experiences as

spirit incorporation, automatic writing, “out-of-body” travel, and recall of “past lives”

lose their bizarre quality and seem to occur quite naturally (Cardeña, 1991). Socialization

processes provide role models and the support of peers. A number of cues (songs, chants,

music, etc.) facilitate spirit incorporation, and a process of social construction teaches

control and appropriate role taking, and provides communal support. Richeport (1992)

observed many similarities between these mediumistic behaviors and those of many

hypnotized subjects (e.g., dissociation and frequent amnesia for the experience).

The traits most admired in mediums resemble those traits that facilitate ordinary social

interactions. If a spirit seems to be taking control of the medium too quickly, the other

mediums may sing a song that will slow down the process of incorporation (Rouget,

1985). Leacock and Leacock (1972) observed that the Brazilian mediums in their study

usually behaved in ways that were “basically rational,” communicated effectively with

other people, and demonstrated few symptoms of hysteria or psychosis. They engaged in

intensive training and, as mediums, pursued hard work that often put them at risk with

seriously ill individuals. These are not likely to be the favorite pastimes of fragile

personalities or malingerers. In fact, contrary to earlier proposal, usually without any

actual data to support them, that practitioners of classical shamanism or spirit possession

were psychotic or at least “hysterical,” recent empirical studies have found that their

27

psychological health is as good if not better than that of their referent groups (Cardeña

Van Duijl, Weiner, & Terhune, in press; Van Ommeren, Komproe et al., 2004).

A fairly consistent similarity among mediums is their supposed inability to recall the

events of the incorporation after the spirits have departed. However, Spanos (1989) has

pointed out that this amnesic quality could just as easily be explained as an

“achievement”; each failure to remember “adds legitimacy to a subject’s self-presentation

as ‘truly unable to remember,” hence as deeply in “trance” (p. 101). And there is

evidence that indigenous practitioners acknowledge different levels of possession depth,

some of which do not involve amnesia (Frigerio, 1989), in a similar way to the different

kinds of mediumship in the West (Cardeña et al., in press). Thus, the interpretation of

hypnotic phenomena as goal-directed action is helpful for understanding mediumship as

an activity that meets role demands because mediums guide and report their behavior and

experience according to these demands. It may be not be that they lose control over the

behavior as they incorporate a spirit, but rather that they engage in an efficacious

enactment of a role that they are eager to maintain.

An alternative point of view maintains that the mediums actually do lose control over

their behavior, entering a “trance” or “dissociative state” that allow “hidden parts” of

their minds to manifest as secondary personalities or spirits. Krippner (1989) discussed

these issues and suggested that both the “role-playing” and “dissociative” paradigms

describe merely the mechanisms by which a medium actually incorporates the orixa,

discarnate entity, or spirit. It is the incorporation itself and the subsequent behavior of the

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spirit that represent the crux of mediumship. Because the possibility of spirit

incorporation is hardly open to demonstration at the present time, one can only

acknowledge this argument and focus on other aspects of these phenomena.

Another important consideration is that spiritistic ceremonies enable clients and mediums

to arrive at a shared world-view in which an ailment can be discussed and treated

(Torrey, 1986). In some spiritistic traditions, there are mediums who specialize in

diagnosis, mediums who specialize in healing by a laying-on of hands, mediums who

specialize in distant healing, and mediums who specialize in intercessory prayer.

Treatment may also consist of removing a “low spirit” from a client’s “energy field,”

integrating one’s past lives with the present incarnation, the assignment of prayers or

service-oriented projects, or referral to another healer.

All of these procedures contain the possibility of enhancing clients’ sense of mastery,

increasing their self-healing capacities, and replacing their demoralization with

empowerment (Frank & Frank, 1991; Torrey, 1986). The mediums are not the only ones

who appear to manifest hypnotic-like effects. Their clients also demonstrate apparent

shifts in consciousness, especially while undergoing crude surgeries without the benefit

of anesthetics; however, Greenfield (1992) observed that the Brazilian mediums make no

direct effort to alter their clients’ awareness. Greenfield, who attributed the benefits of

these sessions to the clients’ alterations of consciousness, has observed that “no one is

consciously aware of hypnotizing. . . patients . . . , and unlike the mediums, patients

participate in no ritual during which they may be seen to enter a trance state” (p. 23).

29

However, there are a number of cultural procedures that Greenfield found to be hypnotic-

like in nature. One of them is the relationship of client to healer, characterized by trust

and resembling “that between hypnotist and client” (p. 23) in that these clients act

positively in response to what the medium tells them. Another procedure is a context that

allows the clients to become totally absorbed in the intervention, a healing ritual that

galvanizes the clients’ attention and distracts them from feeling pain. Greenfield added

that the spiritistic aspects of Brazilian culture foster “fantasy proneness” because large

numbers of people believe that supernatural entities help (or hinder) them in their daily

lives (p. 24). In support of Greenfield’s speculations, Biswas, See, Kogon, and Spiegel

(2000) found that individuals consulting a faith-healer in Nepal were significantly more

hypnotizable than those consulting Western medicine or ayurvedic practitioners, and that

their level of hypnotizability was positively correlated with their assessment of the faith

healer’s efficacy.

CASE AND FORENSIC MATERIAL

A murder case in Puerto Rico and a Haitian oungan

Some years ago the first author was hired by the Puerto Rican post office police to help

solve a murder/robbery with the help of hypnotic interviews. After explaining that there

was no guarantee that any of the information obtained would be valid, he followed the

ASCH forensic interview guidelines (Hammon, Garver et al., 1995) with a couple of

witnesses. The first one, a university student, had no problem with the procedure. The

second one, though, a peasant, illiterate woman with no formal education, responded in

exactly the opposite way to his suggestions. So for instance, when he mentioned that she

30

could allow her eyes to start closing, she would open them even more. Although, this was

done in the presence of a police officer, she obviously did not trust a strange man to help

lead her experience, and understandably so because there was nothing in her background

to have “trained” her to just sit down and follow his instructions, and probably if she had

ever heard about hypnosis it had been in the context of sensationalistic TV shows.

The second example concerns an interview with an intellectually sophisticated Haitian

oungan who did not respond at all to a previous attempt a Western clinician to hypnotize

him. He explained that suggestions of relaxation were very trivial compared with his

frequent experience of interaction with the lwas (spirits; see Cardeña, 1991). Both

examples illustrate that sociocultural context and explanation, besides cognitive and

biological predispositions, mediate hypnotic experience.

Graywolf

A former resident of a Native American community, Graywolf is a shamanic healer

whom the second author visited several times in Oregon. Born as Fred Swinney,

Graywolf holds a master’s degree in counseling. He integrated shamanic procedures into

his practice and his life-style after a number of transformative dreams and visions. Taking

the position that dysfunctional behavior is underscored by dysfunctional images of

oneself and one’s world, Graywolf attempts to assist his clients in identifying and

transforming those models that have permeated cognitive, affective, and physical

functioning. Janis was a client of Graywolf whose behavior manifested an excessive need

for approval yet had been punctuated, of late, by unexpected and uncontrollable bursts of

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rage. One of Graywolf’s procedures was hypnotic-like in that it utilized imaginative

guided imagery to reach the “upper world,” to reach the “lower world,” or to “journey”

back into a recalled dream. In an “upper world” session, Janis discovered herself as a

“deserted child” and gained insight into an important source of her need for approval. In a

“lower world” session, Janis began swaying and dipping like a snake. Convinced that she

had discovered her “power animal,” Janis repeated these movements daily, noticing that

her angry outbursts began to diminish. Finding ways to restore self-esteem to her “child,”

and express her “power animal” in her daily behavior, Janis was delighted to observe an

end to her outbursts.

On one occasion, Graywolf guided Janis back into a dream in which she shot her husband

because he had not given her an expensive present. By imagining herself moving into the

rage, she discovered a dark tunnel at the end of which was a red-faced baby crying

desperately. In her fantasy, Janis picked up the baby, held it, and dried its tears. Later, she

realized that the baby was herself at a younger age, experiencing a lack of attention that

still upset her. The dream was an exaggerated account of her claims on her husband’s

care and affection; no matter how much he gave her, it was never enough to assuage the

needs of the red-faced baby and the deserted child.

Janis understood that her dysfunctional image of being “nice” had begun to break down

and that the uncontrolled bursts of rage had signified its demise. By reveling in the image

and movements of the snake, rather than in her angry outbursts, she was able to enjoy a

part of her that was not necessarily “nice” or “approved” but that was needed for her very

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survival. Graywolf worked with Janis, exploring the feelings accompanying the snakelike

body movements to determine what new self-images they anticipated. Accepting her

repressed sensuality, self-protection, and authenticity was possible because of her almost

instant attraction to her “power animal. ” Janis associated her newly discovered self-

acceptance and self-esteem with a newly discovered enjoyment of life.

In this instance, Graywolf‘s procedures mirrored the findings of Frank and Frank (1991)

that effective treatment procedures involve an emotionally charged, confiding

relationship with a helping person in a healing setting; a conceptual scheme or myth that

provides a plausible explanation for the client’s symptoms and a ritual for resolving

them; and a ritual that requires the active participation of both client and helper and that

is believed by both to be the means of combating the patient’s demoralization. With the

help of Graywolf, Janis engaged in rituals that renewed her understanding, confidence,

and enjoyment of herself and her life.

RESEARCH AND APPRAISAL

Torrey (1986) surveyed indigenous psychotherapists, concluding, on the basis of

anecdotal reports, that “many of them are effective psychotherapists and produce

therapeutic change in their clients” (p. 205). The sources of that effectiveness are the four

basic components of psychotherapy: a shared world-view, personal qualities of the

healer, client expectations, and a process that enhances the client’s learning and mastery

(p. 207). Frank and Frank (1991) had a very similar conclusion after their classical study

of the universal components of healing, and Jilek (1982) found support for the

effectiveness of traditional healers in the Northwest. Strupp (1972) added, “The modern

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psychotherapist . . . relies to a large extent on the same psychological mechanisms used

by the faith healer, shaman, physician, priest, and others, and the results, as reflected by

the evidence of therapeutic outcomes, appear to be substantially similar” (p. 277).

A review of anomalous healing events and experiences (Actherberg & Krippner, 2000) is

beyond the scope of this chapter but it is worth mentioning that some studies support

indigenous healing practices. For example, the Journal of the American Medical

Association (JAMA) published a report of an apparently successful treatment of systemic

lupus erythematosus (SLE) by a native healer (Kirkpatrick, 1981). In early 1977, a 28-

year-old Philippine-American woman was diagnosed as having this disease, one that is

notably resistant to treatment. After a year of unsuccessful medical attention, the patient

returned to the remote Filipino village of her birth, contacting a local healer who then

claimed to remove a curse that had supposedly been placed on her by a previous suitor.

Within 3 weeks, she returned to face her skeptical physicians. She declined further

medication, appeared to be in good health, and 23 months later gave birth to a healthy

girl. The physician who authored the report concluded, “It is unlikely that this patient’s

SLE ‘burned out.’ . . . But by what mechanism did the machinations of an Asian

medicine man cure active lupus nephritis, change myxedema into euthyroidism, and

allow precipitous withdrawal from corticosteroid treatment without symptoms of adrenal

insufficiency?” (Kirkpatrick, 1981, p. 137).

Kleinman (1980) conducted a follow-up study of 19 clients treated by Taiwanese tang-

kis, or shamans, at a healing shrine. All clients were visited at their homes 2 months after

34

their initial visit to the tang-ki. Interviews could not be held with 7 clients, but of the 12

interviewed, 10 (83%) reported at least partially effective treatment. Six (50%) regarded

themselves as completely cured, and 2 (17%) were “treatment failures.” The evaluations

of family members were also considered, and the mother of one of the “failures” felt that

the treatment would have been successful had her daughter continued for a longer period

of time. The father of the other failure implied that his daughter’s condition had worsened

after treatment. Even though the sample was small, Kleinman noted that “there are

virtually no other follow-up studies of indigenous practice.” Even so, “these findings are

in line with our findings from studies of other indigenous healers and our impressions

from observation of large numbers of patients treated by [the] tang-ki. . . . Even with

these cautions in mind the results are striking” (p. 320).

Kim (1973), a psychiatrist, conducted a follow-up study of individuals treated by a

shaman in South Korea. He noted that temporary symptom relief was obtained in the four

cases he diagnosed as suffering from psychoneuroses. However, of the eight cases he

diagnosed as schizophrenic, six deteriorated following the shamanic ceremonies.

Spiritualist healers in a rural community in Mexico were investigated by Finkler (1985),

who found that their treatments were most effective for nonpathogenic diarrheas, simple

gynecological disorders, psychosomatic problems, and mild psychiatric disorders. The

former two ailments were treated with teas, enemas, and douches; the latter two by

symbolic manipulations and ministrations. However, Finkler found that in most cases, by

the patients’ own accounts, spiritual practitioners failed to heal. Little change was noted

35

in the case of serious physiological symptoms caused by physical or mental illness,

probably because the living conditions had not changed. The underlying factors

instrumental in producing the disease expressed in physiological or somaticized

symptoms continue, including the unceasing flow of untreated sewage waters in the

irrigation canals and the unremitting presence of disease vectors in the open garbage pits.

Concomitantly, and equally to the point, violent deaths due to alcoholism and violence

will continue, given the extant socio-structural conditions. Finkler also reported that in

50% of the cases, clients of the spiritualist healers claimed that they did not “feel sick,”

yet still reported symptoms. Of the 108 clients in the study, he judged 30% to have had

successful treatments, 35% unsuccessful treatments, and the others inconclusive or

unclassifiable results. Campos Navarro (1997) conducted an in-depth field study with

Mexican indigenous healers and supported their efficacy for some types of malaise along

the same lines described by Finkler.

Katz (1982, 1984) carried out a 22-month field study among Fijian healers, recording

data on 500 clients in one community who sought help during the course of a year. He

noted that in 5% of the interactions, more than one type of healer was consulted. Overall,

nearly 79% of the client/healer contacts were with the local nurse and 13% with the

traditional healer. However, the latter saw each of his clients more times, so that the

actual time spent in the respective healing efforts was about equal. The most frequent

complaints were various aches and pains (35%). The nurse saw most of the cuts and

wounds, whereas the traditional healer handled all of the requests for help against

36

misfortune. However, Katz noted considerable overlap because of the ways in which

clients conceptualized the problems and their etiology.

Additional research projects are needed to follow up the leads provided by these studies,

and long-term follow-ups are needed to determine the stability of any improvement.

Expectation and excitement can produce dramatic short-term effects but may not

demonstrate staying power. The hypnotic-like aspects of native healing are possibilities

for fruitful investigation. Scales are now available to measure absorption, imagination,

suggestibility, and other human capacities that might be related to long-term

improvement. Most of these scales are amenable to modification and adaptation to non-

Western populations. Various instruments to evaluate variations of consciousness (Pekala

& Cardeña, 2000) are promising candidates for cross-cultural studies, as are the imagery

scales developed by Achterberg and Lawlis (1984), which have been used in the

prognosis of life-threatening illnesses. These imagery scales are especially suitable for

cross-cultural research because they simply ask patients to draw images representing their

disease, the treatment they are receiving for the disease, and their body’s self-healing

capacities. In one study, Achterberg and Lawlis’s psychological and imagery measures

predicted a disease’s progress more accurately than the patients’ blood chemistry (p. 3).

Qualitative analyses of the experiences of both practitioners and their clients have also

been an underdeveloped area. Krippner (1990) used questionnaires to study perceived

long-term effects following visits to Filipino and Brazilian folk healers, finding such

variables as “willingness to change one’s behavior” to significantly correlate with

37

reported beneficial modifications in health. Cooperstein (1992) interviewed 10 prominent

alternative healers in the United States, finding that their procedures involved the self-

regulation of their “attention, physiology, and cognition, thus inducing altered awareness

and reorganizing the healer’s construction of cultural and personal realities” (p. 99).

Cooperstein concluded that the concept that most closely represented his data was “the

shamanic capacity to transcend the personal self, to enter into multiform identifications,

to access and synthesize alternative perspectives and realities, and to find solutions and

acquire extraordinary abilities used to aid the community” (p. 121). Indeed, the shaman’s

role and that of the alternative healer are both socially constructed, as are their operating

procedures and their patients’ predispositions to respond to the treatment. It is important

not only to study the effects of the hypnotic-like procedures found in native healing, but

to accurately describe them and to understand them within their own framework.

CONCLUSION

Although some critics continue to heap scorn on native healers (cf. Campos Navarro,

1997) the positive contributions of native healers are finally being given serious attention.

In 1980, Nigerian legislators passed a law that integrated traditional healers into the state-

run national medical health service. In Zimbabwe, the government has encouraged the

ngungus to set up their own 8,000-member professional association (Seligmann, 1981).

In Swaziland, traditional healers have been accorded equal professional standing with

Western-oriented medical practitioners. In 1977, the United Malay National

Organization, Malaysia’s dominant political party, decided to promote the use of bomohs

in the treatment of drug addicts.

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The professionalization of shamanic and other traditional healers may suggest their

similarity to practitioners of Western medicine; nevertheless, the differences cannot be

ignored. Rogers (1982) has contrasted the Western and native models of healing, noting

that in Western medicine, “healing procedures are usually private, often secretive. Social

reinforcement is rare. . . . The cause and treatment of illness are usually regarded as

secular. . . . Treatment may extend over a period of months or years.” In native healing,

however, “healing procedures are often public: many relatives and friends may attend the

rite. Social reinforcement is normally an important element. The shaman speaks for the

spirits or the spirits speak through him [or her]. Symbolism and symbolic manipulation

are vital elements.” (p. 169; see also Cardeña, 1994). Rogers also presented three basic

principles that underlie the native approach to healing:

• The essence of power is such that it can be controlled through

incantations, formulas, and rituals;

• the universe is controlled by a mysterious power that can be directed

through the meticulous avoidance of certain acts and through the zealous

observance of strict obligations toward persons, places, and objects;

• the affairs of humankind are influenced by spirits, ghosts, and other

entities whose actions, nonetheless, worldview-which fosters the

efficacy of hypnotic-like procedures-varies from locale to locale but is

remarkably consistent across indigenous cultures.

•

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Ceremonial activities produce shifts of attention for both the healer and the client, and the

culture’s rules and regulations produce a structure through which the clients’ motivations

may operate to empower them and stimulate their self-healing aptitudes. Western

practitioners of hypnosis employ the human capacities that have been used by native

practitioners in their hypnotic-like procedures. These include the capacity for imaginative

suggestibility, the ability to shift attentional style, the potential for intention and

motivation, and the capability for self-healing made possible by neurotransmitters,

internal repair systems, and other components of mind-body interaction. Hypnosis and

hypnotic-like activity are complex and interactive and hence take different forms in

different cultures. Yet, as with other forms of therapy, “the mask. . . crafted by the

group’s culture will also fit a majority of its members” (Kakar, 1982, p. 278). When in

Malaysia, a World Federation of Mental Health workshop suggested collaboration

between the university’s department of psychiatry and the traditional bomoh

practitioners. The psychiatrists objected, claiming that such a move would only confirm

the prejudice held by other departments in the medical school against psychiatry as

unscientific (Carstairs, 1973). Despite similar complaints in México, there have been

encouraging events such as having indigenous healers talk to physicians and university

professors (Campos Navarro, 1997). By investigating ways in which different societies

have constructed diagnostic categories and remedial procedures, therapists and physicians

can explore novel and vital changes in their own procedures, hypnotic or otherwise, that

have become obdurate and rigid. It is also the case that many underprivileged groups

throughout the globe do not have the financial or geographical access to Western-trained

practitioners and/or the latter may not understand their clients’ world-view, one of the

40

cornerstones of therapeutic interaction. Western medicine and psychotherapy have their

roots in traditional practices and need to explore avenues of potential cooperation with

native practitioners, whose healing methods may contain wise insights and practical

applications. However, it is also dangerous to go to the other extreme and romanticize the

potential efficacy of traditional healing methods, as there may be some unscrupulous or

incompetent practitioners, but the same can be said of practitioners of hypnosis or any

other forms of psychotherapy or medicine.

REFERENCES

Achterberg, J. (1985). lmagery in healing: Shamanism and modern medicine. Boston:

Shambhala.

Achterberg, J., & Lawlis, G. F. (1984). Imagery and disease. Champaign, IL: Institute for

Personality and Ability Testing.

Achterberg, J., & Krippner, S. (2000). Anomalous healing experiences. In E. Cardeña, E.,

S. J. Lynn, & S. Krippner, S. (Eds.). Varieties of anomalous experience: Examining

the scientific evidence (pp. 353-395). Washington, DC: American Psychological

Association.

Adair, J., Deuschle, K. W., & Barnett, C. R. (1988). The people’s health: Anthropology

and medicine in a Navajo community (rev. ed.). Albuquerque: University of New

Mexico Press.

Agogino, G. A. (1965). The use of hypnotism as an ethnologic research technique. Plains

Anthropologist, 10, 31-36.

Angoff, A., & Barth, D. (Eds.) (1973). Parapsychology and anthropology. London, UK:

Parapsychology Foundation.

Balthazard, C. G. & Woody, E. Z. (1992). The spectral analysis of hypnotic

performance with respect to “Absorption”. International Journal of Clinical and

Experimental Hypnosis 40, 21-43.

41

Barber, T. X. (1969). Hypnosis: A scientific approach. New York: Van Nostrand

Reinhold.

Barber, T. X. (1984). Changing "unchangeable" bodily processes by (hypnotic)

suggestions. In A. A. Sheikh Ed.), Imagination and healing (pp. 69-127).

Farmingdale, NY: Baywood.

Barrett, D. (1990). Deep trance subjects: A schema of two distinct subgroups. In R. G.

Kunzendorf (Ed.), Mental imagery (pp. 101-112). New York: Plenum.

Belo, J. (1960). Trance in Bali. New York: Columbia University Press.

Biswas, A., See, D., Kogon, M. M., & Spiegel, D (2000). Hypnotizability and the use of

traditional Dhami-Jhankri healing in Nepal. International Journal of Clinical and

Experimental Hypnosis. 48, 6-21.

Bourguignon, E., & Evascu, T. (1977). Altered states of consciousness within a general

evolutionary perspective: A holocultural analysis. Behavior Science Research, 12,

199-216.

Bowers, M. K. (1961). Hypnotic aspects of Haitian voodoo. International Journal of

Clinical and Experimental Hypnosis, 9, 269-282.

Brown, D. P. (1977). A model for the levels of concentrative meditation. International

Journal of Clinical and Experimental Hypnosis, 25, 236-273.

Brown, D. P., & Fromm, E. (1986). Hypnotherapy and hypnoanalysis, Hillsdale, NJ:

Erlbaum.

Campbell, J. (1990). Transformations of myth through time. New York: Harper & Row.

Campos Navarro, R. (1997). Nosotros los curanderos (We the healers). México, D. F.:

Nueva Imagen.

Cardeña, E. (1989). The varieties of possession experience. Association for the

Anthropological Study of Consciousness Quarterly, 5 (2-3), 1-17.

Cardeña, E. (Spring, 1990). The concept(s) of trance. Annual Conference of the Society

for the Anthropology of Consciousness, Pacific Palisades, CA.

Cardeña, E. (1991) Max Beauvoir. An island in an ocean of spirits. In R. I. Heinze (Ed.),

Shamans of the XXth Century. New York: Irvington , 27-32.

42

Cardeña, E. (1995). Review of “Shamans, priests and witches: A cross-cultural study of

magico-religious practitioners” by Michael Winkelman, Transcultural Psychiatric

Research Review 32, 69-73.

Cardeña, E. (1996). “Just floating on the sky”. A comparison of shamanic and hypnotic

phenomenology. In R. Quekelbherge & D. Eigner (Eds.) 6th Jahrbuch für

Transkulturelle Medizin und Psychotherapie (6th Yearbook of cross-cultural

medicine and psychotherapy) (pp. 367-380). Berlin: Verlag für Wissenschaft und

Bildung.

Cardeña, E. (1999). Culture, and psychopathology. The hidden dimensions in T. X.

Barber’s theory. Contemporary Hypnosis, 16, 132-138.

Cardeña, E. (2005). The phenomenology of deep hypnosis: Quiescent and physically

active. International Journal of Clinical & Experimental Hypnosis, 53, 37-59.

Cardeña, E. (2006). Anomalous experiences and hypnosis. Proceedings of the 49th

Annual Conventions of the Parapsychological Association, 32-42.

Cardeña, E., & Beard, J. (1996). Truthful trickery: Shamanism, acting and reality.

Performance Research, 1, 31-39.

Cardeña, E., Kallio, S., Terhune, D., Buratti, S., & Lööf, A. (under review). The effect of

translation and sex on hypnotizability testing.

Cardeña, E., Van Duijl, Weiner, L., & Terhune, D. B. (in press). Possession/trance

phenomena. In Dell, P.F., & O'Neil, J. A. (Eds.). Dissociation and the dissociative

disorders: DSM-V and beyond. New York: Routledge.

Cardeña, E., & Spiegel, D. (1991). Suggestibility, absorption, and dissociation: An

integrative model of hypnosis. In John F. Schumaker (Ed.) Human suggestibility:

Advances in theory, research and application. New York: Routledge, 93-107.

Carstairs, G. M. (1973). Psychiatric problems in developing countries. British Journal of

Psychiatry, 123, 271-277.

Cooperstein, M. A. (1992). The myths of healing: A summary of research into

transpersonal healing experiences. Journal of the American Society for Psychical

Research, 86, 99-133.

De Certeau, M. (2000). The possession at Loudun (Michael B. Smith, Trans.) Chicago:

University of Chicago Press.

43

Desmangles, L., & Cardeña, E. (1996). Trance possession and Vodou ritual in Haiti. In

R. Quekelbherge & D. Eigner (Eds.) 6th Jahrbuch für Transkulturelle Medizin und

Psychotherapie (6th Yearbook of cross-cultural medicine and psychotherapy) (pp.

297-309). Berlin: Verlag für Wissenschaft und Bildung.

Dixon, R. B. (1908). Some aspects of the American shaman. Journal of American

Folklore, 21, 1-12.

Eliade, M. (1964). Shamanism: Archaic techniques of ecstasy. New York: Pantheon

Books.

Ellenberger, H. F. (1970). The discovery of the unconscious. New York: Basic Books.

Erickson, M. H., Rossi, E. L., & Rossi, S. H. (1976). Hypnotic realities: The induction of

clinical hypnosis and the indirect forms of suggestion. New York: Irvington.

Finkler, K. (1985). Spiritualist healers in Mexico: Successes and failures of alternative

therapeutics. New York: Praeger.

Frank, J. D., & Frank, J. B. (1991). Persuasion and healing (3rd ed.). Baltimore: Johns

Hopkins University Press.

Frigerio, A. (1989). Levels of possession awareness in Afro-Brazilian religions.

Association for the Anthropological Study of Consciousness Quarterly, 5, 5-11.

Furst, P. T. (1977). “High states” in culture-historical perspective. In N. E. Zinberg (Ed.),

Alternate states of consciousness (pp. 53-88). New York: Free Press.

Gauld, A. (1992). A history of hypnotism. Cambridge, UK: Cambridge University

Press.

Gergen, K. J. (1985). The social constructionist movement in modem psychology.

American Psychologist, 40, 266-275.

Gergen, K. J. (1990). Therapeutic professions and the diffusion of deficit. Journal of

Mind and Behavior, 11, 353-368.

Greenfield, S. M. (1992). Hypnosis and trance induction in the surgeries of Brazilian

spiritist healer-mediums. Anthropology of Consciousness, 2, 20-25.

Gussow, Z. (1985). Pibloktoq (hysteria) among the polar Eskimo: An ethnopsychiatric

study. In R. C. Simons & C. C. Hughes (Eds.), The culture bound syndromes (pp.

271-288). Boston: Reidel.

Halifax, J. (1980). Shamanic voices. Penguin: Middlesex, England.

44

Hammond, D.C., Garver, R.B., Mutter, C.B., Crasilneck, H.B., Frischholz, E., Gravitz,

M.A., Hibler, N.S., Olson, J., Scheflin, A.W., Spiegel, H., & Wester, W. (1995).

Clinical hypnosis and memory: Guidelines for clinicians and for forensic hypnosis.

Des Plaines, IL: American Society of Clinical Hypnosis Press.

Hilgard, E. R. (1973). The domain of hypnosis. With some comments on alternative

paradigms. American Psychologist, 28, 972-982.

Hilgard, J. (1979). Personality and hypnosis: A study of the imaginative involvement.

Chicago, Il: Chicago University Press.

Hughes, C. (1985). Glossary of “culture bound” or folk psychiatric syndromes. In R. C.

Simons & C. C. Hughes (Eds.), The culture bound syndromes (pp. 469- 505). Boston:

Reidel.

Jilek, W. G. (1982). Indian healing: Shamanic ceremonialism in the Pacific Northwest.

Blaine, WA: Hancock House.

Kakar, S. (1982). Shamans, mystics and doctors: A psychological inquiry into India and

its healing traditions. New York: A. A. Knopf.

Kalweit, H. (1988). Dreamtime and inner space: The world of the shaman. Boston:

Shambhala.

Katz, R. (1982). The utilization of traditional healing systems. American Psychologist,

27, 715-716.

Katz, R. (1984). Toward a paradigm of healing. Personnel and Guidance Journal, 61,

494-497.

Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes?

Implications for conceptualizing their etiology. Psychological Bulletin, 129,747-769

Kim, H. (1973). Review of shamanist healing ceremonies in Korea. Transcultural

Psychiatric Research Review, 10, 124-125.

Kirkpatrick, R. A. (1981). Witchcraft and lupus erythematosus. Journal of the American

Medical Association, 245, 137.

Kirsch, I. (1990). Changing expectations: A key to effective psychotherapy. Pacific

Grove, CA: Brooks/Cole.

Kleinman, A. (1980). Patients and healers in the context of culture. Berkeley: University

of California Press.

45

Kleinman, A. (1988). Rethinking psychiatry: From cultural category to personal

experience. New York: Free Press.

Kluckholn, C., & Leighton, D. (1962). The Navaho. Garden City, NY: Anchor Books.

Kok, L. P. (1989). Hypnotic susceptibility in kavadi carriers in Singapore. Annals of the

Academy of Medicine, Singapore, 18, 655-657.

Krippner, S. (1987). Dreams and shamanism. In S. Nicholson (Ed.), Shamanism: An

expanded view of reality (pp. 125-132). Wheaton, IL: Theosophical.

Krippner, S. (1989). A call to heal: Patterns of entry in Brazilian mediumship. In C. Ward

(Ed. ), Altered states of consciousness and mental health: A cross-cultural

perspective (pp. 186-206). Newbury Park, CA: Sage.

Krippner, S. (1990). A questionnaire study of experiential reactions to a Brazilian healer.

Journal of the Society for Psychical Research, 56, 208-215.

Krippner, S. (2002). Conflicting perspectives on shamans and shamanism: Points and

counterpoints. American Psychologist, 57, 960-977.

Krippner, S. (2005). Trance and the trickster: Hypnosis as a liminal phenomena.

International Journal of Clinical and Experimental Hypnosis, 53, 97-118.

Krippner, S., & Bindler, P. (1974). Hypnosis and attention: A review. American Journal

of Clinical Hypnosis, 16, 166-177.

Kroger, W. S. (1977). Clinical and experimental hypnosis (2nd ed.). Philadelphia:

Lippincott.

Laurence, J. R. & Perry, C. (1988). Hypnosis, will & memory: A psycho-legal history.

New York: Guilford

Leacock, S., & Leacock, R. (1972). Spirits of the deep: Drums, mediums and trance in a

Brazilian city. Garden City, NY: Doubleday.

Lewis, Williams, D., & Pearce, D. (2005) Inside the Neolithic mind: Consciousness,

cosmos, and the realm of the Gods. London, UK: Thames & Hudson.

Locke, R.G., & Kelly, E.F. (1985). A preliminary model for the cross-cultural analysis of

altered states of consciousness. Ethos, 13, 3-55.

Ludwig, A. M. (1966). Altered states of consciousness. Archives of General Psychiatry,

15, 225–234.

46

Lynn, S. I., & Rhue, J. (1988). Fantasy proneness: Hypnosis, developmental antecedents,

and psychopathology. American Psychologist, 43, 35-44.

Lynn, S. J., & Rhue, J. (1991). An integrative model of hypnosis. In S. J. Lynn & J. Rhue

(Eds.), Theories of hypnosis: Current models and perspectives (pp. 397-438). New

York: Guilford Press.

Morgan, A. H. (1973). The heritability of hypnotic susceptibility in twins. Journal of

Abnormal Psychology, 82 55-61.

McGregor, P. (1962). The moon and the two mountains. London: Souvenir Press.

Miranda, J. (1997). Curanderos y chamanes de la sierra mazatec (Healers and shamans

of the mazateca sierra). Mexico, D. F.: Gatuperio.

Murphy, G. (1947). Personality: A biosocial approach to origins and structure. New

York: Harper & Brothers.

Noll, R. (1985). Mental imagery cultivation as a cultural phenomenon. Current

Anthropology, 26, 443-461.

Overton, J. A. (1998). Shamanism and clinical hypnosis: A brief comparative analysis.

Shaman, 6, 151-170.

Pekala, R., & Cardeña, E. (2000). Methodological issues in the study of altered states of

consciousness and anomalous experiences. In E. Cardeña, S. J. Lynn., & S. Krippner

(Eds.), Varieties of anomalous experience (pp. 47-81). Washington, DC: American

Psychological Association.

Perry, C., Nadon, R. & Button, J. (1992). The measurement of hypnotic ability. In E.

Fromm & M. R. Nash (Eds.), Contemporary hypnosis research (pp. 459-490). New

York: Guilford.

Price-Williams, D. (1975). Explorations in cross-cultural psychology. San Francisco:

Chandler & Sharp.

Raboteau, A. J. (1986). The Afro-Brazilian traditions. In R. L. Numbers & D. W.

Amundsen (Eds.), Caring and curing: Health and medicine in Western religious

traditions (pp. 539-562). New York: Macmillan.

Richeport, M. M. (1992). The interface between multiple personality, spirit mediumship,

and hypnosis. American Journal of Clinical Hypnosis, 34, 168-1 77.

47

Rogers, S. L. (1982). The shaman: His symbols and his healing power. Springfield, 1L:

Charles C Thomas.

Rosen, G. (1969). Madness in society. Chapters in the historical sociology of mental

illness. New York: Harper.

Rouget, G. (1985). Music and trance: A theory of the relations between music and

possession. Chicago: University of Chicago Press.

Sandner, D. (1979). Navaho symbols of healing. New York: Harcourt Brace Jovanovich.

Seligmann, J. (1981, September 21). The new witch doctors. Newsweek, p. 106.

Shor, R. E. (1962). Three dimensions of hypnotic depth. International Journal of

Clinical and Experimental Hypnosis, 10, 23-38.

Spanos, N. P., & Chaves, J. F. (1989). Hypnosis: The cognitive-behavioral perspective.

Buffalo, NY: Prometheus Books.

Spanos, N. P., & Chaves, J. F. (1991). History and historiography of hypnosis. In S. J.

Lynn & J. W. Rhue (Eds.), Theories of hypnosis: Current models and perspectives

(pp. 43-78). New York: Guilford Press.

Stanford, R. G. (1992). Experimental hypnosis-ESP literature: A review from the

hypothesis-testing perspective. Journal of Parapsychology, 56, 39-56.

Strupp, H. H. (1972). On the technology of psychotherapy. Archives of General

Psychiatry, 26, 270-278.

Tart, C. T. (1975). States of consciousness. New York: Dutton.

Topper, M. D. (1987). The traditional Navajo medicine man: Therapist, counselor, and

community leader. Journal of Psychoanalytic Anthropology, 10, 17-249.

Torrey, E. F. (1986). Witchdoctors and psychiatrists: The common roots of

psychotherapy and its future. New York: Harper & Row.

Tseng, W.S. (1997). Overview: culture and psychopathology. In W. S. Tseng & J.

Streltzer (Eds.), Culture and psychopathology (pp. 1-27). New York: Brunner.

van Duijl, M., Cardeña, E., & de Jong, J. (2005). The validity of DSM-IV dissociative

disorders categories in SW Uganda. Transcultural Psychiatry, 42, 219-241.

Van Ommeren, M., Komproe, I., Cardeña, E., Thapa, S. B., Prasain, D., de Jong, J., &

Sharma, B. (2004). Mental illness among Bhutanese shamans in Nepal. Journal of

Nervous and Mental Disease, 192, 313-317.

48

Vogel, V. J. (1990). American Indian medicine. Norman: University of Oklahoma Press.

(Original work published 1970)

Ward, C. (1989). Introduction. In C. Ward (Ed.), Altered states of consciousness and

mental health: A cross-cultural perspective (pp. 8-10). Newbury Park, CA:Sage.

Winkelman, M. J. (1992). Shamans, priests and witches: A cross-cultural study of

magico-religious practitioners. Arizona State University: Anthropological Research

Papers No. 44.

Woody, E. Z., Bowers, K. S., & Oakman, J. M. (1992). A conceptual analysis of hypnotic

responsiveness: Experience, individual differences, and context. In E. Fromm & M.

R. Nash (Eds.), Contemporary hypnosis research (pp. 3-33). New York: Guilford.